medsurg eye and ear chapter 20, 21

client with chronic glaucoma is being started on medication therapy with acetazolamide. The nurse teaches the client that which can occur EARLY with the use of this medication? 1. fatigue 2. diuresis 3. headache 4. loss of libido

2. diuresis

the nurse is assigned to care for a client after a mastoidectomy. Which nursing intervention would be a priority in the care of this client? 1. maintain a supine position 2. change the ear dressing daily. 3. monitor for signs of facial nerve injury. 4. position the client on the affected side

3. Sudden pressure changes in the ear and postoperative infections can disrupt the surgical repair during the healing phase or cause facial nerve paralysis

Betaxolol dyrochloride eye drops have been prescribe for a client with glaucoma. which nursing action is most appropriate related to monitoring for side and adverse effects of this medication. 1. assessing for edema 2. monitoring temp 3. monitoring bp 4. assessing blood glucose level

3. Monitoring bp -Hypotension, dizziness nausea, diaphoresis, headache, fatigue, constipation and diarrhea are side and adverse effects of the medication.

The nurse working in a long-term care facility notes that several clients are taking pilocarpine hydrochloride eye drops. The nurse ensures that which medication is available on the nursing unit for use if a client should develop systemic toxicity from pilocarpine hydrochloride? 1. disulfiram 2.cyclopentolate 3. atropine sulfate 4. naproxen hydrocloride

3. atropine sulfate Pilocarpine hydrochloride is a cholinergic agent. atropine sulfate must be available in the event of systemic toxicity from pilocarpine hydrochloride.

when teaching a client with glaucoma about the effects of biotic medication, the nurse should tell the client that the medication will produce which effect? 1.Reshape the lens to eliminate blurred vision 2. Dilate the pupil to reduce intraocular pressure 3. Interrupt the drainage of aqueous humor from the eye 4. Lower intraocular pressure and improve blood flow to the retina

4.

The nurse is performing an admission assessment on a client who has a history of glaucoma and uses latanoprost eye drops. Which assessment finding would indicate a side/adverse effect of these eye drops? 1. irregular pulse 2. periorbital edema 3. elevated blood pressure 4. brown pigmentation of the iris

4. Latanoprost is a topical medication used to lower intraocular pressure in clients with open-angle glaucoma and ocular hypertension. The most significant side/adverse effect is heightened brown pigmentation of the iris.

the nurse is providing instructions to a client who will be self-administering eye drops. To minimize systemic absorption of the eye drops, the nurse should instruct the client to take which action? 1. eat before instilling the drops 2. swallow several times after instilling the drops 3. blink vigorously to encourage tearing after instilling the drops 4. occlude the nasolacrimal duct with a finger after instilling the drops

4. applying pressure on the nasolacrimal duct prevents systemic absorption of the medication. Options 1, 2, and 3 will not prevent systemic absorption

which medication, if prescribed for the client with glaucoma, should the nurse question? 1. betaxolol 2.. Pilocarpine 3. Erythromycin 4. Atropine sulfate.

4. - options 1 and 2 are miotic agents used to treat glaucoma. Option 3 is an antiinfective medication used to treat bacterial conjunctivitis. Atropine sulfate is a mydriatic and cycloplegic (also anticholinergic) medication, and its use is contraindicated in clients with glaucoma. Mydriatic medications dilate the pupil and can cause an increase in intraocular pressure in the eye.

risk factors for glaucoma

HTN, cardiovascular, DM and obesity

What do Miotics medications do?

Miotics cause pupillary construction and are used to treat glaucoma. they lower the IOP, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision.

diet for Menderes disease

The nurse encourages the client to follow a low-salt diet and to avoid caffeine, sugar, monosodium glutamate, and alcohol.

what is the most common complaint of clients with otological disorders involving the inner ear

Tinnitus

what is seen with a perforated eardrum?

a round or oval darkened area on the eardrum would be seen

discharge instructions to a client who had a fenestration procedure for the treatment of otosclerosis. the nurse should instruct the client to take which measure.

after ear surgery the client needs to be instructed to avoid air travel, excessive coughing, and drinking through a straw for 2 to 3 weeks. in addition the client should avoid straining when having a BM and should avoid washing the hair, getting the head wet or showering for 1 week. the client also needs to avoid rapidly moving the head, bouncing, and bending over for 3 weeks.

semicircular canals function is to

aid the clients sense of balance

what is acetylsalicylic acid and what is it potentially toxic to

asa is asprin. its contraindicated for GI bleeding and is potentially ototoxic

PACG Primary angle closure glaucoma assessment finding

blurred vision, ocular erythema, and halos around lights.

presbycusis

hearing loss that occurs with aging

what is cyclopentolate used for before cataract surgery

it is used to paralyze the ciliary muscle

what is cyclopentolate? and how long does it take to work?

it takes 25 -75minutes and its used for dilation to occur

what does cyclopentolate do?

its a rapidly acting mydriatic used preoperatively to dilate the eye. effective in 25-75 min

whats the difference between mydriatic medication and biotic medication

mydriatic: dilation of the pupil miotic: constrics the pupil

what surgery would be recommended for a client with acute otitis media if mediation doesn't resolve the issue?

myringotomy a surgical procedure that will allow fluid to drain from the middle ear and may be necessary to treat acute otitis media.

what is the use/action for pilocarpine.

pilocarpine hydrochloride is a biotic that is used to lower the IOP, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision.

what findings would you expect to observe with a pt with mastoiditis

red, dull, thick and immobile tympanic membrane

list of drug therapy for Meniere's disease?

sedatives benzodiazepines anticholinergics antihistamines antiemetics

dense white patches are seen on the eardrum of a client with a?

sequelae of repeated ear infections

what are early stages of cataract formation

slightly blurred vision and decrease in color perception

pilocarpine hydrochloride is used for

treatment of glaucoma

DRUG ALERT Miotics

warn patients about decreased visual acuity, especially in dim light.

a colony of black dots on the eardrum suggest a ?

yeast or fungal infection

-what is the normal range of IOP (intraocular pressure) - if the # is slightly higher than normal what do you do and why

- 10-21 -note the time of day the test was done because IOP is slightly higher in the morning.

what does Betaxolol do? side effects?

- it is a cardioselective blocker, decreases IOP and decreases aqueous humor production.

Betaxolol eye drops have been prescribed for a client with glaucoma. The home health nurse preparing to visit the client develops a plan of care that includes monitoring for the side/adverse effects of this medication by taking which assessment action Monitoring body weight 2. Assessing the glucose level 3. Assessing peripheral pulses 4. Monitoring body temperature

1 his medication is an antiglaucoma medication and a β-adrenergic blocker. The nurse assesses for evidence of heart failure manifested by dizziness, night cough, peripheral edema, and distended neck veins. Intake greater than output, weight gain, and decreased urine output also may indicate heart failure

the nurse is preparing to administer eye drops. Which interventions should the nurse take to administer the drops? Select all that apply 1. wash hands 2. put on gloves 3. place the drop in the conjunctival sac 4. pull the lower lid down against the cheekbone. 5. instruct the client to squeeze the eye shut after instilling the eye drop 6. instruct the client to tilt the head forward, open the eyes and look down.

1 2 3 4 -its not 5 and 6 because you instruct the pt to tilt head backwards, open the eyes and look up. The client is instructed to close the eyes gently and NOT SQUEZE the shut to prevent the loss of medication.

The home care nurse is reviewing the record of a client newly diagnosed with glaucoma who is scheduled for a home visit. The nurse notes that the health care provider (HCP) has prescribed atropine sulfate and pilocarpine hydrochloride eye drops. The nurse should contact the HCP before the home visit for which reason? 1. Clarify the prescription for the atropine sulfate. 2. Clarify the prescription for the pilocarpine hydrochloride. 3. Determine the date of the scheduled follow-up HCP visit. 4. Determine the extent of the intraocular pressure caused by the glaucoma.

1. Atropine sulfate is a mydriatic and cycloplegic medication that is contraindicated in clients with glaucoma. Mydriatic medications dilate the pupil and cause increased intraocular pressure in the eye. Pilocarpine hydrochloride is a miotic agent used in the treatment of glaucoma. It is unnecessary to contact the HCP regarding the date for follow-up treatment. In fact, the client may know this date, which the nurse can ask about during the home care visit. It is unnecessary to know the extent of the intraocular pressure caused by the glaucoma in planning care for the client.

A caloric test is prescribed for a client suspected of having disease of the labyrinth. The nurse should obtain which essential item in preparation for this test? 1. otoscope 2. tongue blade 3. an emesis basin 4. ophthalmoscope

1. A caloric test is contraindicated if the client has a perforated tympanic membrane (air may be used as a substitute) or if the client has an acute disease of the labyrinth. An otoscopic examination should be performed before the caloric test to rule out perforation and to determine whether the ear canal contains cerumen, which must be removed before the test. An ophthalmoscope, a tongue blade, and an emesis basin are not essential items

The nurse prepares a client for ear irrigation as prescribed by the health care provider. Which action should the nurse take when performing the procedure? 1.Warm the irrigating solution to 98.6°F (37.0°C) . 2. Position the client with the affected side up following the irrigation. 3. Direct a slow, steady stream of irrigation solution toward the eardrum. 4. Assist the client to turn his or her head so that the ear to be irrigated is facing upward.

1. before ear irrigation, the nurse should inspect the tympanic membrane to ensure that it is intact. The irrigating solution should be warmed to 98.6°F (37.0°C) because a solution temperature that is not close to the client's body temperature will cause ear injury, nausea, and vertigo. The affected side should be down following the irrigation to assist in drainage of the fluid. When irrigating, a direct and slow steady stream of irrigation solution is directed toward the wall of the canal, not toward the eardrum. The client is positioned sitting, facing forward with the head in a natural position; if the ear is faced upward, the nurse would not be able to visualize the canal

a client is prescribed an eye drop and an eye ointment for the right eye. How should the nurse best administer the medications? 1. administer the eye drop first, followed by the eye ointment 2. administer the dye ointment first, followed by the eye drop. 3. administer the eye drop, wait 15 minutes and administer the eye ointment.

1. when an eye drop and an eye ointment are scheduled to be administered at the same time, the eye drop is administered first. The instillation of two medications is separated by 3 to 5 minutes.

the nurse is preparing a teaching plan for a client who had a cataract extraction with intraocular implantation which home care measures should the nurse include in the plan. 1. avoid activities that require bending over. 2. contact the surgeon if eye scratchiness occurs 3. take acetaminophen for minor eye discomfort 4 expect episodes of sudden severe pain in the eye. 5. place an eye shield on the surgical eye at bedtime 6. contact the surgeon if a decrease in visual acuity occurs.

1. avoid activities that require bending over 3. take aceteaminophen for minor eye discomfort 5. place an eye shield on the surgical eye at bedtime 6. contact the surgeon if a decrease in visual acuity occurs.

The nurse is caring for a client who was recently diagnosed with primary open-angle glaucoma (POAG). Which assessment finding is specific to this type of glaucoma. 1.client report of blurred vision 2. client report of tunnel vision 3. client report of ocular erythema 4. client report of halos around lights

2

The nurse is performing an assessment on a client with a diagnosis of Ménière's disease. The nurse anticipates that the client is most likely to report which symptom during an acute attack 1. fatigue 2. tinnitus 3. headache 4 insomnia

2 attacks may be preceded by feelings of illness in the ear or by tinnitus and muffled hearing.

client arrives at the emergency department with a foreign body in the left ear and tells the nurse that an insect flew into the ear. Which intervention should the nurse implement initially 1. irrigation of the ear 2. instillation of mineral oil 3. instillation of antibiotic eardrums 4. instillation of corticosteroid ointment

2. Insects are killed before removal unless they can be coaxed out by a flashlight or by a humming noise. Mineral oil or diluted alcohol may be instilled into the ear to suffocate the insect, which is then removed by using ear forceps