NCLEX EYE and EAR

Otalgia

Pain in the ear

Pilocarpine hydrochloride is prescribed for the client with glaucoma. Which medication would the nurse plan to have available in the event of systemic toxicity?

Atropine sulfate

Eustachian tube

A narrow tube between the middle ear and the throat that serves to equalize pressure on both sides of the eardrum.

Age-related changes in the ear

-Skin of auricle becomes dry and wrinkled

Hyperopia

Farsightedness

Health history of the ear

Present health - Changes in hearing acuity, pain, tinnitus, dizziness, vertigo, n/v, and problems with balance.

The nurse is providing discharge instructions to a client who is postoperative cataract surgery on the left eye. Which statement indicates a need for further teaching?

"If I have severe eye pain, I will take the narcotic pain pill that my doctor will prescribe for me."

Tinnitus

"Ringing in the ears", the perception of ringing even with no external stimuli.

Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse reviews the test and determines that the intraocular pressure is normal if which result is noted?

15 mm Hg

Miotics

CONSTRICT (Pilo-Carpine) For glaucoma - increased outflow of aqueous Caps and label are green

Impact of serious vision loss

Can affect independence, mobility, employment, and interpersonal relationships. May trigger a grief response.

Cochlea

A coiled, bony, fluid-filled tube in the inner ear through which sound waves trigger nerve impulses.

Cochlear implants

A device for converting sounds into electrical signals and stimulating the auditory nerve through electrodes threaded into the cochlea.

The nurse is assigned to administer the prescribed eye drops for a client preparing for cataract surgery. Which type of eye drops would the nurse expect to be prescribed?

A mydriatic medication

Fluorescein angiography

A radiographic study of the blood vessels in the retina of the eye following use of a mydriatic drops and intravenous injection of a fluorescein dye as a contrast medium. Signed consent required. Patients should be asked about allergies to dyes. Dye causes the the patients skin ti appear yellow for several hrs. As the dye is excreted , urine appears green.

Iris

A ring of muscle tissue that forms the colored portion of the eye around the pupil and controls the size of the pupil opening.

The nurse notes that the primary health care provider (PHCP) has documented a diagnosis of presbycusis on the client's chart. Which explanation would the nurse give to the client to explain this condition?

A sensorineural hearing loss that occurs with aging

Ear drops (otic drops)

Liquid medication placed into the external auditory canal to treat external ear infections, typically containing antibiotics and anti-inflammatory drugs.

A client was just admitted to the hospital to rule out a gastrointestinal bleed. The client has brought several bottles of medications prescribed by different specialists. During the admission assessment, the client states, "Lately, I have been hearing some roaring sounds in my ears, especially when I am alone." Which medication would the nurse determine to be the cause of the client's complaint?

Acetylsalicylic acid

The nurse notes documentation that a client has conductive hearing loss. The nurse plans care knowing that this kind of hearing loss can be caused by which circumstances? Select all that apply

Acute otitis media with effusion, A physical obstruction to the transmission of sound waves

The client is receiving an eye drop and an eye ointment to the right eye. Which action would the nurse take?

Administer the eye drop first, followed by the eye ointment.

Measures to support patient with impaired vision and to prevent injury

Announce presence when entering room, speak before touching the patient, use normal tone of voice, address patient in appropriate manner for age and intellect, tell pt when leaving the room, call bell within reach, doors should be open or closed, keep furniture in place after orienting patient, when leading - have blind person take nurse's arm.

Tympanic membrane

At the end of the external auditory canal, shiny and pearly gray, vibrates when sound waves enter the external auditory canal.

A client with Ménière's disease is experiencing severe vertigo. The nurse reinforces instructions to the client to do which to assist with controlling the vertigo?

Avoid sudden head movements.

Refraction

Bending of light as they focus on the retina. Errors occur when light does not bend properly, adversely affecting the vision.

Mastoid process

Bony structure behind the auricle, directly connected to the inner ear.

A client is brought to the emergency department by the ambulance team after collapse at home. Cardiopulmonary resuscitation is attempted but is unsuccessful. The wife of the client tells the nurse that the client is an organ donor and that their eyes are to be donated. Which action would the nurse take next?

Close the eyes, elevate the head of the bed, and place a small ice pack on the eyes.

Cataracts

Clouding or opacity of the normally transparent lens within the eye, causing vision to blur and objects to take on a yellowish hue.

Types of hearing loss

Conductive, sensorineural, mixed, central

Key points when irrigating the ear

Correct solution, warm solution to body temp, emesis basin under the ear, auricle in proper position, direct solution toward the top of the canal, do not do this if the tympanic membrane has been perforated.

Past health: Be alert for the following conditions.

Diabetes(elevated blood glucose can cause temp blurry vision. Permanent changes in retina associated with diabetes can cause permanent blindness). Neurological disorder(Brain tumors, head injuries and strokes may impair vision) Thyroid disease( hyperthyroidism may cause exophthalmos(bulging eyes). Hypertension(elevated blood pressure levels eventually lead to vision loss

Vertigo

Different than dizziness, feels as if the room and its contents are spinning.

Drugs that may cause visual disturbances

Digoxin, steroids, indomethacin, and sulfisoxazole.

Mydriatics

Dilates the pupils (Atropine) Don't use in pts with glaucoma (build up IOP)

Key points when administering topical eye medications

Drops should be room temperature when administered.

Ototoxic

Drug that is damaging to the ear/hearing to include aspirin and aminoglycoside antibiotics.

Caloric test

Dx disorders in the vestibular system or CNS connections by irrigating ear with warm or cold water.

Ophthalmologic examination

Examines the inner eye through the pupil to diagnose abnormalities of retina, optic disc, and blood vessels.

Three major sections of the ear

External ear - auricle (pinna), lymph drainage, facial nerve, external auditory canal containing eardrum and cerumen

The nurse is assigned to care for a client hospitalized with Ménière's disease. The nurse expects that which would most likely be prescribed for the client?

Low-sodium diet

Presbyopia

Farsightedness caused by loss of elasticity of the lens of the eye, occurring typically in middle and old age.

The nurse is reviewing the health record of a client diagnosed with a cataract. Which are signs and symptoms of cataract formation? Select all that apply.

Floaters in visual field,Increasing farsightedness,Decreased color perception

Physical examination

Inspect the eyelids for redness, drainage, and position; lids not covering iris, sclera should be clear white; pupil size and reaction, accommodation, visual acuity.

A client arrives at the emergency department with a foreign body in the left ear that has been determined to be an insect. Which initial intervention would the nurse anticipate to be prescribed?

Instillation of mineral oil or diluted alcohol

An older client confides to the visiting nurse the fear of falling while going to the bathroom at night. Considering the visual changes affecting the older client, the nurse would make which recommendation?

Keep a red light on in the bathroom at night."

Visual pathway

Light enters the eye, passing through the transparent cornea, aqueous humor, lens, and vitreous humor - refract the light rays to focus on the retina.

S/sx of hearing loss

May c/o others' mumbling, lean toward the speaker or turn one ear toward the speaker, fail to follow directions, speak while others are speaking, or turn the radio or tv up very loudly.

Choroid

Middle layer of the eye located between the sclera and the retina containing connective tissue rich in blood vessels for nourishment.

Guidelines for communicating with hearing-impaired patient

Move into patient's line of sight, speak slowly and distinctly, lower your voice tone, speak toward that side.

Cerumen

Only normal secretion of the external auditory canal, should be golden to brown in color.

Health history of the eye

Present health: eye complaints, changes in vision (blurring, diplopia, floaters, flashes of light, blind spots, and diminished visual fields), pain, photophobia.

The nurse is preparing to administer eardrops to an adult client. The nurse administers the eardrops by which technique?

Pulling the pinna up and back

Adaptations to hearing loss

Reading lips, sign language, electronic devices, earphones, guide dogs, flashing lights, communication boards.

Vision changes associated with age

Related to changes in the lens and the ciliary muscle. Light passing through the lens scatters, therefore more sensitive to glare. Ability to focus on near objects is impaired.

The nurse is caring for a client after enucleation and notes the presence of bright red drainage on the dressing. The nurse would take which appropriate action?

Report the finding to the registered nurse (RN).

Tuning fork test

Rinne test - An examination that compares bone conduction and air conduction. Air conduction should be greater than bone conduction.

Three layers of eye tissue

Sclera, choroid, and the retina

Physical age-related changes in the eye

Skin around the eye becomes wrinkled and looser, excess tissue around the eyelids, decreased fat around the eye, decreased tear secretion, less sensitive cornea, gray ring around the iris (arcus senilis).

The nurse is attempting to communicate with a hearing-impaired client. Which strategy by the nurse would be least helpful when talking to this client?

Smiling continuously during

The nurse is caring for a client who is hearing-impaired. Which approach would the nurse take to facilitate communication?

Speak in a normal tone.

The nurse is preparing to communicate with an older client who is hearing impaired. Which intervention would be implemented initially?

Stand in front of the client.

Equilibrium

State of balance needed for walking, standing, and sitting.

Potentially serious eye problems

Sudden loss of vision in one eye, sudden hazy or blurred vision, flashes of light or black spots, halos or rainbows around the light, curtain-like blotting out of vision, loss of peripheral (side) vision.

Signs of eye problems in adults

Unusual trouble adjusting to dark rooms, difficulty focusing, squinting/blinking, change in iris color, irritated lids, recurrent pain, double vision, dark spots in the center of viewing, excess tearing, dry eyes.

Assumption to make regarding visual impairments

That all people with this condition can be independent and productive.

Otoscopic examination

The examination of the ear canal and tympanic membrane through the use of an otoscope. Pull the auricle up and back for an adult. Dx inflammation and infection.

Retina

The light-sensitive inner surface of the eye, containing the receptor rods and cones plus layers of neurons that begin the processing of visual information.

Tonometry

The measurement of intraocular pressure(normal pressure is 10-20mm)

A miotic medication has been prescribed for the client with glaucoma. The client asks the nurse about the purpose of the medication. The nurse would tell the client which purpose?

The medication causes the pupil to constrict and will lower the pressure in the eye."

Optic nerve

The nerve that carries neural impulses (visual messages) from the eye to the brain.

Audiometry

The use of an audiometer to measure hearing acuity. Can also do a whisper test to check gross assessment of hearing.

Normal position of the auricle

Top of auricle should be at the approximate level of the eye. Ears should be symmetrical.

Sclera

Tough outer layer of the eyeball that is a white opaque membrane except for the clear covering over the cornea.

Which intervention would be implemented for the older client with presbycusis who has a hearing loss?

Use low-pitched tones

Key points when administering ear drops

Use otic solution, warm bottle to room temperature, affected ear positioned to you, position external auditory canal appropriate for the age, do not touch tip of dropper to the canal, have patient keep treated ear up for several minutes to decrease leakage of Rx.

Nutrition considerations for vision

Vitamin A is essential for normal vision. Night blindness is early sx of vitamin A deficiency. Severe vitamin A deficiency can lead to blindness.

The nurse assists with preparing the client for ear irrigation as prescribed by the primary health care provider (PHCP). Which action would the nurse plan to take?

Warm the irrigating solution to 98°F (36.6°C).

Eye irrigation

Washing of the eye with water or other fluid to remove irritating chemicals from the eye. Normal saline is the best solution for this.

Key points for eye irrigation

Wear gloves and clean the eyelids and eyelashes. Position so that the affected eye is "down."

Patient teaching for eyes and vision

Younger than 40, eyes should be checked q 3 - 5 years.

Anterior Chamber

filled with aqueous humor (clear watery fluid) produced by the ciliary body. Canal of Schlemm returns fluid to the venous circulation.

Posterior Chamber

filled with vitreous humor, clear gelatinous material that holds the retina in place.