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CARE OF THE CLIENTS
WITH
EYE AND EAR
DISORDER
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Review of Systems
EYES
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Eyes
Supplies about 70% of all sensoryinformation of the brain.
Composed of:
External structures: Eyelid
conjunctiva (a thin, transparent mucousmembrane that lines the lid)
lacrimal apparatus (which lubricates andprotects the cornea and conjunctiva byproducing absorbing tears)
extraocular muscles (which hold the eyes toparallel to create binocular vision)
Eyeball
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Internal structures. Iris - gives color to the eye and
divides the space between the corneaand lens into anterior and posteriorchambers.
Cornea - works with the sclera to givethe eye its shape
Pupil - the circular aperture in the iristhat changes size as the iris adapts toamount of light entering the eye
Lensa biconvex, avascular,
colorless and transparent structure Vitreous bodya clear, transparent,
avascular, gelatinous fluid that fillsthe space in the posterior portion ofthe eye
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Retinaa thin semitransparentlayer of nerve tissue that linesthe eye wall
Retinal cones colordiscoloration
Retinal rods peripheral vision
Optic nerve - transmit visualimpulses from the retina to thebrain
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Disorders of Conjunctiva/CorneaConjunctivitis
Caused by viral, bacterial infections
Assessment: redness, swelling, lacrimation, pain,
itching, discharge from eyes
Corneal Ulceration
May result to corneal perforation, blindness
Causes: trauma, exposure, allergy, Vit def, infection
Corneal TransplantationDonor of cornea from cadavers
Cornea removed from body 2-4 hrs of death, 12
hrs if body is refrigerated, 48 hrs if cornea
is kept on sterile container
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Retinal Disorders
Retinal DetachmentSeparation of two layers of the retina
Causes
Trauma
Sudden, severe exertion in debilitated clients
Tumor
Exudates
Aphakia (absence of lens)
Assessment
floaters, flashes of lights
constriction of vision in one area
Vitreous cloudy in fundoscopy
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Collaborative ManagementKeep client quiet in bed with eyes covered
Head positioned so that retinal hole is in the lowest part of the eye
Early surgery; scleral buckling
Preop care: mydriatics as orderedPostop care
Position depends on extent and location of retinal detachment
Area affected should be in superior portion
Ambulation and activity to be prescribed by the surgeonPressure patch over the eye
Rest the eye and head immediate post op
Avoid increase in ICP
Hemorrhage is a common complication of the surgery
Sedentary activities in 3 wks, strenous activity in 2 months
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Glaucoma
Types:
Acute (Narrow Angle Glaucoma/Close Angle)
Chronic (Wide Angle Glaucoma/Open Angle)
Causes:
InfectionInjury
Hereditary
Narrowing of Canal of Schlemm
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Assessment
Chronic Glaucoma
Impaired peripheral vision (Tunnel Vision)
Insidous onsetno discomfort
Frequent bumps
Initially affects one eye
Dull eye pain in AM, persistentPoor discrimination of color, blurred vision
Rainbows or halos in VF
Headache, pain behind eyeballs, nausea & vomiting
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Assessment
Acute Glaucoma
Rapid onset of severe eye pain
Blurred vision, rainbows or halos around lights
Headache, nausea & vomiting
Inflamed eyes, fixed dilated pupils
Visual impairment
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Collaborative Management
Promote bedrest
Administered miotics as ordered
Administer acetazolamide, glycerol as orderedAvoid mydriatics ( Atropine)
Assess visual impairment & IOP (>20 mmHg)
Administer antiemetics and analgesics as ordered
Provide emotional support
Prepare for surgery as ordered
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Cataract
Clouding/blurring of lens leading to eventual loss of sight
Causes: old age, congenital, traumaClassification:
Senile: associated with aging
Traumatic: associated with injury
Congenital: occurs at birth
Secondary: associated with a systemic disease
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Collaborative Management
SURGERY
ECCE: Extracapsular Cataract ExtractionICCE: Intracapsular Cataract Extraction
Cryoextraction
Iridectomy
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Preop Care
General Care for Eye Surgeries
If both eyes are to be covered postop, client needs to be
oriented to the staff and the physical environmentprior to procedure
Child client should be practiced to have eyes covered to
decrease anxiety and restlessness postop
If both eyes will be covered or vision is severelyimpaired, place call light within reach of client
Preparation of the eyes prior to surgery may involve
instillation of eye medications.
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Postop Care
Eye/s is/are covered with eyepads and eyeshields
OOB 1 day after surgery
Daily change of dressing is done, removed on the 7-10thdayEyeshields at night for 1 month post op
Administer eyedrops as ordered
Temporary glasses may be prescribed for 1-4thweek,
permanent glasses in 6-12thweek when healing iscomplete
Intraocular lens implant may be installed at time of
surgery (better binocular vision)
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Review of Systems
EARS
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Diagnostic Tests for Auditory Acuity
Tuning Fork Test
Rhinnes
Weber
Whisper Voice Test
Audiometry
Pure Tone
SpeechTympanogram/Impedance Audiometry
Oculovestibular Test/Caloric Ice Water Test
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Assessment of Client with Hearing Loss
Irritable, hostile, hypersensitive in interpersonal relations
Has difficulty in following directions
Complains about people mumbling
Turns up volume of TV
Ask for frequent repetition
Answers questions inappropriately
Leans forward to hear betterHas abnormal articulation
Has unusually soft or loud voice
Experience social isolation
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Guidelines in Communicating
Talk directly to the person facing him/her
Speak clearly using normal tone of voice
Do not whisper to someone when in front of hearing impaired
Use gestures with speech
Do not avoid conversation with a person who has hearing loss
Do not show annoyance by careless facial expression
Move closer to the person toward the better earDo not smile, chew gum or cover mouth when talking
Encourage use of hearing aid when available
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Menieres Disease(Endolymphatic Hydrops)
Characterize by accumulation of endolymph in the
inner ear
It is chronic, with remissions and exacerbations
CausesVirus
Emotional Stress
Idiopathic
Assessment
Vertigo
Tinnitus
Hearing loss
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Collaborative Management
Bed rest
Low Na dietLimit fluids
Avoid reading in times of vertigo
Avoid alcohol, caffeine, tobacco
Stress therapy
Tranquilizers, vagal blockers, antihistamines,, vasodilators,
diuretics
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Different Types of Ear Surgeries
Myringoplasty: closure of perforated TM
Tympanoplasty: closure of TM if middle ear is involved
Myringotomy: simple incision in the TM
Ossiculoplasty: ossicular reconstruction
Stapedectomy: removal of stapes and replacement of
prosthesisStapedotomy: laser creating hole in footplate of stapes and
prosthesis replacement
Labyrinthectomy: removal of the membranous labyrinth
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Post op Care in Ear Surgery
Lie on unoperated side
Blow nose gently one side at a time
Sneeze or cough with mouth open for 1 week post op
Avoid physical activity for one week, exercise or sports for 3 weeks
Keep dry for 6 weeks post op
Do not shampoo hair for 1 week
Protect ear with 2 pieces of cotton, outer piece saturated with
petrolatum
Avoid plane travel for 1 week, equalize pressureReport any unusual drainage other than slight bleeding
Avoid straining of eyes for 1 week
Seek assistance when ambulating for the 1sttime