Eye Ear Disorders

8/2/2019 Eye Ear Disorders

1/43

:

1


2/43

Good lighting Rest eyes on distant object

Meds only by MD; discard old meds; maintain

sterility Avoid bright light exposure

Goggles

Dont rub eyes

Under 40, test every 3-5 yrs; over 40, every 2years

2


3/43

Report to MD: sudden sharp eye pain, deepeye pain; photophobia; blurred or doublevision; loss of part of visual field; halosaround lights; floaters; excess tearing;

drainage from eye

Clean eye from inner to outer canthus

Vitamins A & B are important

Wear contacts appropriately

3


4/43

Client is blind, not deaf Treat as adults

Speak when entering or leaving room

Inform before touching Determine amount of help needed

Let person take your arm when walking

4


5/43

Independence fostered by: Braille

Special cane

Seeing eye dog Keep bed low position

Eliminate noise

Room free of clutter

Reduce glare

5


6/43

Ophthalmoscopy Look into eye-see retina, optic disk,blood vessels

May see changes with eye disorders May see changes with diabetesmellitus

Visual field Peripheral vision

Important in some eye diseases

6


7/43

Refraction Look into series of refractors-lenses

Client chooses the clearest vision

Tonometry Measures eye pressure

Pneumotonometer uses puff of air

Normal pressure 12-21 mm Hg

7


8/43

Snellen eye chart

Visual acuity Normal is 20/20

Example: 20/30the person sees at20 feet what a person with normalvision sees at 30 feet

20/70 is visual impairment

20/200 is legally blind

8


9/43

Eye lid, conjunctiva, sclera Any discharge, signs of inflammation or

infection

Visual acuity PERLA

Current and past medical Hx RT eyes

Dry, red, edema

9


10/43

Change from medical problems Diabetes mellitus

Neurological damage

Hypertension Eye injury

Family history

Corticosteroid use Occupation

10


11/43

Keratitis Inflammation of cornea

From infection, irritation, injury, allergy

Symptoms: severe eye pain, red watery

eye, photophobia May cause reduced vision, rash

Treatment: anesthetics, mydriatics, darkglasses, antibiotics

11


12/43

pustular inflammation of eyelash follicle orsebaceous gland on lid margin

Staphylococcal organism

Symptoms: pain, redness, swelling

Treatment: warm compress; topical antibiotic

May need I&D if severe

12


13/43

Cyst of meibomian glands Hard, filled with fatty material

Painless

Develops over weeks Treatment: surgical excision if infected,interferes with sight

13


14/43

Inflammation of conjunctiva frombacteria, virus, ricketsia, allergen, irritant

Symptoms: burning, itching eyes,

discharge, edema, pain, redness Treatment: WMC, antibiotic, antiviralointments; if allergy, treat allergy

Is contagious-use infection control

measures

14


15/43

Myopia: nearsightedness Light focuses on front of retina

Starts with children

Hyperopia: farsightedness. Light focusesbehind the retina

Astigmatism: hard to see small objects. Lightrays distorted

Presbyopia: poor accommodation

15


16/43

Preoperatively

Orient to room if bilateral eye patch, veryimportant

Consent form

NPO Expectations postoperatively

Eye drops

Report any S/S of infections

16


17/43

Safe environment

HOB up 30-45 degrees NO cough, lifting, stooping over,straining, laying on affected side

If nausea, get antiemetic order Avoid constipation

Eye shield, esp. at night

Report any eye pain STAT

Report any bloody drainage

PO meds for mild to moderate pain

17


18/43

Mydriatics: dilate the pupil Cycloplegics: paralyze muscles of

accommodation

Both used in diagnostic eye procedures,eye surgery

Anticholinergics: dilate the pupil; paralyzemuscle of accommodation

Relax ciliary & dilator muscles by blockingacetylcholine

18


19/43

Examples: Atropine sulfate (cycloplegic);Propine for open angle glaucoma;epinephrine for eye surgery or openangle glaucoma

19


20/43

Opacity or clouding of lens Congenital, chemical, traumatic,

mechanical, or degenerative

Assessment: subjectiveC/O cloudyvision, seeing spots or ghost images;floaters

Gradual loss of vision

Advanced: can see milky white lens

20


21/43

Extract lens, implant new one Outpatient status, go home 2-3 hrs. postop

Mild sedative, local anesthesia Preop: mydriatic, cycloplegic

Post op: avoid increasing IOP

Do not drive car until released to doso

Wear dark glasses

21


22/43

Separation of retina from choroid layer Collection of fluid between sensory andpigmented layer

From: trauma, degenerative changes;secondary to other surgeries

Myopic clients at more risk

Assessment: C/O flashes of bright lights

or floaters

22


23/43

Cloudy vision No pain

May have sudden blindness

Objective data Loss of peripheral vision

Loss of acuity of vision

23


24/43

Treatment Prompt medical attention needed

Laser reattachment: adhesion formed

Cryosurgery: cold used to adhere layers Scleral buckling: silicon implant used toband retina

Pneumatic retionopexy: use air or gas to

hold retina in place

24


25/43

Abnormal pressure within the eyeball Damages cells of optic nerve bydecreasing blood flow

Most common form: primary open angle

glaucoma Incidence increases over 40 years, familyhistory; more prevalent in African

Americans

25


26/43

Drainage of eye system blocked-trabecular meshwork and canal ofSchlemm

Bilateral condition

26


27/43

Acute angle-closure glaucoma Highest incidence in Asians, women over40, nearsighted

Unilateral Narrowed angle at the junction where irismeets cornea

Iris protrudes into anterior chamber,

occludes angle

27


28/43

Loss of peripheral vision cardinal symptom Other complaints: blurred vision, halos

around lights, complaints of tired eyes

Glaucoma painless, untreated = blindness

Diagnosis: tonometry

Pupils should be dilated first

28


29/43

Treatment: first lineopening aqueous flow

Use miotics (Pilcar) Constricts pupil, iris pulls away fromdrainage canal

Diamox: decreases production ofaqueous

29


30/43

Timoptic: beta blocker, decreasesproduction

Steroids if inflammation

Must use meds BID or TID for life

30


31/43

Narrow angle glaucoma Avoid anticholinergics: Atropine

Avoid antihistamines: Benadryl, Vistaril

31


32/43

Laser surgery: laser emits an intenseconcentrated ray of light Can cauterize, create holes in tissue, seal layers of

tissue

Cryotherapy Use of frozen probe: retinal tear or cataract

Enucleation Removal of entire eyeball

32


33/43

Inability of sound to reach inner ear Can occur because of cerumen,perforated tympanic membrane, fixation

of one or all of ossicles Hearing aids useful

33


34/43

Inner ear or cochlear portion of cranialnerve VIII unable to function

Occurs from: tumor, infection, trauma,

exposure to noise, some medications Presbycusis: unable to hear high pitchedsounds

Cochlear implant helpful

34


35/43

Turn up volumes Ask What did you say?

Learn forward, turn head to one side

Cup hands around ears

Speaks unusually softly or loudly C/O people mumbling Answers questions inappropriately, not at all

35


36/43

Difficulty with: f, s, k, sh Cannot filter background sounds

Avoids group activities

Appears to not be paying attention

Seems aloof

C/O ringing, buzzing, roaring noise

May have paranoia or social isolation

36


37/43

Bone fixation of stapes Begins in adolescence

Hereditary

Conductive hearing loss

Young, Caucasian, female, 40

Bilateral hearing loss

Hears own voice well

C/O tinnitus

37


38/43

Hearing aid Reconstruct ossicles

Stapedectomy

38


39/43

Operative ear up Ear plug for asepsis

Treat Nausea/Vomitting

Safety measures Dont dislodge prosthesis

No cough, sneeze, blowing of nose,

vomiting, flying, lifting, showering If gets a cold: call MD

39


40/43

Edema and congestion in mucousmembrane of cochlea and semicircularcanals

2 million people

Assessment: classic S/S unilateralhearing loss, vertigo

40


41/43

Attacks at regular intervals, havedizziness, unsteadiness on feet

Tinnitus occurs during attack

Classic triad Progressive hearing loss with eachattack

Vertigo

Tinnitus

41


42/43

Usually occurs in 40-60 year old Men more than women

Interventions

Bed rest during acute phase Low sodium diet

Avoid alcohol, caffeine, tobacco

42


43/43

Antihistamines

Antiemetics

Vasodilators

Diuretics

Surgical intervention Severing of acoustic nerve (8thcranial nerve)

labyrinthectomy

Documents

Eye Ear Disorders