Nursing Care of Clients Nursing Care of Clients with Eye and Ear Disorderswith Eye and Ear Disorders

Chapter 40Chapter 40

Physical Assessment of Eye Physical Assessment of Eye and Visionand Vision

Snellen chart or E chart for testing Snellen chart or E chart for testing visional acuityvisional acuity 20 feet20 feet

Cardinal fieldsCardinal fields test for extraocular eye movementstest for extraocular eye movements

Cover-uncover test Cover-uncover test test for stabismstest for stabisms

Physical Assessment of Ear Physical Assessment of Ear and Hearingand Hearing

HearingHearing

Weber testWeber test

Rinne testRinne test

Whisper testWhisper test

Eye DisordersEye Disorders

Age Related Vision ChangesAge Related Vision Changes flatting of the corneaflatting of the cornea pupillary constrictionpupillary constriction decrease in lens elasticitydecrease in lens elasticity loss of sensory cellsloss of sensory cells

Physical changesPhysical changes inversion, eversion of lid, decreased tear inversion, eversion of lid, decreased tear

secretion, “hollowed-eyed”secretion, “hollowed-eyed”

Conjunctivitis-red, pain, Conjunctivitis-red, pain, itchy, sticky drainageitchy, sticky drainage

Eye DisordersEye Disorders

Inflammatory DisordersInflammatory Disorders conjunctivitisconjunctivitis

inflammation of the conjunctivainflammation of the conjunctiva bacterial or viralbacterial or viral

TreatmentTreatment topical anti-infectivestopical anti-infectives anti-inflammatoriesanti-inflammatories

Eye DisordersEye Disorders

Corneal Infections/InflammationsCorneal Infections/Inflammations corneal scarring and ulcerations are a corneal scarring and ulcerations are a

major cause of world-wide blindnessmajor cause of world-wide blindness TreatmentTreatment

Corneal TransplantCorneal Transplant

The Client with Eye TraumaThe Client with Eye Trauma

Corneal AbrasionCorneal Abrasion BurnsBurns Penetrating TraumaPenetrating Trauma Blunt TraumaBlunt Trauma TreatmentTreatment

topical anesthesiatopical anesthesia facial X-rays or C-T Scansfacial X-rays or C-T Scans

The Client with Eye TraumaThe Client with Eye Trauma

Foreign body removalForeign body removal sterile saline irrigationsterile saline irrigation

Eye irrigationEye irrigation chemical burnchemical burn

SurgerySurgery penetrating woundpenetrating wound

The Client with CataractsThe Client with Cataracts

CataractCataract a clouding of the lens of the eyea clouding of the lens of the eye interferes with light transmission and interferes with light transmission and

the ability to perceive images clearlythe ability to perceive images clearly Significant cause of visional problems in Significant cause of visional problems in

the elderly (50-70%)the elderly (50-70%) Senile CataractsSenile Cataracts

normal aging processnormal aging process

The Client with CataractsThe Client with Cataracts

TreatmentTreatment Surgical removal of cataract and lensSurgical removal of cataract and lens Implantation of intraocular lensImplantation of intraocular lens

Post-operative Nursing CarePost-operative Nursing Care assessmentassessment eye patcheye patch semi-folwer’ssemi-folwer’s

Post-operative Nursing Care Post-operative Nursing Care

Avoid coughing, sneezing strainingAvoid coughing, sneezing straining these increase intraocular pressurethese increase intraocular pressure

Assess for post-op painAssess for post-op pain Assess for surgical complicationsAssess for surgical complications Approach from unaffected sideApproach from unaffected side Teach Home CareTeach Home Care

meds., symptoms to report, photophobiameds., symptoms to report, photophobia

GlaucomaGlaucoma

Characterized by increased Characterized by increased intraocular pressure and gradual loss intraocular pressure and gradual loss of visionof vision

““Silent” thief of visionSilent” thief of vision Narrowing of visual fieldsNarrowing of visual fields 2 Types2 Types

Open Angle and Closed AngleOpen Angle and Closed Angle

Glaucoma - inner eye Glaucoma - inner eye pressurepressure

GlaucomaGlaucoma

Open AngleOpen Angle common (90%)common (90%) >35yrs, genetic link, African-American >35yrs, genetic link, African-American

PathophysiologyPathophysiology impaired aqueous outflowimpaired aqueous outflow increased intraocular pressureincreased intraocular pressure usually bilateralusually bilateral

GlaucomaGlaucoma

Clinical ManifestationsClinical Manifestations nonenone frequent lens changes in glassesfrequent lens changes in glasses impaired night visionimpaired night vision haloshalos reduction of vision field, become narrowreduction of vision field, become narrow increased intraocular pressure increased intraocular pressure

(tonometry)(tonometry)

GlaucomaGlaucoma

TreatmentTreatment miotics - pilocarpinemiotics - pilocarpine

Laser Surgery (trabeculoplasty)Laser Surgery (trabeculoplasty) cause scar tissue to create tension to stretch cause scar tissue to create tension to stretch

opening to drain aqueous fluidopening to drain aqueous fluid

Glaucoma Stage 4Glaucoma Stage 4

Diabetic RetinopathyDiabetic Retinopathy Leading cause of new Leading cause of new

blindness between blindness between ages of 20-74ages of 20-74

84% of diabetics will 84% of diabetics will develop some form develop some form depends of length of depends of length of

time you have time you have diabetesdiabetes

Vascular disorder that Vascular disorder that affects the retinaaffects the retina capillaries become capillaries become

scleroticsclerotic

Diabetic RetinopathyDiabetic Retinopathy

ManagementManagement Yearly ophthalmologic examsYearly ophthalmologic exams Laser photocoagulationLaser photocoagulation Focus is educationalFocus is educational

vision changes -blurredvision changes -blurred black spots (Floaters)black spots (Floaters) flashing lightsflashing lights sudden loss of visionsudden loss of vision

Diabetic Retinopathy - Diabetic Retinopathy - visionvision

Ear DisordersEar Disorders

External OtitisExternal Otitis swimmers earswimmers ear pseudomonas, bacteria, fungus or pseudomonas, bacteria, fungus or

traumatrauma TreatmentTreatment

cleansingcleansing antibiotics - local and systemicantibiotics - local and systemic educationeducation

Ear DisordersEar Disorders

Otitis MediaOtitis Media inflammation of middle earinflammation of middle ear common in infants and young childrencommon in infants and young children Red bulging tympanic membraneRed bulging tympanic membrane

TreatmentTreatment antibioticsantibiotics myringotomymyringotomy

Ear Infection check upEar Infection check up

Inner Ear DisordersInner Ear Disorders

Meniere’s DiseaseMeniere’s Disease chronicchronic recurrent attack of vertigo with tinnitusrecurrent attack of vertigo with tinnitus progressive hearing lossprogressive hearing loss

TreatmentTreatment antivertantivert

The Client with Hearing LossThe Client with Hearing Loss

Affects 24% of older adultsAffects 24% of older adults Affects 39% of those over age 75Affects 39% of those over age 75 2 Types2 Types

ConductiveConductive disruption transmission of sounddisruption transmission of sound

obstructions - cerum, scarring, tumorsobstructions - cerum, scarring, tumors

SensorineuralSensorineural inner ear, auditory nerve or pathwaysinner ear, auditory nerve or pathways

The Client with Hearing LossThe Client with Hearing Loss

TreatmentTreatment AmplificationAmplification

hearing aidshearing aids SurgerySurgery

reconstruct the middle ear - tympanoplastyreconstruct the middle ear - tympanoplasty cochlear implantcochlear implant

Nursing CareNursing Care Sensory/Perceptual Alteration: Auditory, Sensory/Perceptual Alteration: Auditory,

Impaired communication, Social isolationImpaired communication, Social isolation

What are your What are your interventions?interventions?

What kind of pt. teaching What kind of pt. teaching will you provide?will you provide?

What’s your post-op nursing What’s your post-op nursing care?care?

What is happening here?What is happening here?

What about this visionWhat about this vision