Chapter 22 Visual and Auditory Problems Flashcards
Correctable Refractive Errors
This defect prevents light rays from converging into a single focus on the retina
Result of irregularities of the corneal curvature
Focusing power of the lens
Length of the eye
Major symptom is blurred vision
Additional symptoms: ocular discomfort, eyestrain, or headaches
Myopia
(nearsightedness)
Inability to accommodate for objects at a distance
Causes light rays to be focused in front of the retina
May occur because of excessive light refraction by the cornea or lens or because of an abnormally long eye
Hyperopia
Hyperopia (farsightedness)
Inability to accommodate for near objects
Causes light rays to be focused behind the retina
May occur because the cornea or lens does not have adequate focusing power or when the eyeball is too short
Presbyopia
(loss of accommodation due to age)
As the eye ages, the lens becomes larger, firmer, & less elastic
Inability to focus on near objects
Astigmatism
(an irregular corneal curvature)
Causes the incoming light rays to be bent unequally
Light rays do not come to a single point of focus on the retina
Aphakia is the absence of the lens (absent congenitally or removed during cataract surgery)
Replaced with an intraocular lens (IOL) implant
Corrective Glasses
Myopia, hyperopia, presbyopia (reading glasses) & astigmatism
Combined corrective glasses (presbyopic correction is in the lower portion of the spectacle lens); “bifocals”
Distance focusing in the top two thirds & near focus in the bottom one third of the lens
Contact Lens
Pattern of wear (daily versus extended)
Microbial keratitis – poor hand or lens case hygiene
Patient education key for the prevention of sight-threatening complications
Laser
(laser-assisted in situ keratomileusis – LASIK)
Creates a flap in the cornea, flap is folded back on the middle section, or stroma of the cornea
Laser pulses vaporize a part of the stroma
Flap is then repositioned
Implant
Refractive intraocular lens implantation is an option for patients with a high degree of myopia or hyperopia
Removal of the patient’s natural lens
Risk of complications is higher
Phakic intraocular lens implantation
Implanted into the eye without removing the eye’s natural lens, placed in front of the eye’s lens
Preserves the eye’s ability to focus for reading vision
Uncorrectable Visual Impairment
In the U.S., 6.5 million people over the age 65 have severe visual impairment
inability to read newsprint even with glasses
9% have no useful vision
91% are partially sighted
Total blindness – no light perception & no usable vision
Functional blindness – some light perception & no usable vision
Legal blindness – central visual acuity of 20/200 or less in the better eye with correction, or a peripheral visual field of 20 degrees or less
1.3 million people in the U.S. are legally blind
Assessment
How the patient’s visual impairment affects functioning
Personal feelings & meaning
Support System
Planning
Successful Adjustments
Coping Strategies
Goals
Implementation
Health Promotion Acute Intervention Patient & Family Respect & Communication Sight-guide technique Ambulatory & Home Care Rehabilitation services American Foundation for the Blind (www.afb.org) ADLs Optical Devices for Visual Enhancement Nonoptical Methods for Visual Enhancement
Evaluation
Expected outcomes
No further loss of vision
Use adaptive coping strategies
Maintain self-esteem or social interactions (no decrease)
Function safely within environment (personal & outside the home)
Gerontologic Considerations
Older adults is at increased risk for vision loss caused by eye disease
Other deficits (cognitive impairment, limited mobility) may further affect the older adult’s function in usual ways
Higher risk for falls
Diminished self- esteem and independence
Decreased manual dexterity may cause difficulty with eyedrops instillation
Eye Trauma
In the U.S. approximately 2.5 million eye injuries occur each year
More than 10% will lose useful vision in the affected eye
Most common ocular injuries occur in the home
Followed by sport and work-related injuries
Eye trauma often is a preventable injury
Protective eyewear
Role of Nursing – patient and community education
Herdeolum
(sty)- infection in sebaceous glands in lid margin
Most common - Staph aureus
May evolve into inflammation of gland → Chalazion
Apply warm, moist compresses at least four times a day
If no improvement refer to ophthalmologist for lancing or removal
Chalazion
chronic inflammatory granuloma of the meibomian (sebaceous) glands in the lid
Blepharitis
Bilateral infection of the lid margins
Lids are red rimmed with scales or crusts on the lid margins and lashes
May experience burning, irritation and photophobia
Ophthalmic ointment
Emphasize thorough cleaning practices of skin & scalp – baby shampoo
Bacterial Conjunctivitis
most common
Commonly occurs in children due to poor hygienic habits
Irritation, tearing, redness, drainage
Antibiotics and hand washing
Viral Conjunctivitis
Tearing, foreign body sensation, redness
Adenovirus conjunctivitis: contaminated swimming pools, direct contact
Good hygiene and palliative care
Chlamydial Conjunctivitis
Due to increase in sexually-transmitted chlamydia
Irritation, discharge, redness, lid swelling
Treated with ointment
Pt. may have concurrent genital chlamydia as well and may need systemic antibiotic
Educate for both ocular and STI
Allergic Conjunctivitis
Caused by exposure to some allergen
Defining symptom – itching
Other symptoms – burning, redness, tearing
Artificial tears, antihistamines, corticosteriods
Keratitis
Infection of the cornea due to disruption of the epithelial layer
Can be caused by bacteria, virus or fungi
Topical antibiotics, antiviral or antifungal advised, if not successful, subconjunctival injections or IV
Corneal ulcer – infectious keratitis – aggressive treatment
Strabismus
Cannot focus both eyes on the same object simultaneously May deviate: In (esotropia) Out (extropia) Up (hypertropia) Down (hypotropia) May be caused by: thyroid disorder, neuromuscular of the eye, retinal detachment repair, cerebral lesions Pt. may c/o double vision
Intraocular Disorders - Cataracts
Opacity with the lens
May be in one or both eyes
May have better vision in one than the other
Cataract removal is most common surgical procedure in the US
Cataracts
Age related (senile cataracts) Develops due to altered metabolic process within the lens that creates a accumulation of water and alterations in the lens fiber structure Trauma, congenital factors, drugs such as steroids, DM
Nursing Diagnosis
Self-deficits related to visual deficit
Anxiety related to lack of knowledge about the surgical and postoperative experience
Expected Outcomes
Pre-op
Make informed decisions regarding therapeutic options
Experience minimal anxiety
Post-op:
Understand and comply with postoperative therapy
Maintain an acceptable level of physical and emotional comfort
Remain free of infection and other complications
Nursing Interventions
Pre-op teaching concerning procedure
Administering mydriatic & cycloplegic agents
Post-op
Patient and family teaching
Eye patched for 24 hours
May take 1-2 weeks for visual acuity to reach adequate level
Home care
Table 22-3 – Teaching Plan Post-op
Patient and family teaching
Eye patched for 24 hours
May take 1-2 weeks for visual acuity to reach adequate level
Home care
Table 22-3 – Teaching Plan
Retinopathy
Process of microvascular damage to the retina
Can develop slowly or rapidly – leads to blurred vision – progressive vision loss
Most associated in adults with diabetes mellitus & hypertension
Retinal Detachment
Separation of the sensory retina and the underlying pigment epithelium, with fluid accumulation between the two layers.
Almost all patients with untreated detached retina become blind in the involved eye
Retinal Breaks- break in full thickness of retinal tissue
Retinal Holes- atrophic, spontaneous
Retinal Tears- vitreous humor shrinks during aging and pulls at the retina
Clinical Manifestations - Retinal Detachment
Photopsia- light flashes
Floaters and “cobweb” or “hairnet” or ring in the field of vision
Painless loss of peripheral or central vision “curtain”
Treatment - Retinal Detachment
Expected Outcomes Seal retinal breaks Relieve inward traction on the retina Surgery Laser photocoagulation & cryopexy Scleral buckling Intraocular procedures
Laser Photorefractive Keratectomy
(PRK)
Good option for patients with insufficient corneal thickness for a LASIK flap
Only epithelium removed
Laser sculpts the cornea to correct the refractive error
Laser-assisted subepithelial keratomileusis (LASEK)
Similar to PRK except epithelium is replace
Cataracts Symptoms
Decreased vision
Abnormal color perception
Glare
Vision loss is gradual, varies from pt. to pt.
Secondary Glaucoma can develop if the enlarging lens causes an increased IOP
Treatment is surgical with removal and replacement of the lens
Age-Related Macular Degeneration
Two classic forms
Dry (atrophic, 90%)
Wet (exudative, more severe)
Most common cause of vision loss in persons over 55
Related to retinal aging
Hallmark sign – drusen in the fundus
Symptoms – blurred vision, scotomas or metamorphopsia
Collaborative Care
Laser photocoagulation – leaves blind spot
Photodynamic therapy (PTD)
Permanent loss of central vision
p. 388 Nursing management of the patient with visual impairment
Glaucoma
Group of disorders characterized by:
Increased IOP
Optic nerve atrophy
Peripheral visual field loss
May present as primary disease or secondary to other ocular or systemic conditions
Primary open-angle glaucoma (POAG)= 90% of cases of primary glaucoma
Main Focus of Glaucoma Treatment
Keep IOP low enough to prevent the patient from developing optic nerve damage
Prevention Focus
Exam 2-4 years for ages 40-64
Exam 1-2 years for ages 65 and up
African-Americans in ever age category should have exams more often
Primary Open-Angle Glaucoma
Develops slowly & without symptoms
Outflow of aqueous humor is decreased in the trabecular meshwork - Drainage channels become blocked
S/S: “Tunnel vision”
Acute Angle Closure
Sudden, excruciating pain
Nausea/vomiting
Colored halos around lights, blurred vision, ocular redness
Collaborative Care
Diagnostic Tests/Collaborative Therapy Table 22-9 Drug Therapy Table 22-7 β – Adrenergic Blockers α – Adrenergic Agonists Cholinergic Agents (Miotics) Carbonic Anhydrase Inhibitors
Nursing Diagnosis
Noncompliance related to the inconvenience and side effects of medications
Risk for injury related to visual acuity deficits
Self-care deficits related to visual acuity deficits
Acute pain related to pathophysiologic process and surgical correction
Patient Expected Outcomes
No progression of visual impairment
Understand the disease process and rationale for therapy
Comply with all aspects of therapy, including medication administration & follow-up care
No postoperative complications
Acute Otitis Media
Most common problem of the middle ear
Bacteria – predominant etiologic agents
Signs/symptoms – pain, fever, malaise, headache, & reduced hearing
Amoxicillin current therapy of choice
Myringotomy (incision in tympanum) for those who do not respond to treatment
Tympanostomy tube may be placed
Meniere’s Disease
Characterized by:
Episodic vertigo, tinnitus, fluctuating sensorineural hearing loss & aural fullness
Cause of disease unknown
Causes significant disability
Duration of attacks may be hours or days
Hearing recovery is often less complete with each episode leading to progressive permanent hearing loss
Meniere’s Disease - Acute Nursing Management
Medications Sedatives Benzopdiazepines Anticholinergics Antihistamine Antiemetics Low sodium diet – avoid caffeine, nicotine, alcohol, MSG Surgical intervention
Miner’s Disease - Acute Nursing Management (expected outcomes and nursing interventions)
Expected Outcomes Minimize vertigo Provide for patient safety Nursing Interventions Quiet, dark room Avoid sudden head movements or position changes No fluorescent/flickering lights or watching TV Emesis basin available Side rails up and bed in low position Medications and fluids given I & O Assist patient with ambulation
Types of Hearing Loss
Conductive – occurs in outer & middle ear; impairs sound being conducted from outer to inner ear
Sensorineural - impairment of function of the inner ear or CN VIII
Mixed – combo of above two
Central & Functional
Central – problems in CNS
Functional – emotional/psychologic factor
Health Promotion in Hearing
Environmental Noise Control
Immunizations
Ototoxic Drugs
Assisting Devices and Techniques for Hearing
Hearing Aids
Speech Reading/ Sign Language
Cochlear Implant
Assisted Listening Devices
Presbycusis
Hearing loss associated with aging Types Sensory Neural Metabolic Cochlear Older adults reluctant to wear hearing aids
Communication with Hearing Impaired Patient
Non-verbal aids and verbal aids
