Disorders of the Eyes & Ears Flashcards
What is tinnitus?
Ringing in the ears
List 6 age-related changes in the eyes.
- Cornea is less transparent
- Lens hardens
- Lens becomes yellow and cloudy (cataracts)
- Pupil size becomes smaller
- Scattering of light within the eye globe
- Presbyopia
What is presbyopia?
Impaired vision as a result of aging, harder to see closer up, muscle becomes weaker within the eye, starts around age 40
What is myopia?
Nearsightedness, can see close up but not far away
What is hyperopia?
Farsightedness, can see far away but not close up
What is astigmatism?
Blurred vision at any distance
What education should be provided for the eyes?
Proper screening for refractive errors, importance of wearing glasses/contacts if patient has them
What are clinical manifestations of refractive errors?
Blurred vision, headaches, eyestrain, ocular discomfort
How is the Snellen chart used?
20 feet away, read the smallest row you can read, cover one eye at a time then with both eyes open, bottom line is 20/20 vision
What does it mean to be legally blind?
If you cannot make out the E at the top of the Snellen chart
What is the Rosenbaum chart used for?
To test near vision or hyperopia/presbyopia
What are types of screening for the eyes?
Annual vision exam, colorblindness, tonometry
What is tonometry?
The measurement of intraocular pressure
What is the treatment for refractive errors?
Corrective lens (glasses, contacts), surgery (LASIK)
Will LASIK prevent presbyopia?
No, because LASIK only fixes the lens, not the muscle
What is visual impairment?
Legal blindness (20/200 or less), peripheral vision of 20 degrees or less
What are the roles of the nurse with eye disorders?
Health promotion/early detection, patient safety
What are safety risks with patients with impaired vision?
Fall risk, risk for poor communication, medication errors
What are nursing interventions for the visually impaired patient?
Normal tone of voice, alert client of approach, orient to environment, meal tray placement
What are types of eye trauma?
Blunt or penetrating, chemical or thermal burns, foreign bodies
What else should be looked for whenever a patient comes in with eye trauma?
Any other injuries (facial fractures especially)
What are clinical manifestations of eye trauma?
Pain, photophobia, erythema, edema, tearing, vision changes
What is photophobia?
Sensitivity to light
What diagnostics are used for eye trauma?
H&P, visual acuity, fluorescein
What is fluorescein?
Bright green fluorescent dye dropped onto the surface of the eyeball to highlight corneal abrasions
What is the first test that needs to be done if a patient complains of eye/vision problems?
Visual acuity exam
What are treatments for eye traumas?
Cover injury, maintain NPO (in case of procedure), analgesics, elevate head of bed (decrease pressure in eye), no medications in the eye
If a patient comes in with a chemical burn in the eye, what should be done first?
Flush with normal saline for 15-20 minutes
What are the top priorities for a patient with lawn chemicals in their eyes and swelling around the mouth and cheeks?
- Airway
- Irrigate the eyes
- Assess the extent of the injury
What are types of conjunctivitis?
Bacterial, viral, allergic, chlamydial
What is the most common cause of bacterial conjunctivitis?
S. aureus
What is conjunctivitis?
Inflammation or infection of the eye
What are clinical manifestations of bacterial conjunctivitis?
Mucopurulent discharge (yellow and thick), discomfort, redness, starts unilaterally
What are clinical manifestations of viral conjunctivitis?
Foreign body sensation, watery eye (clear drainage), redness, mild photophobia
What is the main clinical manifestation to determine chlamydial conjunctivitis?
Enlarged preauricular lymph node (in front of ear)
What are clinical manifestations of allergic conjunctivitis?
Itching, swelling, redness, watery eyes (bilaterally)
What supportive treatments are used for viral and allergic conjunctivitis?
Treat allergies (Flonase and oral antihistamines), artificial tears for itching and dryness, topical steroid if severe
What supportive treatment is used for bacterial and chlamydial conjunctivitis?
Topical antibiotics, chlamydial may require STI treatment
Are oral antibiotics effective in treating eye infections?
No
What teaching can reduce eye infections?
Wash hands, don’t share makeup (throw away if infected), proper contact lens care
What are cataracts?
Lens of eyes become cloudy and opaque, can be seen by shining light into the eye, progresses slowly over time, decreases visual acuity, typically older adults
What are causes of cataracts?
Age-related, trauma, maternal rubella, UV exposure, long-term use of topical corticosteroids
How are cataracts diagnosed?
H&P, ophthalmoscopic exam
What are the first indicators of cataracts?
Vision decreased, having a hard time seeing at night
What are nonsurgical treatments for cataracts?
Visual aids, management (more light when reading, avoid driving at night)
What is the difference between nonsurgical and surgical cataract treatment?
Depends on the severity of the disorder and the patient’s age; if the patient has underlying conditions such as hypertension or diabetes, the provider would probably go ahead with the surgery
What is the surgical treatment for cataracts?
Removal of old lens and replace lens
What is preoperative care for cataract surgery?
EKG, PT INR (clotting factor), chest x-ray, mydriatics, NSAIDs, antibiotics, antianxiety VS
What are mydriatic eye drops used for?
Pupillary dilation (makes removal of lens easier)
Why is antianxiety medication given before surgery?
Due to the patient being awake during the surgery
What is postoperative care for cataract surgery?
Topical antibiotics and corticosteroids, activity restrictions, eye shield, teaching
What are activity restrictions after eye surgery?
No bending, stooping, coughing, or lifting; these could increase intraocular pressure and prevent healing
What is return demonstration?
Demonstration after the patient has first observed the teacher and then practiced the skill in mock or real situations
What teaching should be provided for a patient having eye surgery?
Medications, s/s of infection, safety
What are signs and symptoms of infection after eye surgery?
Purulent drainage, intense pain (some pain is normal), redness
How long can it take for full vision to return after surgery?
1-2 weeks
What is retinopathy?
Microvascular damage to the retina, red spots on the back of the eye
What is the goal of treatment of retinopathy?
Treat the cause (diabetes/hypertension), blindness can occur if not treated
What is retinal detachment?
Separation of retina from underlying structures (including the blood vessels), causes retina to be unable to get oxygen and nutrients
What are risk factors for retinal detachment?
Age, severe myopia, trauma, cataract surgery, family or personal history
What are types of retinal detachment?
Small tear or complete detachment
What are clinical manifestations of retinal detachment?
Photopsia, floaters, ‘cobweb’ in field of vision, painless loss of vision
What is photopsia?
Bright flashes of light
What diagnostics are used for retinal detachment?
Visual acuity test, ophthalmoscopy (look into eye), ultrasound (look at blood supply and other structures)
Why is teaching important after retinal detachment?
25% risks of developing detachment on opposite eye
What is age-related macular degeneration?
Most common cause of irreversible central vision loss >60 years old, can be managed but not reversed
What are risk factors for age-related macular degeneration?
Age, family history, hypertension, smoking, ethnicity, nutrition
Which ethnicity is at a higher risk for AMD?
Caucasian
Why is nutrition important for AMD?
Slows down progression, vitamins and supplements
What are clinical manifestations of AMD?
Blurred/darkened vision, scotomas, metamorphopsia
What are scotomas?
Blind spots
What is metamorphopsia?
Distorted vision
Why might a patient with AMD not notice a change if only one eye is affected?
The unaffected eye will take over
What are drusen?
Yellow deposits on the eye
What is the Amsler grid test?
Diagnosis for AMD, used to show progression of the disorder, will show distorted grid if they have the disorder
What is the treatment for AMD?
Treat underlying conditions, medications, photodynamic therapy
What medications would be used to treat AMD?
Intravitreal injections into the eyes to prevent progression
What is photodynamic therapy?
Laser therapy for the eye
In which ethnicity is glaucoma most common?
African Americans
What is the group of disorders for glaucoma?
Increased intraocular pressure, optic nerve atrophy, vision loss/blindness
What are the two types of glaucoma?
Open angle and angle closure
What is open angle glaucoma?
Most common form, pressure build-up in the eye, damage to optic nerve, slower progression
What is angle closure glaucoma?
Drug-induced mydriasis (pupillary dilatation), darkness, emotional excitement, very sudden attack
What are the signs and symptoms of open angle glaucoma?
Loss of peripheral vision, ‘tunnel vision’
What are the signs and symptoms of angle closure glaucoma?
Pain in or around the eye, nausea/vomiting, colored halos, blurred vision, redness of the eye
What is the normal intraocular pressure?
10-21 mm/Hg
What medications are used for open angle glaucoma?
B-adrenergic blockers (betaxolol), alpha-adrenergic blockers, cholinergics (decrease pressure)
What medications are used for angle closure glaucoma?
Cholinergics, mannitol (osmotic diuretic), PO isosorbide
What are important steps for administering eye drops?
Hand hygiene, pull down with index finger, drops go into pocket and don’t touch tip to eye, close eyes and put pressure on corners of eyes
What are types of hearing loss?
Conductive, sensorineural
What is conductive hearing loss?
External ear disorders (obstruction), middle ear disorders
What is sensorineural hearing loss?
Inner ear disorders, presbycusis
What can cause sensorineural hearing loss?
Sound exposure, trauma, age
What is presbycusis?
Age-related hearing loss
What are clinical manifestations of hearing loss?
Answering questions inappropriately or not at all, irritability when others don’t speak up, cupping ear, tinnitus, speaks softly
What are treatments for hearing loss?
Hearing aid, speech/lip reading, assistive listening devices, cochlear implant
What is important for hearing aid management?
Consistent use, restrict to quiet areas, disconnect battery when not in use, keep in a safe dry place
What immunization can prevent hearing loss?
MMR vaccine, rubella in pregnancy can cause infant deafness
What are toxic medications that can cause hearing loss?
Salicylates (aspirin), loop diuretics, chemotherapy, antibiotics
How should you communicate with a patient with hearing loss?
Normal tone of voice, speak slowly, maintain eye contact, use touch, decrease distractions
What is otitis externa?
Infection of outer ear and canal
What are signs and symptoms of otitis externa?
Pain with palpation (tragus), drainage, externally red, puffiness of the ear canal
What is otitis media?
Infection of the middle ear
What are signs and symptoms of otitis media?
Pain radiating behind the ear, fever, redness/swollen, loss of landmarks
How is otitis externa treated?
Antibiotic ear drops
How is otitis media treated?
Oral antibiotics but doesn’t always have to be treated
How are inner ear disorders characterized?
Tinnitus, sensorineural hearing loss, vertigo
What is Ménière’s disease?
Increased accumulation of fluid in the ear, leads to dizziness and can be debilitating
What are signs and symptoms of Ménière’s disease?
Fullness in ear, ‘drop attacks’, tinnitus, muffled hearing, intermittent (random attacks that last hours to days)
What diagnostics are used for Ménière’s disease?
Glycerol test, positional test
What is the glycerol test?
Oral glycerol is given and 3 hearing exams are taken, should have improved hearing due to pulling fluid off the ear
How are acute attacks of Ménière’s disease managed?
Antihistamines (dry up ear), antivertigo drugs, antiemetics (treat N/V)
What is the maintenance of Ménière’s disease?
Antihistamines used daily, CCB, diuretics (fluid balance), low sodium diet (keeps from retaining fluid)
What is vertigo?
Free floating debris in semicircular canal (crystals get out of balance)
What else should be checked for if someone complains of dizziness with positional changes?
Orthostatic hypotension, need a good cardio assessment
What are signs and symptoms of vertigo?
Nystagmus (H test), dizziness and lightheadedness (with positional change), loss of balance
What is the treatment for vertigo?
Physical therapy (reposition crystals), medications to treat symptoms
