Eye and Ear Flashcards
1
Q
Myopia
A
Near-sighted
focus rays anterior to retina
2
Q
Hyperopia
A
Far-sighted
focus rays posterior to retina
3
Q
Astigmatism
A
There are refractive errors where the light rays are diffusely spread; not sharp focus on the retina due to the curvature of the cornea
4
Q
Presbyopia
A
decrease in accommodation related to aging
5
Q
OD
A
R eye
6
Q
OS
A
L eye
7
Q
OU
A
Both eyes
8
Q
Snellen chart
A
(20/20 standard); Tests distance vision
**If a patient’s vision is 20/40 then the patient can see at 20 feet what a patient with normal vision can see at 40 feet
9
Q
Ishihara Plate Test
A
Tests for color blindness
10
Q
Ptosis
A
Drooping of the eyelid
11
Q
What does a healthy sclera look like?
A
Normally clear and white (African Americans can have a yellowish sclera, its normal)
12
Q
Direct light reflex
A
Constriction of a stimulated pupil
13
Q
Consensual light reflex
A
Constriction of the opposite pupil when the other pupil is stimulated
14
Q
What is accommodation?
A
The ability to focus and refocus
15
Q
Tonometry
A
Measure ocular tension which tells us the intraocular fluid pressure
16
Q
Normal IOP range
A
10-21 mm Hg
17
Q
What is a slit-lamp examination?
A
Is used to illuminate and examine the anterior segment of the eye under magnification
18
Q
When is fluorecein dye used?
A
It is often used in a slit-lamp examination to highlight corneal irregularities
19
Q
How do you test extraocular movement (EOM)?
A
By assessing the six cardinal fields of gaze
20
Q
Amsler Grid
A
Geometric grid which tests for macular degeneration
21
Q
What should be noted during an ophthalmoscopic exam?
A
- Papilledema - edema of ophthalmic nerve
- Vasculature - veins and arteries
- Lesions/Smudges - indicated hemorrhage
- Lipids - yellowish (indicates increased cholesterol)
- Microaneurisms/Hemorrhages - secondary to HTN or DM
22
Q
Procedure for administering eye drops
A
- Evert lower lid and drop into conjunctival sac
- Apply pressure to inner canthus to prevent med from entering systemic circulation
- Only 1-7% of med is absorbed
- Tears dilute med
- Wait 30 seconds between drops of the same medicine
- Wait 5 minutes between instillation of separate medicines
23
Q
Procedure for administering eye ointment
A
- Evert lower lid
- Squeeze med from inner to outer canthus
* *Patient could complain of blurred vision
24
Q
What is Phototherapeutic Keratotomy (PTK)?
A
A laser removes/reduces corneal opacities, smooths corneal surface, and changes eyeball shape
25
When would a patient undergo a phototherapeutic keratotomy (PTK)?
To improve vision and correct nearsightedness
26
Common complications of PTK
1. Hyperopia
| 2. Stromal haze
27
What should a nurse do for a patient post PTK surgery?
1. PO analgesic
2. Pressure patch to heal
3. Antibiotics and steroids
4. NSAIDS for pain
* *They should improve 1 week to 1 year
28
Causes of retinal detachment
1. Trauma
| 2. Hemorrhage
29
S/Sx of retinal detachment
1. Sudden flashes of light
2. Blurred vision
3. Floaters
4. Veil in front of eye
5. Painless
30
How is a retinal detachment managed medically?
1. Reattach with surgery
2. Immediate bedrest
3. Eye patch
31
What can lead to retinal vascular disorder?
Retinal vascular disorder is secondary to CVD, HTN, DM, and glaucoma
* *The vein or the artery can get occluded
* *If the artery gets occluded, it is considered an emergency
32
S/Sx of retinal vascular disorders
1. Decreased visual acuity
2. Blurred vision
3. Blindness
33
Treatment for retinal vascular disorder
1. Laser photocoagulation
34
What is macular degeneration and what are the two types?
* *Presence of Drusen bodies - tiny yellow spots beneath the retina; the central vision is most affected
1. Dry/Non-Exudative Type
2. Wet/Exudative Type
35
S/Sx of macular degeneration
1. Blurred vision
2. Straight lines become crooked
3. Broken letters
36
Treatment of macular degeneration
1. Carotenoids
2. Fish oil PO
3. Bright lights
4. Magnification devices
37
Causes of cataracts
1. Age
2. Trauma
3. Heredity
4. DM
5. Medications
38
Risk Factors for cataracts
1. Aging
2. Prolonged corticosteroid usage
3. Smoking
4. DM
39
S/Sx of cataracts
1. Painless blurred vision
2. Sensation of dimmed surroundings and fogged glasses
3. Increased sensitivity to glare and contrast
4. Diplopia
5. Color shift
6. Brunescence
40
What diagnostic tests are used to confirm cataracts?
1. Snellen chart
2. Opthalmoscope
3. Slit lamp
41
How are cataracts corrected?
* *By removing the lens
1. Intracapsular extraction
2. Extracapsular extraction
3. Lens replacement after surgery
42
Nursing Care pre-op cataract surgery
1. Dilate pupil 1 hour before
2. No ASA or anticoagulants
3. Administer mydriatics and cycloplegics
43
Nursing Care post-op cataract surgery
1. No lifting
| 2. Call MD if there is an increase in pain, discharge, increased redness, increased edema
44
Home care after cataract surgery
1. Antibiotic drops
2. Eye shield for 1 week
3. Position themselves on their non surgical eye
4. Cycloplegic
5. No Valsalva maneuver
6. PRN acetaminophen
45
Why is IOP higher in glaucoma patients?
1. Because there is an increased rate of aqueous production
2. Increased passage flow resistance encountered
3. Increased venous pressure
46
Primary prevention of glaucoma
1. Maintain ideal body weight
2. No smoking
3. Control HTN/DM/CVD
4. Avoid increasing PO fluid
47
Secondary prevention of glaucoma
1. No alcohol/caffeine before an eye exam
2. Side effect of hormone replacement therapy in females
3. Regular eye exams with optic nerve assessment and tonometry
48
Tertiary prevention of glaucoma
1. No bending
| 2. No Valsalva maneuver
49
Teaching for a patient with glaucoma
1. No stress
2. No excess fluids
3. There is no cure, but meds can control it
4. Carry drops at all times
5. Medicalert bracelet
6. Notify MD with pain, sudden change in vision, halos, or headache
50
Risk Factors for glaucoma
1. Alcoholism
2. Drugs
3. Chronic steroids
4. Increased fluids
5. HTN
6. CVD
7. DM
8. Obese
9. Smoking
10. Caffeine
51
Treatment of glaucoma
1. Pharmacologic therapy
2. Trabeculoplasty
3. Peripheral iridotomy
4. Filtering procedures - opening in the trabecular meshwork to drain excess humerous
52
Trabeculoplasty
widens the canal of Schlemm (which drains excess aqueous humor)
53
Peripheral iridotomy
Opening into iris to eliminate blockage
54
What is enucleation?
Removal of the eyeball
55
Why would an enucleation be done?
1. Trauma that forces content of globe to escape
2. Infection
3. Intraocular tumors
4. Eye without useful vision causing problems with the good eye
5. Glaucoma, retinal detachment, or inflammation causing irritated, painful, blind eye
56
Treatment for enucleation
Wear prosthesis or eye patch
57
Legal criteria for blindness
20/400 vision
58
S/Sx of diabetic retinopathy
1. Asymptomatic
2. Painless
3. Blurred vision
59
Treatment for diabetic retinopathy
1. Prevent DM and increased BG
| 2. Photocoagulation
60
What is cytomegalovirus (CMV)
It is an AIDS related complication causing retinal inflammation
61
Treatment of cytomegalovirus (CMV)
1. Ganciclovir
2. Foscarnet
3. Cidofoviar
* *Side effect = nephrotoxic
62
S/Sx of cytomegalovirus (CMV)
1. Floaters
| 2. Decreased peripheral vision
63
S/Sx of HTN related changes in eyesight
1. Change in light reflex
| 2. Decreased visual acuity
64
Procedure for a whisper test
1. Examiner occludes the patient's untested ear
2. Examiner stands 1-2 feet behind the patient and whispers
3. The patient should be able to repeat the words
65
What does a Weber exam test for?
Bone conduction and lateralization
66
After a Weber test, what is conductive loss?
It means they heard the tuning fork better in the affected ear
**this could indicate otosclerosis or otitis media
67
After a Weber test, what is sensorineural loss?
It means that the patient heard the tuning fork better in the unaffected ear
**This could indicated damage to the cochlear/vestibulocochlear nerve
68
What does a Rinne exam test for?
Bone vs. Air
| Conductive loss vs Sensorineural loss
69
What does conductive loss mean?
| Rinne exam
The bone sound is better than the air sound
| **This could indicate otitis media, wax buildup
70
What does sensorineural loss mean?
| Rinne exam
The air sound is better than the bone sound
| **This could indicate nerve damage
71
Tympanogram
Measure the middle ear muscle reflex to sound stimulation
72
Auditory brain stem response (ABR)
Measures electrical auditory potential from cranial nerve VIII to the brainstem
73
Middle Ear Endoscopy
Microscopic visualization of the middle ear
74
What is mixed loss?
| hearing loss
Dysfunction of air and bone conduction
75
What is functional loss?
| hearing loss
Usually related to emotional disturbance
76
What is presbycusis?
progressive hearing loss related to aging
77
Causes of cerumen impaction/foreign body
1. Excessive accumulation
| 2. Unintentional introduction of foreign body into the canal
78
S/Sx of cerumen impaction/foreign body
1. Otalgia (ear ache)
2. Decreased hearing
3. Aural fullness
79
Treatment for cerumen impaction/foreign body
1. Removal by irrigation
2. Suction
3. Do NOT use water to irrigate insect use mineral oil only
80
How long should a patient hold their position after instillation of ear drops?
5-10 minutes
81
What position should the patient be in after irrigation of the ear?
They should be lying on the side of the affected ear in order to promote drainage
82
Dizziness
Altered sensation of orientation in space
83
Vertigo
Misperception/illusion of motion
84
Ataxia
Failure of neuromuscular coordination related to vestibular disease
85
Nystagmus
Involuntary rhythmic movement of the eyes related to vestibular dysfunction
86
Causes of Motion sickness
1. Disturbance of equilibrium caused by constant motion (vestibular overstimulation)
87
S/Sx of motion sickness
1. Sweating
2. Pallor
3. N/V
88
Treatment for motion sickness
1. Antihistamines - dramamine
2. Anticholinergics - scopolamine patch
3. Instruct the patient about the side effects such as drowsiness
89
Causes of Meniere's disease
Unknown. Too much circulating fluid in the inner ear causing endolymphatic hydrops (edema) causing increased pressure and/or rupture of the inner ear membranes
90
S/Sx of Meniere's disease
1. Fluctuating sensorineural loss
2. Tinnitus
3. Incapacitating vertigo
4. Aural fullness
5. N/V
6. Weber to unaffected ear (sensorineural loss) and "Pike's Peak" on audio
91
Treatment for Meniere's disease
1. 2000 mg Na diet
2. Meclizine
3. Diazepam
4. Promethazine
5. Hydrochlorothiazide
6. Vasodilators
7. Surgery
92
Surgical treatments for Meniere's disease
1. Endolymphatic shunt
2. Ototoxic med perfusion into the middle ear and inner ear - gentamycin
3. Intraotologic catheter
4. Labyrinthectomy
