Eye & Ear Disorders Flashcards
Central loss of vision that affects the macula of the eye
Macular degeneration
T or F: macular degeneration has no cure
True
What is the most common cause of vision loss in older adults?
Age-related macular degeneration (AMD)
What are the two types of macular degeneration?
Dry and Wet
Most common type of macular degeneration caused by gradual blockage in retinal capillary arteries, resulting in ischemia and necrosis of the macula
Dry macular degeneration
Type of macular degeneration caused by new growth of blood vessels that have thin walls that leak blood and fluid
Wet macular degeneration
Risk factors for dry macular degeneration
Smoking, HTN, short body stature
Which sex is more at risk for dry macular degeneration?
Females
A diet lacking _____ and _____ may place an individual at higher risk for developing dry macular degeneration
Carotene and vitamin E
What type of macular degeneration can occur at any age?
Wet
Expected findings of macular degeneration
Lack of depth perception, objects appear distorted, blurred vision, loss of central vision, blindness
Dietary education for the client with macular degeneration
Encourage consumption of antioxidants, carotene, and vitamin E and B12
An opacity in the lens of an eye that impairs vision
Cataract
Common causes of cataracts
Age-related, trauma
Medications that can cause cataracts if used long-term
Corticosteroids, pheothiazine derivatives, beta blockers, miotic meds
Associated conditions that can cause cataracts
Diabetes, hypoparathyroidism, Down syndrome, chronic sunlight exposure
Intraocular diseases that can cause cataracts
Glaucoma, retinal detachment
Client education for prevention of cataracts
Sunglasses, protective eyewear (hazardous activities), annual eye exams (40+)
Cataracts expected findings
Decreased visual acuity, blurred vision, diplopia (double vision), visible opacity, absent red reflex
Tool used to measure visual acuity
Snellen chart
Tool used to examine internal and external eye structures
Opthalmoscope
MOA of atropine for cataracts
Prevents pupil constriction for prolonged periods of time (mydriasis) and relaxes muscles in the eye (cycloplegia)
Medication used to dilate the eye preoperatively and for visualization of the eye’s internal structures
Atropine
Client education for atropine
Effects can last 7-12 days; wear sunglasses (photosensitivity)
Client education following surgical removal of lens
Wear sunglasses, report signs of infection (yellow or green drainage), avoid activities that increase IOP
Activities that increase IOP
Bending over at waist, sneezing, blowing nose, coughing, straining, head hyperflexion, restrictive clothing, sexual intercourse
Indications of increased IOP or hemorrhage
Pain with N/V
Best vision is not expected until ___ to ___ weeks following lens surgery
4-6
Expected reference range for IOP
10-21 mmHg
What are the two primary types of glaucoma?
Primary open-angle and Primary angle-closure
Most common type of glaucoma by which aqueous humor outflow is decreased due to blockages in the eye’s drainage system, causing a gradual increase in IOP
Primary open-angle
Type of glaucoma in which the angle between the iris and sclera suddenly closes, causing a SUDDEN increase in IOP
Primary angle-closure
Glaucoma risk factors
Age, HTN, infection, trauma, diabetes, severe myopia, retinal detachment
Expected findings of primary open-angle glaucoma
headache, mild eye pain, loss of peripheral vision, decreased accommodation, halos seen around lights, elevated IOP (>21 mmHg; usually 22-32)
Expected findings of primary angle-closure glaucoma
Rapid onset of elevated IOP (>30 mmHg), decreased/blurred vision, colored halos seen around lights, pupils nonreactive to light, severe pain and nausea, photophobia
Diagnostic procedure that measures IOP
Tonometry
Client education for glaucoma medication administration
Instill one eye drop in each eye twice daily (q12h), wait 5-10 min between eye drops if more than one is prescribed, avoid touching applicator tip to eye, ALWAYS wash hands before and after use, apply pressure to inner corner of eye once eye drop is instilled (punctal occlusion technique)
Examples of miotic cholinergic agents
Carbachol, echothiophate, pilocarpine
MOA of miotic medications
Constrict pupil allowing for improved circulation and outflow of aqueous humor
Side effect of miotics
Blurred vision
Second line drug for POAG
Pilocarpine
Patient education for miotic cholinergic agents
Use good lighting to avoid falls
Examples of adrenergic agonists for glaucoma
Apraclonidine, brimonidine tartrate, dipivefrin hydrochloride
MOA of adrenergic agonists for glaucoma
Reduction of IOP by limiting production of aqueous humor and dilating pupils to improve fluid flow to site of absorption
Client education for adrenergic agonists for glaucoma
Wear sunglasses in bright light because of pupil dilation
First line drug therapy for glaucoma that decreases IOP by reducing aqueous humor production
Beta blockers (timolol)
Nursing considerations for timolol
Can be absorbed systemically causing bronchoconstriction and hypoglycemia — use cautiously in patients with asthma, COPD, and diabetes; can cause bradycardia and hypotension
Examples of carbonic inhibitors for glaucoma
Acetazolamide, dorzolamide, and brinzolamide
MOA of carbonic anhydrase inhibitors for glaucoma
Decreases IOP by reducing aqueous humor production
Nursing action for carbonic anhydrase inhibitors for glaucoma
Assess sulfa allergy
Examples of prostaglandin analogs for glaucoma
Bimatoprost and latanoprost
MOA of prostaglandin analogs for glaucoma
Increases outflow by dilating blood vessels draining aqueous humor at a more rapid rate
Client education for prostaglandin analogs for glaucoma
Can darken iris with long-term use
Osmotic diuretic used in the emergency treatment for primary angle-closure glaucoma to quickly decrease IOP
IV mannitol
Potential consequence of untreated glaucoma
Blindness
Regular glaucoma checks for individuals under 40
Every 2-4 years
Regular glaucoma checks for individuals ages 40-54
Every 1-3 years
Regular glaucoma checks for individuals ages 55-64
Every 1-2 years
Regular glaucoma checks for individuals 65+
Every 6-12 months
Function of the ears
Hearing and balance
Middle ear structures
Tympanic membrane (eardrum) and ossicles
Ossicles (smallest bones of body) of the middle ear
Malleus, incus, stapes
Structure that separates the middle ear from the inner ear
Oval window
Inner ear structures
Cochlea (hearing organ) and semicircular canals (balance)
Causes of conductive hearing loss
Otitis media, otosclerosis, foreign body (impacted cerumen)
Cause of sensorineural hearing loss
Damage to cranial nerve VIII (vestibulocochlear)
5 senses
Visual, auditory, olfactory, gustatory, tactile
Being aware of position and movement of body parts without seeing them
Kinesthetic
__________ allow a person to recognize the shape, size, and texture of an object
Stereognosis
3 components to any sensory experience
Reception, perception, reaction
Reaction stops after continuous reception of the same stimulus EXCEPT for _____
Pain
Deficit in the normal function of reception and perception
Sensory deficit
Most common sensory deficits
Visual and hearing
Reduced sensory input
Sensory deprivation
The inability to perceptually disregard or selectively ignore multiple sensory stimuli
Sensory overload
Colored portion of pupil
Iris
Inner most layer of eye that contains the rods and cones
Retina
Retinal structures responsible for peripheral vision and perception of low level light
Rods
Retinal structures responsible for central vision and perception of bright level lights
Cones
Eye structure located under the iris that bends light rays to focus properly on the retina
Lens
“Blind spot” of the eye that contains nerve fibers, but lacks photoreceptors
Optic disc
Eye structure that contains fovea where vision is most acute
Macula
Visual test that assesses color blindness through detection of red and green colors
Ishihara color plate
What vitamin deficiency can cause vision problems?
Vitamin A (found in fruit colors orange, red, and green)
PERRLA
Pupils equal, round, reactive to light and accommodation
Which sex is at higher risk for retinal detachment?
Men
Medical management of cataracts
Surgical removal of lens, replacement with artificial lens
Increased intraocular pressure (IOP) causing progressive damage to the optic nerve
Glaucoma
Production of aqueous humor
5 mL per day, but only about 1 mL preset at a time
Last resort medical management for glaucoma
Laser surgery
MOA of glaucoma medications
- Reduce production of aqueous humor
- Increase absorption of aqueous humor
T or F: glaucoma medications improve lost vision
False; vision loss is irreversible
The separation of the retina from the epithelium in the back of the eye
Retinal detachment
Behaviors of retinal detachment
Small flashes of light (“shooting stars” or “lightening streaks”), floaters
Most common cause of retinal detachment
Posterior vitreous detachment
The shrinking of fluid causing retina to become detached from back of eye
Posterior vitreous detachment
Example of surgical management for detached retina
Scleral buckling
Leading cause of blindness in individuals 65+
Macular degeneration
Adverse events of miotic
Drug-induced myopia (near-sightedness), accommodative spasms, vascular congestion, ocular inflammation
Anticholingeric medications that paralyze ciliary muscle resulting in pupil dilation
Cycloplegics
Adrenergic medications used in primary open-angle glaucoma that mimic norepinephrine and epinephrine
Mydriatics
Outer ear structures
Pinna, ear canal, tympanic membrane
Structure that touches the eardrum
Malleus
Assessment of tympanic membrane
Should be pearly-gray and clear
Hearing tests
Tuning fork (Weber and Rinne); audiometry
Abnormal growth of bone in middle ear, primarily affecting the stapes, causing hearing loss
Otosclerosis
Behaviors of otosclerosis
Hearing loss, dizziness, balance problems, tinnitus
Otosclerosis management
Surgery (stapedectomy, prosthetic replacement), hearing aids
Hearing loss than can be corrected
Conductive
Permanent hearing loss
Sensorineural
Eye disorder caused by excess endolymphatic fluid that distorts the inner ear system
Ménière’s disease
Ménière’s disease occurs in individuals between the ages ___ and ___ initially
20-50
Behaviors of Ménière’s disease
Tinnitus, one-sided sensorineural hearing loss, vertigo, headache, increasing tinnitus and fullness of ear can precede episodes
Ménière’s disease impacts vital signs increasing ___
BP
Ménière’s disease drug therapy
Antiemetics, pulse pressure treatment
Surgical management of Ménière’s disease
Labyrinthectomy (resection of vestibular nerve)
Effects of hearing impairment in the pediatric population
Speech and language developmental delays, learning problems
Effects of hearing impairment in the elderly population
Loss of independence, inability to live alone and perform ADLs, inability to communicate, social isolation
Assessment of sclera
White; no redness or yellowing
Assessment of conjunctiva
Pink; no drainage
Assessment of visual acuity using snellen chart
Patient should stand 20 ft from chart, cover one eye then other (assess both eyes), have patient read chart backwards when assessing second eye (prevents memorization), may assess with and without glasses
Behaviors indicative of vision loss
Inability to perform ADLs, falls/accidents, poor hand/eye coordination, head tilt, short attention span, inconsistent reading pace
Post operative teachings cataracts
Avoid aspirin, wear eyepatch at night, report significant swelling, bruising, or loss of vision
Instillation of eye drops
Put on gloves, tilt head back, pulls down lower lid, instill drops into inner canthus
Retinal detachment post-op patient education
Avoid close work such as reading, writing, sewing for first week
Body language cues when caring for a patient with hearing impairment
Directly face the patient
Otoscopic examination for adult
Pull pinna up and back
Otoscopic examination for children
Pull ear down and back
Behaviors indicative of hearing loss
Turning good ear toward speaker, failure to respond, answering questions incorrectly, asking people to repeat, shouting in conversation
nursing care for the client with hearing loss
Speak slowly and clearly with low voice, directly facing the patient. Provide alternate forms of communication
Hearing aids education
Keep hearing aids clean and dry, do not apply moisture, avoid cleansing with alcohol, turn them off if not in use, store them in same place at all times
Nursing care for Ménière’s disease
Teach pt. To move head from side to side slowly, institute fall precautions, smoking cessation (causes vasoconstriction)
Drug therapy for Ménière’s disease
Antiemetics, antihistamines, anti-vertigo
Patient education for labyrinthectomy
Will result in total hearing loss on that side
Nothing smaller than a __________ should be inserted into the ear canal
Fingertip
Condition of the inner ear that occurs when the client has the sensation that they or their surroundings are in motion
Vertigo
Type of vertigo that has a sudden onset and occurs in response to a change in position. May last for a few weeks or years
Benign paroxysmal positional vertigo
Treatment for benign paroxysmal positional vertigo
Bed rest and short course of meclizine
Inflammation of the labyrinth in the inner ear, often secondary to otitis media
Labyrinthitis
Manifestations of labyrinthitis
Sudden onset of severe vertigo, N/V, and possible hearing loss and tinnitus
Treatment for labyrinthitis
Bed rest in a darkened environment, meclizine and dimenhydrinate for nausea and vertigo, systemic antibiotic therapy
Viral or bacterial infection of the middle ear
Otitis media
manifestations of otitis media
Ear pain, pressure, fever, headache, conductive hearing loss, purulent/bloody drainage
Otoscopic exam findings related to otitis media
Redness, bulging of tympanic membrane, inability to visualize landmarks
Medical management of otitis media
Systemic antibiotic therapy, analgesics and heat for pain, decongestants
Surgical management of otitis media
Myringotomy (surgical opening of eardrum) and placement of grommet to equalize pressure
A non-invasive test of hearing ability, including frequency, pitch, and intensity, in which the client indicates when a tone is heard through earphones
Audiometry
Diagnostic tool that measures the mobility of the tympanic membrane and middle ear structures relative to sound
Tympanogram
Examples of ototoxic antibiotics
Gentamicin, erthyromycin
Examples of ototoxic diuretics
Furosemide, ethacrynic acid
Examples of ototoxic NSAIDs
Aspirin, ibuprofen
Example of ototoxic chemotherapeutic agent
Cisplatin
Medication that has antihistamine and anticholinergic effects used to treat the vertigo that accompanies inner ear problems
Meclizine
Patient education for meclizine
Sedative effects (avoid driving or operating heavy machinery)
Example of antiemetics used to treat N/V associated with vertigo
Ondansetron
Ondansetron contraindication
Clients with certain cardiac rhythm disorders
Ondansetron patient education
Report dizziness or rash
Examples of antihistamines for the treatment of vertigo and nausea that accompany inner ear problems
Diphenhydramine and dimenhydrinate
side effects of antihistamines
Urinary retention, dry mouth (anticholinergic effects), sedation
Example of anticholinergic medication for treatment of nausea related to inner ear problem
Scopolamine
Patient education on vertigo prevention
Restrict movement of head, change positions slowly, avoid caffeine and alcohol, decrease sodium intake, maintain safe environment free of clutter
Nursing actions following labyrinthectomy
Patient will have severe nausea and vertigo following procedure. Implement safety precautions and given antiemetics as needed
Client education following middle ear surgery
Avoid air travel for 2-3 weeks, avoid straining or coughing, blow nose gently with mouth open for 2-3 weeks, keep ear canal clean and dry (avoid showering for several days to one week), loosely place cotton ball with petroleum jelly in ear when able to shower to prevent water from entering, temporary hearing loss normal in affected ear, report drainage
