Eyes & Ears Flashcards
1
Q
Subjective Data for Eye Assessment
A
Health History Medications Surgery Other Treatments Allergies
2
Q
Objective Data Eye Assessment
A
Assessment of Drainage
Oculomotor Assessment
Vision Exam
3
Q
When assessing visual acuity, does it matter which eye the nurse assesses first?
A
Assess right eye first. Then left eye.
4
Q
Chart that assesses normal visual acuity.
A
Snellen Chart
5
Q
Normal Vision
A
20/20
6
Q
Legal blindness is defined as
A
20/200 or less in the better eye
7
Q
Chart to assess near vision
A
Rosenbaum Chart
8
Q
Normal vision using the Rosenbaum Chart
A
14/14
9
Q
How far away should a Rosenbaum chart be held from the patient?
A
12-14 inches
10
Q
What is a jaeger chart
A
Similar to rosenbaum chart
Assesses near vision in age 40 or older
No particular number recorded
11
Q
Ishihara color test
A
Distinguishes a pattern of color in series of color palates
12
Q
Ophthalmic tool to measure Intraocular Pressure
A
Tonometry
13
Q
What is tonometry used for
A
Measure intraocular pressure
Diagnose and treat glaucoma patients
14
Q
Age related changes in the eye
A
- Cornea is less transparent.. 2. Lens Hardens.. 3. Lens becomes yellow & cloudy b/c decreased amt of blue light entering the eye… 4. Pupil size = smaller… 5. Scattering of light w/in eye.. 6. Presbyopia
15
Q
Nearsightedness due to aging
A
Presbyopia
16
Q
Age related refractive errors
A
Presbyopia
17
Q
Not age-related refractive errors
A
Myopia
Hyperopia
18
Q
Myopia is
A
Nearsightedness - can see objects near clearly but objects in the distance are blurred
19
Q
Hyperopia is
A
Farsightedness - distant objects clearly seen but close objects appear blurry
20
Q
When light rays are unable to converge to single focus on the retina this is known as
A
Refractive error
21
Q
Irregular corneal curvature which causes a split focus; type of refractive error
A
Astigmatism
22
Q
Corrections for refractive errors
A
Eyeglasses
Contact lenses
Refractive surgery (LASIK and Lens Implantation)
23
Q
Types of conjunctivitis
A
Bacterial
Viral
STI
Allergic
24
Q
What is “pink-eye”?
A
Bacterial form of conjunctivitis caused by the bacteria S. Aureus
25
Assessment for Conjunctivitis
```
Health History (subjective and objective data)
Recent Travel
Physical Assessment (visual acuity; v/s; physical inspection; surroundings)
```
26
Examples of bacterial conjunctivitis:
“Pink-eye”
27
Manifestation of viral conjunctivitis
Tearing; Foreign Body sensation; redness; mild photophobia
28
STI conjunctivitis causes
Usually chronic
| Caused by chlamydia
29
Why is STI borne conjunctivitis so important to get treated right away
Major cause of blindness
30
How to avoid getting conjunctivitis
WASH YOUR HANDS!!!
AVOID Shared: towels, contacts, make-up
Avoid using old make-up
Avoid rubbing or scratching eye
31
Types of eye trauma
Penetrating
Burns
Blunt Force
32
Penetrating eye trauma causes
Foreign body - glass, knife, hook...
33
Penetrating eye trauma interventions
Irrigation and removal of LOOSE foreign body
| Stabilize NOT loose objects
34
Types of Burns (EYE TRAUMA)
Chemical - insecticide; nail polish remover
| Thermal
35
Blunt force (eye trauma cause)
Direct impact - fall, baseball bat, kicked
36
Chemical eye trauma interventions
Flush eye immediately for 15 minutes
37
Blunt force eye trauma interventions
Place the patient in semi-Fowler’s position (45 degree angle) and put eye shield over eye. Give meds and analgesia as ordered
38
Diagnostic Tests for Eye Trauma
X-ray (most common)
| MRI, CT, Ultrasound
39
Leading cause of blindness worldwide
Glaucoma
40
What is glaucoma?
Damage to the optic nerve caused by an increase in intraocular pressure.
Result = loss of peripheral vision
41
What is normal intraocular pressure?
10-21 mmHg
42
What is the goal of glaucoma treatment?
To decrease intraocular pressure
43
Modifiable risk factors for Glaucoma
Cardiovascular disease
High Blood pressure
Diabetes
44
Non-Modifiable Risk factors for Glaucoma
Older Age
Family History
African American
Migraines
45
Open-angle glaucoma
Angle between iris and cornea is wide open
Typically affects both eyes (may be asymptomatic)
Slow progression; Outflow is decreased and drainage channels become clogged which results in damage to the optic nerve
46
90% of all Glaucoma Cases
Open-angle glaucoma
47
Closed angle glaucoma
Narrow angle between iris and cornea; sudden blockage of drainage cannal which results in increased intraocular pressure
Requires immediate medical attention
48
Symptoms of Glaucoma
Severe eye pain (in or around eye)
Headache, N/V, Blurred vision
Tunnel vision
Ocular redness
49
Glaucoma assessment
Comprehensive eye exam - annually
Optic Disc pictures - at eye exam
Visual field testing
50
Type of glaucoma that developes slowly often w/o symptoms of pain/pressure
Open-angle glaucoma
51
Medications to control glaucoma
Cholinergics (Mitotics)
Alpha-adrenergic agonists
Beta-adrenergic blockers ; Hyperosmotic agents
Carbonic Anhydrase Inhibitors; Prostaglandin analogs
52
Mitotic used to control glaucoma. How does it function?
Increases outflow drainage to relieve IOP
| Example: pilocarpine (Carbachol)
53
How does alpha-adrenergic agonists control glaucoma symptoms? Give an Example.
Decreases production and increases outflow of drainage
| Example: brimonidine (Alphagen)
54
How do beta-adrenergic blockers control the effects of glaucoma? Give and example.
Decreases production of aqueous humor in the ciliary body
| Example: Timolol (timoptic istalol)
55
What is crucial in administering Timolol optically?
Close tear duct and hold to prevent systemic effects of beta blocker such as bronchospasm and decreased heart rate and blood pressure brought on by stimulation of the parasympathetic nervous system.
56
What is the function of carbonic anhydase inhibitors. Give an example.
Decreases the production of aqueous humor.
| Example: Acetazolamide (Diamox)
57
What is the function of prostaglandin analogs r/t glaucoma treatment. Give an example.
Increases drainage outflow
| Example: lantanoprost (Xalatan)
58
What is the major side effect of lantanoprost?
Permanently changes the color of the iris and can cause color changes to the eyebrow.
59
Effect of hyperosmolar agents on glaucoma treatment. Give an example.
Immediate decrease in intraocular pressure
| Examples: Glycerin (oral liquid); Isosorbide solution (Ismotic) - oral liquid; Mannitol (Osmitrol) - IV solution
60
Glaucoma Surgical Treatments:
Laser Trabeculoplasty
Trabeculectomy
Peripheral laser irodotomy
Surgical irodotomy
61
Goal of surgical interventions for glaucoma treatment:
Allow aqueous humor to flow through newly created opening in the iris and into normal outflow channels
62
Nursing care: Glaucoma
Teach Signs and symptoms
Medication therapy
Health promotion: Risk factors and Annual Eye exams
63
Opacity w/in the eye lens that may be in one or both eyes.
Cataracts
64
Risk factors for Cataracts
```
Congenital - (maternal rubella)
Aging
Toxicity (systemic or topical)
Accidents/Trauma
Radiation/Sunlight
Altered metabolism (diabetes)
Cigarette Smoking
```
65
Symptoms of cataracts
Blurred vision
Inability to see in dim light
Seeing halos around lights
Vision loss
66
Diagnosis of cataracts
```
Visual acuity exam
Complaints of visual dysfunction
Opacity visible
Tonometry to measure IOP
Dilated eye exam
```
67
Pre-/Postoperative Nursing Care (cataracts)
Monitor V/S
Assess Surgical Site
Avoid laying on stomach and surgical eye side
Protective eyewear
Avoid rubbing eyes
Contact provider if: pain increases; swelling; discharge; floaters; flash of light
68
Nursing diagnoses (cataracts)
Self care deficits r/t visual deficit
| Anxiety r/t lack of knowledge about the surgical & PostOp experience
69
Irreversible central vision loss caused by deterioration of macula
Age-Related Macular Degeneration
70
Types of Age-related macular degeneration
Non-exudative (Dry)
| Exudative (Wet)
71
Most common form of macular degeneration
Non-exudative (dry) AMD
72
Dry AMD Symptoms
Gradual
Close vision tasks = more difficult
Macular cells atrophy
Virtually painless b/c slow onset
73
More severe form and faster progression of macular degeneration
Exudative (Wet) AMD
74
Wet AMD Etiology
Weak blood vessels in retina contribute to hemorrhage
Big cause of the majority of AMD-related blindness
Rapid onset
Had dry first
75
Risk factors for Macular Degeneration
Aging; Smoking
Race (Whites)
Hypertension; Hyperopia
Chronic Inflammatory conditions
76
What is macular degeneration like?
Blurred/Darkened vision
Blind spots in the visual field
Visual distortion
77
How is AMD detected?
Visual acuity exam
Pupil dilation
Amsler grid
78
Collaborative care - AMD
Improve modifiable risk factors
Health promotion; Protect eyes from UV light
Vitamin combinations (later forms)
Injections and Laser surgery
79
What is retinal detachment?
Retina peels away from the inner wall of the eye
80
Risk factors for retinal detachment
Aging
Myopia
Hx of cataract surgery; Eye trauma; Family/personal history
81
Retinal Detachment Symptoms
“Cobwebs” in vision (“hairnet” or ring)
Flashes of light
Curtain coming into visual field
floaters
82
Is retinal detachment a medical emergency? Why or why not.
Yes; requires prompt ophthalmologist referral
| As retina detaches it becomes ischemic. This prompts us to worry about permanent and complete vision loss
83
Treatment for retinal detachment
Laser photo coagulation
Scleral buckling
Pneumatic retinopexy
84
Treatment in which an intense light beam triggers and inflammatory response to seal holes in the retina
Laser photocoagulation
85
Treatment where the eye ball is intended and the sclera is folded to seal the tear in the detached retina
Scleral buckling
86
Intravitreal injection of gas to form a temporary bubble in the vitreous that closes retinal breaks
Pneumatic retinopexy
87
Nursing Care for Retinal Detatchment
Recognize manifestations
Early interventions (contact provider)
Educate patient:
Assist w/ grieving process if vision is lost
Assess eye patch and provide infor
Activity restrictions (no bending/straining)
88
Ear physical assessment
Physical inspection
Otoscopy (look inside); Hearing acuity
Weber and Rinne Tests (Tuning Fork tests)
89
Types of hearing loss
Conductive
Sensorineural
Presbycusis
Tinnitus
90
Hearing loss caused by obstruction of the ear canal
Conductive
91
Hearing loss caused by inner ear/auditory nerve damage; loud impulse noise or ototoxic drugs
Sensorineural
92
Hearing loss associated with aging
Presbycusis
93
Hearing loss caused by toxicity, obstruction of the auditory meats or infection
Tinnitus
94
Hearing loss presented by an equal loss of hearing at all frequencies. Speech discrimination is generally good.
Conductive
95
Hearing loss presented with an initial loss of high pitch tones and conversational speech.
Presbycusis
96
Hearing loss that impairs one’s ability to hear high frequency tones and speech discrimination is difficult
Sensorineural
97
Hearing loss characterized by a buzzing, roaring, or ringing sensation.
Tinnitus
98
Examples of ototoxic drugs
Furosomide (Lasix)
| Aspirin
99
Management of hearing loss
Prevention
Hearing Aids
Telecommunications device for the deaf (TDD)
Assistive devices
100
Nursing care for Hearing Loss
Identification of type through assessment
Provide health promotion: ear cleaning, treatment of infection, avoid exposure to loud noise
Assessment: occupation, meds, unsteady gait/vertigo; health history
101
Possible nursing diagnosis for hearing loss
Impaired verbal communication
102
Conditions of the middle ear
Otitis media (chronic and acute)
103
Otoscope showed red/inflamed or dull and bulging eardrum
Acute Otitis Media
104
Bulging or retraction of the tympanic membrane
Chronic Otitis Media
105
Complication of Otitis Media
Tympanic membrane perforation - whistling sound heard
106
Conditions of the inner ear
Ménière’s disease
Labyrinthitis
Benign Paroxysmal Positional Vertigo
107
Caused by increased pressure/rupture of the inner ear membranes
Meniere’s Disease
108
Manifestations of Meniere’s disease
Gradual or sudden hearing loss
Vertigo, hearing loss, tinnitus
May be preceded by fullness in ears or ringing sensation
109
Goals of Meniere’s disease
Prevention of exacerbation: teach low sodium diet, lower stress, monitor allergies
110
Inflammation of the inner ear
Labyrinthitis
111
Manifestation of Labyrinthitis
Vertigo
| Hearing loss
112
Disorder characterized by the sensation of movement when there is none
Benign Paroxysmal Positional Vertigo
113
Vertigo =
Dizziness
114
Health Promotion for vertigo
Early diagnosis may lower risk for injury
115
When assessing patient for vertigo, the nurse should look for
Tinnitus, hearing loss, balance, nystagmus, and medications patient may be on.
116
Priority for patients with vertigo
Sit patient down
| Maintain safe environment
117
Medications for patient with vertigo
Diazepam
Promethazine
Dexamethasone
Meclizine (Antivert)
118
Vestibular rehabilitation excercises for vertigo
The Epley and Semont
The Brandt-Daroff
Log roll exercises
119
Precautions for patient with vertigo
Driving a car/operating machinery
Working
(May not be able to drive or operate machinery and may also not be able to perform the duties of their jobs)
