Final Flashcards
What is emmetropia? Myopia? Hyperopia? Astigamatism?
Normal vision
Nearsighted and have blurred distance vision
Farsighted, have excellent distance vision but blurry near vision
Distortion due to curvature of the cornea
What is glaucoma? Cause? What is normal IOP? How often are the eye screenings?
damage to the optic nerve is related to increased intraocular pressure (IOP) caused by excessive aqueous humor/production and drainage are not in balance
Increased IOP causes irreversible mechanical and/or ischemic damage
Normal IOP is 10 to 21 mm Hg
Before age 40: every 2 to 4 years
40 to 54: every 1 to 3 years
55 to 64: every 1 to 2 years
65 and older: every 6 to 12 months
What does the angle refer to when distinguishing glaucoma? What is open-angle glaucoma/primary open angle? How does the IOP increase? Is it acute or gradual? S/S? Treatment?
angle between iris and cornea
Most common form
The aqueous humor outflow is decreased due to blockage in the drainage system
IOP increases due to reduced outflow of fluid
Gradual rise in IOP (22-32 mm Hg)
“Silent thief” of vision
Gradual loss of peripheral vision
Often initially asymptomatic, mild eye pain, blurry vision, halos around lights, and HA can occur
Requires chronic lifelong treatment
What is narrow-angle/primary-angle closure? Does IOP increase acutely or slowly? S/S? Treatment?
The angle suddenly closes, usually due to dilation of pupil
IOP increases suddenly (30 mm Hg or higher)
Severe eye pain, NV, photophobia, HA, decreased or blurry vision, colored halos around lights, red eyes, hazy cornea, pupils nonreactive to light
Requires immediate treatment to reduce IOP
What are nursing actions when administering eye drops? Why use punctal occlusion?
one drop in each eye twice daily
Wait 5 to 10 minutes between eye drops if more than one is prescribed
Avoid touching the tip of the applicator to the eye
Always wash hands before and after use
to insure the med does not go into the system.
What is first-line pharm therapy for both chronic and acute glaucoma? What is used for closed-angle specifically? MOA? SE? What are 3 other common meds?
Timolol (beta blocker)- first-line therapy, reduces fluid production
Drops can cause reduced BP, bradycardia, hypoglycemia, and bronchospasm
Pilocarpine (cholinergic)
Drops cause miosis of the pupil, used in closed-angle glaucoma
Can cause bradycardia and dizziness (low BP)
Apraclonidine (alpha-adrenergic agonist)
Acetazolamide (carbonic anhydrase inhibitor)
Iatanoprost (prostaglandin analogue)
What is the client teaching for glaucoma surgery?
Wear sunglasses
Report manifestations of infection
Avoid activities that increase IOP
Bending at the waist, sneezing, coughing, straining, head hyperflexion, restrictive clothing, sexual intercourse
Use stool softener daily (docusate)
Do not lift anything > 15 lbs.
Limit activities such as tilting the head back to wash hair, cooking, housekeeping, rapid/jerky movements (vacuuming), driving and operating heavy machinery, playing sports
Do not lie on operative side
Report severe pain or nausea as this can indicate possible hemorrhage
Final best vision occurs 4 to 6 weeks after surgery
What is cataracts? Common causes?
An opacity or cloudiness of the lens that impairs vision
Common causes: age-related, traumatic, toxic (meds such as corticosteroids), associated (DM, hypoparathyroid, chronic sun exposure), complicated (intraocular disease such as glaucoma or retinal detachment)
What are clinical manifestations of cateracts?
Painless and progressive, blurry vision
Reduced night vision
Sensitivity to glare of light
Reduced visual acuity
Prescription changes, reduced night vision, decreased color perception
Myopic shift (return of ability to do close work)
Diplopia in a single eye
Color shifts as lens becomes more brown
Opacity of the lens
What is client teaching for cataracts surgery?
Final best vision occurs 4 to 6 weeks after surgery
Protective eye patch for 24 hours
Eyeglasses during the day
Eye shield at night
Washing of hands
Cleaning of eye
Shampoo hair cautiously
Decrease intraocular pressure
Avoid lying on side of affected eye the night of surgery
Health promotion teaching:
Protective eyewear while playing sports, hazardous activities (yard work)
Encourage annual eye exams
What is retinal detachment? S/S?
Separation of the sensory retina and the retinal pigment epithelium (RPE)
Hole or tear develops in the retina
Liquid vitreous seeps through and causes the retina to detach
S/S
Sensation of a shade or curtain coming across the vision of one eye
Bright flashing lights
Sudden onset of floaters
This is a true ocular emergency!
What is macular degeneration? What accumulates in the retina? S/S? What is dry macular degeneration? Wet?
Central loss of vision that affects the macula of the eye
drusen: Clusters of debris or waste material
Tiny, yellowish spots beneath the retina
Lack of depth perception
Objects appear distorted
Blurred vision
Loss of central vision
Blindness
The most common type
Caused by gradual blockage in retinal capillary arteries ischemia and necrosis
Caused by new growth of blood vessels of thin walls causing the vessels to leak blood and fluid
What is the treatment for macular degeneration? Client education on vitamins?
Laser therapy to seal leaking vessels
Ocular injections
Consume foods high in antioxidants, carotene, vitamin E, and B12
May be prescribed a supplement high in carotene and vitamin E
What is diabetic retinopathy? Early symptoms? Treatment?
damage to the blood vessels in the tissue at the back of the eye (retina) resulting in microaneurysms,ischemic retina, and hemorrhages
Floaters, blurriness, dark areas of vision, difficulty perceiving colors
Mild cases may be treated with careful diabetes management
Advanced cases may require laser treatment or surgery
What is enucleation? What two ways is it done?
Removal of the eyeball (globe) from the orbit
Evisceration-removal of contents through an incision
Exenteration-removal of entire contents
What is the purpose of the Weber test? How are ear conditions categorized? How is sound heard with each category?
Weber Test:used to establish a diagnosis in clients with unilateral hearing loss
Is it from the outer ear, eardrum, ossicles (conductive)or the nerves? (sensorineural)
Sensorineural hearing loss: sound is heard louder on the side of the intact ear
Conductive hearing loss: sound is heard louder on the side of the affected ear
What is Rinne test? What do the findings indicate?
Useful for distinguishing between conductive and sensorineural hearing loss- assesses both air and bone conduction of sound of affected ear
If no conductive problem like earwax, eardrum,ossicles, then sounds will be heard longer through air
If there is a conductive problem, then the bone vibration will last longer than through air
How is vertigo tested? How is it detected? How is it conducted? Nursing actions? Contraindication? What other test can be done concurrently and test for nystagmus?
Electronystagmography (ENG):used in vertigo testing
Detects involuntary eye movements (nystagmus)
Assess for disease of the vestibular system
Electrodes are taped near the eyes and recorded when the ear canal is stimulated with cold water instillation or injection of air
Keep the client alert during the procedures
Client should maintain bedrest and NPO until vertigo subsides
Fast before the procedure
Restrict caffeine, alcohol, sedatives, and antihistamines several days before the test
Contraindicated in clients with pacemakers (pacemaker signals inhibit sensitivity of ENG)
caloric test
What causes a conductive hearing issue? Sensorineural? Can you have both at the same time?
Due to external canal or middle ear problem
Often caused by otitis media, otosclerosis, and foreign bodies, ear wax
Sensorineural
Due to damage to the cochlea or vestibulocochlear nerve (CN VIII)
yes
What is otitis externa? Common causes? Manifestations?
Inflammation/infection (most commonly from bacteria or fungus) of the external auditory canal
Swimmer’s ear or trauma
Pain and tenderness
Pain with pulling on pinna of ear or pressing the tragus
Discharge- yellow/green/foul-smelling; fungal infections contain hairlike black spores
Edema of canal
Erythema of canal
Pruritus
Hearing loss
Feelings of fullness in the ear
What are causes of a tympanic membrane perforation? Is it self-limiting? What is the surgical intervention if needed?
Otitis media, nearby explosion, severe blow to ear, deep diving
Heal spontaneously in weeks to several months
Tympanoplasty
Tissue is placed across the perforation to allow healing and improves hearing
What is otorrhea? Rhinorrhea? Hemotympanum?
leakage of fluid from ear
CSF from the ear in a basal skull fracture, a clear, watery drainage
nasal fluid discharge
CSF from the nose, also in basal skull fracture
Blood behind the ear drum from trauma and basal skull fracture
What is acute otitis media? S/S?
Acute viral or bacterial infection of the middle ear
Otalgia (sensation of fullness or pain in ear)
Drainage from the ear (purulent or blood drainage)….only if TM perforation
Fever
Headache
Conductive hearing loss
What is serous otitis media? S/S? Treatment?
Middle ear effusion
Can occur following an acute otitis media
Fluid without infection
Hearing loss
Fullness or congestion
Popping or crackling noises as the eustachian tube attempts to open
May need a tympanostomy tube to drain
What is a tympanoplasty? Ossiculoplasty?
reconstruction of tympani membrane
reconstruction of middle ear bones with prostheses
What is a mastoidectomy? What is a cholesteatoma?
Removal of diseased bone, mastoid air cells, and cholesteatoma to create a non-infected, healthy ear
Cholesteatoma:
A benign tumor that is an ingrowth of skin that causes persistently high pressure in the middle ear
Causes hearing loss, facial pain and paralysis, tinnitus, vertigo, and destroys ear structures
What is Meniere disease? S/S? Treatment? Why is a low sodium diet effective?
Abnormal inner ear fluid balance in vestibular system
S/S
Fluctuating, progressive hearing loss
A long-term chronic condition
Tinnitus
Feeling of pressure or fullness
Episodic, incapacitating vertigo that may be accompanied by N/V
Low-sodium diet, 1000-1500 mg a day
Meclizine, tranquilizers, antiemetics, and diuretics can be used
Surgical management
Pressure point treatment
Inserting a tympanostomy tube, which applies micropulses at intervals to relieve vertigo by displacing fluid of the inner ear
Sodium and fluid retention disrupts the balance of fluid in the inner ear
What is tinnitis? Vertigo? Ototoxicity? Meds that can cause it?
Ringing in the ear
Roaring, buzzing, hissing sound in one or both ears
The illusion of motion or a spinning sensation when not occurring
Usually occurs from disease in the vestibular ear system
r/t medications:
gentamycin, erythromycin, furosemide, ethacrynic acid, NSAIDs, chemotherapy agents (cisplatin)
What is benign paroxysmal positional vertigo? Treatment?
Caused by debris (small crystals of calcium carbonate) located within the semicircular canal
Sudden onset, can last a few weeks or years
Aggravated by any head movements until crystal is out of semicircular canal
Treatment: bedrest, meclizine, Epley maneuver to move crystal
What is labyrinthitis? Treatment?
Labyrinthitis
Often secondary to a viral infection in vestibular system
Sudden onset of severe vertigo, NV, hearing loss, and tinnitus
Treatment: bedrest, darkened room, meclizine or dimenhydrinate, antibiotics if bacterial
