Final Review- Eye/Ear Flashcards
A patient diagnosed with exudative macular degeneration reads as primary recreation. What should the nurse suggest to this patient?
- Obtain books on tape or CD.
- Find another activity that does not require reading.
- Spend more time with friends and family.
- Listen to music instead of watching so much television.
- Obtain books on tape or CD.
Global Rationale: Activities that require close central vision, such as reading and sewing, are particularly affected by exudative macular degeneration. The nurse should provide other tools or items that can help compensate for diminished vision, such as books on tape. Suggesting that the patient find another activity, spend time with family and friends, or listen to music instead of watching television does not support the patient’s primary recreation of reading.
A patient with an ectropion continues to experience eye dryness and corneal abrasions. This patient might benefit from what intervention?
- corrective surgery
- corrective lenses
- UV protective sunglasses
- contact lenses
- corrective surgery
Global Rationale: In ectropion, surgery may be performed to correct the defect, reduce the risk of damage to the eye, and improve cosmetic appearance. Corrective lenses, UV protective sunglasses, and contact lenses would not be beneficial in correcting the eversion of the lid margin.
The nurse working in the ophthalmology clinic sees clients with eyelid and eye problems. What information should the nurse understand about these disorders? (Select all that apply.)
a. A chalazion is an inflammation of an eyelid sebaceous gland.
b. An ectropion is the eyelid turning inward.
c. An entropion is the eyelid turning outward.
d. A hordeolum is an infection of the eyelid sweat gland.
e. Keratoconjunctivitis sicca is caused by drugs or diseases.
. A chalazion is an inflammation of an eyelid sebaceous gland.
d. A hordeolum is an infection of the eyelid sweat gland.
- A chalazion is an inflammation of one of the sebaceous glands in the eyelid. A hordeolum is an infection of a sweat gland in the eyelid. Keratoconjunctivitis sicca can be caused by drugs or diseases. An ectropion is an outward turning and sagging eyelid, while an entropion is an inward turning of the eyelid.
(6) What kind of eye drops are used for dry eye, when tear production is reduced WHAT KIND OF EYE DROPS
Cyclosporine (Restasis)
Artificial tears
How is conjunctivitis caused
S. aureus
how to prevent the spread of bacterial conjunctivitis
- hand washing
- discard makeup
he nurse is instructing a patient on the self-instillation of eye drops for acute conjunctivitis. What is the most important step for the nurse to teach this patient?
- proper hand hygiene before instilling the drops
- rub the eyes only when necessary
- reuse cotton swabs as needed
- insert contact lenses after the eye drops have been instilled
. proper hand hygiene before instilling the drops
Global Rationale: Hand hygiene is the single most important measure to prevent transmission of infection to the eye. Rubbing the eyes and reuse of cotton swabs should be avoided as they can contribute to infection. Contact lenses should be avoided until the infection has resolved.
A client is seen in the ophthalmology clinic with bacterial conjunctivitis. Which statements by the client indicate a good understanding of home management of this condition? (Select all that apply.)
a. “As long as I don’t wipe my eyes, I can share my towel.”
b. “Eye irrigations should be done with warm saline or water.”
c. “I will throw away all my eye makeup when I get home.”
d. “I won’t touch the tip of the eyedrop bottle to my eye.”
e. “When the infection is gone, I can use my contacts again.”
CD
Bacterial conjunctivitis is very contagious, and re-infection or cross-contamination between the client’s eyes is possible. The client should discard all eye makeup being used at the time the infection started. When instilling eyedrops, the client must be careful not to contaminate the bottle by touching the tip to the eye or face. The client should be instructed not to share towels. Eye irrigations are not needed. Contacts being used when the infection first manifests also need to be discarded.
Q: A 6-year-old child is brought to the pediatric clinic with an eye problem. The child is diagnosed with viral conjunctivitis. What is important information to discuss with the parents and child?
A) The condition is highly contagious and handwashing is extremely important
B) The importance of compliance with antibiotic therapy
C) The signs and symptoms of complications such as meningitis and septicemia
D) The importance of surgery to prevent scarring of the conjunctiva
Feedback: The nurse must inform the parents and child that viral conjunctivitis is highly contagious and instructions should emphasize the importance of handwashing and avoiding sharing towels, face cloths, and eye drops. Viral conjunctivitis is not responsive to any treatment, including antibiotic therapy. Patients with gonococcal conjunctivitis are at risk for meningitis and generalized septicemia; these conditions do not apply to viral conjunctivitis. Surgery to prevent scarring of the conjunctiva is associated with trichiasis and is not associated with viral conjunctivitis.
A
patient is diagnosed with a corneal abrasion. What should the nurse instruct this patient?
- Do not share or use another person’s eye makeup.
- Only share a towel with family members.
- Gently rub the eyes when itchy.
- Use the prescribed eye drops until the symptoms disappear.
1
Teach all patients about proper eye care, including the importance of not sharing makeup and towels, avoiding rubbing or scratching the eyes, and preventing trauma and infection. Rubbing the eyes may further cause trauma or injury. Prescribed medications must be taken as long as ordered.
Q: A patient with an ectropion continues to experience eye dryness and corneal abrasions. This patient might benefit from what intervention?
- corrective surgery
- corrective lenses
- UV protective sunglasses
- contact lenses
- corrective surgery
- Global Rationale: In ectropion, surgery may be performed to correct the defect, reduce the risk of damage to the eye, and improve cosmetic appearance. Corrective lenses, UV protective sunglasses, and contact lenses would not be beneficial in correcting the eversion of the lid margin.
An older patient with a mobility disorder is being discharged after having a cataract removed as an outpatient. For what should the nurse assess this patient?
- the ability to administer eye drops postprocedure
- the ability to read discharge instructions
- the ability to drive
- the ability to ambulate
1
Global Rationale: Assess for factors that may interfere with the patient’s ability to provide self-care postoperatively. A chronic condition such as arthritis that may affect the ability to administer eye drops may indicate the need to include a family member in teaching. A mobility disorder would not affect the patient’s ability to read discharge instructions. Driving and ambulation are not related to the postoperative care required for this patient.
A client is in the preoperative holding area waiting for cataract surgery. The client says “Oh, yeah, I forgot to tell you that I take clopidogrel, or Plavix.” What action by the nurse is most important?
a. Ask the client when the last dose was.
b. Check results of the prothrombin time (PT) and international normalized ratio (INR).
c. Document the information in the chart.
d. Notify the surgeon immediately.
d
Clopidogrel is an antiplatelet aggregate and could increase bleeding. The surgeon should be notified immediately. The nurse should find out when the last dose of the drug was, but the priority is to notify the provider. This drug is not monitored with PT and INR. Documentation should occur but is not the priority.
Cataract is extracted by:
Phaco- Emulsification- watch for pain, hemorrhage, IOP, call surgeon if nausea and vomiting and teach them how to do activates, safety
Phaco- Emulsification- watch for pain, hemorrhage, IOP, call surgeon if nausea and vomiting and teach them how to do activates, safety
Creamy, white crusty drainage is NORMAL for
post op cataract
Glaucoma causes a decrease
drainage of aqueous humor and - increase of IOP
The nurse assesses a reduction in a patient’s peripheral vision. Which additional measure would be a priority during the assessment of this patient?
- intraocular pressure assessment
- cranial nerve assessment
- neck range of motion assessment
- retinal assessment
- intraocular pressure assessment
- Global Rationale: Glaucoma is a condition characterized by optic neuropathy with gradual loss of peripheral vision and, usually, increased intraocular pressure of the eye. Measuring intraocular pressure is the priority, so that glaucoma can be diagnosed and appropriately treated. Cranial nerve assessment, retinal assessment, and neck range of motion may all be performed as part of patient assessment; however, measuring intraocular pressure is the priority so that glaucoma can be diagnosed and appropriately treated.
In reviewing a 55-year-old patient’s medical record, the nurse notes that the last eye examination revealed an intraocular pressure of 28 mm Hg. The nurse will plan to assess a. visual acuity. b. pupil reaction. c. color perception. d. peripheral vision.
D
The patient’s increased intraocular pressure indicates glaucoma, which decreases peripheral vision. Because central visual acuity is unchanged by glaucoma, assessment of visual acuity could be normal even if the patient has worsening glaucoma. Color perception and pupil reaction to light are not affected by glaucoma.
Q: To determine whether treatment is effective for a patient with primary open-angle glaucoma (POAG), the nurse can evaluate the patient for improvement by
a.
questioning the patient about blurred vision.
b.
noting any changes in the patient’s visual field.
c.
asking the patient to rate the pain using a 0 to 10 scale.
d.
assessing the patient’s depth perception when climbing stairs.
B
POAG develops slowly and without symptoms except for a gradual loss of visual fields. Acute closed-angle glaucoma may present with excruciating pain, colored halos, and blurred vision. Problems with depth perception are not associated with POAG.
Eye drop: Travatan - why are we using it? What is the main goal? What is it used for?
to lower IOP
Teaching for macular degeneration,
recognize this patient may have safety hazard issue
Retinitis pigmentosa : etiology, s/s, maifestations, how exam is done
earliest manifestation= night blindness (1childhood)
The nurse is assessing a patient with retinitis pigmentosa. Which findings should the nurse identify as consistent with this health problem? Select all that apply.
- loss of visual acuity
- loss of peripheral vision
- progressive night blindness
- one dilated, unresponsive pupil
- reduced perception of blue-green tones
1,2,3,4
Retinitis pigmentosa results in progressive night blindness, with loss of visual acuity and peripheral vision. A patient who has one dilated and unresponsive pupil may have paralysis of the oculomotor nerve. A change in blue-green perception is an age-related change caused by the atrophy of photoreceptor cells in the eyes.
A mother is concerned that her school-age child is having difficulty walking and seeing during the night. The nurse realizes that this patient might be demonstrating signs of what health problem?
- retinitis pigmentosa
- early macular degeneration
- detached retina
- glaucoma
1
- Global Rationale: The initial manifestation of retinitis pigmentosa, which is difficulty with night vision, is often noted during childhood. The clinical manifestations that are described do not indicate early macular degeneration, detached retina, or glaucoma
A nurse is completing a health history interview of a patient with a suspected diagnosis of retinitis pigmentosa. What questions should the nurse ask this patient during the interview? Select all that apply.
- Do you have any health problems that have a genetic basis?
- Do you know if your parents have had or your children are experiencing any symptoms similar to what you are experiencing?
- What is your current occupation?
- Have you ever suffered blunt trauma to the head?
- Have you ever been told you were HIV positive?
1,2,3
Global Rationale: Retinitis pigmentosa is a hereditary degenerative disease characterized by progressive loss of retinal function from the periphery to the central region of the retina. It is an autosomal dominant, autosomal recessive, or X-linked trait and may be associated with other genetic defects. Initial manifestations are noted in childhood, and the patient may be totally blind by age 40. Therefore, consideration of occupation is important, as the patient may be referred to vocational rehabilitation services. This disease is not associated with blunt trauma to the head or HIV infection, although these questions would be relevant to any patient with a suspected eye disorder.
Q: A 20-year-old patient is experiencing difficulty with near vision. The nurse realizes that this finding is:
- consistent with the aging process.
- normal in a 20-year-old patient.
- evidence of presbyopia.
- evidence of hyperopia.
- evidence of hyperopia.
Global Rationale: Changes in near vision, especially in patients over 45, can indicate presbyopia, which is impaired near vision that results from a loss of elasticity of the lens related to aging. In younger patients, this condition is referred to as hyperopia or farsightedness. This is not a normal finding in a 20-year-old.
The nurse is assessing a 65-year-old patient for presbyopia. Which instruction will the nurse give the patient before the test?
a.
“Hold this card and read the print out loud.”
b.
“Cover one eye at a time while reading the wall chart.”
c.
“You’ll feel a short burst of air directed at your eyeball.”
d.
“A light will be used to look for a change in your pupils.”
A
The Jaeger card is used to assess near vision problems and presbyopia in persons over 40 years of age. The card should be held 14 inches away from eyes while the patient reads words in various print sizes. Using a penlight to determine pupil change is testing pupil response. A short burst of air may be used to test intraocular pressure but is not used for testing presbyopia. Covering one eye at a time while reading a wall chart at 20 feet describes the Snellen test.
External ottis manifestations
red, swollen, tender to touch and movement treated with antibiotics and steroid therapies
A patient experiences an increase in ear pain when the auricle is pulled up and back. The nurse realizes that this patient might be experiencing what health problem?
- otitis externa
- otitis media
- otitis interna
- mastoiditis
1
Global Rationale: The pain of otitis externa can be differentiated from that associated with otitis media by manipulating the auricle. In external otitis, this maneuver increases the pain, whereas the patient with otitis media experiences no change in pain perception. Otitis interna would not be manifested by pain on external manipulation. Mastoiditis is a complication of otitis media and is manifested by recurrent earache and hearing loss
A client has external otitis. On what comfort measure does the nurse instruct the client?
a. Applying ice four times a day
b. Instilling vinegar-and-water drops
c. Use of a heating pad to the ear
d. Using a home humidifier
C
- A heating pad on low or a warm moist pack can provide comfort to the client with otitis externa. The other options are not warranted.
A patient diagnosed with external otitis is being discharged from the emergency department with an ear wick in place. Which statement by the patient indicates a need for further teaching?
a.
“I will apply the eardrops to the cotton wick in the ear canal.”
b.
“I can use aspirin or acetaminophen (Tylenol) for pain relief.”
c.
“I will clean the ear canal daily with a cotton-tipped applicator.”
d.
“I can use warm compresses to the outside of the ear for comfort.”
c
Insertion of instruments such as cotton-tipped applicators into the ear should be avoided. The other patient statements indicate that the teaching has been successful.
Perichondritis is formed by
opening an area of pus or localized infection, insect bites, trauma, and cartilage piercing
Which action will the nurse take when performing ear irrigation for a patient with cerumen impaction?
a.
Assist the patient to a supine position for the irrigation.
b.
Fill the irrigation syringe with body-temperature solution.
c.
Use a sterile applicator to clean the ear canal before irrigating.
d.
Occlude the ear canal completely with the syringe while irrigating.
B
- Solution at body temperature is used for ear irrigation. The patient should be sitting for the procedure. Use of cotton-tipped applicators to clear the ear may result in forcing the cerumen deeper into the ear canal. The ear should not be completely occluded with the syringe.
what happens to the eardrum in acute and chronic ottis media?
the presence of biofilm bacteria effect cells of the ear which can scar the eardrum and middle ear if untreated. Necrosis of ossicles destroys middle ear structures and causes hearing loss
he nurse is assessing a patient who has recently been treated with amoxicillin for acute otitis media of the right ear. Which finding is a priority to report to the health care provider?
a.
The patient has a temperature of 100.6° F.
b.
The patient complains of “popping” in the ear.
c.
The patient frequently asks the nurse to repeat information.
d.
The patient states that the right ear has a feeling of fullness.
A
- The fever indicates that the infection may not be resolved and the patient might need further antibiotic therapy. A feeling of fullness, “popping” of the ear, and decreased hearing are symptoms of otitis media with effusion. These symptoms are normal for weeks to months after an episode of acute otitis media and usually resolve without treatment.
Post of teaching for myringotomy
- keep external ear dry
- no shower no bath
- avoid air travel
- when blowing nose , blow gently
- avoid rapidly moving head
- report excessive drainage
Following myringotomy for acute otitis media, the patient should be instructed by the nurse on what aspect of home management?
- Avoid sudden changes in barometric pressure.
- Ear irrigations should be placed on the wall of the external canal.
- Sterile, cotton-tipped swabs can be used to clean the ear drainage.
- Swimming is restricted for approximately two weeks.
1
. - Global Rationale: The patient should be instructed to avoid sudden changes in air pressure. No ear irrigations should be done during the postoperative as solution could enter through the tubes and contaminate the middle ear. Sterile swabs are not to be placed in the external canal because of the potential of dislodging the tubes, as well as the potential for middle ear contamination. Therefore, nothing should be inserted into the ear following surgery. A sterile cotton ball can be placed loosely at the external opening of the ear, not in the canal or near the tympanic membrane, to collect any drainage, but it should not be packed deeply into the ear canal. Swimming, submerging in water, and getting water in the ear are contraindicated for several months (not weeks) due to the risk of water contamination in the middle ear.
A client had a myringotomy. The nurse provides which discharge teaching?
a. Buy dry shampoo to use for a week.
b. Drink liquids through a straw.
c. Flying is not allowed for 1 month.
d. Hot water showers will help the pain.
-A
The client cannot shower or get the head wet for 1 week after surgery, so using dry shampoo is a good suggestion. The other instructions are incorrect: straws are not allowed for 2 to 3 weeks, flying is not allowed for 2 to 3 weeks, and the client should not shower.
Q: A 2-year-old girl is scheduled to have a myringotomy. How long would the nurse tell the parents that it will take for the incision to heal? A) 2 weeks B) 1 week C) 5 days D) 24 to 72 hours
D
Feedback: Myringotomy also allows the drainage to be analyzed (by culture and sensitivity testing) so that the infecting organism can be identified and appropriate antibiotic therapy prescribed. The incision heals within 24 to 72 hours. This makes options A, B, and C incorrect.
Mastoiditis - can lead to
brain abscess, meningitis and death
S/S of mastoiditis
swelling behind the ear, pain when when moving the ear
eardrum is red thick and immobile
lymph nodes are tender and enlarged
procedure for mastoiditis
radical mastoidectomy
A client is scheduled for a tympanoplasty. What actions by the nurse are most appropriate?
(Select all that apply.)
a. Administer preoperative antibiotics.
b. Assess for allergies to local anesthetics.
c. Ensure that informed consent is on the chart.
d. Give ordered antivertigo medications.
e. Teach that hearing improves immediately.
A, C
Preoperatively, the nurse administers antibiotics and ensures that informed consent is on the chart. Local anesthetics can be used, but general anesthesia is used more often. Antivertigo medications are not used. Hearing will be decreased immediately after the operation until the ear packing is removed.
Q: A patient who has undergone a left tympanoplasty should be instructed to a. remain on bed rest. b. keep the head elevated. c. avoid blowing the nose. d. irrigate the left ear canal.
- Coughing or blowing the nose increases pressure in the eustachian tube and middle ear cavity and disrupts postoperative healing. There is no postoperative need for prolonged bed rest, elevation of the head, or continuous antibiotic irrigation.
ear trauma safety precautions
avoid the insertion of objects into the ear…ear protectors hen blunt trauma is likely
Neoplasm S/s
progressive hearing loss and tinnitus
- bulging of eardrum or a mass extending to external ear…treatment necessary Because it can effect the facial and trigeminal nerve
A patient with chronic otitis media is diagnosed with a cholesteatoma. The nurse realizes that what would be the treatment of choice for this patient?
- surgery
- nothing; it will resolve on its own
- antibiotics
- tympanostomy tubes
1.
Global Rationale: Cholesteatomas are benign and slow-growing tumors that can enlarge to fill the entire middle ear. Untreated, the cholesteatoma can progressively destroy the ossicles and erode into the inner ear and cause profound hearing loss. A cholesteatoma may require delicate surgery for its removal. If at all possible, radical mastoidectomy with removal of the tympanic membrane, ossicles, and tumor is avoided. Antibiotics are not appropriate treatment. Tympanostomy tubes are not used to treat a cholesteatoma.
Tinnitus, dizziness, know terms, what educations do you want to give to a patient who has vertigo,
- do not move head too quick
- dont listen to loud music
- take drugs that reduce vertigo affect (dimenhydrinate, diazepam, meclizine, scopolamine)
Q:The nurse is planning care for a patient with severe symptoms of tinnitus, vertigo, sensorineural hearing deficit, nausea, and vomiting. What issue should the nurse identify as a priority for this patient?
- anticipating future attacks
- ensuring adequate nutritional intake
- problems with interpersonal relationships
- difficulty sleeping
Global Rationale: The symptoms listed are for labyrinthitis and Ménière disease, a disorder of the inner ear that disturbs all balance and coordination of motor skills related to gravitational pulls. Because of the unpredictable nature of attacks, the patient with vertigo due to an inner ear disorder needs to learn strategies for dealing with an acute episode. Although the patient is experiencing nausea and vomiting, there is no evidence that this will be prolonged. There is no evidence that the patient will have problems with interpersonal relationships because of the health problem. Some patients might have difficulty sleeping; however, this is not a priority since the patient is not experiencing a change in sleep at this time
what medication us used for vertigo
Meclizine (antivert, Bonamine )
A patient is experiencing a severe episode of Ménière disease. Which medication should the nurse expect to be prescribed to help reduce the sensation of spinning and nausea occurring in this patient?
- meclizine hydrochloride (Antivert)
- hydrochlorothiazide (HydroDIURIL)
- diazepam (Valium)
- droperidol (Inapsine)
Global Rationale: Antivertigo/antiemetic medication such as meclizine hydrochloride (Antivert) is prescribed to reduce the whirling sensation and nausea. HydroDIURIL is a diuretic and would not be used to treat Ménière disease. Valium is a benzodiazepine used for sedation and to treat anxiety. Inapsine is a tranquilizer and not the drug of choice.
what are the 3 parts to maniere’s disease
- tinnitus
- vertigo
- one sided hearing loss
acoustic neuroma-
benign tumor and effected by cranial never #8 what does that then cause?
- damage to movement, hearing and sensation can occur
Q:When teaching a patient about the treatment of acoustic neuroma, the nurse will include information about a. a low sodium diet. b. ways to avoid falls. c. how to apply sunscreen. d. the chemotherapy side effects.
B
Intermittent vertigo occurs with acoustic neuroma, so the nurse should include information about how to prevent falls. Diet is not a risk factor for acoustic neuroma and no dietary changes are needed. Sunscreen would be used to prevent skin cancers on the external ear. Acoustic neuromas are benign and do not require chemotherapy.
