Sensory Flashcards
Eye trauma interventions include:
- Determine mechanism of injury
- Ensure ABC’s, assess for other injuries - eye is close to the airway!
- Assess for chemical exposure - Ocular irrigation immediately if chemical exposure
- Assess visual acuity - No pressure on eye!!
- Tell pt do not blow their nose
- Do not attempt to treat the injury (except flushing for chemical exposure)
- Stabilize foreign objects
- Cover with dry, sterile patch & protective shield
- No food or fluids - In case they need surgery
- HOB 45⁰
Hordeolum
sty
warm/moist compresses - 4x/day; allow to dry lid scrubs (maybe - if exudates or flaking) antibiotics - topical ointments or drops (maybe)
Chalazion
huge sty!!
warm/moist compresses - 4x/day; allow to dry
lid scrubs (maybe - if exudates or flaking)
antibiotics - topical ointments or drops (maybe)
may be surgically removed
Blepharitis
bilateral inflammation
s/s: itching, burning, irritation, photophobia
Tx: antibiotic ointment (wash hands when using)
baby shampoo for removing scales/crusts
Viral Conjunctivitis
S/S: Foreign body sensation, Mild photophobia
Tx: Topical steroids for relief (Does not cure, Eventualy goes away even without treatment)
Chlamydial conjunctivitis
trachoma and adult inclusion
s/s: mucopurulent discharge, irritation, redness, lid swelling
Allergic conjunctivitis treatment
avoid allergen
artificial tears
topical antihistamines and steroids
Keratitis
inflammation of cornea
S/S: pain photophobia, foreign body sensation
Bacterial keratitis treatment
topical antibiotics
subconjuctival injection of antibiotics
Viral keratitis treatment
usually from Herpes
Antivirals can be oral, drops, and topical ointment
Topical steroids
Pain medication
Warm compresses
Corneal Ulcer
infection of cornea
S/S: VERY PAINFUL
foreign body sensation
tearing, purulent discharge, redness, photophobia
Tx: AGGRESSIVE eye drops - q1hr for 24 hrs (antibiotic, antiviral, or antifungal)
Nursing management of extraocular problems:
Assess ocular changes: edema, redness, decreased visual acuity, foreign body feeling, discomfort/pain
- Psychosocial considerations
a. Especially if vision is impaired - Careful asepsis: frequent hand washing
a. don’t touch their eye or anything really - Avoid sources of ocular irritation (including contact lens issues)
- Consider sexual mode of transmission
- Warm or cool compresses
- Darken room
- Comfort measures
- Medications as indicated: stagger if more than one eye drop
a. if they have two meds, they could alternate them every half hour (if hourly) - Discard used cosmetics and open contact lens products
- If vision impaired, address issues related to that (environment)
Cataract causes
Opacity within the lens - May occur in one or both eyes
Causes/Etiology
- Most are age related (senile cataracts)
- Blunt or penetrating trauma
- Radiation or UV light exposure
- Systemic or long-term topical corticosteroids
a. people with chronic conditions with inflammatory component are often on long term steroids (like prednisone) cause cataracts - Ocular inflammation
- Congenital
a. Maternal rubella (German measles) - Diabetes
Cataract symptoms
decrease in vision
abnormal color perception
glare
Teaching for patient after cataract surgery
Hygiene & eye care - when using eye drops make sure to tell them not to touch tip of bottle to eye, wash hands before and after inserting eye drops
Monitor pain, pain meds & when to report
Eye drops
Eye patch/shield (Up to physician – protect the eye, Head positioning)
Follow-up appointments
2-3 times over next 6-8 weeks following surgery
New eyeglass prescription - Wait until eyes are healed (6-8 weeks)
Retinal Detachment
retinal tear or hole - can cause PAINLESS loss of vision if untreated
emergency so may bump someone off surgical schedule
Risk Factors for Retinal Detachment
- Increasing Age
- Severe Myopia
- Eye Trauma
- Cataract Surgery
- Family or personal hx retinal detachment (2-25% risk in other eye)
- If untreated blindness almost always occurs
Retinal Detachment symptoms
photopsia (light flashes)
floaters
vision changes: cobwebs, hairnet or ring in field of vision
Retinal Detachment patient care
Emotional support – urgent situation, urgent surgery
(nursing diagnoses related to anxiety, risk for infection, deficient knowledge — look at interventions and rationales!)
Post-operative (Table 22-5)
- Bed rest & positioning - positioning related to whether or not we use an air bubble
- Eyedrops (antibiotics, antiinflammatory, dilating)
- Activity (possible restrictions usually due to air bubble)
- Pain management
- Discharge planning – goes home a few hours after surgery; want to make sure we maximize visual acuity for the remaining vision; want to minimize injury, infection (mostly hand washing)
Age Related Macular Degenerations (AMD)
degeneration of macula which is responsible for SHARP, CENTRAL VISION
2 Types - Dry (more common) and Wet (more severe)
Risk factors
- *Aging
- *Genetics
- family history = MAJOR risk factor !
- UV light exposure
- Hyperopia
- Cigarette smoking
- Light-colored eyes
- Nutritional deficiencies
- Vitamin C, E, beta carotene, zinc - intake of dark, green leafy vegetables may help slow or prevent the progression
AMD symptoms
blurred or darkened vision
scotomas (blind spots)
metamorphopsia (distorted vision)
AMD collaborative care
- Photodynamic therapy uses an IV dye & “cold” laser to excite the dye - destroys abnormal blood vessels without permanent damage
- Medications injected into the vitreous cavity every 4-6 weeks (side effects = blurred vision, eye irritation, eye pain, and photosensitivity)
- Vision will not improve, but treatment limits progression
- no specific treatment for dry AMD except some supplements that may help slow vision loss
- Vision enhancement techniques are useful so that the patient can utilize what vision they do have
- Desktop video magnification, hand-held magnifiers, text-to-speech scanners, e-readers, computer tablets with magnification, brighter screens, voice recognition
Glaucoma
increased intraocular pressure
2 types:
Primary Open Angle Glaucoma (POAG) -most common
Primary Angle Closure Glaucoma (PACG) - more severe
IOP:
normal 10 – 21mmHg
POAG 22-32 mmHg
PACG ≥50 mmHg
POAG symptoms
Slow onset
No pain, no pressure
Eventually notice “tunnel vision”
increased pressure leading to loss of peripheral vision
untreated = painful, hard, sightless eye requiring enucleation
PACG symptoms
Sudden, excruciating pain
Nausea & vomiting
Halos, blurred vision
Ocular redness
untreated = painful, hard, sightless eye requiring enucleation
Glaucoma requires long term treatment with:
antiglaucoma medications
Some medication concerns with beta-blocker agents:
a. If taking a systemic beta-blocker, an additive effect may be experienced if prescribed a beta-blocking eye drop (cardiac issues)
b. Also need to pay attention to those with COPD, asthma, heart failure, pulmonary edema
i. limit systemic absorption of medication in eye
c. Occlude puncta (bottom picture)
Nursing Care of Glaucoma includes:
Prevention – educate
eye exams! q 2-4 yrs 40-64yo; q 1-2 yrs if 65+; more for African American
Acute (angle-closure) - Meds, surgery, Comfort
Ambulatory & home care - Encourage compliance, Information, Follow up (routine checking of IOP — helps know if meds are working, if patient is being compliant, etc.)
The most common problem of the middle ear is:
acute otitis media (ear infection).
It can be bacterial or viral. The treatments include antibiotics and surgery (placing a tympaanoplasty tube).
Risk factors for acute otitis media are:
- Young age
- Congenital abnormality
- Immune deficiency
- Cigarette smoke exposure
- Family Hx
- Recent URI
- Male
- Allergies
Chronic otitis media and mastoiditis occur when:
there are untreated or repeated episodes of acute OM.
Complications include perforation and a mass of tumor like cells that may need to be surgically removed (cholesteatoma)
Chronic otitis post surgery patient teaching
- Avoid sudden head movements.
- Do not try to get out of bed w/o assistance.
- Take drugs to reduce dizziness if prescribed.
- Change positions slowly.
- Avoid getting the head wet (including showering) until directed by surgeon.
- Report fever, pain, an increase in hearing loss, or drainage from the ear.
- Do not cough or blow the nose bc this causes increased pressure in the eustachian tube and middle ear cavity and disrupts healing.
- In need to cough or sneeze, leave the mouth open to help reduce the pressure.
- Avoid crowds where respiratory infections may be contracted.
- Avoid situations where pressure or popping in the ears is normally experienced, such as high elevations or airplane travel.
chronic otitis management:
Ear irrigations Oral, otic, or parenteral antibiotics Analgesics Antiemetics Surgery i. Tympanoplasty ii. Mastoidectomy
can put antibiotic beads, drain in behind the ear, etc; LAST RESORT
Miniere’s Disease symptoms
- Episodic vertigo
- Tinnitus
- Hearing loss
- Aural fullness
- Fluid builds up and ear drum can rupture
Can be extremely debilitating SUDDEN severe attacks of vertigo, N/V, sweating, pallor “Drop Attack” Whirling in space Falling
Last hours to days and May occur several times a year!
Miniere’s Disease care
acute attack: medications and bed rest
routine care: medications, possibly surgery
nursing care:
- quiet dark room, no sudden movements, ambulation assistance
- minimize vertigo
- maximize safety
- can have frequent incapacitating attacks
interpersonal care for hearing loss and deafness
- control environmental noise like tv’s
- immunizations: some childhood diseases cause hearing loss
- ototoxic substances: industrial
- ototoxic drugs: salicylates, diuretics, antineoplastic drugs, antibiotics
assistive devices for hearing loss
hearing aids, lip reading (allows for 40% understanding), sign language, cochlear implant, assistive listening devices (amplifiers, lighted alerts)
when communicating with someone who has hearing loss do these 4 things:
speak slowly and normally - Do NOT shout
simple sentences
eye contact - don’t cover mouth
speak in “better” ear
