Visual and Auditory Problems Flashcards
Correctable Refractive Errors
This defect prevents light rays from converging into a single focus on the retina Result of irregularities of the corneal curvature Focusing power of the lens Length of the eye Major symptom is blurred vision Additional symptoms: ocular discomfort, eyestrain, or headaches
Myopia
(nearsightedness) Inability to accommodate for objects at a distance Causes light rays to be focused in front of the retina May occur because of excessive light refraction by the cornea or lens or because of an abnormally long eye
Hyperopia
Hyperopia (farsightedness) Inability to accommodate for near objects Causes light rays to be focused behind the retina May occur because the cornea or lens does not have adequate focusing power or when the eyeball is too short
Presbyopia
(loss of accommodation due to age) As the eye ages, the lens becomes larger, firmer, & less elastic Inability to focus on near objects
Astigmatism
(an irregular corneal curvature) Causes the incoming light rays to be bent unequally Light rays do not come to a single point of focus on the retina Aphakia is the absence of the lens (absent congenitally or removed during cataract surgery) Replaced with an intraocular lens (IOL) implant
Corrective Glasses
Myopia, hyperopia, presbyopia (reading glasses) & astigmatism Combined corrective glasses (presbyopic correction is in the lower portion of the spectacle lens); “bifocals” Distance focusing in the top two thirds & near focus in the bottom one third of the lens
Contact Lens
Pattern of wear (daily versus extended) Microbial keratitis – poor hand or lens case hygiene Patient education key for the prevention of sight-threatening complications
Laser
(laser-assisted in situ keratomileusis – LASIK) Creates a flap in the cornea, flap is folded back on the middle section, or stroma of the cornea Laser pulses vaporize a part of the stroma Flap is then repositioned
Implant
Refractive intraocular lens implantation is an option for patients with a high degree of myopia or hyperopia Removal of the patient’s natural lens Risk of complications is higher Phakic intraocular lens implantation Implanted into the eye without removing the eye’s natural lens, placed in front of the eye’s lens Preserves the eye’s ability to focus for reading vision
Uncorrectable Visual Impairment
In the U.S., 6.5 million people over the age 65 have severe visual impairment inability to read newsprint even with glasses 9% have no useful vision 91% are partially sighted Total blindness – no light perception & no usable vision Functional blindness – some light perception & no usable vision Legal blindness – central visual acuity of 20/200 or less in the better eye with correction, or a peripheral visual field of 20 degrees or less 1.3 million people in the U.S. are legally blind
Assessment
How the patient’s visual impairment affects functioning Personal feelings & meaning Support System
Planning
Successful Adjustments Coping Strategies Goals
Implementation
Health Promotion Acute Intervention Patient & Family Respect & Communication Sight-guide technique Ambulatory & Home Care Rehabilitation services American Foundation for the Blind (www.afb.org) ADLs Optical Devices for Visual Enhancement Nonoptical Methods for Visual Enhancement
Evaluation
Expected outcomes No further loss of vision Use adaptive coping strategies Maintain self-esteem or social interactions (no decrease) Function safely within environment (personal & outside the home)
Gerontologic Considerations
Older adults is at increased risk for vision loss caused by eye disease Other deficits (cognitive impairment, limited mobility) may further affect the older adult’s function in usual ways Higher risk for falls Diminished self- esteem and independence Decreased manual dexterity may cause difficulty with eyedrops instillation
Eye Trauma
In the U.S. approximately 2.5 million eye injuries occur each year More than 10% will lose useful vision in the affected eye Most common ocular injuries occur in the home Followed by sport and work-related injuries Eye trauma often is a preventable injury Protective eyewear Role of Nursing – patient and community education
Herdeolum
(sty)- infection in sebaceous glands in lid margin Most common - Staph aureus May evolve into inflammation of gland → Chalazion Apply warm, moist compresses at least four times a day If no improvement refer to ophthalmologist for lancing or removal
Chalazion
chronic inflammatory granuloma of the meibomian (sebaceous) glands in the lid
Blepharitis
Bilateral infection of the lid margins Lids are red rimmed with scales or crusts on the lid margins and lashes May experience burning, irritation and photophobia Ophthalmic ointment Emphasize thorough cleaning practices of skin & scalp – baby shampoo
Bacterial Conjunctivitis
most common Commonly occurs in children due to poor hygienic habits Irritation, tearing, redness, drainage Antibiotics and hand washing
Viral Conjunctivitis
Tearing, foreign body sensation, redness Adenovirus conjunctivitis: contaminated swimming pools, direct contact Good hygiene and palliative care
Chlamydial Conjunctivitis
Due to increase in sexually-transmitted chlamydia Irritation, discharge, redness, lid swelling Treated with ointment Pt. may have concurrent genital chlamydia as well and may need systemic antibiotic Educate for both ocular and STI
Allergic Conjunctivitis
Caused by exposure to some allergen Defining symptom – itching Other symptoms – burning, redness, tearing Artificial tears, antihistamines, corticosteriods
Keratitis
Infection of the cornea due to disruption of the epithelial layer Can be caused by bacteria, virus or fungi Topical antibiotics, antiviral or antifungal advised, if not successful, subconjunctival injections or IV Corneal ulcer – infectious keratitis – aggressive treatment
Strabismus
Cannot focus both eyes on the same object simultaneously May deviate: In (esotropia) Out (extropia) Up (hypertropia) Down (hypotropia) May be caused by: thyroid disorder, neuromuscular of the eye, retinal detachment repair, cerebral lesions Pt. may c/o double vision
Intraocular Disorders - Cataracts
Opacity with the lens May be in one or both eyes May have better vision in one than the other Cataract removal is most common surgical procedure in the US
Cataracts
Age related (senile cataracts) Develops due to altered metabolic process within the lens that creates a accumulation of water and alterations in the lens fiber structure Trauma, congenital factors, drugs such as steroids, DM
Nursing Diagnosis
Self-deficits related to visual deficit Anxiety related to lack of knowledge about the surgical and postoperative experience
Expected Outcomes
Pre-op Make informed decisions regarding therapeutic options Experience minimal anxiety Post-op: Understand and comply with postoperative therapy Maintain an acceptable level of physical and emotional comfort Remain free of infection and other complications Nursing Interventions Pre-op teaching concerning procedure Administering mydriatic & cycloplegic agents Post-op Patient and family teaching Eye patched for 24 hours May take 1-2 weeks for visual acuity to reach adequate level Home care Table 22-3 – Teaching Plan Post-op Patient and family teaching Eye patched for 24 hours May take 1-2 weeks for visual acuity to reach adequate level Home care Table 22-3 – Teaching Plan
Retinopathy
Process of microvascular damage to the retina Can develop slowly or rapidly – leads to blurred vision – progressive vision loss Most associated in adults with diabetes mellitus & hypertension
Retinal Detachment
Separation of the sensory retina and the underlying pigment epithelium, with fluid accumulation between the two layers. Almost all patients with untreated detached retina become blind in the involved eye Retinal Breaks- break in full thickness of retinal tissue Retinal Holes- atrophic, spontaneous Retinal Tears- vitreous humor shrinks during aging and pulls at the retina
Clinical Manifestations - Retinal Detachment
Photopsia- light flashes Floaters and “cobweb” or “hairnet” or ring in the field of vision Painless loss of peripheral or central vision “curtain”
Treatment - Retinal Detachment
Expected Outcomes Seal retinal breaks Relieve inward traction on the retina Surgery Laser photocoagulation & cryopexy Scleral buckling Intraocular procedures
Laser Photorefractive Keratectomy
(PRK) Good option for patients with insufficient corneal thickness for a LASIK flap Only epithelium removed Laser sculpts the cornea to correct the refractive error Laser-assisted subepithelial keratomileusis (LASEK) Similar to PRK except epithelium is replace
Cataracts Symptoms
Decreased vision Abnormal color perception Glare Vision loss is gradual, varies from pt. to pt. Secondary Glaucoma can develop if the enlarging lens causes an increased IOP Treatment is surgical with removal and replacement of the lens
Age-Related Macular Degeneration
Two classic forms Dry (atrophic, 90%) Wet (exudative, more severe) Most common cause of vision loss in persons over 55 Related to retinal aging Hallmark sign – drusen in the fundus Symptoms – blurred vision, scotomas or metamorphopsia
Collaborative Care
Laser photocoagulation – leaves blind spot Photodynamic therapy (PTD) Permanent loss of central vision p. 388 Nursing management of the patient with visual impairment
Glaucoma
Group of disorders characterized by: Increased IOP Optic nerve atrophy Peripheral visual field loss May present as primary disease or secondary to other ocular or systemic conditions Primary open-angle glaucoma (POAG)= 90% of cases of primary glaucoma
Main Focus of Glaucoma Treatment
Keep IOP low enough to prevent the patient from developing optic nerve damage Prevention Focus Exam 2-4 years for ages 40-64 Exam 1-2 years for ages 65 and up African-Americans in ever age category should have exams more often
Primary Open-Angle Glaucoma
Develops slowly & without symptoms Outflow of aqueous humor is decreased in the trabecular meshwork - Drainage channels become blocked S/S: “Tunnel vision”
Acute Angle Closure
Sudden, excruciating pain Nausea/vomiting Colored halos around lights, blurred vision, ocular redness
Collaborative Care
Diagnostic Tests/Collaborative Therapy Table 22-9 Drug Therapy Table 22-7 β – Adrenergic Blockers α – Adrenergic Agonists Cholinergic Agents (Miotics) Carbonic Anhydrase Inhibitors
Nursing Diagnosis
Noncompliance related to the inconvenience and side effects of medications Risk for injury related to visual acuity deficits Self-care deficits related to visual acuity deficits Acute pain related to pathophysiologic process and surgical correction
Patient Expected Outcomes
No progression of visual impairment Understand the disease process and rationale for therapy Comply with all aspects of therapy, including medication administration & follow-up care No postoperative complications
Acute Otitis Media
Most common problem of the middle ear Bacteria – predominant etiologic agents Signs/symptoms – pain, fever, malaise, headache, & reduced hearing Amoxicillin current therapy of choice Myringotomy (incision in tympanum) for those who do not respond to treatment Tympanostomy tube may be placed
Meniere’s Disease
Characterized by: Episodic vertigo, tinnitus, fluctuating sensorineural hearing loss & aural fullness Cause of disease unknown Causes significant disability Duration of attacks may be hours or days Hearing recovery is often less complete with each episode leading to progressive permanent hearing loss
Meniere’s Disease - Acute Nursing Management
Medications Sedatives Benzopdiazepines Anticholinergics Antihistamine Antiemetics Low sodium diet – avoid caffeine, nicotine, alcohol, MSG Surgical intervention
Miner’s Disease - Acute Nursing Management (expected outcomes and nursing interventions)
Expected Outcomes Minimize vertigo Provide for patient safety Nursing Interventions Quiet, dark room Avoid sudden head movements or position changes No fluorescent/flickering lights or watching TV Emesis basin available Side rails up and bed in low position Medications and fluids given I & O Assist patient with ambulation
Types of Hearing Loss
Conductive – occurs in outer & middle ear; impairs sound being conducted from outer to inner ear Sensorineural - impairment of function of the inner ear or CN VIII Mixed – combo of above two Central & Functional Central – problems in CNS Functional – emotional/psychologic factor
Health Promotion in Hearing
Environmental Noise Control Immunizations Ototoxic Drugs
Assisting Devices and Techniques for Hearing
Hearing Aids Speech Reading/ Sign Language Cochlear Implant Assisted Listening Devices
Presbycusis
Hearing loss associated with aging Types Sensory Neural Metabolic Cochlear Older adults reluctant to wear hearing aids
Communication with Hearing Impaired Patient
Non-verbal aids and verbal aids
