VN 36 Test 6 eye & ear

Question 1

1. Client education conjunctivitis (pp slide 16)

Answer 1

 Stay away from people (if contagious), use separate linens/towels
 Apply UNG in conjunctival sac, instruct to close eye but not squeeze (if need to wipe: from inner to outer canthus)

Question 2

2. Retinal detachment client education (PP slide 23)

Answer 2

 Instruct patient to remain upright preop & restrict eye movement
 Eyepatch over affected eye
 Post op: eyepatch when sleeping to avoid injury, avoid bending, coughing & straining

Question 3

3. Most common cause of visual loss in older adults/ Normal aging changes (PP slide 24)

Answer 3

 Macular degeneration

Normal aging changes of the eye (pp slide 1)
 Crystalline lens hardens
 Loss of accommodation
 Macular degeneration
 Presbycusis (gradual hearing loss)
 Calcification of the ossicles (can cause hearing loss)

Question 4

4. Macular degeneration assessment, diagnostic tests, and nursing management (pp slide 24)

Answer 4

Assessment:
 Loss of central vision
 No detail in images
 Lack of depth perception

Diagnostic tests:
 Amsler grid (peripheral vision tests)

Nursing Management:
 Arrange community resources
 Nurse assists w/ambulation by letting client follow their lead & encourage client to turn head side to side (so they don’t miss a step)

Question 5

5. Nursing interventions for visually impaired clients (pp slide 11)

Answer 5

 Lead client, walk a bit ahead during ambulation
 Introduce yourself each time you enter the room because many voices sound similar
 Call client by name during group conversations because blind client cant see to whom questions or comments are directed
 Speak before touching client
 Tell the client when you are leaving the room

Question 6

6. Glaucoma manifestations(pp slide 25)

Answer 6

 Affects people of all ages & all races
 Characterized by increased ocular pressure (IOP) in the eye brought on by an excessive amount of aqueous

Manifestations:
 Open angle: mild eye discomfort, temporary blurred vision, reduced peripheral vision, halos around lights
 Acute angle closure: hard, painful, sightless eyes, N/V, red conjunctiva, headache, Colored halos around lights

Question 7

6. Glaucoma Diagnostic findings (pp slide 25)

Answer 7

 Visual field exam
 Anterior chamber inspection
 Tonometry
 Optic disc visualization

Question 8

6. Glaucoma Nursing/Surgical management & Client education (pp slide 25)

Answer 8

Nursing & Surgical Management:
 Medication & laser surgery

Client Education:
 Drops taken for life
 Stress importance of drop regimen
 Call w/OTC meds
 Keep yearly appointments
 Post op (surgery): avoid lifting, bending, coughing, straining

Question 9

7. Stapedectomy client education (pg.560)

Answer 9

 Refrain from blowing nose because it can dislodge the prosthesis
 Avoid high altitudes or flying
 Refrain from lifting heavy objects, straining when defecating, or bending over at the waist (can increase pressure in the middle ear)
 Prevent water from getting in the ear (avoid swimming, showering, washing hair until approved by PCP)
 Follow PCP instructions for keeping ear clean
 Stay away from people w/respiratory infections (if a head cold occurs, contact PCP immediately!)
 Notify the PCP immediately if severe pain, excessive drainage, sudden loss of hearing or fever occurs.
 Adhere to restriction of activities recommended by the surgeon until told otherwise. (Normal activities can be resumed within 2-4 weeks.)
 Activity is restricted for 24 hrs or more after surgery & hearing may be temporarily the same as or worse than before surgery

Question 10

7. Stapedectomy nursing management(Pp slide 14)

Answer 10

 Place client on opposite side & monitor for dizziness, assist w/ambulation
 Avoid coughing, vomiting & monitor for prosthesis dislodgement
 Assess facial nerve function
 Monitor for infection, use aseptic technique when cleaning wound

Question 11

8. Cataract surgery client education (pp slide 22)

Answer 11

 Blurring for days to a week
 Unexpected findings : flashes of light, yellow or green drainage, sudden increase in pain
 Sunglasses 1x/week
 Might feel mild itching & bloodshot
 Eye shield 24hrs
 Eye drops
 Expect white drainage (call provider if drainage yellow or green)
 Eye patch changed every day
 NO heavy lifting, straining, coughing, or bending could indicate increase LOC

Question 12

8. cataract manifestations (pp slide 22)

Answer 12

 Halos
 Difficulty in reading
 Color vision changes
 Reduced distorted vision

Question 13

9. Diagnostic tests for hearing loss (Pp slide 5)

Answer 13

 Audiometry: noninvasive preliminary test
 Tympanogram: measures the mobility of the TM to detect middle ear disease
 Weber: tests bone conduction in conductive hearing loss, client will hear on affected side
 Rinne: Tuning forks to determine if hearing loss- hears through air conduction
 Otoscopy: to examine external auditory canal, TM, & malleus bone
 History & Assessment: trauma, medications, chemotherapy

Question 14

10. Paroxysmal positional vertigo nursing interventions (Pp slide 12)

Answer 14

Safety in nurse :PRIORITY! (Major fall risk)
 Bed rest
 Watch for sedation
 Antiemetics as needed
 Meclizine: antihistamine & anticholinergic effects

Question 15

11. Tonometry education (PP slide 25, pg.531)

Answer 15

 Tonometry measures intraocular pressure (IOP) to screen for glaucoma.
 Topical anesthetic solution is instilled in the lower conjunctival sac (Anesthesia begins almost immediately and lasts a few minutes)
 Client does not feel the tonometer while the eye is anesthetized.

Question 16

12. Timolol K,H,K (PG.546)

Answer 16

 USE: Tx of glaucoma
 AE: Burning/stinging, discomfort, dry eyes & eyelid erythema
 Use w/caution when hypertensive beta blocker drugs are used
 Avoid canthus duct to limit systemic effect, can cause bradycardia (Apply pressure to inner canthus)

Question 17

13. Cerumen removal assessment & nursing management (Pp slide 6)

Answer 17

Assessment:
 Blocked or muffled hearing
 Plugged feeling in the ear
 Otalgia (ear pain)

Nursing management:
 Soften wax w/mineral oil or debrox, let set overnight, then flushing w/a syringe. If left untreated, impacted cerumen leads to tinnitus

Question 18

14. LASIK complications (pp slide 9)

Answer 18

 Complications of the flap (inflammation, displacement, infection)

Question 19

15. Brimonidine K,H,K (PG. 546)

Answer 19

 USE: Glaucoma
 AE: burning, stinking, discomfort, dry eyes
 Don’t take w/MAOI’s
 Confusion noted in frail elderly when used

Question 20

16. Pilocarpine K,H,K (PG.546)

Answer 20

 USE: Glaucoma
 AE: periorbital pain, blurry vision
 Warning regarding difficulty w/vision in evening or dark areas

Question 21

17. Uveitis risk factors (PP slide 17, PG.542)

Answer 21

 Histoplasmosis (skin rashes)
 Ankylosing spondylitis (spine)
 Tuberculosis
 Toxoplasmosis (nfection from parasite)
 Clients w/juvenile rheumatoid arthritis
 Herpes zoster infection

Question 22

18. Quinine K,H,K (pharm pg.155)

Answer 22

 USE: leg cramps
 Long term use can cause hearing loss

Question 23

19. Weber test nursing considerations (pg.533)

Answer 23

 Performed by striking the tuning fork & placing its stem in the midline of client’s skull or center of the forehead
 A person w/normal hearing perceives the sound equally well in both ears. (if the sound seems lateralized to one ear, it suggests a conduction hearing loss in that ear or a sensorineural loss in the opposite ear

Question 24

20. Ear drops instillation client education (pp slide 8)

Answer 24

 Assist w/drop instillation (always point toward roof of canal not directly at eardrum (never insert dropper into ear!)
 Warm drops prior to instillation
 Clean external ear w/warm cloth
 Remain lying on the side 2-3 mins after instillation

Question 25

21. Otosclerosis client education (pp slide 14, pg.560)

Answer 25

 Unknown cause but can be accelerated in pregnancy
 Causes bilateral hearing loss

Question 26

22. Otitis externa client education (Pp slide 9)

Answer 26

 After swimming instill alcohol drops to dry
 Wear earplugs/swim cap
 Do not use cotton swabs inside ear
 Use a low heat hair dryer to dry ear

Question 27

23. Otitis media contributing factors (pp slide 8)

Answer 27

 Viral or bacterial infections
 Allergens like smoke