x Eye & Ear Take Home Flashcards
Types of Infectious and Inflam Eye Disorders
- Blepharitis (inflame of eyelid)
- Hordeolum aka Sty (infect of sebaceous gland, eyelid)
- Chalazion (cyst of nodule of eyelid)
- Conjuctivitis (inflame of conjunctiva, common)
- Keratitis (inflam of cornea)
- Uveitis (inflam of mid layer of eye)
- Iritis (inflam of iris only)
Blepharitis
Inflammation of eyelid
CAUSE: infection or dermatitis
SS: eyelid irritated, itchy, eyelid margin red, crusted, scaly
Hordeolum
aka STY
Infection of sebaceous glands of eyelid
CAUSE: staphyloccos aureus
SS: red, painful, may affect internal or external lid
Chalazion
Painless cyst or nodule of eyelid
Conjunctivitis
aka Pink Eye
inflammation of conjunctiva, COMMON
CAUSE: viral, bacterial, direct contact
SS: mild, redness, itching, tearing, discharge of eye. (sever infections i.e. gonnorhea and trachoma major cause of blindness in sub saha africa, mid east, asia)
Disorders of Cornea
clear cornea transmits and helps focus light and images onto retina. protects internal eye. scarring can lead to blindness. no blood supply
- Keratitis (inflame of cornea)
- Corneal Ulcer
Keratitis
Inflammation of cornea
CAUSE: infection, lack of tears, trauma
SS: discomfort, tearing, discharge, photophobia, blepharospasm (spasm of eyelid, inability to open eye), sudden severe pain (corneal perf)
Corneal Ulcer
MEDICAL EMER
CAUSE: infection (herpes, shingles) , trauma, misuse of contacts
-superficial or deep
-scarring can occur
-if cornea perforated, can lead to infection –> vision loss
-Uveitis/Iritis
- Uveitis (inflam of mid layer of eye)
- Iritis (inflam of iris only), more common
SS: severe pain, photophobia, blurred vision, constricted pupil, red limbus (where cornea meets conjunctiva)
Eye Disorders: NI/MM
- GOAL: to Preserve Vision, Prevention, Client teaching
- DX: med Hx, eye exam, Flourescein stain w slit lamp exam (ulcers green at staining), Conjunctival/Ulcer scrapings (exam/culture)
- MED:
- prevent further infection, reduce pain, client teaching
- frequent handwashing, discard old makeup, don’t share facial cosmetics, test vision using Snellen or Rosenberg chart
- Dry sterile dressing over affected eye, perforation etc.
Corneal Transplant
done when cornea is scarred/opaque. taken from cadavors 65/under
MED: Antihistamine, Corticosteroids
-limited blood supply so rare for body to reject
-eye patch 24hrs after
-avoid activities that increase ocular pressure (lifting, BM,
Eye Disorder: Nursing Diagnoses
-Risk for disturbed sensory perception
OUTCOME: w remain free from visual deficits
-Acute Pain
OUTCOME: w state pain is absent or at tolerable level
-Risk for Injury
OUTCOME: w remain free from injury
Types of eye trauma
- foreign bodies
- abrasions
- lacerations
Corneal Abrasion
- scratch of cornea
- cause: contact lens, eyelash, small foreign bodies
- SS: painful, photo phobia, tearing
- heal rapidly, no scar
Eye Burns
-affect outer portion of eye
-chem: ammonia, car battery acid, oven drain cleaners
-thermal burns from explosion
-UV light
SS: pain, affects vision, swollen eyelid, red edematous conjunctiva, may slough. Cornea appears cloudy or hazy
Eye perforation
- cause: metal flakes, glass shards, weapons,
- SS: pain, partial/complete loss of vision, bleeding, possible loss of eye contents
Blunt Eye Trauma
- Cause: sport injuries
- minor ecchymosis (black eye) or subconjunctival hemmorhage (bleeding into conjunctiva)
- RX: no treatment needed
Hyphema
Bleeding into anterior chamber of eye
-SS: Red tint to vision, visible blood in ant chamber, Diplopia, pain w eye mvmt.
NI/MM for eye injury
DX:
- eye exam (eye mvmt, abrasions)
- Fluorescein staining (presence of foreign bodies)
- opthalmoscopic exam (bleeding/trauma to int chamber)
- X-ray, CT scan
MM/NI:
- eye irrigate w saline, copious amt. chem burn,
- direct to INNER CANTHUS, head tipped lightly to affected side to avoid contam of other eye.
- Sterile cotton tip applicator to remove foreign bodies.
- eye patch to keep eye closed for 24 hrs
- SX for penetrating wounds
MED:
- topical analgesic (pain, photophobia)
- topical ABX
- Narcotics, Sedatives, Antiemetics, Analgesics ( pain, anxiety, prevent vomiting which Inc ocular pressure
Nursing Care, eye injury
PROTECTING EYE, PRESERVING VISION
- asses, record vision each eye (baseline)
- asses eye for traum
-STAT irrigation if chem burn. Priority
-
Refractive Errors
change in shape or cornea, lens or eyeball affect focus of light on the retina
- Myopia
- Hyperopia
- Astigmatism
Myopia
- Near sighted. see close objects clear
- DEC w age
Hyperopia
- far sighted. see far objects clear
- INC w age
Presyopia
-impaired accommodation d/t age
Astigmatism
Irregular curvature of cornea and lens
** Myopia (see clear near) DEC w age
Hyperopia (see clear far) INC w age
Refractive Errors: NI and SX
- encourage pt to seek Tx
- check vision w chart
- refer to optometrist prn
- encourage wear glasses
- teach MED eye drops admin, use as directed
SX:
- Radial Keratotommy
- LASIK
- PRK (photorefractive keratectomy)
Cataracts
Clouding of lens
- affect both eyes
- EARLY SS: Clouding around edges (IMMATURE)
- LATE SS: Clouding into center (MATURE), pupil grey/white, red reflex lost
- SS: diff adjusted btwn light and dark
- RISK: DM, Smoking, ETOH, Congenital, eye trauma, over -MED (corticosteroids, chlorpromazine), UV
- DX: Eye exam, Hx
Glaucoma
NO CURE
- UP ocular eye pressure, gradual vision loss (silent thief). Aqueous humor fills space btwn lens and cornea. Produced by ciliary body and flows thru pupil into anterior chamber. Then drains through trabecular mesh into canal of schlemm
- Leading cause of blindness
- SS: peripheral vision lost then progress
Normal Inter ocular Eye Pressure
12 - 20 mm Hg
Types of Glaucoma
- Open angle
- Closed angle
Open Angle Glaucoma
-RSK: Af-Am, Mexican, prior Hx (screen every 2 yrs over 40yrs old)
-aqueous humor drainage thru canal of Schlemm is obstructed.
-Slow buildup of pressure
-damage retinal neurons and optic nerve
SS:
-peripheral vision gradually lost
-visual field narrows
-no pain
-diff adjusting light to dark
-blurred vision
-halo around lights
-diff focusing on near objects
Closed Angle Glaucoma
-RSK: older adults, Asian, previous closed angle glaucoma
-MED EMERGENCY
-angle between cornea and iris closed
-BLOCKS drainage of aqueous humor
-sudden rapid UP Intraocular Pressure
-damage retina and optic nerve
-One eye affected
-AVOID MEDS that dilate the eye (w reduce angle and make worse)
SS:
-severe sudden eye pain w blurred vision
-N/V
-Halos aroun dlithst
-affected eye RED, cornea clouded
-dilated, fixed, non reactive pupil
LOOK Nursing Care Checklist: Eye Sx
Box 40-2, Burke pg 1025
LOOK Manifestations of Glaucoma
Box 40-4, Burke pg 1026
MEDS: Mydriatics
- Drugs to dilate pupils (Atropine)
- MyDriatic, Dilate (pneumonic)
- NOT FOR CLOSED ANGLE GLAUCOMA
Glaucoma: Population Focus
- Open Angle Glaucoma: Af-Am, Mexican, prior Hx (screen every 2 yrs over 40yrs old)
- Closed Angle Claucoma: older adults, Asian, previous closed angle glaucoma
Glaucoma: Dx Test
- routine eye exam
- Tonometry (measure IOP_
- Funduscopy (asses fundus pallor, optic disc cupping)
- Gonioscopy (mesaures depth of anterior chamber to diff open vs closed angle)
- Visual Field testing (identify loss of peripheral vision)
Glaucoma: MEDS
Preserve Vision, Reduce IOP
ACUTE
MED: Adrenergic Agonists
reduce IOP by REDUCE aqueous humor production, INC it’s absorption
- Aproclonidine (Lopidine)
- Brimonidine (Alphagan)
NI:
.NOT in Closed Angle, cardiac arrhythmia, coronary artery disease
.report itching, lid edema, discharge
MED: Beta Blockers
reduce IOP by RED production of aqueous humor. Does not affect vision
- Betaxolol (Betoptic)
- Timolol (Timoptic)
NI:
.report asthma, COPD, heart issues
.HOLD PRESSURE of bridge of nose (1 min) after instilling drops, to prevent systemic absorption. **
.report bradycardia, hypotension, diff breathing
MED: Prostoglandin Analog
reduces IOP by improving outflow of aqueous humor
-Latanoprost (Xalatan)
NI:
. at bedtime as vision blurry after drops
.1x qhs
.report burning, stinging, redness
.IRIS will darken while using drug (normal)
MED: Cabonic Anhydrase Inhibitor
reduce IOP by RED prod of aqueous humor (drops, IV)
-Dorzolamide (Trusopt eyedrops)
NI:
instill 10min apart from other opthalmic drugs
.report irritation, hypotension, diff breathing
.may cause eye sting and BITTER taste in mough
.
.
Glaucoma: Sx
Lower IOP
Open
Glaucoma: NI/MM/Diagnosis
-Health promotion
-eye exam q2-4 yrs over 40yrs
-eye exam q1-2yrs if past HX or over 65yrs
-
Diagnoses:
.Reduced ability to provide self care
.increase anxiety
.risk for injury d/t altered peripheral vision
How to administer EyeDrops, Ointment
- apply drop in inner canthus
- hold bridge of nose for beta blocker to prevent systemic absorption (Timolol)
- Ointment, pull down lower lid, squeeze ointment in pocket, release lid and blink.
Glaucoma: Nursing Diagnosis
-Deficient Knowledge (Ocular care)
OUTCOME: w verbalize understanding of glaucoma an demonstrate appropriate eye care
-Risk for Injury
OUTCOME: w remain free from injury
-Anxiety
OUTCOME: w report less anxiety
Detached Retina
MED EMERGENCY
- retinal contains neurons that allow us to see light and images. Detached, separation of retina from the choroid, the vascular layer of the eye
- If layers stay separates (retina/choroid), neurons become ischemic and die
CAUSE: spontaneous, trauma, aging (vitreous humor shrink w aging inc risk for detachment)
DX: Eye exam, SS
SS:
- sudden change in vision
- no pain
- veil across vision
- floaters
- flashing lights
NI:
-keep detached portion lower that rest of eye. want to keep flaps touching as much as possible
Macular Degeneration
Macula atrophies or separates from choroid
- common in OVER 65,
- leading cause of blindness
SS: *.center vision disturbed *.peripheral intact .one eye affected .straight lines appear wavy
NI:
.large print
.bright light
Diabetic Retinopathy
capillaries dilate, develop micscopic aneurysms, leak, reupture. Cause edema and hemorrhages into retina. New fragile, weaker capillaries form no longer able to transport blood and oxygen to retina
- 85% of DM pts develop
- develops 15yrs after Dx w DM 1/2
- leading cause of new blindness 20-74yrs
NI:
.regular eye exam
.take meds
.control glucose
Enucleation
removal of an eye
NI: observe for prosthesis when documenting PERRLA
Blindness: Promoting indipendence
- notify staff of blind client
- verbally communicate freely (narrate what you are doing)
- orient client to room
- never move furniture without notifying client
- offer assistance w ADLs
Ear Disorders
-External Otitis
External Otitis
inflammation of the ear canal RSK: -Swimmers ear -Hearing Aid -Earplugs CAUSE: -bacteria SS: -ear pain -drainage -canal swollen
External Otitis: Teach/NI
Pt TEACH:
- out of water 7-10days
- use earplugs to swim
- hair dryer on low setting to dry ear canal after swim
- NO cotton swabs or other objects in ear canal
NI:
- hand-washing
- warm drops by holding bottle in hand or pocket for 5 min
- place client on unaffected side or tilt head toward unaffected side
- partially fill ear dropper w MED
- use non-dominant hand, straighten ear canal by pulling pinna UP an BACK
- instill RX #of drops
- keep client on side about 5 min after apply drops
- loose cotton ball in opening of ear canal for 15-20min
Impacted Cerumen/Foreign Bodies
- common in older adults (cerumen drier and harder w age)
- interferes w sound conduction and hearing
- pt c/o fullness and tinnitus
- visualized using otoscope
TX:
FOCUS: clearing canal
-irrigation
-removed using ear curet, forceps etc (wax/foreign bodies)
-Mineral oil or topical lidocaine used to immobilize or kill insects before removal
-**never use water to items such as beans, insects, as it may cause object to swell
Otitis Media
- inflammation or infection of Middle Ear
- most common ME disorder
- Infants/Young Children usually
- eardrum protects mid ear from envt. Eustachian tube connects it with the nasopharynx .
- Organisms can enter ME from nose/throat thru eustachian tube
RSK:
- URI
- eustachian tube dysfunction
DX:
- med HX
- SS
- pneumatic otoscope exam (puff air blowin into ear canal. causes slight mvmt of eardrum. less mvmt indicates OM)
- impedance audiometry (assess mvmt of eardrum and ME structures)
Ottitis Media: Serous
SEROUS Otitis Media
CAUSE:
-Eustachian tube obstructed for a long time. Air in ME gradually absorbed, causing NEG pressure in ME. Neg press draws serous fluid from capillaries in the space
SS: .DEC hearing .snapping/popping sensation in ears .eardrum moves less free and may bulge .fluid bubble can be seen behind drum .changes in atmos press can cause; acute pain, bleeding into ME, rupture of drum, or rupture of round window
Ottitis Media: Acute
CAUSE
- usually follows URI
- swelling of Eustachian tube impairs drainage of ME
- Mucus, serous fluid collect in ME, bacteria enter from nasopharynx, growing, multiply in fluid.
- infection causes immune response, pus forms in ME. Pus INC pressure in ME and can rupture the eardrum.
SS: -severe pain in affected ear -F -hearing loss dizzineess -vertigo -tinnitus -eardrum red, inflamed OR dull, bulging -purulent drainage -can lead to Acute Mastoiditis
Acute Mastoiditis
CAUSE:
-UnRx Acute Mastoiditis
PATHOS:
- pus fills air cells of mastoid process of temporal bone, next to ME
- destroys the air cells
SS:
- earache
- hearing loss on affected side
- mastoid process tender, swollen, red, inflamed
- tinitus
- HA
- F
- may lead to meningitis (rare)
Ottitis Media: Chronic
permanent performation of the eardrum. recurrent ME infections, destroy the ear drum
SS:
- recurrent ME infections
- severe conductive hearing loss
Ottitis Media: MEDS/SX
MEDS:
- Decongestants
- mild analgesics
- Abx (5-10days, if acute)
SX:
to relieve press in ME
-Tympanocentesis (needle thru ear drum, draw fluid and pus out of ME
-Myringotomy (surgical drainage of ME
-Ventilation (typanostomy) tubes (allows ventilation and drainage of ME during healing)
-Mastoidectomy (removal of infected cells, bone, pus)
ALTERNATIVE:
- 1 drop lavendar oil on cotton in ear canal
- warm cloth or chammomile tea bag steeped in warm water, apply heat to side of face or ear, reducing pain
- pulsatilla, belladonna, aconite
Ear Sx: Nursing Care Checklist
(Burke, pg1036, Box 40-8)
PRE-OP
- assess hearing
- discuss post-op communication strategies
- avoid blowing nose, coughing, sneezing. instruct to leave mouth open to relieve pressure during.
POST-OP
- assess for bleeding, drainage from affected ear
- asses for N, admin antiemetics
- elevate hob and position on unaffected side
- assess for vertigo, dizziness
- assess hearing
- stand on unaffected side to communicate, use other comm strategies such as writing etc.
- avoid coughing, blowing nose, sneezing
- provide home care instructions (avoid showers until approved by MD)
Mid Ear Disorder: Diagnoses
- Acute Pain
- Deficient Knowledge
Inner Ear Disorders
-Labrinthitis
-Meneiere’s Disease
NO CURE
hearing loss
NI/MM GOALS: manage symptoms, prevent hearing -Bed rest -dark room -DEC stimuli -min mvmt
DX:
- electronystagmography (ass involun eye mvmt)
- Xray/CT scan
- Glycerol Test (oral glycerol to DEC press in Inner Ear)
MED:
- Diuretic: Hydrochlorothiazine ( Diuretic, DEC IE press)
- Vertigo/Nausea: Meclizine (Antivert), Prcholrparazine (Compazine), hydroxyzine (Vistaril):
Vertigo
sensation of whirling or mvmt when there is none
Vertigo is a disorder of equilibrium. Can be disabling, causing falls, injury, diff walking.
Dizziness, however, is a feeling of unsteadiness, lack of balance, light headedness or mvmt within the head. Not as severe.
Labrynthititis
inflammation of inner ear. Uncommon
CAUSE:
bacteria or viruses
SS:
- severe vertigo
- hearing loss
- nystagmus (rapid involuntary eye mvmts)
- N/V
Meniere’s Disease
chronic inner ear disorder caused by excess fluid and pressure in the labrynth of the inner ear
Onset: sudden or gradual
SS:
- recurring vertigo w tinnitus (sudden, min-hours)
- gradual hearing loss (usually one ear)
NI:
- lo Na diet (reduce attacks)
- no smoking, ETOH
Inner Ear: Home Care
reduce risk for injury and promote normal sleep patterns
- change position slowly
- turn whole body, not just head
- don’t walk alone
Hearing Loss
class: conductive, sensorineural or mixed. hearing deficit can be partial or total, congenital or acquired. one or both ears.
Conductive Hearing Loss
anything that affecrs sound transmission from external opening of ear to inner ear.
(i.e.) obstruction of ear canal (cerumen, perf eardrum, damage to ossicles in mid ear, fluid, scarring, tumors of mid ear.
Sound Amplification devices are effective (hearing aids)
Sensorineural Hearing Loss
- affect inner ear or auditory pathways of brain
- affects ability to hear hi-freq sounds and understanding of consonants (t,p or s)
Hearing Aid may not be effective
CAUSE:
- Trauma
- infection
- disease (Menier’s)
- ototoxic meds (asa, Lasix, vancomycin, streptomycin, aminoglycoside abx, antimalarial, chemo)
- renatoal exp to rubella
- noise (most comm in US)
Presbycusis
- progressive hearing loss d/t aging, hair cells of cochlea degenerate
- sensorineural
SS:
loss of hi pitch, conversation
Hearing Aids useful
Talking louder DOES NOT help
Rinne/Weber Tests
to determine whether hearing loss is conductive or sensory
RINNE Test
tuning fork on mast bone, wen stop hearing sound, put to ear. If you still hear it, air conduction is better than bone conduction
WEBER Tests
Tuning fork on top of head. Should hear equally in both ears.
Amplification
.
Hearing Aids
devices that amplify sounds making it easier for clients to hear. Rx only IN EAR -discreet, head dexterity OVER EAR louder, easier to handle POCKET TALKER cheaper, no Rx MICROPHONE/AMP for profound hearing loss
Hearing Loss: NI
- wear hearing aids
- cleon our cerumen
- DEC background noise when speaking to pt
