Chapter 40 Nursing Care of Clients with Eye and Ear Disorders Fall
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Transcript Chapter 40 Nursing Care of Clients with Eye and Ear Disorders Fall
Nursing Care of Clients with
Eye and Ear Disorders
Chapter 40
Physical Assessment of Eye and
Vision
Snellen chart or E chart for testing visional
acuity
Cardinal fields
20 feet
test for extraocular eye movements
Cover-uncover test
test for stabisms
Physical Assessment of Ear and
Hearing
Hearing
Weber test
Rinne test
Whisper test
Eye Disorders
Age Related Vision Changes
flatting of the cornea
pupillary constriction
decrease in lens elasticity
loss of sensory cells
Physical changes
inversion, eversion of lid, decreased tear
secretion, “hollowed-eyed”
Conjunctivitis-red, pain, itchy,
sticky drainage
Eye Disorders
Inflammatory Disorders
conjunctivitis
inflammation of the conjunctiva
bacterial or viral
Treatment
topical anti-infectives
anti-inflammatories
Eye Disorders
Corneal Infections/Inflammations
corneal scarring and ulcerations are a major
cause of world-wide blindness
Treatment
Corneal Transplant
The Client with Eye Trauma
Corneal Abrasion
Burns
Penetrating Trauma
Blunt Trauma
Treatment
topical anesthesia
facial X-rays or C-T Scans
The Client with Eye Trauma
Foreign body removal
Eye irrigation
sterile saline irrigation
chemical burn
Surgery
penetrating wound
The Client with Cataracts
Cataract
a clouding of the lens of the eye
interferes with light transmission and the
ability to perceive images clearly
Significant cause of visional problems in the
elderly (50-70%)
Senile Cataracts
normal aging process
The Client with Cataracts
Treatment
Surgical removal of cataract and lens
Implantation of intraocular lens
Post-operative Nursing Care
assessment
eye patch
semi-folwer’s
Post-operative Nursing Care
Avoid coughing, sneezing straining
these increase intraocular pressure
Assess for post-op pain
Assess for surgical complications
Approach from unaffected side
Teach Home Care
meds., symptoms to report, photophobia
Glaucoma
Characterized by increased intraocular
pressure and gradual loss of vision
“Silent” thief of vision
Narrowing of visual fields
2 Types
Open Angle and Closed Angle
Glaucoma - inner eye pressure
Glaucoma
Open Angle
common (90%)
>35yrs, genetic link, African-American
Pathophysiology
impaired aqueous outflow
increased intraocular pressure
usually bilateral
Glaucoma
Clinical Manifestations
none
frequent lens changes in glasses
impaired night vision
halos
reduction of vision field, become narrow
increased intraocular pressure (tonometry)
Glaucoma
Treatment
miotics - pilocarpine
Laser Surgery (trabeculoplasty)
cause scar tissue to create tension to stretch
opening to drain aqueous fluid
Glaucoma Stage 4
Diabetic Retinopathy
Leading cause of new
blindness between ages of
20-74
84% of diabetics will
develop some form
depends of length of
time you have diabetes
Vascular disorder that
affects the retina
capillaries become
sclerotic
Diabetic Retinopathy
Management
Yearly ophthalmologic exams
Laser photocoagulation
Focus is educational
vision changes -blurred
black spots (Floaters)
flashing lights
sudden loss of vision
Diabetic Retinopathy - vision
Ear Disorders
External Otitis
swimmers ear
pseudomonas, bacteria, fungus or trauma
Treatment
cleansing
antibiotics - local and systemic
education
Ear Disorders
Otitis Media
inflammation of middle ear
common in infants and young children
Red bulging tympanic membrane
Treatment
antibiotics
myringotomy
Ear Infection check up
Inner Ear Disorders
Meniere’s Disease
chronic
recurrent attack of vertigo with tinnitus
progressive hearing loss
Treatment
antivert
The Client with Hearing Loss
Affects 24% of older adults
Affects 39% of those over age 75
2 Types
Conductive
disruption transmission of sound
obstructions - cerum, scarring, tumors
Sensorineural
inner ear, auditory nerve or pathways
The Client with Hearing Loss
Treatment
Amplification
hearing aids
Surgery
reconstruct the middle ear - tympanoplasty
cochlear implant
Nursing Care
Sensory/Perceptual Alteration: Auditory,
Impaired communication, Social isolation
What are your interventions?
What kind of pt. teaching will
you provide?
What’s your post-op nursing care?
What is happening here?
What about this vision