Transcript Eye disorders

Concept: Sensory Perception
Exemplars
Revised July 2015
EYE DISORDERS
Reduced Vision
 Visual acuity of 20/200 or less with corrective lenses
= legal blindness
 Reduced visual acuity may be in one or both eyes
Causes of Reduced Vision
 Refractory errors
 Cataracts*
 Glaucoma*
 Diabetic retinopathy
 Macular degeneration*
 Eye infection
 Eye injury*
 Tumors
Signs and Symptoms of
Reduced Vision
 Frequent headaches
 Reports of blurred or double vision
 Closes one eye to read
 Trips over or bumps into furniture
 Poor depth perception
 Inability to discriminate between
similar colors/ shapes
 No PERRLA
Reduced Vision
 Interventions include:
 Communication regarding use of adaptive items
 Safety in familiar settings
 Ambulation assisted with care
 Self-care and independence promoted
 Support for the difficulty of adapting
to loss of sight
Interventions to Maintain Safety with
Reduced Vision
 Increase amount of light without glare
 Utilize bright colors
 Remove hazards
 Throw rugs
 Electric cords
 Coffee table
 Clear path to bathroom
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Orient to surroundings
Interventions to Assist in
Adapting to Reduced Vision
 Large print books and handouts
 Audio books
 Magnifying glass
 Talking devices (alarm clocks)
 Large key pad phone
 Hand held call bell
 Orient to food location on tray
 Color coded or raised label med bottles
Communicating with the
Visually Impaired
 Use normal voice tones
 Knock, introduce self
 Describe the environment
 Don’t move anything
without permission
 Announce your movements
 Read for the patient
 Therapeutic communication
Ambulating with the
Visually Impaired
 Offer arm
 Hold elbow in close
 Cane or laser
Community Resources
 National Federation for the Blind
 Chicago Lighthouse for the Blind
 American Foundation for the Blind
 Blind/ Visual Impairments website
 Blindness Resource Center
 AER Online
 Association of Education and Rehabilitation for the Visually
Impaired
Cataracts
Cataracts
 Clouding and blurring of the lens distort the
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image and color projected onto the retina.
As cataract matures, opacity makes it
difficult to see the retina.
Visual acuity is reduced.
No pain or eye redness is associated with
age-related cataracts.
One or both eyes
Vision with Cataracts
Vision with Cataracts
Cataract
Risk Factors
 Aging
 Heredity
 Eye trauma
 Diabetes mellitus
 Chronic steroid use
 Sun exposure
 Cigarrete smoking
Cataract Treatment
 Ambulatory surgery
 Pre-op teaching
 Local anesthesia, sedative
 Home 1 hour after surgery
 Multiple eye drops
TID x 2-4 weeks
 Eye assessment
Cataract Surgery
Cataract: Postoperative Care
 Eye is unpatched (usually).
 Eye shield.
 Discharge usually occurs within 1 hr with
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dark glasses.
Instill antibiotic-steroid eye drops.
Mild itching is normal.
Pain indicates a complication.
Reduce IOP (usually ordered).
Prevent infection.
Assess for bleeding.
Cataract Surgery
Discharge Teaching
 Report to surgeon—sharp, sudden pain in
the eye, bleeding or yellow or green
discharge, lid swelling, decreased vision, or
flashes of light or floating shapes.
 Avoid activities that might increase IOP.
 Review procedure for use of eye drops.
 Follow up appointment with surgeon,
usually in 48 hours.
Activities that Increase IOP
 Bending over
 Lifting objects over 10 lb.
 Coughing, sneezing, blowing nose
 Constipation, straining
 Vomiting
 Sexual intercourse
 Tight collars
Glaucoma
 Decrease fluid drainage or increased fluid
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production
Group of ocular diseases resulting in
increased IOP
Disturbance of the optic nerve
Primary open-angle glaucoma
Angle-closure glaucoma
Glaucoma
Risk Factors for Glaucoma
 Aging
 Heredity
 African American race
 Diabetes mellitus
 Infection
 Tumors
Primary Open Angle Glaucoma
Clinical Manifestations
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Generally no symptoms
Elevated IOP (> 21 mm Hg)
Loss of peripheral vision
Decreased accommodation
Usually affects both eyes
Untreated = blindness
Vision with Glaucoma
Diagnostic Tests
 Tonometry
 Measures IOP (normal 10-21 mm Hg)
 Gonioscopy
 Determines the drainage angle
of the anterior chamber of the eye
Opthalmoscopy
Visual Field Perimetry
Optic Disc Photographs
Optic Nerve Imaging
Used at regular intervals to assess for
loss of optic nerve fibers
Tonometry
Glaucoma Drug Therapy
 Reduce production or increase absorption of
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aqueous humor
Prostaglandin analogs
Alpha-adrenergic agonists
Beta- blockers
Cholinergic agonists
(miotics: constrict the pupil
Carbonic anhydrase inhibitors
Patient Teaching:
Administration of Eye Drops
 Don’t skip doses
 If more than one medication,
wait 5-15 minutes between doses
 Punctal occlusion
Glaucoma Surgical Treatment
Glaucoma Surgery
 Laser or conventional
 Ambulatory surgery
 Post operative care
 IOP checked by surgeon 1-2hr
 Eye patch or shield
 Position on back or non-operative side
 Monitor for severe pain, N/V
 Eliminate activities that increase IOP
Glaucoma Surgery
S&S Postoperative Complications
 Acute eye pain
 Decreased vision
 Vital sign changes
 Nausea and vomiting
Retinal Disorders
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Macular degeneration*
Retinal hole
Retinal tear
Retinal detachment
Diabetic retinopathy
Macular Degeneration
Risk Factors
 Aging
 Hypertension
 Smoking
 Family history
 UV light exposure
 Light colored eyes
Macular Degeneration
 The macula—the area of central vision—
deteriorates.
 Degeneration can be atrophic age-related
(dry) or exudative (wet).
 Rod and cone photoreceptors
die.
 Central vision declines;
patient reports mild blurring,
distortion or a blind spot.
Vision with Macular Degeneration
Macular Degeneration
Treatment
 Control of underlying causes (smoking, HTN)
 Vitamins (C, E, beta carotene, zinc and others)
 Statins
 Pegaptanib (Macugen) eye injections
 Laser surgery
Eye Injury/ Trauma
 Eye trauma- the leading cause of blindness in
children and young adults.
Treatment of Eye Injuries
 Splash injuries- irrigate
 Foreign bodies- cover and seek treatment
EAR DISORDERS
Hearing Loss
 One of the most common physical handicaps in
North America.
 2 Types
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Conductive
Sensorineural
Anatomy of Hearing Loss
Causes of Conductive Hearing Loss
 Inflammatory process
 Tympanic membrane perforation
 Obstruction of the external or middle ear by
cerumen or foreign objects
 Otosclerosis
Causes of Sensorineural Hearing Loss
 Loud noises
 Aging
 Ototoxic drugs:
 Antibiotics (gentamycin, amikacin, vancomycin)
 Diuretics (furosemide)
 NSAIDS (aspirin)
 Chemo (cisplatin)
Causes of Sensorineural Hearing Loss
 Meniere’s
Disease
 Other diseases: Atherosclerosis, HTN, fever, DM
 Ear Surgery
 Acoustic Neuroma
Treatment of Hearing Loss
 Early detection
 Drug therapy
 Assistive devices:
 Hearing aids
 Cochlear implants
Tips for Hearing Aids
 Start at the lowest setting and gradually increase
 Wear for short periods in beginning
 Amplifies all noise, background noise
 Clean earmold
regularly
 Turn off and remove
battery when not in use
 Carry extra batteries
Cochlear Implant
 Used with sensorineural
hearing loss
 Electrodes near inner ear
 Computer device external ear
 50% hearing improvement
Cochlear Implant
Communicating with the Hearing Impaired
 Be sure they can see your lips during conversation
 Use good lighting
 Get the patient’s attention
prior to speaking.
 Move closer to hearing ear
 Speak clearly and slowly
 Don’t shout
 Minimize distracting noises
Community Resources
 ADARA
 American Deafness and Rehabilitation Association
o
RID
o
Registry of Interpreters for the Deaf
o Soft
TTY
o [email protected]
o
NAD
oNational Association for the Deaf
Other Sensory Disorders:
PERIPHERAL NEUROPATHIES
Peripheral Neuropathies
 Risk factors: Diabetes, impaired perfusion, smoking
 Decreased tactile sense
 Increased risk for burns, foot injury, falls.