NUR 207 Intraocular Eye Disorders, Inner Ear Problems

myopia

nearsighted

• Cant see MY own hand

hyperopia

farsighted

astigmatism

imperfect eye curvature

presbyopia

normal loss of accommodation with age

PRESBY- Older age → PRESident

hordeolum

sty

chalazlon

chronic inflammatory granuloma of. sebaceous gland

• warm compress/lancet

blepharitis

chronic bilateral inflammation of a lid margin

• prevent: hand washing, antibiotics with bacterial

conjunctivitis

infection of the conjunctive (pink eye)

• viral/allergic

eye crusted shut → bacteria

keratitis

infection of the cornea

• more SEVERE than rest

aggressive treatment with antibiotics

ex: contact lenses, makeup products, hand hygiene

cataracts

very common in old age

cloudy lens

may be in one or both eyes

can get surgically removed

are visible to the eye.

what cause cataracts

diabetes

certain medications

blunt penetrating trauma to the eye

symptomology of cataracts

gradual vision loss

abnormal color perception

GLARE***** (scattering of light, worse at night when pupils dilate)

after ABC are established

when someone comes in with visual acuity problems, DO A VISUAL ACUITY TEST!!!!!!!!!!

interocular pressure NORMAL

10-21

cycloplegic

paralysis of accommodation and dilation

phacoemulsificaton

most common type of surgery

• vibrations to dissolve clouded lens (small incisions or tears)

post op of cataracts

meds: antibiotic and corticosteroids drops (to prevent inflammation/infection)

• can come off once eye fully healed.

SURGERY ON ONE EYE AT A TIME!

have to have a ride home after procedure (OUTPATIENT)

implementation of cataracts

• no specific preventative measures

• wear sunglasses, avoid unnecessary radiation (tanning beds)

• antioxidant vitamins (C and E); adequate nutrition

pros and cons education.

if increased/intense pain

CONTACT PROVIDER ASAP

• could be a sign of intraocular pressure

• can damage optic nerve

• lead to permanent vision loss/blindness

ambulatory care

most have little visual impairments

review instructions with patient and caregiver

if significant visual impairments, activity and environment modifications (Bending, coughing, bearing down)

use of eye patch: altered depth perception, fall precautions

CRAIG the crusty dog

Color perception abnormal

Reduced vision

Age-related

I need a ride after surgery

Glare

retinopathy

microvascular damage to the retina, blurred vision; progressive loss of vision

Most common with HTN or diabetes mellitus

diabetes retinopathy

can prevent with tight glucose control!

nonproliferative: loss of CENTRAL VISION, most common.

proliferative: advanced disease, severe vision loss,

treatment: laser photocoagulation

hypertensive retinopathy

blockages in retinal blood vessels from hypertension.

treatment: lower BP to restore vision

papylodemia

MEDICAL EMERGENCY → swelling of optic disc and nerve, causes sudden vision loss

retinal detachment

retina detached from where supposed to be. fluid accumulation between layers.

related to trauma

MEDICAL EMERGENCY

breaks, holes (spontaneous), tears (aging or trauma)

********EXPERIENCE COBWEB/HAIRNET in field of vision*******

risk factors for retinal detachment

age

eye trauma

recent cataract surgery

family/personal

severe myopia

manifestations of retinal detachment

photopsia

floaters

COBWEB/HAIRNET in field of vision

UNTREATED: LEAD TO BLINDNESS IN INVOLVED EYE

person comes in with suspected retinal detachment

VISUAL ACUITY TEST

laser photocoagulation

light beam makes inflammatory reaction

helps push retina up against skin behind to reattach.

cryoplexy

freezing → SCAR

freeze, thaw (ON REPEAT) - seals break.hole

scleral buckling

band placed around globe

band around eye to keep it attached

more things around to push scleral toward detached retina

scleral buckles inward

retinal detachment intraocular procedures

pneumatic retinopexy: intravitreal injection of has to form bubble to close retinal break

keep patient in prescribed position.

PATIENT CAN BE AT RISK FOR RETINAL DETACHMENT IN OTHER EYE.

• any symptoms following procedure, needs to be seen ASAP!

retinal detachment postoperative considerations

bedrest/activity restrictions

medications: analgesia and topical

patient education

• promote the use of eyewear to protect from eye damage (trauma)

  • sports/mowing/woodworking

age-related macular degeneration (ARMD)

most common cause of irreversible CENTRAL VISION LOSS

ARMD Dry (nonexudative)

atrophy of macular cells

• more common

• slow, progressive, painless loss of vision

• close vision tasks become harder for them.

ARMD wet (exudative)

more severe, abnormal blood vessels develop in or near macula

• RAPID ONSET OF VISION LOSS; AMD related blindness

more wet had dry first

• catch it dry before it leads to wet

ARMD manifestations

acute vision loss, blurred or darkened vision, scotomas (blind spots), and metamorphopsia (visual distortion)

ARMD test

VISUAL ACUITY TEST

AMSLER GRID

DRUSEN SPOTS

in ARMD

• small, yellow deposits of fatty proteins (lipids) that accumulate under the retina

• BIP LIPS = LIPIDS

use an ophthalmoscope to look for drusen in the fundus

ARMD interprofessional care

medications directly injected every 4-6 weeks into vitreous cavity to stop new vessel formation and slow vision loss.

photodynamic therapy: use dye and laser to damage abnormal blood vessels.

• patient must avoid sunlight and intense light for 5 days.

glaucoma

can be caused by cataracts

NO CURE

catch early → can be fixed (REGULAR EYE EXAMS)

causes PERIPHERAL VISION LOSS

glaucoma pathophysiology

aqueous production (inflow) and aqueous reabsorption (outflow) must be balanced to maintain IOP.

inflow > outflow = increased IOP

increased IOP → permanent loss of vision

primary open-angle glaucoma

outflow of aqueous decreased; drainage channels clogged → optic nerve damage

develops slowly

IOP = 22-32

acute closure glaucoma

reduced outflow from angle closure

sudden, onset

• painful

• pressure leads to nausea and vomiting

• see colored halos around lights

• IOC over 50!!!!

optic nerve starts to atrophy.

focus of glaucoma

decrease IOP to prevent blindness

low enough to prevent optic nerve damage (blindness)

AACG

OCULAR EMERGENCY

immediate intervention

miotics → work to decrease production of fluid in eyes.

Myotic eye drops = pupil constricts and angle to open to allow outflow. USE IV diuretics, glycerin liquid

PATIENT WITH GLAUCOMA + COPD/ASTHMA

-olol beta blockers

can affect patient systematically

do not give if patient has heart block or bradycardia

otits media

infection in middle ear,

seen in children (antibiotics)

severe = ear tubes

presbycusis

TYPE OF SENSORY NEURAL HEARING LOSS

• hearing loss associated with aging

tinitus

ringing in ears.

come along with some hearing loss

medications causing tinitus

monitor patient → relation to ototoxicity

figure out the meds and stop them!

nystagmus

eye shaking

babies/ neuro patients

inner ear

plays a big role in keeping us steady.

pt with inner ear infection → off balance and more prone to falls

Meniere’s Disease

progressive disorder

inner ear

usually affects 1 ear. can affect both

cause: UNKNOWN

Meniere’s disease symptoms

excess fluid and pressure → hearing and balance problems

disability - sudden, severe attacks of vertigo, nausea, vomiting, sweating: unpredictable

prior to attack: fullness in ear, tinnitus, and muffled hearing

some experience feelings of being pulled to the ground (DROP ATTACKS)

last hours, several times/year; variable

what to start with on a susptected pt with Meniere’s disease

HEARING TEST

glycerol test: pull fluid out of inner ear and improve symptoms

medications for Meniere’s disease

NO CURE
treating symptoms

corticosteroids, antihistamines, anticholinergics → draw fluid out, decrease production of fluid

benzodiazepines→ sedatives

vertigo: bed rest, sedation, antiemetics, or antivertigo

surgical interventions Meniere’s disease

between attacks: diuretics, corticosteroids, low-sodium diet, and stress reduction

• decompression (shunting fluid away from inner ear)

• vestibular nerve section (Cut nerve)

• gentamicin injections (go through tympanic membrane, results in inner ear damage → save for severe cases)

Meniere’s disease nursing care

• dark, quiet room

• avoid sudden movements

• close eyes during vertigo

• avoid fluorescent, flickering lights and TV

• emesis basin (to catch vomit)

PRN MEDS

patient safety for Meniere’s disease

fall precautions

montior intake and output

patient education: protect from injury/fall

• NO SWIMMING UNDER WATER

• NO CLIMBING HIGH SURFACES

Conductive hearing loss

external and middle ear

• decrease sound intensity and/or distortion

impair transmission of sound

SOUND IN HEAD = LOUD

hear best in noisy environment

CAUSES:

• infection

• wax in ear

• perforation of ear drum

• narrowing of external canal

HEARING AIDS ARE HELPFUL!!!!!!!!!!!

Sensorineural hearing loss

inner ear

distortion or faintness of sound

alter the ability to understand speech

complete hearing loss

can lead to misunderstanding by others

SOUNDS MUFFLED; DIFFICULT TO UNDERSTAND, ESPECIALLY HIGH-PITCHED SOUNDS

audiogram: loss in decibel levels

HEARING AIDS MAKE SOUNDS LOUDER BUT NOT CLEARER

caused by:

• impairment of the inner ear

• vestibulocochlear nerve (CN VIII) damage

• congenital and hereditary factors

• noise exposure

• aging (presbycusis)

• Meniere’s disease

• Trauma

• ototoxicity

central hearing loss

impaired auditory pathways in the brain

problems understanding the meaning of words heard

conductive hearing loss expectations

audiogram → better hearing through BONE than AIR

patient often speaks softly

identify and treat cause

sensoineural hearing loss ototoxic drugs

aspirin - oral

antibiotics - slow, IV

loop diuretics - LASIX, IV PUSH, be careful. hearing loss

weber test

stem of vibrating tuning fork placed on midline of skull or forehead

pt asked to indicate where sound is best heard

conductive loss in 1 ear: sound will be heard louder in that ear

sensorineural: sound is louder in the normal (unaffected) ear

conductive hearing loss RINNE TEST

bone conduction is longer than air conduction

sensorineural hearing loss RINNE TEST

both air conduction and bone conduction are reduced; AC is longer

hearing loss and deaf patients

ALWAYS GET AN INTERPRETER

use visual aids- need to validate understanding

• irritability and frustration with speech and understanding

• withdrawal, depression, cognitive decline as advances

noise is the

most preventable cause of hearing loss

• limit exposure of loud noises throughout lifespan

cochlear implant

DIRECTLY ADVANCES CN VIII

gerontologic considerations

elderly not wanting to improve as they age.

reluctant to use new technology

diminished ability to understand speech

• cannot differentiate consonants

consonant sounds have HIGHER frequency