unit 1 eyes and ears (med surg 2)

what is the most common visual problem

-refractive errors

^ blurred vision- corrected by classes, contacts nonsurgical or surgical interventions

myopia

-nearsightedness

^can’t see far away

hyperopia

-farsightedness

^can’t see close up

presbyopia

-losing sight due to aging

astigmatism

-irregular corneal curvature

^can’t focus light on retina

hordeolum (sty)

-infection of sebaceous gland in eyelid

chalazion

-chronic inflammation of sebaceous gland in eyelid

blepharitis

-chronic bilateral inflammation of the lid margin (red and scaly)

keratitis

inflammation of cornea

conjunctivitis

-can be bacterial (pink eye): self- limiting- treated with antibiotic drops and hand washing

-viral (palliative, treatment with corticosteroid eye drops)

-chlamydial: spread by hands and flies, treat with antibiotics, can lead to chronic inflammation

keratitis treatment

-bacterial: topical antibiotics

-viral: (caused by herpes simplex or varicella-zoster) treat with antiviral meds, analgesics, and some cases corticosteroids

-fungi: (sometimes form contaminated contact lenses or outdoor eye trauma)

corneal ulcer (extraocular disorder)

-tissue loss related to infection of cornea

-patient may feel like something is stuck in their eye

-tearing, purulent or watery drainage, redness, photophobia

-aggressive treatment with anti-infective eye drops

^may be hourly the first 24 hours to prevent vision loss

-if not treated may need corneal transplant

keratoconjunctivitis

-dry eyes

strabismus

-eyes do not focus together on the same object

^may cause double vision in adults

keratoconus

-thinning of cornea

^may be treated buy cornea replacement

cataracts (intraocular disorder)

-clouding of the eyes natural lenses

-caused by

^age, trauma, long term use of corticosteroids

^DM, hyperthyroidism, down syndrome, chronic sunlight exposure

cataracts risk factors

-advances age

-diabetes

-genetics

-smoking

-eye trauma

-sunlight exposure

-chronic corticosteroid use

cataracts clinical manifestations

-decrease in vision

-glare

-abnormal color perception

cataracts prevention

-sunglasses outdoors

-protective eyewear

-annual eye exams

-good eye health

cataracts surgery steps

-preop: analgesics and dialating meds administered

-intra op: cataracts is extracted and replaced with an intraocular lens

postop: sent home with antibiotics and corticosteroid eye drops

*avoid bending, coughing, and lifting

retinopathy

-microvascular damage to retina

-leads to blurred vision and progressive vision loss

-often related to HTN and DM

retinal detachment

-can result from tears or holes

-clinical manifestations

^breaks: floaters, cobwebs, hairnet or rings

^detachment: pain and loss of vision

age- related macular degeneration

-dry AMD

^most common, close vision tasks progressively become more difficult

^slow progressive painless vision loss due to atrophy of macular cells

^treated with vitamins and mineral supplements

-wet AMD

^more severe with rapid onset

^blurred, disordered and darkened vision with vision field blind spots

^treated with vitamins and mineral supplements may also need laser photocoagulation, photo dynamic therapy, and intavitreous injectable drugs

glaucoma

-increased intaocular pressure, optic nerve atrophy, peripheral visual field loss

-often occurs with advanced age and major cause of permanent blindness

primary open angle glaucoma

-most common type

-clogged drain channels

-develops slowly and is usually unnoticed until peripheral vision in compromised

primary angle-closure glaucoma

-is usually the result of lens bulging forward due to age

glaucoma clinical manifestations

-develops slowly

-tunnel vision

-angle closure: may have sudden excruciating pain in or around the eye

-blurred vision

-seeing halos

-redness

-eye or brow pain

glaucoma diagnostics

-measure IOP: tonometry

-slit lamp microscope: examine the angle and otic disc

glaucoma treatments (chronic open-angle)

-drug therapy

^alpha blocker

^beta blocker

^carbonic anhydrase inhibitors

^miotics

^prostaglandin agonists

-argon laser trabeculoplasty

-trabeculectomy

glaucoma treatments (acute angle closure)

-miotics

-oral and hyperosmotic

-laser peripheral iridectomy

external otitis

-”swimmer’s ear”

-inflammation or infection of epithelium of the auricle and ear canal

acute otitis media

-result of swelling that traps bacteria, causing infection

-more common in children than adults

-treated with antibiotics in infection is present

chronic otitis media

-purulent exudate and inflammation

-is often painless, but can lead to hearing loss, nausea, and dizziness

-treated with antibiotics

meniere’s disease

-results in episodic vertigo, nausea, vomiting, sweating, and pallor

-cause is unknown

benign paroxysmal positional vertigo

-caused by floating debris in circular canal causing vertigo with head movements

-there is no hearing loss and symptoms are intermittent

conductive hearing loss

-impaired transmission of sound through the air of the inner canal

-common cause otitis media with effusion, impacted cerumen, narrowing of external canal

-patients often speak softly because hearing their own voice seems loud

-treated by identifying cause and correcting it

sensorineural hearing loss

-caused by impairment of CN 8

-ability to hear sound but not understand speech

-caused by impairment of inner ear, CN 8 damage, meniere’s disease

-also caused by ototoxic drugs like

^aspirin, NSAIDs, ad certain antibiotics

tinnitus

-ringing in ears or head noise

-sometimes the first symptom of hearing loss

-most common cause is noise but can be a side of effect of certain meds

visual problems (cultural)

-glaucoma is the leading cause of blindness in blacks and hispanics

-hispanics, blacks, and native americans have the highest incidence of diabetic retinopathy

-whites have the highest incidences of AMD

aphakia

-absence of the lens

emergency management (eye injury)

-begin eye irrigation immediately in case of chemical exposure

^do not stop until emergency personnel arrive

-do not put pressure on eye

-tell patient to not blow nose

-do not give patient food or fluids

-elevate head of bed 45 degrees

risk factors of retinal detachment

-age

-AMD

-diabetic retinopathy

-eye surgery

-eye trauma

-family or personal history

-sever myopia

-thinning of the peripheral retina

normal physical assessment of auditory system

-able to hear low whisper at 30 cm

-weber test results: no lateralization

-rinne test results: air conduction> bone conduction

after ear surgery

-avoid air travel and sun exposure for 6 weeks

-if need to cough or sneeze keep mouth open

-blow your nose gently without blocking either nostril

-do not shampoo your hair for 5 days, wear shower cap

-no swimming keep ear dry for 6 weeks

meniere’s disease drug therapy

-anticholinergics

-antihistamines

-antiemetics

-benzo

meniere’s disease nursing management

-keep patient in quiet darkened room

-avoid sudden head movements

-close eyes until vertigo stops

-avoid fluorescent or flickering lights and tv