unit 3 test

Macular degeneration

Deterioration of this area through waste buildup or blood vessel leakage results in central blindness

AMD-age related macular degeneration

occurs bc of waste build up called drusen bc of old age

leading cause of irreversible blindness in those over 65

Dry AMD versus Wet AMD

Dry is gradual, outer retina,accumulated drusen, and most common.

Wet AMD is sudden and severe, triggered by abnormal blood vessel growth under the retina and leaks fluid and blood

Metamorphopsia

straight lines appearing wavy or distorted: key symptom

Risk factors modifiable versus non modifiable macular degeneration

Modifiable-smoking,hypertension,high cholesterol,obesity

non modifiable-age,family history(2x risk), light skin/eye pigmentation

Other epidemiology for macular degeneration

affects 2m americans

more prevalent in white than black people

linked genetically to alterations in cholesterol metabolism and chromosomal reactions

direct association with atherosclerotic conditions,cardiovascular disease, and renal disease

Clinical presentations and diagnostics for macular degeneration

Dry AMD graduate blurring, diminished central vision, difficulty reading in low light

Wet AMD sudden appearance of blind spots or profound distortion

Diagnostic tools= Opthalmoscopy/fundoscopy- dilated exam to visualize drusen or bleeding

Flurorescin angiography-Dye study to identify retinal blood flow and leakage

Amsler grid- A tool used to detect and monitor central vision distortion

Subjective data macular degeneration

Reports of wavy lines, dark spots, difficulty recognizing faces, blurriness while reading, CENTRAL (it was in all caps lol) vision loss

Objective data macular degeneration

Visual acuity- use the snellen chart

Amsler grid- test each eye individually for distortion

Psychosocial assessment macular degeneration

Monitor for signs of anxiety and depression resulting from loss of independence and driving privileges.

Role of nurse: safety and mobility macular degeneration

Visual impairment significantly increases risks of falls and hip fractures

Home safety mods: remove rugs and floor clutter, install grab bars and handrails, ensure brought overhead lighting, color code med labels

AMD patients need more lights

Independence they need to be referred to occupational therapy for low vision and rehab

Health promotion and treatment macular degeneration

PREVENTION IS KEY- also was in all caps

Lifestyle- smoking cessation is the numba one modifiable intervention

Nutrition-med. diet- leafy greens, fish for omega 3s,and antioxidants

AREDS2 supplements-zinc,lutein,zeaxanthin,vitamin c/e

Med management- anti VEGF injections (ranibizumab) injected into the vitreous to stop wet AMD leakage

photodynamic therapy- laser treatment to eliminate abnormal vessels

Cataracts Patho

When proteins in the lens clump together due to age,trauma,the lens gets cloudy and scatters light before it gets to the retina.

Protein and fibers cause the lens to become denser, thicker, and less transparent.

Cataracts risk factors

Primary-Advanced age; over 65

Medical-DM,HTN,and obesity

Lifestyle/environment- Alcohol use, and overexposure, to UV/sunlight

Secondary-Long term steroid use, previous eye trauma, or prior eye surgeries

Cataracts Clinical presentation and diagnosis

Slow growing and painless, like looking through a foggy window

Subjective- Hazy or blurred vision often mistaken for dirty glasses, difficulty driving at night, faded or yellowed color perception

Objective-pacification of the lens

Diagnostic studies; Visual acuity- snellen chart assessment, opthalmoscopy- visualizing the lens with dilated pupils

Cataracts treatment and therapies

When cataracts interfere with ADLS the only effective treatment is surgery

Procedure- The cloudy lens us broken up with ultrasound and suctioned out-spooky af

Restoration- An artificial lens (IOL) is implanted to restore vison

Nursing preop priorities are verify medical history like bacteria and viral illnesses, med audit that identifies anticoagulants or antiplatelets and report these to surgeon and administer dilating my drastic and numbing eye drops

Cataracts Post op care and patient education

Preventing Increased intraocular pressure-avoid bending at waist, lifting over 10 pounds,sneezing,coughing, or straining

Infection prevention, no water in the eye or shower for one week, no rubbing or touching the eye

Med compliance, use of prescribed antibiotic and steroid drops several times a day.

Health promotion, wear dark UV protected sunglasses and wide brimmed hats outdoors,nutrition diet high in vitamin c and e,and antioxidants found in leafy greens

red flags notify provider for sudden pain, purple T drainage, floaters or sudden vision loss

Glaucoma patho

If the drain is blocked or too much fluid is produced intraocular pressure rises and damages the optic nerve.

Its a progressive optic neuropathy characterized by the degeneration of retinal ganglion cells typically due to elevated intraocular pressure

Aqueous humor is either overproduced or cannot drain properly through the trabecular meshwork. This pressure damages the optic nerve , leading to irreversible blindness

Primary open angle glaucoma POAG

Most common

Develops slowly and painlessly

The drainage angle is open but inefficient

Symptom= gradual loss of peripheral vision ( tunnel vision)

Angle closure glaucoma ACG

Medical emergency

Sudden blockage of the drainage angle causes a rapid spike in IOP

Symptoms=Severe eye pain, headache,nausea,and halos around lights

Risk factors Glaucoma

Over the age of 60

Significantly higher risks in black and Hispanic populations

Comorbidities:DM,HTN,CVD

POAG- Often asymptomatic until peripheral vision is gone

ACG-Red eye,mid dilated non reactive pupil, and extreme pain

Glaucoma diagnostics

Tonometry- Meausres IOP

Perimetetry-Visual field testing to map peripheral loss

Opthalmoscopy-Visualizing optic disc

Glaucoma treatment and therapies

Lifelong and focused on lower IOP by either decreasing fluid production or increasing drainage

Meds: Beta blockers-Timolol- decrease fluid production. Nurse alert-can cause Brady and bronchospasm; monitor vitals

Prostaglandin analogs-Latanoprost-Increase drainage, side effect may permanently darken eye color or thicken lashes

Alpha agonists-Brimonidine-Dual action that decreases production and increases drainage.

I didn’t add nursing skill for eye drop;felt it was self explanatory if you want it tho its on slide 22 of sensory perception PowerPoint.

Treatment and therapies continued for Glaucoma

Surgical options=Laser trabeculoplasty uses lasers to tighten the meshwork and improve flow

Trabeculectomy- Creates drainage flap to bypass the blocked meshwork

Post op nursing care-IOP control- avoid bending, lifting ten pounds, coughing or straining

Infection control-Use protective shield at night over eyes ad avoid water in eyes

Education-Glaucoma is a chronic condition

Surgery and drops only control pressure, they do not cure the disease.

Retinal detachment Patho

If the retina pulls away from the blood supply of the choroid layer it is deprived of oxygen and becomes ischemic

Often by age related changes where the vitreous humor liquifies and collapses pulling the retina with i

Retinal detachment risk factors

Advanced age -60-80

Previous cataract surgery

Severe nearsightedness

Trauma

High incidence in contact sports age 25-45

Systemic;DM and HTN

Retinal detachment clinical presentation

Sudden onset photopsia(flashes of light)

A sensation of a shadow or curtain being pulled across field of vision

Painless but requires immediate surgical intervention to prevent permanent blindness

Visual Field Test: Used to identify loss of peripheral vision

• IOP: Pressure is typically low (<10

mmHg) because fluid drains out

Treatment and therapy detached retina

Surgical Procedures:

• Scleral Buckling: A silicone band is sewn to the sclera to

indent the eye wall, pushing it back against the retina

• Pneumatic Retinopexy: An absorbable gas bubble is injected to press the retina back into place

• Crucial Post-Operative Nursing Education:

• Positioning: If a gas bubble is used, the client must lie face-down (prone) for up to 3 months to keep the bubble against the retina

• Restrictions: No vigorous exercise or lifting for 3 months; no driving for 2 weeks

• Protection: Wear a protective eye shield at night; wear sunglasses outdoors

• Red Flags: Report sudden pain, new floaters, or purulent

Hearing loss patho

Hearing loss is categorized by where the "break" in the communication

chain occurs

• Conductive (External/Middle Ear): Sound is blocked before reaching

the inner ear

• Causes: Impacted cerumen, fluid (allergies/infection), or a ruptured eardrum

• Note: Often treatable and reversible

• Sensorineural (Inner Ear): Permanent damage to cochlear hair cells or

the auditory nerve

• Causes: Presbycusis (age-related), loud noise exposure, or Ototoxic drugs

• Mixed: A combination of both, often seen in head trauma or chronic

infections

Hearing Lo

Risk factors and ototoxixity

Non-Modifiable: Age (>60), genetics, and male gender

• Modifiable: Smoking, obesity, and loud noise exposure (occupational

or recreational)

• Comorbidities: Diabetes and Cardiovascular disease

(hypertension/cholesterol) reduce blood supply to the delicate ear

structures

• Ototoxic Medications:

• Diuretics: Furosemide

• Antibiotics: Gentamicin

• Chemotherapy: Cisplatin

• NSAIDs: Aspirin and Ibuprofen (often linked to tinnitus)

Tinnitus

Tinnitus is the perception of sound (ringing, roaring, clicking) without

an external source.

• Subjective: Only the patient hears it. Linked to hair cell damage or

metabolic disorders. Most common

• Objective: The provider can actually hear it (often pulsatile). Linked to

vascular disorders like aneurysms or muscle spasms

• The Pathophysiology: Disruption in the auditory pathway leads to

"suppressed neural feedback," causing the brain to create

misperceptions of noise

• Psychosocial Impact: High correlation with anxiety, depression, and

sleep deprivation

Nursing assessment and screening for hearing loss

Screening Tests:

• Whispered Voice Test: Stand behind the client; they should repeat 4/6

words

• Finger Rub Test: Rub fingers 6 inches from the ear; detect 4/6 times

• Otoscopic Exam: Check for cerumen impaction or foreign bodies

• Asking about hearing difficulty

• Diagnostics: Audiometry (objective threshold testing) and CT/MRI

(to rule out tumors or vascular causes for tinnitus

Nursing interventions hearing loss

Effective communication is the priority for patients with auditory

deficits.

• Environment: Turn off background noise (TV/Radio) and ensure a well-

lit room.

• Face the patient directly (allow for lip reading).

• Do not shout (shouting can distort sound for those with sensorineural loss).

• Use erasable whiteboards or picture boards if needed.

• Assistive Devices:

• Alerting Devices: Visual indicators (flashing lights) for doorbells and smoke

alarms.

• Amplifiers: Specialized telephone and TV headsets.

Management of hearing aids

Nurses are often responsible for the care and "troubleshooting" of

these devices

• Proper Care (Do’s):

• Remove cerumen/debris regularly

• Keep them in a case when not in use

• Check batteries frequently

• Common Pitfalls (Don’ts):

• Do not get them wet (remove before showering/swimming)

• Do not sleep with them in

• Do not use hairspray while wearing them (clogs the microphone)

Cochlear implants

Indicated for severe sensorineural

loss where hearing aids are no longer effective

• Surgically implanted electrodes bypass damaged hair cells to stimulate the auditory nerve directly

• Post-Operative Care:

• Safety: Lie on the unaffected side;

keep the surgical site dry for 1 week

• IOP/ICP Control: Avoid straining, coughing, or bending. Sneezing should be done with the mouth open

• Positioning: Semi-Fowler’s with the

operative ear upward

Tinnitus management and safety

Because there is often no "cure" for tinnitus, nursing care focuses

on desensitization.

• Acoustic Therapy: Use of white noise (fans, sound generators) to

mask the tinnitus.

• Tinnitus Retraining Therapy: Combining counseling with sound

therapy to "teach" the brain to ignore the signal.

• Safety & Falls: Auditory straining causes fatigue, which increases

fall risk. Tinnitus also impairs concentration and balance.

• Lifestyle Education: Decrease intake of caffeine, nicotine,

alcohol, and sodium, all of which can exacerbate the "ringing."

Menieres Disease patho

Progressive inner ear disorder caused by

an excessive buildup of fluid in the

compartments of the inner ear

• Disrupts sensory cells for hearing and

balance

• Membranes in cochlea or semicircular

canals can rupture

Meniere clinical presentation

Episodes of Meniere’s often occur without

warning and can be completely

incapacitating

• Acute Manifestations:

• Severe nausea and vomiting (secondary to vertigo)

• A sensation of pressure or "congestion" in the ear

• Diaphoresis (cold sweats) and trembling

• Nystagmus (uncontrolled eye movements)

• Psychosocial Impact: anxiety and fear

regarding driving, working, or leaving the

house

• Considerations for Aging Adults: High risk

for falls and hip fractures due to sudden

imbalance

Meniere’s Disea

Meniere diagnostics studies and assessment

Key Diagnostics:

• Audiometry: Confirms low-tone hearing loss.

• Electronystagmography (ENG): Evaluates eye movements to determine

if balance issues are inner-ear or brain-related.

• Electrocochleography (ECog): Measures the actual fluid pressure within

the inner ear.

• Nursing Assessment:

• Assess for "Drop Attacks" (sudden falls without loss of consciousness).

• Monitor the frequency and duration of vertigo episodes.

• Check for nystagmus and unsteady gait during an active flare.

Nursing interventions and safety Meniere

Acute management:

• Place the patient in a quiet, darkened room

• Maintain bedrest and instruct the patient to avoid head movements

• Implement fall precautions

• Pharmacology:

• Motion Sickness Meds: Meclizine or Diazepam (Valium) to settle the

vestibular system

• Antiemetics: Promethazine or Ondansetron for nausea

• Maintenance: Diuretics (Hydrochlorothiazide/Spironolactone) to reduce

overall fluid volume in the endolymphatic sac

Client education Meniere

Long-term management centers on controlling fluid retention and

triggers

• Sodium: Limit to 1,000–2,000 mg daily (prevents fluid shifts)

• Limit caffeine, nicotine, alcohol, and high-sugar foods

• Stress Management: Stress is a major trigger for exacerbations.

Recommend meditation, relaxation breathing, and adequate sleep

• Safety at Home:

• Remove area rugs and clutter

• Install grab bars

• Identify "aura" or warning signs (like increased ear pressure) so the

patient can sit or lie down before vertigo starts

Meniere’s Diseas