medsurg--mix mainly eyes

tonometer

instrument used to measure intraocular pressure

what anatomical structure in the ear helps us equalize pressure like while on a plane?

Eustachian tube (from middle ear to nasopharynx)

permits air to enter or leave the middle ear cavity

What part of the eye gives it its color?

iris

acute otitis media

infection of the middle ear usually associated with an upper respiratory infection and is most commonly seen in young children

otosclerosis

hardening of the bony tissue of the middle ear

mastoiditis

inflammation of the mastoid bone

canthus

angle where the upper and lower eyelids meet

myringotomy

incision into the tympanic membrane (performed to release pus or fluid and relieve pressure in the middle ear) (also called tympanocentesis)

furnucle

boil; acute, localized bacterial infection of the hair follicle

Meniere's disease

Abnormal condition within the labyrinth of the inner ear that can lead to a progressive loss of hearing. The symptoms are dizziness or vertigo, hearing loss, and tinnitus (ringing in the ears).

BPPV (benign paroxysmal positional vertigo)

balance disorder when otoliths get out of place and it causes the fluid to be displaced and go the wrong directions

nystagmus

Involuntary rapid eye movements

Rinne test

hearing test using a tuning fork; checks for differences in bone conduction and air conduction

more for conductive hearing loss

Weber test

hearing test using a tuning fork; distinguishes between conductive and sensorineural hearing loss

more for sensorineural

whisper test

A hearing test in which the examiner stands 28-24 inches from one of the patient's ears, has the person block sound in one ear and whispers a random set of 3 numbers and letters (or three non-related words) into the other ear, asking the person to repeat what was heard.

detect for hearing impairment

retinal detachment

two layers of the retina separate from each other

floaters and flashes of light. curtain vision

painless

photopsia

presence of what appears to be flashes of light in eyes

photophobia

sensitivity to light

Is cerumen a normal finding?

yes

what technique is used to test peripheral visual ability?

visual fields

six cardinal fields of gaze

A test to evaluate extraocular muscle function; performed by having the patient visually track an object in six visual fields in an H pattern.

what is the purpose of applying pressure to the eyes after eyedrops have been administered?

to reduce absorption of eyedrops through tear duct

what are indicators of hearing loss?

Reluctance to talk on the phone, irritable with background noise, turning up TV, off the wall answers when asking a question, cupping ear, prefers small groups, leans towards person talking

what is the function of cerumen?

to protect the ear canal; just use a washcloth to clean external ear

hearing aids help what type of hearing loss?

conductive

what eye disorders come from lack of vitamin A?

corneal damage and night blindness

presbycusis

Age-related hearing loss, first to the high frequency sounds, gradually spreading.

so to talk to them use a low frequency voice!!

if a pt has a change in color vision what is impacted?

cones

what are the receptors in the organ of corti?

hair cells for hearing

what is the cranial nerve for hearing?

CN VIII

Romberg's Test

cerebellar function, test for balance

test to assess for vestibular function

if a patient is having a hard time balancing what does it indicate?

an inner ear problem

Snellen chart

used to measure visual acuity

20/200 on Snellen chart

indicates legal blindness

a patient is being tested for visual acuity. What distance from the eyes should the patient hold the visual acuity chart during this testing?

14 inches

when does noise hit a pain threshold?

130 dB

what is it called when a light is shined on the left pupil eye and the right eye pupil constricts

A consensual response occurs when the pupil of one eye constricts when the other eye has a light shined into it

The nurse determines that a patient is experiencing common age-related changes in vision and hearing. What did the nurse assess in the patient? (Select all that apply.)a. Presbycusis b. Yellowing of the lens c. Distorted depth perception d. Decreased lacrimal secretions e. Increased pupil size and response to light f. Loss of ability to hear low-frequency sounds

abcd

what tests are used to evaluate eye muscle balance?

The cover test is used in conjunction with an abnormal corneal light reflex test to evaluate muscle balance.

Normal eye pressure

10-21 mmHg

Glaucoma

increased intraocular pressure results in damage to the retina and optic nerve with loss of vision

Risk factors of glaucoma

age, black race, diabetes, eye trauma, long-term steroid use, IOP, family history, refractive error, vascular disease

Primary open-angle glaucoma (POAG)

peripheral vision is lost gradually, with central visual field loss occuring if damage to the optic nerve continues

--optic nerve damage/loss of fibers--chronic and progress over time

open anterior chamber angle, high IOP, visual field abnormalities, cupping/atrophy of optic disc

Cause of POAG

unknown

increased IOP

improper production and drainage of fluid in the eye

Primary angle-closure glaucoma (PACG)

Also called narrow angle glaucoma; due to the reduction of the outflow of fluid because of angle closure related to pupils; a fast and sudden increase in intraocular pressure

seen in hyperopic over myopic

greater speed of progression and visual morbidity

hyperopia

farsightedness; difficulty seeing close objects when light rays are focused on a point behind the retina

myopia

nearsightedness; difficulty seeing distant objects when light rays are focused on a point in front of the retina

aqueous humor

the clear fluid filling the space in the front of the eyeball between the lens and the cornea

if there's excess production or decreased outflow---> glaucoma

vitreous humor

jellylike substance found behind the lens in the posterior cavity of the eye that maintains its shape

what is the optic nerve number?

cranial nerve 2

visual acuity

Snellen chart

20 feet away from chart

what do the numbers in 20/60 mean?

20 --how far the person is standing or sitting from the chart

60- distance at which a normal eye can read the line

Jaeger chart

a chart for testing near vision

14 in away from eyes normal is 14/14

PERRLA stands for

pupils equal, round, reactive to light and accomodation

color vision tests

use of multicolored charts to determine ability of patient to recognize color

Confrontation visual field testing

Method most often used to test peripheral vision

intraocular pressure testing: tonometry

measures IOP normal is 10-21mmHg

keratometry

Measures the curvature of the cornea. It also determines the focusing power of the cornea.

opthalmoscopy (funduscopy)

procedure used to examine the interior eye structures; may be direct or indirect (magnified view of retina and optic nerve)

pupil function test

determine if pt has normal pupillary response

extra ocular muscle function

What are you testing?

Instruct the patient to follow your finger through the six cardinal fields of gaze; watch for symmetrical movements.

Note presence of lid lag when the patient looks down.

To detect nystagmus, pause during lateral and upward gaze.

what part of the eye does macular generation impact, cataracts, glaucoma, retina?

macula, lens, aqueous humor/optic nerve, retina detach from choroid/vascular layer

macula

round darker area of the ocular fundus that mediates vision only from the central visual field

Cataracts

clouding/opacification of the lens which interferes with light transmission to the retina/disrupt ability to see images clearly

cause of cataracts

• aging process (senile cataracts starting at age 50)

• congenitally acquired/trauma

• injury to lens

• secondary to other eye diseases

• high incident in diabetes or family history

• prolong to rays, radiation, or drugs (steroids)

risk factors for cataracts

smoking, UV rays, poor nutrition, diabetes, alcohol, topical corticosteroids use

can be unilateral/bilateral

one side may be worse than the other

early symptoms of cataracts

blurred vision, faded colors, glare/halos around light, hard time driving at night

late sx of cataracts

diplopia, absence of red reflex, white pupil, decreased vision progressing to blindness if no action is taken

What is the red reflex?

Red pupils when picture is taken.

interventions/treatments for cataracts

corrective lenses, then surgery

most common surgery in those over 65

same day surgery procedure with local anesthetic

what are the steps of the cataract surgery process?

preoperatively: nurse puts anti-inflammatory and dilating and paralyzing drops in

during surgery: lens are replaced with another lens (donor)

after: patch worn overnight and removed next day by doctor during a follow up appt

if something is in your eye what is the first thing you should do?

get help, anything can get sucked into the eye

do you need stitches in your eye?

no, intraocular pressure will seal the eyes

Discharge Teaching for Pt with cataracts:

continue eye appt, continue eye drops (teach and show how to put in), may or may not wear a patch, avoid activities that increase IOP for 1 week (lift/cough/bend/sneeze), cornea may be cloudy, vision almost normal but may need glasses for near vision, report sudden severe eye or brow pain (could be increased IOP or hemorrhage)

primary prevention for cataracts

UV protection/filter and a wide brimmed hat

glaucoma

increased intraocular pressure results in damage to the retina and optic nerve with loss of vision, nerve atrophy and loss of peripheral vision

Glaucoma is the --- leading cause of blindness in US, with more blindness affecting -----

2nd, Blacks

glaucoma is often called the " " why?

silent thief, people are unaware they have it until it is in advanced stage, no early SX

what are the two types of glaucoma?

1. Primary open-angle = chronic

2. Closed angle = acute and painful

primary prevention for glaucoma

screening tests for early detection

reccomended screenings for glaucoma for age groups

40-54 2-4 yr

55-64 1-3 yr

65 and older 1-2 yr

if increased IOP is not treated, can it cause permanent vision loss?

YES

Normal IOP range

10-21 mmHg

What is IOP regulated by

aqueous humor (nourishes cornea/lens by supplying nutrition, maintaining IOP, transports vitamin C)

Primary open-angle glaucoma (POAG) notes

most common type, AH outflow decreased

Primary open-angle glaucoma symptoms

gradual loss of peripheral vision losing to blindness, tunnel vision in the end stage, subtle happens over time pt doesnt realize, painless

POAG interventions

decrease IOP

meds can control but you will need to use for rest of life

laser surgery if meds not effective, or trabeculoplasty/

Primary angle-closure glaucoma (PACG) notes

ocular emergency--can cause blindness (only 10% of cases)

AH flows in but cannot flow out due to lens bulging forward

PACG signs and symptoms

sudden onset, halo vision, blurry severe generalized ocular pain, nausea and vomiting, red eyes, pupil nonreactive

PACG interventions

urgently drop IOP

iridotomy

trabeculoplasty

procedure to treat open-angle glaucoma

cause formation of scar tissue which leads to tension and stretching of meshwork which increases outflow (bigger opening)

iridotomy

incision into the iris creates new opening for AH to flow through

TCAs

tricyclic antidepressants, have sedative effects, good for patients with insomnia; meds with 3 ring (tricyclic) chem structure that keeps norepinephrine and serotonin at nerve terminals and helps electrical impulses to cross synapse

what meds can increase eye angle closure? (POAG)

antihistamines, tricyclic antidepressants

POAG post operatively instructions

analgesics, eye drops, avoid increasing pressure, no driving 1 week, no water in eye, no reading

age-related macular degeneration

condition in which the center of the retina gradually loses its ability to discern fine details; leading cause of irreversible visual impairment in older adults

aging retina allows formation of abnormal accumulation of waste material in retinal pigment---failure of outer layer to remove waste

is family history significant for AMD

yes!

what are the two forms of AMD

dry and wet

Dry AMD (nonexudative)

characterized by yellow deposits of extracellular material in the macula (drusen). Areas of retinal atrophy may lead to vision loss over time. Dry AMD is the most common type of AMD.

90% of cases atrophy of macular cells

Wet AMD (exudative)

progresses more rapidly and is characterized by a proliferation of abnormal blood vessels that leak blood and fluid into the macula

abnormal BV develop near macula, more severe form, 90% of AMD blindness