Eye and Ear Disorders Flashcards

Introduction to Eye and Hearing Disorders

• The course covers materials related to Eye and Ear Disorders across three key chapters:
  • Chapter 58: Review of Vision and Hearing Introduction.
  • Chapter 59: Eye and Vision Disorders.
  • Chapter 60: Ear and Hearing Disorders.

Common Eye Infections: Blepharitis, Hordeolum, and Chalazion

• Blepharitis:
  • Characterized by crusted eyelashes and blocked meibomian glands.
• Hordeolum (Stye):
  • Definition: An infection occurring at the edge of the eyelid.
  • Trigger: Triggered specifically by an infection.
  • Signs and Symptoms: Marked by pain, tearing, and sensitivity to light.
  • Treatment: Treated with antibiotics and Over-The-Counter (OTC) solutions.
• Chalazion:
  • Definition: A blocked oil gland on the edge of the eyelid.
  • Cause: A blocked oil gland.
  • Signs and Symptoms: Defined by swelling, blurry vision, and the presence of a hard bump.
  • Treatment/Resolution: Resolved by warm compresses, surgery, or steroid shots.
• General Signs and Symptoms for Infections:
  • Redness.
  • Tenderness.
  • Swelling.
  • Pain.
• Diagnosis:
  • Physical examination.
  • Diagnostic tests, including visual acuity tests (Snellen chart distances include $200$, $100$, $70$, $50$, $40$, $30$, $25$, $20$, and $15$ feet).
• Treatment Protocol:
  • Application of a warm compress.
  • Use of topical antibiotics.
  • May require Incision and Drainage ($I\&D$).
  • Strict handwashing before and after administering medications.
  • Patient instructions: Do not rub the eye.
  • Warning: Do not use over-the-counter medications without instruction.

Conjunctivitis

• Definition: Inflammation of the conjunctiva.
• Etiology (Causes):
  • Bacterial.
  • Viral.
  • Allergic.
  • Trauma.
  • Chemical injury.
• Signs and Symptoms:
  • Redness.
  • Pain.
  • Swelling.
  • Tearing.
  • Purulent discharge.
  • Itching.
• Diagnosis and Treatment:
  • Clinical exam.
  • Culture and Sensitivity ($C\&S$).
  • Antibiotics (Topical).
  • Warm compress.
  • Contraindication: No cold compresses should be used.
  • Sterile irrigations.
• Nursing Interventions:
  • Instruct the patient not to touch the affected eye.
  • Frequent hand washing.
  • Isolation procedures.

Refractive Errors

• Definition: Light does not focus directly on the retina.
• Myopia (Nearsightedness):
  • Symptom: The patient cannot see far away.
  • Physiology: Due to an elongated eyeball, the focus of the image is in front of the retina.
• Hyperopia (Farsightedness):
  • Symptom: The patient cannot see close up.
  • Physiology: Due to a short eyeball, the focus falls behind the retina.
• Astigmatism:
  • Irregularity in the curve of the cornea or lens, leading to multiple focal points rather than a single point on the retina.
• Presbyopia:
  • Definition: Age-related decrease in accommodation.
  • Physiology: The lens hardens with age and is unable to change shape or thicken to focus on near objects.
  • Corrections: Managed with eyeglasses or contact lenses.

Cataracts

• Definition: A clouding or an opacity of the lens of the eye.
• Risk Factors:
  • Exposure to UV light or radiation.
  • Steroid use.
  • Congenital factors: Example: A mother infected with measles during pregnancy.
  • Heredity.
  • Injury to the lens.
  • Secondary to other diseases.
• Signs and Symptoms:
  • Distorted, blurred, or hazy vision (described as looking through a fog).
  • Halos around lights.
  • Difficulty reading.
  • Painless progression.
  • Gradual vision loss.
• Diagnosis and Treatment:
  • Eye examination.
  • Surgical removal of the lens.
  • Post-surgery requirements: Glasses or an Intra-ocular lens implant.
  • Procedure: Frequently performed as same-day surgery under local anesthetic.
• Preoperative Care:
  • Obtain consent.
  • Patient status: $NPO$ (Nothing by mouth) or clear liquids.
  • Sedation.
  • Antibiotics.
  • Mydriatics (medications used to dilate the pupil).
• Post-operative Care and Nursing Education:
  • Primary Goal: To prevent hemorrhage.
  • Instruct the patient not to bend forward.
  • No lifting of weights greater than \text{#}5 (five pounds).
  • No sudden movements.
  • Avoid straining (e.g., during bowel movements).
  • Do not rub the eye.
  • Do not sleep on the affected side.
  • Report pain, discharge, increased redness, or swelling immediately.
  • Teach the proper application of eye medications.
  • Vision improvement will eventually require new glasses.

Glaucoma

• Definition: A condition characterized by increased intra-ocular eye pressure ($IOP$) in the anterior chamber of the eye.
• Epidemiology:
  • The most common cause of blindness.
  • Usually occurs after age $40$.
  • More common in African Americans.
• Types of Glaucoma:
  • Congenital: Present at birth.
  • Primary Open-Angle (Chronic): The more common type.
  • Primary Closed-Angle (Acute): A medical emergency; may lead to blindness in $1-2$ days.
  • Secondary: Due to trauma, tumor, hemorrhage, or inflammation.
• Signs and Symptoms:
  • Severe pain in and around (periorbital) the eye.
  • Blurred or cloudy vision.
  • Halos.
  • Eyes may appear red.
  • Cornea may appear "steamy."
  • Tunnel vision.
  • Nausea and Vomiting ($N/V$).
• Diagnosis:
  • History and Physical examination ($H\&P$).
  • Tonometer: Used to measure increased $IOP$.
• Treatment (Medications):
  • Miotics: Medications that constrict the pupil.
  • Prostalgandins: Example: Xalatan ($latanoprost$).
  • Mechanism: Increase drainage through the Canal of Schlemm and trabecular network.
  • Aqueous Humor Production Blockers: Timoptic ($timolol$), Diamox ($acetazolamide$), and Trusopt ($dorzolamide$) act to decrease the production of aqueous humor.
• Acute Closure Glaucoma Management:
  • Analgesics.
  • Bedrest.
  • Surgical interventions: Iridotomy or Trabeculectomy.
  • Contraindication: Atropine and other Mydriatics are strictly contraindicated with glaucoma.

Retinal Detachment

• Definition: A rip or tear in the retina which allows vitreous humor to seep underneath and cause separation from the choroid.
• Etiology:
  • May occur slowly or quickly.
  • Caused by trauma, inflammation, cataract surgery, or aging.
• Signs and Symptoms:
  • Flashes of light.
  • Floaters.
  • Areas of "missing vision."
  • Painless.
• Treatment:
  • Rest and covering of the eye.
  • Sclerosing, Cryosurgery, or Photocoagulation.
  • Scleral Buckle: Use of a silicone band and sutures to reattach the retina.
• Post Treatment Care:
  • No heavy lifting.
  • Prevent head injuries.
  • Limit reading.

Macular Degeneration (MD)

• Definition: Deterioration of the central part of the retina (the macula).
• Epidemiology: The leading cause of blindness for individuals over the age of $55$.
• Function of the Macula and Fovea:
  • Necessary for fine detail including reading, driving, and recognizing faces and colors.
  • $100$ times more sensitive than the peripheral macula.
• Causative Factor Theories:
  • Decreased blood supply and nutrients.
  • Atherosclerosis.
  • Genetics.
  • Race: Caucasians are more likely to be affected.
  • Smoking: Doubles the risk of development.
• Types of Macular Degeneration:
  • Dry MD: Most common ($80-90\%$). Caused by small yellow fatty deposits called Drusen spots. Leads to retinal thinning and slow deterioration of vision.
  • Wet MD: Follows Dry MD. Characterized by abnormal blood vessel growth under the retina. These vessels leak fluid, causing the macula to bulge and creating significant scarring.
• Signs and Symptoms:
  • Progressive loss of central vision.
• Diagnosis:
  • Amsler Grid: Lines appear wavy or some areas may be blank.
  • Decline in visual acuity via Snellen chart.
  • Drusen spots visible on retinal photography.
  • Angiography to show leaking in Wet MD.
  • Abnormal electroretinogram.
• Treatment:
  • Medication: Lucentis ($ranibizumab$ injection).
  • Reduction of risk factors.
  • Protect eyes from UV light.
  • Increased antioxidants.
  • Surgery (Thermal laser surgery) to stop bleeding/leaking by targeting growing vessels.

Ear and Hearing Disorders: Otitis Media and Mastoiditis

• Otitis Media (Middle Ear Infection):
  • Acute type caused by bacteria entering the Eustachian tube.
  • Increased incidence in bottle-fed babies.
• Signs and Symptoms:
  • Fluid in the ear.
  • Inflamed tympanic membrane.
  • Pain.
  • Hearing loss and ear noises.
  • Headache.
  • Nausea and Vomiting ($N/V$).
  • Fever.
• Diagnosis and Treatment:
  • History and Physical exam ($H\&P$).
  • Antibiotic therapy.
  • Heat or cold applications.
• Complications:
  • Rupture of the tympanic membrane, scarring, and hearing loss (Treatment: Tympanoplasty).
  • Mastoiditis.
  • Meningitis.
  • Brain abscess.
  • Chronic or recurring otitis media.
• Surgical Treatments:
  • Myringotomy.
  • Antibiotic drops.
  • Use of earplugs when submerging the head in water.
  • Myringoplasty (Grafting the eardrum).
• Mastoiditis:
  • Definition: Inflammation of the mastoid process (Osteomyelitis).
  • Signs/Symptoms: Pain, tenderness, edema, abscess formation.
  • Diagnosis: $H\&P$, X-ray, Bone scan.
  • Treatment: Antibiotics, Incision and Drainage ($I\&D$), drains.

Otosclerosis

• Definition: Progressive deafness caused by the formation of new bone, which prevents the stapes from transmitting impulses to the inner ear.
• Etiology: Unknown; more common in women.
• Signs and Symptoms:
  • Gradual loss of hearing.
  • Ringing or buzzing in the ears (tinnitus).
• Diagnosis:
  • Audiometer.
  • Tuning fork: Results show bone conduction is better than air conduction.
• Treatment:
  • Hearing aid.
  • Stapedectomy: A prosthetic device replaces the stapes.
    1. Identification of otosclerosis.
    2. Removal of stapes supra-structures.
    3. Creation of a hole in the footplate.
    4. Hanging a prosthesis on the incus to the hole in the footplate (using a wire-fat prosthesis).
• Postoperative Instructions:
  • Slow change of position and head movements.
  • Avoid blowing the nose or sneezing.
  • No smoking.
  • Report vertigo, ear pain, fever, or headache.
  • Avoid crowds to prevent respiratory infections.
  • Do not submerge the head in water for up to $6$ weeks.
  • No flying during the postoperative recovery period.
• Complications of Surgery:
  • Complete deafness.
  • Nerve damage.
  • Infection.
  • Dizziness.
  • Pain or blood clot in the ear.

Meniere’s Disease

• Definition: Inner ear dysfunction.
• Etiology/Triggers:
  • Infection of the inner or middle ear.
  • Allergies.
  • Alcohol use.
  • Stress or anxiety.
  • Side effects of certain medications.
  • Smoking.
• Signs and Symptoms:
  • Vertigo.
  • Nausea and Vomiting ($N/V$).
  • Tinnitus.
  • Hearing loss.
  • Presence of an Aura.
• Diagnosis:
  • History and Physical exam ($H\&P$).
  • Audiogram.
  • Electronystagmography ($ENG$) or rotational testing.
  • Allergy evaluation.
  • Labyrinth function studies.
• Treatment:
  • Symptom control with Antivert ($meclizine$).
  • Safety precautions and bedrest ($BR$).
  • Sedatives or Dramamine.
  • Diet modifications.
  • Labyrinthectomy.
  • Shunt placement to reduce fluid.

Presbycusis and Hearing Aids

• Presbycusis:
  • Definition: Hearing loss related to aging.
  • Characteristic: Inability to hear high-pitched sounds and spoken words.
  • Diagnosis: Hearing evaluation.
  • Treatment: Hearing aids if applicable.
• Hearing Aid Maintenance:
  • Daily cleaning and storage.
  • Turn off when not in use.
  • Keep in a protective case.
  • Keep the battery compartment open when applicable.
• Nursing Interventions for the Hearing Impaired:
  • Know how to operate a patient's hearing aid.
  • Face the patient directly and speak clearly.
  • Observe facial expressions for feedback.
  • Speak into the person’s "good ear" if possible.
  • Ensure the patient wears their glasses (helpful for lip-reading).
  • Keep environmental noise to a minimum.
  • Use a pad and pencil if messages remain unclear.

Snellen Chart Refresher

• $20/200$: Patient sees at $20$ feet what a normal eye sees at $200$ feet.
• $20/20$: Standard for normal vision ($1.00$ ratio).
• The ratios vary from $0.10$ ($20/200$) to $1.33$ ($20/15$).