Title: Care of Patients with Disorders of the Eyes and Ears
1Chapter 27
- Care of Patients with Disorders of the Eyes and
Ears
2Theory Objectives
- Discuss errors of refraction and their treatment.
- Devise nursing care for the patient who is
undergoing a corneal transplant. - Compare measures used to provide assistance after
a chemical eye burn with measures for an eye
injury with a foreign object. - Describe the signs and symptoms of selected
disorders of the eye and appropriate medical
treatment and nursing interventions for each.
3Theory Objectives (cont.)
- Discuss nursing interventions to care for the
patient after a scleral buckle or a cataract
extraction. - Identify aids and resources for people with
vision loss. - Explore the impact of hearing or vision loss on
an individual and family.
4Theory Objectives (cont.)
- List the signs and symptoms of selected disorders
of the ear, appropriate medical or surgical
treatment, and nursing interventions for each. - Teach the patient with tinnitus or vertigo
measures that may decrease the symptoms. - Discuss aids and resources for people with
impaired hearing or tinnitus.
5Clinical Practice Objectives
- Provide appropriate care for a patient who is
preoperative for eye surgery. - Properly administer eye medications.
- Teach a patient to properly administer ear
medication. - Provide appropriate care for a postoperative ear
surgery patient. - Assist a patient to find resources for low-vision
assistance.
6Errors of Refraction
- Farsightedness (hyperopia)-difficulty seeing
close items - Nearsightedness (myopia)-Difficulty seeing far
away - Accommodation( adjustment made by looking into
the distance and down at something close) and
presbyopia (Hardening of the ciliary
muscles-bifocals) - Astigmatism (Caused by a warped lens or irregular
cornea)
7Correcting Errors of Refraction
- Prescription eyeglasses or contact lenses
- Photorefractive keratectomy (PRK)-remove thin
layer of tissue from cornea. Takes less than a
minute. Results in 3-5 days - LASIK (laser in situ keratomileusis)
nearsightedness Middle layer is reshaped after
a thin outer layer is peeled back. Procedure
takes 10-15 per eye - Radial keratotomy Correct nearsightedness and
astigmatism
8Normal Vision, Hyperopia, and Myopia
9Eye Disorders
- Uveitis-inflammation of uveal tract (consists of
iris, ciliary body and choroid) RA, trauma,
infection, herpes, allergies) tearing, blurred
vision,photophobia,bloodshot sclera, small NR
Iirregular pupil. Treated with resting ciliary
muscle, steroids, antibiotics,,compresses,
sunglasses - Corneal disorders
- Keratitis(infection of cornea) contacts,
comatose) and corneal transplantation
(keratoplasty) - Corneal ulcer
10Keratoplasty and Acute Transplant Rejection
11Postoperative Care
- Recovery for 1-2 hours and then is discharged
home - Pressure dressing and eye shield
- Nursing actions focus on disturbed sensory
perception (visual)-pt may only lie on back and
non-operative side, Shield worn at night for one
month
12Postoperative Care (cont.)
- Instructions for safety
- May lie only on the back and nonoperative side
postoperatively - Graft rejection is a possibility and is heralded
by inflammation beginning near the graft edges.
It must be reported promptly. Should the first
transplant fail, the procedure can be redone
13Eye Trauma
- Removal of foreign bodies
- Chemical burns-irrigation
- Enucleation
- Care of the artificial eye
- -clean with soap and water
- Have head over padded surface, lift upper
lid,notched end toward nose_
14Applying an Eye Patch
- Perform hand hygiene, and cleanse the skin of the
patients forehead and cheek with a skin prep
solution or pad - Prepare strips of nonallergenic paper or other
tape to secure the patch - Ask the patient to close both eyes and position
the pad over the lid of the eye to be patched
15Applying an Eye Patch (cont.)
- Secure the patch by placing strips of tape
diagonally over the patch from the cheek to the
forehead. Use several strips of tape to ensure
adhesiveness - After surgery, the shield is used for 2 to 6
weeks, depending on the surgeons instructions
16Applying an Eye Patch (cont.)
- For a pressure patch
- Use two eye patches. Fold the first one in half
place it over the closed lid and then place the
other patch on top of the folded one. Apply tape
as above - For sleeping
- A plastic or metal eye shield may be placed over
the eye and secured to further protect the eye.
Often, the patch can be left off when the shield
is placed for sleeping
17Applying Eye Ointment
18Cataract
- Etiology (Opacity of lens)
- PathophysiologyCongenital ( maternal infection
with rubella or toxoplasmosis), aging over 50
(senile) cataracts, traumatic - Risks-smoking, drinking and chronic steroid use
- Signs and symptoms(blurred vision, color
perception, photophobia, glare,diplopia, night
vision trouble - Diagnosis
- Treatment
- Extracapsular extraction-most common
- Intracapsular extraction
- Nursing management
19Cloudy Appearance of Eye with Cataract
20General Care After Eye Surgery
- Always wash the hands before instilling
medication - Be careful to check the label of the container of
the medication to be certain it is the right
medication - Do not contaminate the applicator tip of the
medication
21General Care After Eye Surgery (cont.)
- Instill only the number of drops ordered apply
pressure at the inner canthus to prevent systemic
absorption close the eye gently (do not squeeze
the eye shut) - Change the eye patch dressing at least once a
day change as needed to keep the area clean - Follow the medication schedule prescribed by the
physician exactly (send home a written schedule)
22General Care After Eye Surgery (cont.)
- Maintain designated head position and activity
restrictions - Report signs of complications sudden, increasing
pain in the eye, which can indicate hemorrhage
purulent drainage decreasing vision signs of
increased intraocular pressure, such as brow
headache
23General Care After Eye Surgery (cont.)
- Keep the follow-up appointment with the surgeon
- Use caution to prevent water in the eye when
showering or washing hair - Protect the eye during the day with glasses use
sunglasses for outside wear wear a protective
eye shield at night to protect the eye
24Glaucoma
- Etiologyany age, IOP increased
- Pathophysiology optic neuropathy that damages
optic disc. Overproduction of aqueous or blocked
outlet to canal of Schlemm - Causes-tumor, infection, trauma etc
- Narrow-angle or angle-closure (acute) glaucoma
(angle with between cornea and iris) - Open-angle (chronic) glaucoma
- Associated glaucoma(DM,HTN,retinal detachment)
25Pathophysiology of Glaucoma
26Comparison of Open-Angle and Narrow-Angle Glaucoma
27Open-Angle Glaucoma
- Signs and symptoms-more common 90, insidious,
inherited prob with aqueous humor tracts - Glasses that do not correct vision,Blurred that
clears, rainbows around lights - Diagnosis.(
- High risk for glaucoma
- Tonometer
- Treatment
- Medication
- Surgery
28Danger Signals of Glaucoma
- Glasses, even new ones, that do not seem to
clarify vision - Blurred or hazy vision that clears up after a
while - Trouble getting used to darkened rooms, such as
in movie theaters
29Danger Signals of Glaucoma (cont.)
- Seeing rainbow-colored rings around lights
- Narrowing of vision at the sides of one or both
eyes - Encourage a complete eye examination if any of
these signs is present
30Glaucoma Teaching Plan
- Signs of IOP include pain in eye, redness,
tearing, blurred vision, halos around lights,
frequent need for change in eyeglasses - Measures to prevent increase in IOP include
low-sodium diet, little caffeine, prevent
constipation and Valsalva maneuver, decrease
stress
31Glaucoma Teaching Plan (cont.)
- Need to take prescribed medications and refrain
from taking over-the-counter or other medications
without physicians knowledge - Glaucoma medication must be taken regularly for
life - Use good aseptic technique when instilling eye
medication
32Glaucoma Teaching Plan (cont.)
- Wear ID tag or bracelet stating Glaucoma and
carry card in wallet that states what medications
are being taken - Keep extra bottle of eye medication on hand
- Carry eye drops
- Maintain close medical follow-up with physician
- Practice safety habits avoid night driving if
possible
33Narrow-Angle (Angle-Closure) Glaucoma
- Signs and symptoms-sever pain with halos, blurred
vision, N,V. - Diagnosis-Caused when iris lies too close to
drainage canal..Emergency - Treatment
- Nursing management
- Teaching on activity precautions during healing,
schedule for eye drops, symptoms to report to the
surgeon, and aseptic handling of the eye drops
and eye shield
34Treatment and Nursing Management
- Emergency treatment
- Reduce IOP as quickly as possible
- During the attack, use pilocarpine, topical
epinephrine, and IV acetazolamide - Surgery is performed as soon as inflammation
subsides to relieve pressure against the optic
nerve endings
35Retinal Detachment
- Etiology
- Primary retinal detachment spontaneous or
degenerative changes in retina or vitreous humor - Secondary retinal detachment Trauma,
inflammation, DM, HTN,nearsighted - Pathophysiology Risk-Jewish, 40-70, 15 go on to
have both detached). Seperation of sensory layers
of retina from epith layer - Signs and symptomsflashes of color,
floater.curtain drawn, cloudy vision - Diagnosis
36Retinal Detachment (cont.)
37Treatment of Retinal Detachment
- Laser therapy
- Cryotherapy
- Scleral buckling
- Closed vitrectomy removes the cloudy vitreous
humor and stabilizes the retina against the
choroid - Nursing management-
- Home care instructions pg. 607
38Retinopathy
- Etiology-decreased blood supply to retina
- Pathophysiology
- Proliferative( later with DM, new blood vessels
and nonproliferative retinopathy( microaneurysms
, swell and rupture - Signs and symptoms blurred, missing fields of
vision, red or black lines or spots - Diagnosis
- Treatment, Keep bs control
- Nursing management
39Macular Degeneration
- Etiology(color, acute and central vision)Genetic,
aging, HTN, DM - Pathophysiology
- Signs and symptoms-bilateral, progressive,distorti
on of vision, , dark spot on center - Diagnosis-ophthalmologic exam
- Treatment- no tx for dry,wet-laset tx
- Nursing management-quit smoking, omega 3, acetyl
cartine, drinking)
40- WET-abnormal vessels develop near macular.
Central vision is affected - DRY-blockage in retinal capillaries. Kils rods
and cones 80-90 cases
41Preoperative Care of the Patient Having Eye
Surgery
- Patient and family teaching
- Preoperative eye drops and medications
42Postoperative Care of the Patient Having Eye
Surgery
- The key word is gentleness
- Discharge instructions
- Medications
- Positioning and level of activity
- Sexual activity
- Community resources
43Audience Response Question 1
- Following eye surgery, the patient is instructed
to avoid which movement(s) that increase(s) the
venous pressure in the head, neck, and eyes?
(Select all that apply.) - Straining
- Bending over
- Keeping the head up
- Sudden head movements
- Strenuous exercises
44Patient with Eye Patch
45Instilling Eye Drops
46External Otitis
- Etiology and pathophysiology
- Signs and symptoms
- Diagnosis
- Treatment
- Nursing management
47Impacted Cerumen and Foreign Bodies
- Irrigating an ear canal
- When irrigating an ear canal, the water should be
tepid - Cold water and too much irrigation pressure can
cause dizziness and nausea as well as pain - Check the temperature of the water each time the
syringe or irrigation container is refilled - Drape the patient so that the clothing does not
become wet
48Otitis Media
- Etiology
- Pathophysiology
- Signs and symptoms
- Diagnosis
- Treatment
- Nursing management
49Labyrinthitis
- Etiology
- Pathophysiology
- Signs and symptoms
- Diagnosis and treatment
- Nursing management
50Menieres Disease (Menieres Syndrome)
- Etiology
- Pathophysiology
- Signs and symptoms
- Diagnosis
- Treatment
- Nursing management
51Acoustic Neuroma
- Rare benign tumor on the eighth cranial nerve,
usually unilateral - Symptoms are gradual hearing loss and tinnitus
- Usually curable with surgery or stereotactic
(Gamma knife, CyberKnife) radiotherapy - If untreated, it causes deafness
- Treatment is surgical
52Otosclerosis and Hearing Loss
- Etiology and pathophysiology
- Signs, symptoms, and diagnosis
- Treatment
- Hearing aid
- Microsurgical intervention
- Tympanoplasty
- Nursing management
53Nursing Care of the Patient Having Ear Surgery
- Preoperative care
- Postoperative care
- Home care considerations
- Community care
54Audience Response Question 2
- Which instruction(s) would be appropriate for a
patient who has just had ear surgery? (Select all
that apply.) - Cough or sneeze with the mouth open.
- Resume routine exercises.
- Avoid bending or heavy lifting.
- Keep ear dry by plugging with cotton covered with
petroleum jelly. - Drink with a straw.
55An Ear Surgery Dressing