Care of Patients with Disorders of the Eyes and Ears

1
Chapter 27

• Care of Patients with Disorders of the Eyes and
  Ears

2
Theory 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.

3
Theory 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.

4
Theory 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.

5
Clinical 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.

6
Errors 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)

7
Correcting 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

8
Normal Vision, Hyperopia, and Myopia
9
Eye 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

10
Keratoplasty and Acute Transplant Rejection
11
Postoperative 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

12
Postoperative 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

13
Eye 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_

14
Applying 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

15
Applying 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

16
Applying 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

17
Applying Eye Ointment
18
Cataract

• 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

19
Cloudy Appearance of Eye with Cataract
20
General 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

21
General 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)

22
General 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

23
General 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

24
Glaucoma

• 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)

25
Pathophysiology of Glaucoma
26
Comparison of Open-Angle and Narrow-Angle Glaucoma
27
Open-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

28
Danger 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

29
Danger 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

30
Glaucoma 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

31
Glaucoma 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

32
Glaucoma 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

33
Narrow-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

34
Treatment 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

35
Retinal 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

36
Retinal Detachment (cont.)
37
Treatment 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

38
Retinopathy

• 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

39
Macular 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

41
Preoperative Care of the Patient Having Eye
Surgery

• Patient and family teaching
• Preoperative eye drops and medications

42
Postoperative Care of the Patient Having Eye
Surgery

• The key word is gentleness
• Discharge instructions
• Medications
• Positioning and level of activity
• Sexual activity
• Community resources

43
Audience 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

44
Patient with Eye Patch
45
Instilling Eye Drops
46
External Otitis

• Etiology and pathophysiology
• Signs and symptoms
• Diagnosis
• Treatment
• Nursing management

47
Impacted 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

48
Otitis Media

• Etiology
• Pathophysiology
• Signs and symptoms
• Diagnosis
• Treatment
• Nursing management

49
Labyrinthitis

• Etiology
• Pathophysiology
• Signs and symptoms
• Diagnosis and treatment
• Nursing management

50
Menieres Disease (Menieres Syndrome)

• Etiology
• Pathophysiology
• Signs and symptoms
• Diagnosis
• Treatment
• Nursing management

51
Acoustic 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

52
Otosclerosis and Hearing Loss

• Etiology and pathophysiology
• Signs, symptoms, and diagnosis
• Treatment
• Hearing aid
• Microsurgical intervention
• Tympanoplasty
• Nursing management

53
Nursing Care of the Patient Having Ear Surgery

• Preoperative care
• Postoperative care
• Home care considerations
• Community care

54
Audience 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.

55
An Ear Surgery Dressing