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Nursing Care of Clients with Eye and Ear Disorders

Nursing Care of Clients with Eye and Ear Disorders. Chapter 40. Physical Assessment of Eye and Vision. Snellen chart or E chart for testing visional acuity 20 feet Cardinal fields test for extraocular eye movements Cover-uncover test test for stabisms.

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Nursing Care of Clients with Eye and Ear Disorders

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  1. Nursing Care of Clients with Eye and Ear Disorders Chapter 40

  2. Physical Assessment of Eye and Vision • Snellen chart or E chart for testing visional acuity • 20 feet • Cardinal fields • test for extraocular eye movements • Cover-uncover test • test for stabisms

  3. Physical Assessment of Ear and Hearing • Hearing • Weber test • Rinne test • Whisper test

  4. Eye Disorders • Age Related Vision Changes • flatting of the cornea • pupillary constriction • decrease in lens elasticity • loss of sensory cells • Physical changes • inversion, eversion of lid, decreased tear secretion, “hollowed-eyed”

  5. Conjunctivitis-red, pain, itchy, sticky drainage

  6. Eye Disorders • Inflammatory Disorders • conjunctivitis • inflammation of the conjunctiva • bacterial or viral • Treatment • topical anti-infectives • anti-inflammatories

  7. Eye Disorders • Corneal Infections/Inflammations • corneal scarring and ulcerations are a major cause of world-wide blindness • Treatment • Corneal Transplant

  8. The Client with Eye Trauma • Corneal Abrasion • Burns • Penetrating Trauma • Blunt Trauma • Treatment • topical anesthesia • facial X-rays or C-T Scans

  9. The Client with Eye Trauma • Foreign body removal • sterile saline irrigation • Eye irrigation • chemical burn • Surgery • penetrating wound

  10. The Client with Cataracts • Cataract • a clouding of the lens of the eye • interferes with light transmission and the ability to perceive images clearly • Significant cause of visional problems in the elderly (50-70%) • Senile Cataracts • normal aging process

  11. The Client with Cataracts • Treatment • Surgical removal of cataract and lens • Implantation of intraocular lens • Post-operative Nursing Care • assessment • eye patch • semi-folwer’s

  12. Post-operative Nursing Care • Avoid coughing, sneezing straining • these increase intraocular pressure • Assess for post-op pain • Assess for surgical complications • Approach from unaffected side • Teach Home Care • meds., symptoms to report, photophobia

  13. Glaucoma • Characterized by increased intraocular pressure and gradual loss of vision • “Silent” thief of vision • Narrowing of visual fields • 2 Types • Open Angle and Closed Angle

  14. Glaucoma - inner eye pressure

  15. Glaucoma • Open Angle • common (90%) • >35yrs, genetic link, African-American • Pathophysiology • impaired aqueous outflow • increased intraocular pressure • usually bilateral

  16. Glaucoma • Clinical Manifestations • none • frequent lens changes in glasses • impaired night vision • halos • reduction of vision field, become narrow • increased intraocular pressure (tonometry)

  17. Glaucoma • Treatment • miotics - pilocarpine • Laser Surgery (trabeculoplasty) • cause scar tissue to create tension to stretch opening to drain aqueous fluid

  18. Glaucoma Stage 4

  19. Diabetic Retinopathy • Leading cause of new blindness between ages of 20-74 • 84% of diabetics will develop some form • depends of length of time you have diabetes • Vascular disorder that affects the retina • capillaries become sclerotic

  20. Diabetic Retinopathy • Management • Yearly ophthalmologic exams • Laser photocoagulation • Focus is educational • vision changes -blurred • black spots (Floaters) • flashing lights • sudden loss of vision

  21. Diabetic Retinopathy - vision

  22. Ear Disorders • External Otitis • swimmers ear • pseudomonas, bacteria, fungus or trauma • Treatment • cleansing • antibiotics - local and systemic • education

  23. Ear Disorders • Otitis Media • inflammation of middle ear • common in infants and young children • Red bulging tympanic membrane • Treatment • antibiotics • myringotomy

  24. Ear Infection check up

  25. Inner Ear Disorders • Meniere’s Disease • chronic • recurrent attack of vertigo with tinnitus • progressive hearing loss • Treatment • antivert

  26. The Client with Hearing Loss • Affects 24% of older adults • Affects 39% of those over age 75 • 2 Types • Conductive • disruption transmission of sound • obstructions - cerum, scarring, tumors • Sensorineural • inner ear, auditory nerve or pathways

  27. The Client with Hearing Loss • Treatment • Amplification • hearing aids • Surgery • reconstruct the middle ear - tympanoplasty • cochlear implant • Nursing Care • Sensory/Perceptual Alteration: Auditory, Impaired communication, Social isolation

  28. What are your interventions?

  29. What kind of pt. teaching will you provide?

  30. What’s your post-op nursing care?

  31. What is happening here?

  32. What about this vision

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