Dementia and Alzheimer s Disease

1. Dementia andAlzheimer’s Disease

2. Dementia Loss of Memory Orientation Language Judgment Reasoning Personality and behavioral problems Agitation Delusions Hallucinations

3. Dementia Neurodegenerative conditions Alzheimer’s Disease Parkinson’s Huntington’s Vascular dementia, multiinfarct dementia Emboli CVA

4. Clinical Manifestations Mild Forgetfulness Decreased judgment Geographic disorientation Moderate Loss of remote memory Forgets how to do simple tasks Severe Unable to perform ADLs Difficulty eating, swallowing Immobility and incontinence

5. Alzheimer’s disease Chronic, progressive, irreversible 60% - 80% of dementias Etiology unknown Memory loss usually first sign Structural - Neuritic plaques Decrease in neurotransmitters Alzheimer’s disease is a form of dementia characterized by progressive, irreversible deterioration of intellectual functioning and it leads to death. Memory loss tends to be the first sign of Alzheimer’s disease. Friends and family may have difficulty in suspecting a problem due to the subtle nature of the disease. The client and family may also tend to deny or lessen the symptomology. The major risk factors for this disease include aging, family history, and female gender. Alzheimer’s accounts for 60% of dementias in those older than 65 and is the 4th leading cause of death. Alzheimer’s disease is a form of dementia characterized by progressive, irreversible deterioration of intellectual functioning and it leads to death. Memory loss tends to be the first sign of Alzheimer’s disease. Friends and family may have difficulty in suspecting a problem due to the subtle nature of the disease. The client and family may also tend to deny or lessen the symptomology. The major risk factors for this disease include aging, family history, and female gender. Alzheimer’s accounts for 60% of dementias in those older than 65 and is the 4th leading cause of death.

6. Pathophysiology of AD Amyloid plaques Neurofibrillary tangles Loss of connections between cells and cell death

7. Diagnosis of AD Three stages Sundowners Mini mental exam The diagnosis of Alzheimer’s disease can only be confirmed on autopsy and is made when other causes of the deficits are ruled out. It is classified into three stages based on client ability and manifestations of the disease. Stage I lasts approximately 2 to 4 years with decreased attention span and subtle personality changes. State II lasts 2 to 12 years with impaired cognition and impaired motor skills surfacing. Sundowning is a common occurrence in Stage II with behavioral changes that are heightened in the evening hours. Stage III presents with gross cognitive and motor decline. The last stage terminates with the death of the client. The tremendous impact on both client and family is well understood. Caregivers often need emotional support and reassurance. Caregivers also need time away or respite in order to meet the demands of this role. The diagnosis of Alzheimer’s disease can only be confirmed on autopsy and is made when other causes of the deficits are ruled out. It is classified into three stages based on client ability and manifestations of the disease. Stage I lasts approximately 2 to 4 years with decreased attention span and subtle personality changes. State II lasts 2 to 12 years with impaired cognition and impaired motor skills surfacing. Sundowning is a common occurrence in Stage II with behavioral changes that are heightened in the evening hours. Stage III presents with gross cognitive and motor decline. The last stage terminates with the death of the client. The tremendous impact on both client and family is well understood. Caregivers often need emotional support and reassurance. Caregivers also need time away or respite in order to meet the demands of this role.

8. Pharmacology Decreased memory and cognition Aricept, Exelon, Razadyne, Namenda Depression SSRIs, tricyclic antidepressnats Behavioral problems Antipsychotics, neuroleptics, benzodiazepines Sleep disturbance Ambien

9. Caregiver Role Strain Majority cared for by family members Overwhelming - 24/7 task Need support of family Need education and assistance from nurse

10. Delerium Temporary but acute mental confusion 15% to 53% of post-op older adults 70% to 87% of older adults in ICU Medications Anesthesia Major surgery Infection Sleep deprivation

11. Delerium Early signs Inability to concentrate Iritability Insomnia Loss of appetite Restlessness Confusion Later signs Agitation Misperception Misinterpretation Hallucinations

12. Delerium – The Nurse’s Role Recognition of high-risk patients Eliminate precipitating factors Protect from harm

13. Creutzfeldt-Jacob Disease Progressive causes brain degeneration without inflammation Can be fatal Form of dementia is caused by a pathogen called a Prion Believed to be from livestock “Mad Cow Disease” Creutzfeldt-Jacob Disease is also known as “mad-cow disease”. It is believed to be caused by a prion and is transmitted through direct contact with infected neural tissue. Creutzfeldt-Jacob Disease is also known as “mad-cow disease”. It is believed to be caused by a prion and is transmitted through direct contact with infected neural tissue.

14. Creutzfeldt-Jacob Disease Cueutzfeldt-Jacob Disease is progressive and most likely fatal within a year. Creutzfledt-Jacob Disease is characterized by degeneration of the gray matter of the brain. The onset begins with memory changes and sleep disturbances. It can progress to motor and sensory deterioration leading to death. Cueutzfeldt-Jacob Disease is progressive and most likely fatal within a year. Creutzfledt-Jacob Disease is characterized by degeneration of the gray matter of the brain. The onset begins with memory changes and sleep disturbances. It can progress to motor and sensory deterioration leading to death.

15. Effects of Nerve Agents Nerve agents are similar to insecticides and they can be deadly if people are exposed to them. Unfortunately, this has already happened. On March 20, 1995, twelve people were killed and over 5,000 were injured when a nerve gas called "sarin" was released in the Tokyo subway system. 6,000 “injured” Actual number injured closer to 1,300 with the rest suffering psychological damage. People may have also been exposed to nerve agents during the conflict ("Gulf War") in the Middle East.Nerve agents are similar to insecticides and they can be deadly if people are exposed to them. Unfortunately, this has already happened. On March 20, 1995, twelve people were killed and over 5,000 were injured when a nerve gas called "sarin" was released in the Tokyo subway system. 6,000 “injured” Actual number injured closer to 1,300 with the rest suffering psychological damage. People may have also been exposed to nerve agents during the conflict ("Gulf War") in the Middle East.

16. Types of Chemical Nerve Agents Organophosphates • Insecticides are easily obtained and commonly used in the community • Like insecticides: – Parathion – Malathion – Diazinon – Chlorpyrifos Most nerve agents belong to a group of chemicals called "organophosphates". The first of these chemicals was made in 1854 and was originally developed to be used to control insects and save crops. The first nerve agent (Tabun) for military use was made in Germany in 1936. Another nerve agent, "sarin“ , was made in 1938 and "Soman” was made in 1944. It appears that these nerve agents were not used by the Germans during World War II. However, it has been estimated that the Germans had stockpiles of tons of both Tabun and Sarin. The United States and Russia continued producing and stockpiling these nerve agents after the War. Most nerve agents belong to a group of chemicals called "organophosphates". The first of these chemicals was made in 1854 and was originally developed to be used to control insects and save crops. The first nerve agent (Tabun) for military use was made in Germany in 1936. Another nerve agent, "sarin“ , was made in 1938 and "Soman” was made in 1944. It appears that these nerve agents were not used by the Germans during World War II. However, it has been estimated that the Germans had stockpiles of tons of both Tabun and Sarin. The United States and Russia continued producing and stockpiling these nerve agents after the War.

17. Nerves – the "perfect" target Soon after the first organophosphate compound was invented at the German firm IG Farben in 1934, many recognized that it could be used as a pesticide -- or a chemical weapon. Organophosphates kill insects and people by jamming the nervous system. By the end of the 1930s, German chemists had produced about 2,000 organophosphates, including sarin. Military planners assumed these weapons would be used: by the brink of World War II, Britain had stockpiled 30 million gas masks. Acetylcholine is a common neurotransmitter found in the central and peripheral nervous system. When acetylcholine is released from an axon terminal, it moves across the synaptic cleft to bind to a receptor on the other side of the synapse (on the post-synaptic membrane). In the peripheral nervous system, acetylcholine is located at the "neuromuscular junction" where it acts to control muscular contraction. Acetylcholine is also used in the autonomic nervous system. The action of acetylcholine is stopped by an enzyme called "acetylcholinesterase" (AChE). Nerve agents bind to part of the AChE molecule. This makes the AChE inactive and blocks the action of AChE. Therefore, there is no way to stop the action of acetylcholine acetylcholine builds up at the synapse. acetylcholine continues to act. Acetylcholine is a common neurotransmitter found in the central and peripheral nervous system. When acetylcholine is released from an axon terminal, it moves across the synaptic cleft to bind to a receptor on the other side of the synapse (on the post-synaptic membrane). In the peripheral nervous system, acetylcholine is located at the "neuromuscular junction" where it acts to control muscular contraction. Acetylcholine is also used in the autonomic nervous system. The action of acetylcholine is stopped by an enzyme called "acetylcholinesterase" (AChE). Nerve agents bind to part of the AChE molecule. This makes the AChE inactive and blocks the action of AChE. Therefore, there is no way to stop the action of acetylcholine acetylcholine builds up at the synapse. acetylcholine continues to act.

18. How nerve agents work Acetylcholine is a common neurotransmitter found in the central and peripheral nervous system. When acetylcholine is released from an axon terminal, it moves across the synaptic cleft to bind to a receptor on the other side of the synapse (on the post-synaptic membrane). In the peripheral nervous system, acetylcholine is located at the "neuromuscular junction" where it acts to control muscular contraction..

19. Acetylcholine is also used in the autonomic nervous system. The action of acetylcholine is stopped by an enzyme called "acetylcholinesterase" (AChE). Nerve agents bind to part of the AChE molecule. This makes the AChE inactive and blocks the action of AChE. Therefore, there is no way to stop the action of acetylcholine acetylcholine builds up at the synapse. acetylcholine continues to act

20. That causes the typical effects of nerve gas: violent tremors, incontinence, even heart and lung failure. "Exposure to a higher dose [of nerve weapons] leads to bronchioconstriction and secretion of mucous in the respiratory system leads to difficulty in breathing and to coughing. Discomfort in the gastrointestinal tract may develop into cramp and vomiting. Involuntary discharge of urine and defecation may also form part of the picture. The discharge of saliva is powerful and the victim may experience running eyes and sweating.

21. "When exposed to a high dose of nerve agent, the victim may suffer convulsions and lose consciousness. To some extent, the poisoning process may be so rapid that earlier mentioned symptoms may never have time to develop. "Muscular paralysis caused by nerve agents also affects the respiratory muscles. Nerve agents also affect the respiratory center of the central nervous system. ...Consequently, death caused by nerve agents is a kind of death by suffocation."

22. Nerve Agents Tabun, Sarin, Soman Most toxic of the chemical agents Penetrate skin, eyes, lungs Loss of consciousness, seizures, apnea, death after large amount

23. EFFECTS OF NERVE AGENTS Hyperstimulation of organs of cholinergic nervous system – Muscarinic Smooth muscles Glands – Nicotinic Skeletal muscles Ganglions

25. Nerve Agent Treatment Airway/ventilation Antidotes Atropine - Antagonizes muscarinic effects Dries secretions; relaxes smooth muscles Given IV, IM, ET No effect on skeletal muscles 2-PAMCl Diazepam Decreases seizure activity Reduces seizure-induced brain injury

26. Peripheral Nerveand Spinal CordProblems

27. Trigeminal Neuralgia AKA “tic douloureux” Facial pain Etiology unknown Pharmacology Tegretol Surgery Trigeminal neuralgia is also known as Tic Douloureax. It is a chronic disease of the Cranial Nerve V that causes severe facial pain. Because the nerve has three divisions, the pain encompasses a large part of the face. The etiology of this disorder is unknown. The manifestations of this disorder include brief episodes of severe facial pain, unually stabbing in nature. Factors such as chewing or light touch may trigger the episode. Medications to assist in the symptoms may be Tegretol or Neurontin. If medication is not successful, the nerve root may be surgically severed, also known as a rhizotomy. Trigeminal neuralgia is also known as Tic Douloureax. It is a chronic disease of the Cranial Nerve V that causes severe facial pain. Because the nerve has three divisions, the pain encompasses a large part of the face. The etiology of this disorder is unknown. The manifestations of this disorder include brief episodes of severe facial pain, unually stabbing in nature. Factors such as chewing or light touch may trigger the episode. Medications to assist in the symptoms may be Tegretol or Neurontin. If medication is not successful, the nerve root may be surgically severed, also known as a rhizotomy.

28. Bell’s Palsy Sudden onset involving one side of face Facial paralysis, drooping 80% recover completely within few weeks to few months Steroids? Bell’s Palsy is usually characterized by a unilateral paralysis of the facial muscles. The etiology is unknown with the incidence occurring between the ages of 20 and 60. The manifestations include unilateral facial paralysis with ptosis and/or tearing on the affected side. 80% of clients recover fully within weeks to months. The diagnosis is made through the history and physical. Bell’s Palsy is usually characterized by a unilateral paralysis of the facial muscles. The etiology is unknown with the incidence occurring between the ages of 20 and 60. The manifestations include unilateral facial paralysis with ptosis and/or tearing on the affected side. 80% of clients recover fully within weeks to months. The diagnosis is made through the history and physical.

29. Guillian-Barre Rapid muscle weakness and paralysis Post viral in etiology? Epstein Barr virus Ascending paralysis of the limbs Guillian-Barre is an inflammatory process that is characterized by an acute onset of ascending motor paralysis. It is believed to be post viral in nature with some theorists postulating a correlation with the Epstein Barre virus. In most cases (approximately 80%) spontaneous recovery occurs with a mortality rate of about 6%. As a nurse caring for the client, you should be concerned with a diaphragm paralysis leading to respiratory arrest. Links More Syndromes Email Mama What is Guillain-Barré Syndrome? A "syndrome" is a medical condition that is categorized by a multitude of symptoms. Guillain-Barré (Ghee-yan Bah-ray) Syndrome, also called Acute Inflammatory Demyelinating Polyneuropathy and Landry's Ascending Paralysis, is an inflammatory disorder of the peripheral nerves. Peripheral nerves are nerves outside the brain and spinal cord. In this disorder, the body's immune system attacks part of the nervous system. Guillain-Barré Syndrome is characterized by the rapid onset of weakness and often, paralysis of the legs, arms, breathing muscles and face. The disorder can develop over the course of hours or days, or it may take up to 3 to 4 weeks. Most people reach the stage of greatest weakness within the first 2 weeks after symptoms appear. Abnormal sensations also occur. Guillian-Barre is an inflammatory process that is characterized by an acute onset of ascending motor paralysis. It is believed to be post viral in nature with some theorists postulating a correlation with the Epstein Barre virus. In most cases (approximately 80%) spontaneous recovery occurs with a mortality rate of about 6%. As a nurse caring for the client, you should be concerned with a diaphragm paralysis leading to respiratory arrest. Links More Syndromes Email Mama What is Guillain-Barré Syndrome? A "syndrome" is a medical condition that is categorized by a multitude of symptoms. Guillain-Barré (Ghee-yan Bah-ray) Syndrome, also called Acute Inflammatory Demyelinating Polyneuropathy and Landry's Ascending Paralysis, is an inflammatory disorder of the peripheral nerves. Peripheral nerves are nerves outside the brain and spinal cord. In this disorder, the body's immune system attacks part of the nervous system. Guillain-Barré Syndrome is characterized by the rapid onset of weakness and often, paralysis of the legs, arms, breathing muscles and face. The disorder can develop over the course of hours or days, or it may take up to 3 to 4 weeks. Most people reach the stage of greatest weakness within the first 2 weeks after symptoms appear. Abnormal sensations also occur.

30. Guillian-Barre Testing CSF– Increased protein levels EMG—Decreased response Rx: Plasmaphoresis The diagnosis of Guillian Barre is made primarily through the history and physical. Other testing that may assist in the diagnosis would be an increase in the protein level in the CSF and a decreased response to EMG testing. Medications do not usually assist the client in recovery. Some health care practitioners will utilize plasmaphoresis as a means to decrease the symptomology. The diagnosis of Guillian Barre is made primarily through the history and physical. Other testing that may assist in the diagnosis would be an increase in the protein level in the CSF and a decreased response to EMG testing. Medications do not usually assist the client in recovery. Some health care practitioners will utilize plasmaphoresis as a means to decrease the symptomology.

31. Tetanus AKA “Lockjaw” Anerobic microorganism found in dirt Incubation 8 to 12 days Pain at site of infection Pharmacology Human tetanus immune globulin PCN Thorazine Valium Tetanus is more commonly known as lockjaw. In our country it is prevented with immunizations. It can occur in third world countries as a result of instruments that have not been sterilized, i.e., cutting the umbilical cord at birth. The disease is a result of the spores of Clostridium tetani entering the body through an open wound. The average incubation period lasts from 8 to 12 days. The manifestation of the disease begins with pain at the portal of entry. Later stiffness and neck occur. Later, seizures and death can occur. Nursing care of the client is aimed at prevention. A simple vaccination can prevent this life-threatening disease. Prompt treatment (within 72 hours) with antitoxin human tetanus immune globulin IM. Tetanus is more commonly known as lockjaw. In our country it is prevented with immunizations. It can occur in third world countries as a result of instruments that have not been sterilized, i.e., cutting the umbilical cord at birth. The disease is a result of the spores of Clostridium tetani entering the body through an open wound. The average incubation period lasts from 8 to 12 days. The manifestation of the disease begins with pain at the portal of entry. Later stiffness and neck occur. Later, seizures and death can occur. Nursing care of the client is aimed at prevention. A simple vaccination can prevent this life-threatening disease. Prompt treatment (within 72 hours) with antitoxin human tetanus immune globulin IM.

32. Botulism Food poisoning Incubation 12 to 36 hours after ingestion Symptoms Blurred vision n/v Paralysis Botulism is a form of food poisoning caused by ingestion of the bacillus Clostridium botulinum. Manifestations occur from 12 to 36 hours after ingestion and include visual disturbances, fixed dilated pupils, nausea, vomiting, and paralysis in some cases. Stool specimens may be obtained for diagnosis. Botulism impairs the release of acetylcholine at the motor nerve synapse causing motor paralysis. Improperly canned foods at risk include canned foods, smoked meats, and vacuum-packed fish. Rapid administration of trivalent botulism antitoxin, made from horse serum. The patient must receive an intradermal test dose before receiving the antitoxin. Nursing care is geared toward careful assessment for respiratory complications related to paralyzed muscles and client education on food preparation. Botulism is a form of food poisoning caused by ingestion of the bacillus Clostridium botulinum. Manifestations occur from 12 to 36 hours after ingestion and include visual disturbances, fixed dilated pupils, nausea, vomiting, and paralysis in some cases. Stool specimens may be obtained for diagnosis. Botulism impairs the release of acetylcholine at the motor nerve synapse causing motor paralysis. Improperly canned foods at risk include canned foods, smoked meats, and vacuum-packed fish. Rapid administration of trivalent botulism antitoxin, made from horse serum. The patient must receive an intradermal test dose before receiving the antitoxin. Nursing care is geared toward careful assessment for respiratory complications related to paralyzed muscles and client education on food preparation.

33. Spinal Cord Disorders This section of the lecture discusses spinal cord injury, herniated intravertebral disks and spinal cord tumors. This section of the lecture discusses spinal cord injury, herniated intravertebral disks and spinal cord tumors.

34. Spinal Cord Disorders--Types Spinal Cord Injury Herniated Intravertebral Disks Spinal Cord Tumors A spinal cord injury is usually an acute event, whereas herniated intravertebral disks and spinal cord tumors are slower and more progressive in nature. The pathophysiology and the nursing care of the clients for each of these disorders are found in the accompanying slides. A spinal cord injury is usually an acute event, whereas herniated intravertebral disks and spinal cord tumors are slower and more progressive in nature. The pathophysiology and the nursing care of the clients for each of these disorders are found in the accompanying slides.

35. Spinal Cord Injury Usually due to trauma Deformation - abnormal movements Penetrating injuries Classifications of injuries Complete/Incomplete Cause of injury Level of injury A spinal cord injury usually occurs as a result of trauma. The majority of cases that are seen in the trauma units are adults age 16 to 30. Spinal cord injuries are usually a result of motor vehicle accidents, sports injuries, falls, and violence. The major risk factors are age, gender, and alcohol and drug use. The primary injury to the spinal cord includes microscopic hemorrhages in the grey matter of the spinal cord. Later, edema and ischemia to the gray and white matter occur. As a nurse, the care of the spinal cord injury client will depend on whether or not the cord was partially or completely affected and the level of the injury. The causes of injury will also determine patient outcome. A spinal cord injury usually occurs as a result of trauma. The majority of cases that are seen in the trauma units are adults age 16 to 30. Spinal cord injuries are usually a result of motor vehicle accidents, sports injuries, falls, and violence. The major risk factors are age, gender, and alcohol and drug use. The primary injury to the spinal cord includes microscopic hemorrhages in the grey matter of the spinal cord. Later, edema and ischemia to the gray and white matter occur. As a nurse, the care of the spinal cord injury client will depend on whether or not the cord was partially or completely affected and the level of the injury. The causes of injury will also determine patient outcome.

36. Upper and Lower Motor Neuron Deficits Upper Voluntary movement May have spastic paralysis Hyperreflexia Lower Both voluntary and involuntary movement Muscle flaccidity Muscle atrophy Injuries to the spinal cord are often classified as either upper motor neuron lesions or lower motor lesions. Upper motor neurons are responsible for voluntary movements. Deficits to this area results in spastic paralysis and hyperreflexia. Lower motor neurons are responsible for the contraction of skeletal muscles. Deficiencies in this area will result in muscle atrophy and flaccidity. Injuries to the spinal cord are often classified as either upper motor neuron lesions or lower motor lesions. Upper motor neurons are responsible for voluntary movements. Deficits to this area results in spastic paralysis and hyperreflexia. Lower motor neurons are responsible for the contraction of skeletal muscles. Deficiencies in this area will result in muscle atrophy and flaccidity.

37. Spinal Shock Temporary loss of reflex function below level of injury Immediate response to spinal cord injury Manifestations Bradycardia Hypotension Flaccid paralysis Loss of sensation Two complications that arise from spinal cord injury are spinal shock and autonomic dysreflexia. Spinal shock is an immediate response to the injury. It is a temporary loss of reflex function below the level of injury. It can occur within 1 hour of the injury and can last for months. The symptoms that accompany this condition include bradycardia, hypotension, flaccid paralysis of skeletal muscle, loss of sensation, and bowel and bladder disfunction. Nursing goals are aimed at stabilizing the client and correcting the underlying symptomology. Two complications that arise from spinal cord injury are spinal shock and autonomic dysreflexia. Spinal shock is an immediate response to the injury. It is a temporary loss of reflex function below the level of injury. It can occur within 1 hour of the injury and can last for months. The symptoms that accompany this condition include bradycardia, hypotension, flaccid paralysis of skeletal muscle, loss of sensation, and bowel and bladder disfunction. Nursing goals are aimed at stabilizing the client and correcting the underlying symptomology.

38. Autonomic Dysreflexia Exaggerated sympathetic response Caused by a stimuli i.e. over distended bladder Symptoms Bradycardia or tachycardia Hypertension Flushing Diaphoresis, pallor, coolness Autonomic dysreflexia can occur at anytime after recovery from spinal shock. Usually when the injury is above T6. It usually happens in response to something, ex: catheter gets kinked, distended bladder, UTI, fecal impaction, pressure ulcer, a draft in the room. It is an exaggerated sympathetic response. Symptoms include bradycardia or tachycardia, uncontrolled, rapidly occurring hypertension, flushing, headache, and diaphoresis. This condition can be life threatening because the HTN may produce life-threatening consequences such as seizures or CVA. Call MD, HOB up, loosen tight clothing and resolve the noxious stimuli. Autonomic dysreflexia can occur at anytime after recovery from spinal shock. Usually when the injury is above T6. It usually happens in response to something, ex: catheter gets kinked, distended bladder, UTI, fecal impaction, pressure ulcer, a draft in the room. It is an exaggerated sympathetic response. Symptoms include bradycardia or tachycardia, uncontrolled, rapidly occurring hypertension, flushing, headache, and diaphoresis. This condition can be life threatening because the HTN may produce life-threatening consequences such as seizures or CVA. Call MD, HOB up, loosen tight clothing and resolve the noxious stimuli.

39. Emergency Care of Potential Spinal Cord Injury ABCs Immobilize neck Monitor Neuro status--Baseline Monitor VS Cardiac monitor Diagnostics Pharmacology Cervical traction/Halo fixator In any emergency situation, the potential for spinal cord injury must be considered. In addition to the ABCs of emergency care, an emergency caregiver would be wise to immobilize the victim’s neck. Never flex, extend or rotate the neck of a trauma victim. Continue to monitor the neurological status of your client. Vital signs and neuro checks will be frequently evaluated in order to determine neurological deterioration. In any emergency situation, the potential for spinal cord injury must be considered. In addition to the ABCs of emergency care, an emergency caregiver would be wise to immobilize the victim’s neck. Never flex, extend or rotate the neck of a trauma victim. Continue to monitor the neurological status of your client. Vital signs and neuro checks will be frequently evaluated in order to determine neurological deterioration.

40. Spinal Cord Tumors Benign/malignant Primary/metastatic Symptoms depend on location, level of tumor, size of tumor, type of tumor, and spinal nerves involved Tx: Surgery/Radiation Spinal cord tumors can be classified as either primary or secondary. The symptoms of the disease as well as the treatment will depend on the area, size, and type of tumor. Medications prescribed will aim at the relief of pain and the control of edema. Spinal cord tumors can be classified as either primary or secondary. The symptoms of the disease as well as the treatment will depend on the area, size, and type of tumor. Medications prescribed will aim at the relief of pain and the control of edema.

41. Herniated Intervertebral Disk/Back Pain Cervical vertebrae and lumbosacral most commonly affected Kyphoplasty Back pain can result from multiple etiologies including sprain, strain, etc. For the purposes of this discussion a global discussion of back pain will be presented with an emphasis on herniation of the intervertebral disks as a common cause. A herniated disk, or herniated neucleus propulsus (HNP). It is defined as a rupture of the cartilage surrounding the intervertebral disk with a protrusion of the nucleus propulsus. It can result from age, arthritis, after fusion, accidents, and degenerative disease. Back pain is generally classified according to cervical (usually C5 or C6) or lumbar (L4/L5 or L5/S1) pain. The symptomalogy and treatment will depend on the area affected. Back pain can result from multiple etiologies including sprain, strain, etc. For the purposes of this discussion a global discussion of back pain will be presented with an emphasis on herniation of the intervertebral disks as a common cause. A herniated disk, or herniated neucleus propulsus (HNP). It is defined as a rupture of the cartilage surrounding the intervertebral disk with a protrusion of the nucleus propulsus. It can result from age, arthritis, after fusion, accidents, and degenerative disease. Back pain is generally classified according to cervical (usually C5 or C6) or lumbar (L4/L5 or L5/S1) pain. The symptomalogy and treatment will depend on the area affected.

42. Kyphoplasty

43. Cervical Back Pain Can result from herniated nucleus propulsus (HNP) in an intervertebral disc May also occur from muscle sprain or ligament sprain The pain associated with the insult to the area is dependent upon the dermatome innervations. Clients will express pain in the shoulder, neck and arm. This pain can be unilateral or bilateral depending on the impairment. Other symptoms include parasthesia, muscle spasms, and/or diminished reflexes. There may also be lower motor symptomology such as urinary elimination problems, unsteady gait, or hyperactive lower extremity reflexes. The pain associated with the insult to the area is dependent upon the dermatome innervations. Clients will express pain in the shoulder, neck and arm. This pain can be unilateral or bilateral depending on the impairment. Other symptoms include parasthesia, muscle spasms, and/or diminished reflexes. There may also be lower motor symptomology such as urinary elimination problems, unsteady gait, or hyperactive lower extremity reflexes.

44. Lumbosacral Back Pain Also known as low back pain More common than cervical pain Acute pain - muscle strain or spasm, ligament sprain, disc injury Young - usually due to trauma Elderly - can be from DJD Lower back pain appears to be more common that cervical back pain. A common complaint is sciatica, a condition in which the client experiences pain or burning that radiates down one leg. Certain positions such as walking or climbing stairs can aggravate this condition. Other complaints include numbness and tingling with diminished reflexes of the knee and ankle. Lower back pain appears to be more common that cervical back pain. A common complaint is sciatica, a condition in which the client experiences pain or burning that radiates down one leg. Certain positions such as walking or climbing stairs can aggravate this condition. Other complaints include numbness and tingling with diminished reflexes of the knee and ankle.

45. Herniated Disk - HNP

46. Assessment of Back Pain Posture and gait Vertebral alignment Sensation Muscle tone For the client with back pain it is essential to get a good medical history. First, try to determine if back pain is a primary or secondary condition. Other diseases can manifest itself as back pain, such as kidney disease, aneurysms, bone cancer, pancreatic problems, gall bladder, MI, or blood transfusion reactions. The assessment of the client with back pain should be detailed and comprehensive. For the client with back pain it is essential to get a good medical history. First, try to determine if back pain is a primary or secondary condition. Other diseases can manifest itself as back pain, such as kidney disease, aneurysms, bone cancer, pancreatic problems, gall bladder, MI, or blood transfusion reactions. The assessment of the client with back pain should be detailed and comprehensive.

47. Diagnostic Testing X-rays MRI CT EMG Myelography The client with back pain may require several diagnostic tests such as x-rays, MRIs, CT scans, EMGs and myelography. The client with back pain may require several diagnostic tests such as x-rays, MRIs, CT scans, EMGs and myelography.

48. Pharmacology Muscle relaxants - Flexeril NSAIDs Opioids - avoid if possible Steroid injections For the client receiving more conservative treatment, medication may be prescribed. Muscle relaxants such as Flexeril may be of benefit. Flexeril is an autonomic nervous system agent and a skeletal muscle relaxant. The dosage usually is 20 to 40mg/day in divided doses. It is contraindicated in clients receiving MAO inhibitors, acute MI clients, CHF or heart block. Use with caution in glaucoma client or a client with increased intraocular pressure. It can cause edema of the tongue as an adverse effect. NSAIDs may be prescribed for the client as well. NSAIDs such as Motrin, Ibuprofen, or Toradol may be prescribed. This class of medications is helpful because they usually have no addictive effect and many of these have anti-inflammatory/analgesic/and antipyretic effects. Caution is given to clients who have GI disorders such as peptic ulcer disease and may be contraindicated. Opiods are avoided due to the addictive effects that these medicines possess. Steroid injections may be ordered to alleviate inflammation. However, they are given in imited quantities because of the side effects of the steroids. All nurses should be familiar with the side effects of steroids. Bed rest is NOT indicated. Heat/ice, weight loss, physical therapy/stretching, body mechanics education, supportive back belt. For the client receiving more conservative treatment, medication may be prescribed. Muscle relaxants such as Flexeril may be of benefit. Flexeril is an autonomic nervous system agent and a skeletal muscle relaxant. The dosage usually is 20 to 40mg/day in divided doses. It is contraindicated in clients receiving MAO inhibitors, acute MI clients, CHF or heart block. Use with caution in glaucoma client or a client with increased intraocular pressure. It can cause edema of the tongue as an adverse effect. NSAIDs may be prescribed for the client as well. NSAIDs such as Motrin, Ibuprofen, or Toradol may be prescribed. This class of medications is helpful because they usually have no addictive effect and many of these have anti-inflammatory/analgesic/and antipyretic effects. Caution is given to clients who have GI disorders such as peptic ulcer disease and may be contraindicated. Opiods are avoided due to the addictive effects that these medicines possess. Steroid injections may be ordered to alleviate inflammation. However, they are given in imited quantities because of the side effects of the steroids. All nurses should be familiar with the side effects of steroids. Bed rest is NOT indicated. Heat/ice, weight loss, physical therapy/stretching, body mechanics education, supportive back belt.

50. Operative Procedures Diskectomy Laminectomy Spinal fusion In many cases, surgery is warranted. There are several types of procedures for back surgery such as diskectomy, laminectomy, and spinal fusion. In many cases, surgery is warranted. There are several types of procedures for back surgery such as diskectomy, laminectomy, and spinal fusion.

51. Fusion with Plates and Screws

52. Post Op Care Fusion - brace May have to log roll patient Post op care for back and cervical surgeries will depend on the doctor’s orders and the type of procedure that was performed. Some patients will have braces, and will need to be log rolled. Do not sit patients in an upright position unless you have specific orders. You can stretch the spinal cord and put too much pressure on the back. Post op care for back and cervical surgeries will depend on the doctor’s orders and the type of procedure that was performed. Some patients will have braces, and will need to be log rolled. Do not sit patients in an upright position unless you have specific orders. You can stretch the spinal cord and put too much pressure on the back.

53. Iron Lungs – Circa 1945

55. Postpolio Syndrome Complication of previously affected by poliomyelitis virus Fatigue, muscle weakness, respiratory difficulties Polio is rather uncommon today. In the year 2002 there were only 400 cases of polio. In 2003 there were 800 cases due to Muslum resistance to vaccines in areas of Nigeria. However, prior to the 1950s some clients have had polio. It is believed that these clients may experience a remanifestation of the disease. The manifestations may include fatigue, muscle weakness, respiratory complications, cold intolerance, headaches and sleep disorders. Polio is rather uncommon today. In the year 2002 there were only 400 cases of polio. In 2003 there were 800 cases due to Muslum resistance to vaccines in areas of Nigeria. However, prior to the 1950s some clients have had polio. It is believed that these clients may experience a remanifestation of the disease. The manifestations may include fatigue, muscle weakness, respiratory complications, cold intolerance, headaches and sleep disorders.

56. Water Therapy

57. Nursing Care of Clients with Visual Problems This section discusses the nursing care of clients with visual or auditory problems. Please refer to your class syllabus for objectives and reading assignments.This section discusses the nursing care of clients with visual or auditory problems. Please refer to your class syllabus for objectives and reading assignments.

58. Review of the Structure and Function of the Visual System Please review this system in your current nursing or anatomy and physiology book Please review the anat & phy of th eye. A brief review follows.Please review the anat & phy of th eye. A brief review follows.

59. Brief Review of the Eye Eyeball covered with three layers: Outer layer is the sclera Middle layer is the choroid Inner layer is the retina Sclera is made up of tough fibrous tissue. The white of the eye is part of the front surface of the sclera. The other part of the front surface of the sclera is the cornea (the window of the eyebecause it is transparent. It lies over the iris(the colored part of the eye.l Conjunctiva, which are mucous membranes cover the entire front surface of the eyeball & line the upper & lower lids. The front part of the choroid is made up of 2 involuntary muscles –the iris & the ciliary muscle. The iris is shaped like a circle with the center being the pupil. The iris is responsible for constricting the pupil in bright light and dilating the pupil in dim light. The ciliary muscle is responsible for changing the convexity of the lens to accommodate near The retina contains rods (for night vision) & cones for daytime vision and color vision. Fluids fill the inside of the eyeball to maintain its shape, to help refract light is behind the lens and to nourish the eye. The aqueous humor is in front of the lens and the vitreous humor is behind the lens. Sclera is made up of tough fibrous tissue. The white of the eye is part of the front surface of the sclera. The other part of the front surface of the sclera is the cornea (the window of the eyebecause it is transparent. It lies over the iris(the colored part of the eye.l Conjunctiva, which are mucous membranes cover the entire front surface of the eyeball & line the upper & lower lids. The front part of the choroid is made up of 2 involuntary muscles –the iris & the ciliary muscle. The iris is shaped like a circle with the center being the pupil. The iris is responsible for constricting the pupil in bright light and dilating the pupil in dim light. The ciliary muscle is responsible for changing the convexity of the lens to accommodate near The retina contains rods (for night vision) & cones for daytime vision and color vision. Fluids fill the inside of the eyeball to maintain its shape, to help refract light is behind the lens and to nourish the eye. The aqueous humor is in front of the lens and the vitreous humor is behind the lens.

60. VISION Is the reflection of light from an object, through the cornea, aqueous humor, lens, and vitreous humor to the retina, where it is sent to the cerebral cortex and perceived as an image. Same as slide… vision is impaired if there is pathology in ay of these areas. The following slide demonstrates the structures used in the process of vision.Same as slide… vision is impaired if there is pathology in ay of these areas. The following slide demonstrates the structures used in the process of vision.

61. Structures of the Eye

62. Assessment/History Change in vision? Contact lens? Protective eyewear? Family history of eye problems? Problems reading? Pain? Itching? Night Driving? Current diseases/family history/ Medications When a client presents with a visual problem, the nurse should begin an assessment by taking a history. Helps identify the problem. Client may be in for routine checkup & might not be aware of changes. Is he wearing contact lens properly? Does he know to wear sunglasses in bright light? Safety goggles when mowing lawn or woodworking? What is client,s age? Does client have family history of eye problems or diseases which can causes eye problems such as diabetis or hypertension? What is client’s age? Older adults are prone to cataracts or macular problems. Noticed eye strain while reading or using computor? Eye pain or discomfort like foreign body in eye?Allergies? Decreased night vision. Look at how visual problems have effected usual activities & fears (of losing vision)& independence. Some medications effect the eyes..For example, Benadryl causes dryness and codiene causes pin point pupils.When a client presents with a visual problem, the nurse should begin an assessment by taking a history. Helps identify the problem. Client may be in for routine checkup & might not be aware of changes. Is he wearing contact lens properly? Does he know to wear sunglasses in bright light? Safety goggles when mowing lawn or woodworking? What is client,s age? Does client have family history of eye problems or diseases which can causes eye problems such as diabetis or hypertension? What is client’s age? Older adults are prone to cataracts or macular problems. Noticed eye strain while reading or using computor? Eye pain or discomfort like foreign body in eye?Allergies? Decreased night vision. Look at how visual problems have effected usual activities & fears (of losing vision)& independence. Some medications effect the eyes..For example, Benadryl causes dryness and codiene causes pin point pupils.

63. Assessment of the Eye Visual Acuity Snellen Chart Assessment may only include assessment of visual acuity using the Snellen Chart. Client reads from the chart from 20 feet. The nurse notes the smallest line the client can read with 2 or fewer errors. Documentation describes the 20 his vision is recorded as 20/40 OS (left eye) (OD is right eye & OU is both eyes. If client can’t see chart, nurse may hold up fingers & document number of feet required for fingers to be seen.For clients over 40 years of age, near vision should be checked with a Jaeger chart to determine the smallest line client can read from 14 inches.Assessment may only include assessment of visual acuity using the Snellen Chart. Client reads from the chart from 20 feet. The nurse notes the smallest line the client can read with 2 or fewer errors. Documentation describes the 20 his vision is recorded as 20/40 OS (left eye) (OD is right eye & OU is both eyes. If client can’t see chart, nurse may hold up fingers & document number of feet required for fingers to be seen.For clients over 40 years of age, near vision should be checked with a Jaeger chart to determine the smallest line client can read from 14 inches.

64. Assessment of the Eye Visual fields Extraocular muscles Pupil function Intraocular pressure Visual field test determines peripheral vision. Client sits 16-24 inches from nurse. Left eye is covered & client’s right eye focuses on spot 1 foot from the eye. Nurses finger is brought in from side at 15 degree intervals , through 360 degrees. Client signals when he sees object. Extraocular muscles are checked for weakness or imbalance by sitting client in dark room & having cl8ient look straight ahead while penlight is shone directly on cornea. Light reflection should be in center rf both corneas as client faces the light force. Pupils are checked by shining directly into each eye. They should be equal in size, round, and react briskly.(Perrla) PUPILS ROUND, REACT TO LIGHT & accomodation)accomodation is checked by having client focus on object from 2-3 feet & bringing it closes until he is focusing @ 6-8 inches. Pupil should constrict when client focuses on near object. Intraocular pressure can be measured by using a tonometer after anestetizing the cornea.Normal pressure ranges from 10-21mm HG.Visual field test determines peripheral vision. Client sits 16-24 inches from nurse. Left eye is covered & client’s right eye focuses on spot 1 foot from the eye. Nurses finger is brought in from side at 15 degree intervals , through 360 degrees. Client signals when he sees object. Extraocular muscles are checked for weakness or imbalance by sitting client in dark room & having cl8ient look straight ahead while penlight is shone directly on cornea. Light reflection should be in center rf both corneas as client faces the light force. Pupils are checked by shining directly into each eye. They should be equal in size, round, and react briskly.(Perrla) PUPILS ROUND, REACT TO LIGHT & accomodation)accomodation is checked by having client focus on object from 2-3 feet & bringing it closes until he is focusing @ 6-8 inches. Pupil should constrict when client focuses on near object. Intraocular pressure can be measured by using a tonometer after anestetizing the cornea.Normal pressure ranges from 10-21mm HG.

65. Assessment of the Eye IOP by Tonometry Opthalmoscopy An instrument called a Tono-pen is commonly used because it is simple & accurate. Use of this instrument requires anesthesing the eyeball & then touching the cornea several times with the probe. The pen gives an LED readout. The posteria part of the eye can be visualized with an opthalmoscope. Blood vessels in the choroid are visable. Use of the Tono-pen & opthalmoscope requires extra training and is not part of a routine exam in the general hospital.An instrument called a Tono-pen is commonly used because it is simple & accurate. Use of this instrument requires anesthesing the eyeball & then touching the cornea several times with the probe. The pen gives an LED readout. The posteria part of the eye can be visualized with an opthalmoscope. Blood vessels in the choroid are visable. Use of the Tono-pen & opthalmoscope requires extra training and is not part of a routine exam in the general hospital.

66. Healthy Retina? This slide illustrates a healthy retina (above) virsus an unhealthy one as seen through an opthalamoscope. The health retina is bright orange- pink , the optic disc is easily seen & has distinct edges. This slide illustrates a healthy retina (above) virsus an unhealthy one as seen through an opthalamoscope. The health retina is bright orange- pink , the optic disc is easily seen & has distinct edges.

67. Assessment of External Structures Eyebrows, lashes and lids Tear ducts Conjunctiva Sclera Cornea Irises The eyebrows, eyelashes and eyelids should be symetric & without redness or edema. The lids should just touch when closed. The tearducts sould be open & wihtout swelling or redness. The conjunctiva should be pale pink & smooth & the sclera should be white or yellowish in older clients (d/t lipid deposits) In some older adults, the sclera appears bluish due to thinning. The cornea should be clear, transparent & shiney. Both irises should be of similar color and shape. Both eyes should be functional. Absence of vision in one eye impairs the ability to judge distance.The eyebrows, eyelashes and eyelids should be symetric & without redness or edema. The lids should just touch when closed. The tearducts sould be open & wihtout swelling or redness. The conjunctiva should be pale pink & smooth & the sclera should be white or yellowish in older clients (d/t lipid deposits) In some older adults, the sclera appears bluish due to thinning. The cornea should be clear, transparent & shiney. Both irises should be of similar color and shape. Both eyes should be functional. Absence of vision in one eye impairs the ability to judge distance.

68. Visual Defects Myopia Hyperopia Astigmatism Presbyopia Myopia is the most common refractive error . It is commonly known as nearsightedness & is caused by excessive light refracton by the cornea or lens because of a abnormally lengthing of eye which is caused by genetic factors. It may also occur d/t swelling related to high blood glucose levels which is transient. Distance vision is blurred. Hyperopia is also known as farsightedness. This occurs when the eyeball is too short resulting in inadequate focusing power. Near vision is blurred. Astigmatism is caused by an unequal corneal curvature which prevents the light rays to focus on a single point on the retina.Vision is blurred & the client c/o eye fatigue Presbyopia is the loss of accommodation due to aging of the eye causing the lens to become more rigid. This causes blurred near vision & the client typicaly holds objects loike newspaper at arms length in an attempt to clear his vision.Myopia is the most common refractive error . It is commonly known as nearsightedness & is caused by excessive light refracton by the cornea or lens because of a abnormally lengthing of eye which is caused by genetic factors. It may also occur d/t swelling related to high blood glucose levels which is transient. Distance vision is blurred. Hyperopia is also known as farsightedness. This occurs when the eyeball is too short resulting in inadequate focusing power. Near vision is blurred. Astigmatism is caused by an unequal corneal curvature which prevents the light rays to focus on a single point on the retina.Vision is blurred & the client c/o eye fatigue Presbyopia is the loss of accommodation due to aging of the eye causing the lens to become more rigid. This causes blurred near vision & the client typicaly holds objects loike newspaper at arms length in an attempt to clear his vision.

69. Visual Defects Aphakia Corrections include glasses, contact lenses, and surgical intervention such as LASIK. Intraocular lens implant used for aphakia Aphakia occurs when the lens is absent, either due to congenital abnormality or whe it has been removed during cataract surgery. The client lacks near vision in the involved eye. These visual defects can be corrected by glasses, contact lenses or surgery to change the shape of the cornea. Typically, a lens is implanted following cataract surgery.Aphakia occurs when the lens is absent, either due to congenital abnormality or whe it has been removed during cataract surgery. The client lacks near vision in the involved eye. These visual defects can be corrected by glasses, contact lenses or surgery to change the shape of the cornea. Typically, a lens is implanted following cataract surgery.

70. Uncorrectable Visual Impairment Severe impairment Functional blindness Legal blindness Total blindness Severe impairment is characterized by inability to read newsprint with glasses or other aids. Functional blindness is diagnosed when the client has some light perception but no usable vision. Legal blindness is defined as having central vision acuity of 20/200 or worse in the better eye even with corrective lenses. The client is considered totally blind if he has no light perception or usable vision.Severe impairment is characterized by inability to read newsprint with glasses or other aids. Functional blindness is diagnosed when the client has some light perception but no usable vision. Legal blindness is defined as having central vision acuity of 20/200 or worse in the better eye even with corrective lenses. The client is considered totally blind if he has no light perception or usable vision.

71. Nursing Diagnoses for Clients with Visual Impairment Sensory-perceptual alterations Risk for injury Self-care deficits Fear Social isolation Knowledge deficit Nursing diagnoses depend on the amount of impairment the client has and the support systems that are in place. This slide lists some of the diagnoses that can occur with impaired vision. Obviously, the client with uncorrectable impairment experiences much most stress than the one who has minor, correctable impairment. Nursing diagnoses depend on the amount of impairment the client has and the support systems that are in place. This slide lists some of the diagnoses that can occur with impaired vision. Obviously, the client with uncorrectable impairment experiences much most stress than the one who has minor, correctable impairment.

72. Extraocular Disorders Infection & Inflammation of lids Hordeolum (sty) Chalazion Blepharitis Inflamation &/or infection is one of the most common disorders. A hordeolum is an infection of the sebaceous gland in the lid, which is typically caused by staphyloooccus aureus. Symptoms include redness, swelling & tenderness & treatment is application of warm compresses & may include antibiotic drops. Patients should discard used cosmetics to prevent re-contamination. A chalzaion is inflamation of the sebacous gland related to a sty or a blocked gland.Symptoms are the same as those for a sty except the area is nontender. Moist compresses are helpful & surgical removal may be necessary. Blepharitis is bilateral inflammation of the lid margins which causes crusty scaling of the lids & lashes. It may be causes by staphacoccus or seborrheal microorganisms & is treated with anitbiotic ointment or antiseborrheic shampoo.Inflamation &/or infection is one of the most common disorders. A hordeolum is an infection of the sebaceous gland in the lid, which is typically caused by staphyloooccus aureus. Symptoms include redness, swelling & tenderness & treatment is application of warm compresses & may include antibiotic drops. Patients should discard used cosmetics to prevent re-contamination. A chalzaion is inflamation of the sebacous gland related to a sty or a blocked gland.Symptoms are the same as those for a sty except the area is nontender. Moist compresses are helpful & surgical removal may be necessary. Blepharitis is bilateral inflammation of the lid margins which causes crusty scaling of the lids & lashes. It may be causes by staphacoccus or seborrheal microorganisms & is treated with anitbiotic ointment or antiseborrheic shampoo.

73. Extraocular Disorders Conjunctiva Conjunctivitis Conjunctivitis may be caused by bacteria, commonly called pinkeye & commonly occuring in children. Symp;toms are irritation, tearing redness, foreign body sensation & purulent drainage. Treatment is antibiotic drops.Clients should be taught to avoid spreading the disease by proper handwashing and not reusing wash clothes or towels that have touched the eye. Cojunctivitis may also be caused by viral infection, chlamydial infection of may be due to allergies. Treatment is paliative but may include steroids, and antihistimes & artificial tears.Conjunctivitis may be caused by bacteria, commonly called pinkeye & commonly occuring in children. Symp;toms are irritation, tearing redness, foreign body sensation & purulent drainage. Treatment is antibiotic drops.Clients should be taught to avoid spreading the disease by proper handwashing and not reusing wash clothes or towels that have touched the eye. Cojunctivitis may also be caused by viral infection, chlamydial infection of may be due to allergies. Treatment is paliative but may include steroids, and antihistimes & artificial tears.

74. Extraocular Disorders Cornea Keratitis Keratitis occurs when the cornea is damaged, allowing bacteria, viruses, chlamydia or other organisms to invade. Clients who wear soft contact lens, & those with immunosuppression are most at risk. Herpes simple is the most frequent cause of corneal blindness & is becoming a problem for immunosuppressed clients. Treatment includes antibiotics for bacterial infections, & antivirals for viral infections. Trachoma is a severe keratoconjunjtvisis caused by chlamydia trachoma. It is very common in other countries & often causes blindness from corneal scaring. Keratitis occurs when the cornea is damaged, allowing bacteria, viruses, chlamydia or other organisms to invade. Clients who wear soft contact lens, & those with immunosuppression are most at risk. Herpes simple is the most frequent cause of corneal blindness & is becoming a problem for immunosuppressed clients. Treatment includes antibiotics for bacterial infections, & antivirals for viral infections. Trachoma is a severe keratoconjunjtvisis caused by chlamydia trachoma. It is very common in other countries & often causes blindness from corneal scaring.

75. Nursing Diagnoses Pain Anxiety Sensory-perceptual alteration Some of the Nursing diagnoses for the client with inflamation or infection include pain related to irritation, anxiety or fear of outcome and sensory-perceptual alteration d/t decreased or absent visionSome of the Nursing diagnoses for the client with inflamation or infection include pain related to irritation, anxiety or fear of outcome and sensory-perceptual alteration d/t decreased or absent vision

76. Cataracts The client who has a cataract WILL VIEW THE world as you are viewing this slide. The client who has a cataract WILL VIEW THE world as you are viewing this slide.

77. Cataracts Opacification of Lens Etiology: Symptoms: Treatment: A cataract is an opacity within the crystalline lens, which is more common as the client ages. Most cataracts are age-related but they can be related to blunt trauma, maternal rubella, radiation, topical or systemic steroids, and diabetes. Symptoms develop slowly & include decreased or blurred vision, abnormal color perception & glare which is worse at night Treatment is surgical removal of the lens & an intraocular lens implant.A cataract is an opacity within the crystalline lens, which is more common as the client ages. Most cataracts are age-related but they can be related to blunt trauma, maternal rubella, radiation, topical or systemic steroids, and diabetes. Symptoms develop slowly & include decreased or blurred vision, abnormal color perception & glare which is worse at night Treatment is surgical removal of the lens & an intraocular lens implant.

78. Post-op Eye Surgery Care Nursing Interventions and Teaching are Aimed At: Preventing Increased IOP Preventing Infection Preventing Injury Nursing intervenions and teaching are aimed at 1. preventing increased IOP by not bending over, avoiding coughing, straining & the valsalva maneuver 2 preventng infection by careful handwashing, keeping dressing dry , & not contaminating the eye drop medication. & 3. preventing injury by wearing the protective patch & being careful to not fall d/t impaired depth perception while wearing the patch.Nursing intervenions and teaching are aimed at 1. preventing increased IOP by not bending over, avoiding coughing, straining & the valsalva maneuver 2 preventng infection by careful handwashing, keeping dressing dry , & not contaminating the eye drop medication. & 3. preventing injury by wearing the protective patch & being careful to not fall d/t impaired depth perception while wearing the patch.

79. Glaucoma Glaucoma is a group of disorders characterized by increased iop, optic nerve atrophy an peripheral visual field loss.This slide demonstrates the “tunnel vision” experienced by the client as a result of untreated glaucoma. IOP is normally regulated by the balance of production and reabsorption of aqueous humor Gluacoma is caused by an imbalance of this ratio. Glaucoma is a group of disorders characterized by increased iop, optic nerve atrophy an peripheral visual field loss.This slide demonstrates the “tunnel vision” experienced by the client as a result of untreated glaucoma. IOP is normally regulated by the balance of production and reabsorption of aqueous humor Gluacoma is caused by an imbalance of this ratio.

80. Glaucoma Signs and Symptoms Primary open-angle glaucoma Primary angle-closure glaucoma Acute angle-closure glaucoma Primary open angle glaucoma occurs when the outflow of aqueous humor is decreased d/t drainage channel clogging. 90% of the cases are of this type. 10% of the cases are of primary angle-closure type which involves reduced outflow d/t/ angle closure related to a bulging lens (usually in the older person) or prolonged pupil dilation in clients with narrow angles. Signs & symptoms usually develop gradually. It is very important that IOP be checked at least annually because untreated glaucoma causes loss of peripheral vision. Patients are instructed that they must use their eye drops. In acute angle-closure glaucoma, symptoms include sudden severe pain around the eye, seeing colored halos around lights, blurred vision, redness & nausea & vomiting. Acute angle-closure glaucoma is a medical emergency & is treated with miotics hyperosmotic agents either IV or PO.Primary open angle glaucoma occurs when the outflow of aqueous humor is decreased d/t drainage channel clogging. 90% of the cases are of this type. 10% of the cases are of primary angle-closure type which involves reduced outflow d/t/ angle closure related to a bulging lens (usually in the older person) or prolonged pupil dilation in clients with narrow angles. Signs & symptoms usually develop gradually. It is very important that IOP be checked at least annually because untreated glaucoma causes loss of peripheral vision. Patients are instructed that they must use their eye drops. In acute angle-closure glaucoma, symptoms include sudden severe pain around the eye, seeing colored halos around lights, blurred vision, redness & nausea & vomiting. Acute angle-closure glaucoma is a medical emergency & is treated with miotics hyperosmotic agents either IV or PO.

81. Glaucoma Treatment Beta Blockers – Timoptic, Betoptic Cholinergic – Pilocarpine, Adrenergic agonists – Epinephrine, Alphagan Carbonic Anhydrase Inh. – Diamox Laser Iridectomy Trabeculectomy The primary treatment for glaucoma is medication. Most are given in the form of topical drops. Beta blockers & adrenergic agents which are thought to decrease IOP by decreasing the production of aqueous humor. Cholinergics (aka miotics) are parasympathomimetic and decrease IOP by causing the iris sphincter to contract which opens the trabecular meshwork to increase outflow of aqueous humor. Carbonic Anhydrase Inhibitors are given PO and decrease aqueous humor production. This slide shows a example of a drug from each classification. The RN is responsibe for teaching the client to correctly use eye drops. If treatment with medication is not successful in controlling IOP, surgery may be necessary to open the outflow channels. The two examples above are out-patient procedures. The primary treatment for glaucoma is medication. Most are given in the form of topical drops. Beta blockers & adrenergic agents which are thought to decrease IOP by decreasing the production of aqueous humor. Cholinergics (aka miotics) are parasympathomimetic and decrease IOP by causing the iris sphincter to contract which opens the trabecular meshwork to increase outflow of aqueous humor. Carbonic Anhydrase Inhibitors are given PO and decrease aqueous humor production. This slide shows a example of a drug from each classification. The RN is responsibe for teaching the client to correctly use eye drops. If treatment with medication is not successful in controlling IOP, surgery may be necessary to open the outflow channels. The two examples above are out-patient procedures.

82. Age Related Macular Degeneration AMD is uncorrectible loss of central vision as demonstrated in this slide. The cause is unknown but it is related to retinal aging & is the leading cause of vision loss among people over age 55. New research is in process to improve central vision. Implantation of a tiny telescope is each eye is currently being studied & new drugs are being developed for this disorder.AMD is uncorrectible loss of central vision as demonstrated in this slide. The cause is unknown but it is related to retinal aging & is the leading cause of vision loss among people over age 55. New research is in process to improve central vision. Implantation of a tiny telescope is each eye is currently being studied & new drugs are being developed for this disorder.

83. Eye “911” Retinal Detachment Ocular Trauma Infection Acute Glaucoma A retinal detachment is a separation of the retina from the underlying epithelium with fluid accumulation between the 2 layers. The client c/o flashing lights, floaters and a cobweb or ring in the field of vision. When the detachment is complete, the client complains of loss of vision ”like a curtain coming across” the visual field. Small retinal breaks require no treatment but larger breaks require immediate treatment to prevent blindness. Treatment is surgery seal the break. Ocular trauma is another emergency which requires immediate treatment. Generally the eye should be covered and protected until the client is seen by the opthalmologist. Clients who have an chemical exposure injury should have immediate & continuous eye irrigation ,preferably with saline or water.Intraocular infection can lead to irreversible blindness within hours or days. If untreated, the globe can rupture and enucleation may be necessary. Treatment is antibiotic therapy & corticosteroids. The client is usually frightened and in pain & requires emotional support from the RN. Acute angle closure glaucoma is considered an emergency & requires immediate miotic drops & hyperosmolar agents such as glycerine liquid to lower the iop. A retinal detachment is a separation of the retina from the underlying epithelium with fluid accumulation between the 2 layers. The client c/o flashing lights, floaters and a cobweb or ring in the field of vision. When the detachment is complete, the client complains of loss of vision ”like a curtain coming across” the visual field. Small retinal breaks require no treatment but larger breaks require immediate treatment to prevent blindness. Treatment is surgery seal the break. Ocular trauma is another emergency which requires immediate treatment. Generally the eye should be covered and protected until the client is seen by the opthalmologist. Clients who have an chemical exposure injury should have immediate & continuous eye irrigation ,preferably with saline or water.Intraocular infection can lead to irreversible blindness within hours or days. If untreated, the globe can rupture and enucleation may be necessary. Treatment is antibiotic therapy & corticosteroids. The client is usually frightened and in pain & requires emotional support from the RN. Acute angle closure glaucoma is considered an emergency & requires immediate miotic drops & hyperosmolar agents such as glycerine liquid to lower the iop. A retinal detachment is a separation of the retina from the underlying epithelium with fluid accumulation between the 2 layers. The client c/o flashing lights, floaters and a cobweb or ring in the field of vision. When the detachment is complete, the client complains of loss of vision ”like a curtain coming across” the visual field. Small retinal breaks require no treatment but larger breaks require immediate treatment to prevent blindness. Treatment is surgery seal the break. Ocular trauma is another emergency which requires immediate treatment. Generally the eye should be covered and protected until the client is seen by the opthalmologist. Clients who have an chemical exposure injury should have immediate & continuous eye irrigation ,preferably with saline or water.Intraocular infection can lead to irreversible blindness within hours or days. If untreated, the globe can rupture and enucleation may be necessary. Treatment is antibiotic therapy & corticosteroids. The client is usually frightened and in pain & requires emotional support from the RN. Acute angle closure glaucoma is considered an emergency & requires immediate miotic drops & hyperosmolar agents such as glycerine liquid to lower the iop. A retinal detachment is a separation of the retina from the underlying epithelium with fluid accumulation between the 2 layers. The client c/o flashing lights, floaters and a cobweb or ring in the field of vision. When the detachment is complete, the client complains of loss of vision ”like a curtain coming across” the visual field. Small retinal breaks require no treatment but larger breaks require immediate treatment to prevent blindness. Treatment is surgery seal the break. Ocular trauma is another emergency which requires immediate treatment. Generally the eye should be covered and protected until the client is seen by the opthalmologist. Clients who have an chemical exposure injury should have immediate & continuous eye irrigation ,preferably with saline or water.Intraocular infection can lead to irreversible blindness within hours or days. If untreated, the globe can rupture and enucleation may be necessary. Treatment is antibiotic therapy & corticosteroids. The client is usually frightened and in pain & requires emotional support from the RN. Acute angle closure glaucoma is considered an emergency & requires immediate miotic drops & hyperosmolar agents such as glycerine liquid to lower the iop.

84. Systemic Disorders That Effect the Eye Diabetes Hypertension Grave’s Disease Infections – CMV, TB Vitamin deficiencies Immunosuppression-AIDS, Herpes This slide lists a few of the diseases that effect the eye. Some patients may present with ocular symptoms & not be aware of a systemic illness. For example, a patient who c/o blurred vision may be an undiagnosed diabetic and CMV retinitis may be the first symptom of AIDS This slide lists a few of the diseases that effect the eye. Some patients may present with ocular symptoms & not be aware of a systemic illness. For example, a patient who c/o blurred vision may be an undiagnosed diabetic and CMV retinitis may be the first symptom of AIDS.This slide lists a few of the diseases that effect the eye. Some patients may present with ocular symptoms & not be aware of a systemic illness. For example, a patient who c/o blurred vision may be an undiagnosed diabetic and CMV retinitis may be the first symptom of AIDS This slide lists a few of the diseases that effect the eye. Some patients may present with ocular symptoms & not be aware of a systemic illness. For example, a patient who c/o blurred vision may be an undiagnosed diabetic and CMV retinitis may be the first symptom of AIDS.

85. Preventative Care Vision Screenings Glaucoma Screening Protect Your Eyes The nurses role in prevention of ocular problems includes encouraging clients to have annual vision & glaucoma screening. Clients should also be taught to protect their eyes from sunlight and when engaged in activities in which eye injury could occur. Proper use of contact lens also should be encouraged.The nurses role in prevention of ocular problems includes encouraging clients to have annual vision & glaucoma screening. Clients should also be taught to protect their eyes from sunlight and when engaged in activities in which eye injury could occur. Proper use of contact lens also should be encouraged.

86. Ears RN’s Role in Assessment & Prevention of Problems This section describes nursing assessment of clients with problems related to the ear and nursing interventions which preserve hearing or prevent further loss. Please review the structures & functions of the auditory system in your textbook.This section describes nursing assessment of clients with problems related to the ear and nursing interventions which preserve hearing or prevent further loss. Please review the structures & functions of the auditory system in your textbook.

87. Signs of Hearing Difficulty Irritable, Hostile, Withdrawn C/O People Mumbling Doesn’t Get Jokes TV on Loud Asks for words to be repeated Answers questions inappropriately Smiles instead of responding to your question Clients may be unaware of decreased ability to hear, especially if their hearing loss has occurred gradually. Some clues that the client may be having difficulty are listed on this slide. Other clues are evidence of lip reading and turning the head toward the sound. Some clients are reluctant to admit to hearing loss until it has become moderate.Clients may be unaware of decreased ability to hear, especially if their hearing loss has occurred gradually. Some clues that the client may be having difficulty are listed on this slide. Other clues are evidence of lip reading and turning the head toward the sound. Some clients are reluctant to admit to hearing loss until it has become moderate.

88. Hearing Assessment The slide will assist with your review of the structure of the ear. The slide will assist with your review of the structure of the ear.

89. Hearing Assessment This slide is a close up of the middle ear.This slide is a close up of the middle ear.

90. Assessment - History Change in hearing? Balance Tinnitus Pain Effect on job, hobby or relationship Medications The client should be asked about changes in ability to hear & ways he has compensated for the loss such as wearing headphones to hear the television. Because the vestibular system is related to the auditory system, the client should be asked if he experiences dizziness or vertigo, which could effect his ability to drive, climb stairs etc. Tinnitus, or ringing in the ears, often accompanies auditory problems and can disrupt sleep and quiet activities. Pain can be associated with straining or chewing. Is the client employed in a job that requires accurate hearing? Is he in conflict with his family over having the TV or radio on too loud? Has he given up activities such as going to movies or church because of his loss? What activities does he perform which cause exposure to damaging noise levels like mowing the lawn without earplugs? What medications does he take that are ototoxic?The client should be asked about changes in ability to hear & ways he has compensated for the loss such as wearing headphones to hear the television. Because the vestibular system is related to the auditory system, the client should be asked if he experiences dizziness or vertigo, which could effect his ability to drive, climb stairs etc. Tinnitus, or ringing in the ears, often accompanies auditory problems and can disrupt sleep and quiet activities. Pain can be associated with straining or chewing. Is the client employed in a job that requires accurate hearing? Is he in conflict with his family over having the TV or radio on too loud? Has he given up activities such as going to movies or church because of his loss? What activities does he perform which cause exposure to damaging noise levels like mowing the lawn without earplugs? What medications does he take that are ototoxic?

91. Assessment External Ear Otoscopic Exam After taking a careful history, the RN should begin the physical examination by observing the external ears for equality in shape and color. There should be no nodules, swelling or redness. The client should experience no pain or tenderness when the auricle is grasped. Otoscopic examination of the ear requires advanced training and will not be taught in this course. The tympanic membrane can be visualized and should be pearl gray, white or pink and shiny & translucent. A light reflex should be present. If too much cerumen is present, the tympanic membrane may not be seen. After taking a careful history, the RN should begin the physical examination by observing the external ears for equality in shape and color. There should be no nodules, swelling or redness. The client should experience no pain or tenderness when the auricle is grasped. Otoscopic examination of the ear requires advanced training and will not be taught in this course. The tympanic membrane can be visualized and should be pearl gray, white or pink and shiny & translucent. A light reflex should be present. If too much cerumen is present, the tympanic membrane may not be seen.

92. Tympanic Membrane This slide demonstrates a normal tympanic membrane on the left and a bulging red membrane with amber bubbles above the fluid line as seen in otitis media.This slide demonstrates a normal tympanic membrane on the left and a bulging red membrane with amber bubbles above the fluid line as seen in otitis media.

93. Diagnostic Studies Whisper test/Ticking watch test Tuning-Fork tests Audiometry Vestibular function tests The RN can screen for a client’s decreased ability to hear by using the whisper test or the ticking watch test. In the whisper test, the RN stands 12-24 inches to one side of the client and has him/her occlude the opposite ear. The examiner softly whispers numbers or words and asks the client to repeat them. The sounds increase in volume until the client is able to accurately hear them. The opposite ear is them tested. The ticking watch test involves occlusion of one ear and placing a ticking watch ½ to 2 inches from the ear being tested. Clients should be able to hear the ticking normally but clients with sensory or neural loss can not hear the high pitched tones. Tuning fork tests can differentiate between conductive and sensory or neural hearing loses. A conductive hearing loss is due to a problem in the outer or middle ear. A hearing loss is due to disease of the inner ear or nerve pathways. The most commonly used tests are the Rinne and the Weber’s test. Both involve use of a metal instrument that conducts sound. In the Rinne test the activated tuning fork is held against the mastoid bone & then outside of the ear canal. Normally, the client reports hearing sound longer through the ear canal (by air conduction). Weber’s test involves placing the activated tuning fork on the forehead or midline of the skull. Normally sounds should be heard equally in both ears. Using these tests require skill and experience and are not always accurate. Audiometry is a measurement of hearing which helps determine the type and degree of hearing loss. This test is conducted by an audioloogist who is also trained to fit hearing aids. CT & MRIs may also be used to determine presence of a lesion of the auditory nerve. Vestibular function tests include the caloric test in which the ear canal is irrigated with cold or warm water. Normally, the client will exhibit nystagmus, with cold water on the opposite side of instillation. If no nystagmus is elicited, a brain lesion is suspected.The RN can screen for a client’s decreased ability to hear by using the whisper test or the ticking watch test. In the whisper test, the RN stands 12-24 inches to one side of the client and has him/her occlude the opposite ear. The examiner softly whispers numbers or words and asks the client to repeat them. The sounds increase in volume until the client is able to accurately hear them. The opposite ear is them tested. The ticking watch test involves occlusion of one ear and placing a ticking watch ½ to 2 inches from the ear being tested. Clients should be able to hear the ticking normally but clients with sensory or neural loss can not hear the high pitched tones. Tuning fork tests can differentiate between conductive and sensory or neural hearing loses. A conductive hearing loss is due to a problem in the outer or middle ear. A hearing loss is due to disease of the inner ear or nerve pathways. The most commonly used tests are the Rinne and the Weber’s test. Both involve use of a metal instrument that conducts sound. In the Rinne test the activated tuning fork is held against the mastoid bone & then outside of the ear canal. Normally, the client reports hearing sound longer through the ear canal (by air conduction). Weber’s test involves placing the activated tuning fork on the forehead or midline of the skull. Normally sounds should be heard equally in both ears. Using these tests require skill and experience and are not always accurate. Audiometry is a measurement of hearing which helps determine the type and degree of hearing loss. This test is conducted by an audioloogist who is also trained to fit hearing aids. CT & MRIs may also be used to determine presence of a lesion of the auditory nerve. Vestibular function tests include the caloric test in which the ear canal is irrigated with cold or warm water. Normally, the client will exhibit nystagmus, with cold water on the opposite side of instillation. If no nystagmus is elicited, a brain lesion is suspected.

94. Ear Disorders External Ear and Canal Trauma External Otitis Cerumen & foreign bodies Malignancy Blows to the ear can cause inflammation, hematoma and conductive hearing loss. The client should be given antibiotics to prevent infection. External otitis is inflammation of the epithelium of the auricle and ear canal (aka swimmers ear). It may be caused by bacteria or fungi Pain (otalgia) is usually first symptom. There may be drainage from the ear and hearing may be blocked d/t swelling of the canal. Client may also c/o dizziness. Treatment is ASA or Codeine for pain, appropriate topical antibiotics or nystatin if fungal, steroids, and if necessary, PO antibiotics. Warm moist compresses may by helpful. Impacted wax is often related to decreased hearing, especially with the elderly. Wax can be softened with a lubricant and be removed with irrigation of the canal with body-temperature water. Wax may need to be removed by an MD. Foreign bodies should be removed by an otolaryngologist . Insects is the ear should first be drowned with mineral oil or lidocaine before removal. Malignancies, except for skin cancer are rare. Symptoms include an ulcer which doesn’t heal and drainage. Treatment is surgical removal. Skin cancers are not usually life-threatening and are surgically excised.Blows to the ear can cause inflammation, hematoma and conductive hearing loss. The client should be given antibiotics to prevent infection. External otitis is inflammation of the epithelium of the auricle and ear canal (aka swimmers ear). It may be caused by bacteria or fungi Pain (otalgia) is usually first symptom. There may be drainage from the ear and hearing may be blocked d/t swelling of the canal. Client may also c/o dizziness. Treatment is ASA or Codeine for pain, appropriate topical antibiotics or nystatin if fungal, steroids, and if necessary, PO antibiotics. Warm moist compresses may by helpful. Impacted wax is often related to decreased hearing, especially with the elderly. Wax can be softened with a lubricant and be removed with irrigation of the canal with body-temperature water. Wax may need to be removed by an MD. Foreign bodies should be removed by an otolaryngologist . Insects is the ear should first be drowned with mineral oil or lidocaine before removal. Malignancies, except for skin cancer are rare. Symptoms include an ulcer which doesn’t heal and drainage. Treatment is surgical removal. Skin cancers are not usually life-threatening and are surgically excised.

95. Ear Disorders Middle Ear and Mastoid Otitis Media, acute Otitis Media, chronic and Mastoiditis Otosclerosis Acute otitis media is usually seen in children. It is a bacterial infection causing pain, fever, headache malaise and reduced hearing. Treatment includes antibiotics with Amoxicillin being the drug of choice. If medication is not effective, a myringotomy (an incision in the tympanum to release pressure and exudate ) is done to prevent rupture of the tympanic membrane. Placement of a tympanostomy tube may be necessary for short or long tern use. Chronic otitis media and mastoiditis may occur if acute otitis media is not treated. Symptoms include painless purulent mucoid or serous discharge from the ear accompanied by decreased hearing and occasional c/o ear pain, nausea and dizziness. The tympanic membrane may be ruptured. X-rays may show mastoid pathology in the form of a cholestetoma, a soft ball of dead skin which can cause extensive damage to the middle ear and facial nerve unless surgically removed. Treatment involves antibiotics and steroid eardrops with frequent removal of drainage and debris. In some cases, surgical removal of diseased tissue and repair of the tympanic membrane is necessary. Surgery to reconstruct the tympanic membrane is called a tympanoplasty. Surgical removal of diseased tissue of the mastoid is called a mastoidectomy. Otosclerosis is a pathological condition in which new spongy bone forms in the labyrinth, fixation of the stapes & prevention of sound transmission to the inner ear fluid, causing deafness. The cause is unknown. It occurs more commonly in young women than men and has a familial tendency. Client presents with c/o tinnitus & gradual hearing loss which is usually bilateral. A surgical procedure called a stapedectomy can be performed. This involves removing the lesions at the footplate of the stapes & placing a prosthesis to conduct sound. Acute otitis media is usually seen in children. It is a bacterial infection causing pain, fever, headache malaise and reduced hearing. Treatment includes antibiotics with Amoxicillin being the drug of choice. If medication is not effective, a myringotomy (an incision in the tympanum to release pressure and exudate ) is done to prevent rupture of the tympanic membrane. Placement of a tympanostomy tube may be necessary for short or long tern use. Chronic otitis media and mastoiditis may occur if acute otitis media is not treated. Symptoms include painless purulent mucoid or serous discharge from the ear accompanied by decreased hearing and occasional c/o ear pain, nausea and dizziness. The tympanic membrane may be ruptured. X-rays may show mastoid pathology in the form of a cholestetoma, a soft ball of dead skin which can cause extensive damage to the middle ear and facial nerve unless surgically removed. Treatment involves antibiotics and steroid eardrops with frequent removal of drainage and debris. In some cases, surgical removal of diseased tissue and repair of the tympanic membrane is necessary. Surgery to reconstruct the tympanic membrane is called a tympanoplasty. Surgical removal of diseased tissue of the mastoid is called a mastoidectomy. Otosclerosis is a pathological condition in which new spongy bone forms in the labyrinth, fixation of the stapes & prevention of sound transmission to the inner ear fluid, causing deafness. The cause is unknown. It occurs more commonly in young women than men and has a familial tendency. Client presents with c/o tinnitus & gradual hearing loss which is usually bilateral. A surgical procedure called a stapedectomy can be performed. This involves removing the lesions at the footplate of the stapes & placing a prosthesis to conduct sound.

96. Ear Disorders Inner Ear – Meniere’s Hearing Loss Presbycusis Conductive/Sensor neural Meniere’s disease (endolymphatic hydrops) is a chronic disease of the inner ear that causes vertigo, hearing loss and tinnitus. There is no known cause but it involves fluid distention in the labyrinth and destruction of the vestibular and cochlear hair cells. This disease causes severe disability because the client experiences sudden attacks of vertigo which may last for hours or days. Safety is an issue with this client. He/she may not be safe to drive or maintain employment until the disease is under control. Treatment includes antihistamines, anticholinergics & benzodiazepines to suppress the labyrinth. Diuretics, a low Na diet avoidance of stimulants & Antivert (for dizziness) can help decrease attacks. Surgery to decompress the endolymphatic sac may be necessary. Presbycusis is hearing loss of old age, & is caused by degenerative changes in the ear.Conductive hearing loss is caused by conditions interfering with air conduction. Sensory neural loss is caused by impairment of functions of the inner ear or nerve pathways.Meniere’s disease (endolymphatic hydrops) is a chronic disease of the inner ear that causes vertigo, hearing loss and tinnitus. There is no known cause but it involves fluid distention in the labyrinth and destruction of the vestibular and cochlear hair cells. This disease causes severe disability because the client experiences sudden attacks of vertigo which may last for hours or days. Safety is an issue with this client. He/she may not be safe to drive or maintain employment until the disease is under control. Treatment includes antihistamines, anticholinergics & benzodiazepines to suppress the labyrinth. Diuretics, a low Na diet avoidance of stimulants & Antivert (for dizziness) can help decrease attacks. Surgery to decompress the endolymphatic sac may be necessary. Presbycusis is hearing loss of old age, & is caused by degenerative changes in the ear.Conductive hearing loss is caused by conditions interfering with air conduction. Sensory neural loss is caused by impairment of functions of the inner ear or nerve pathways.

97. Ear surgery Post-op Care Pain High Risk for Injury High Risk for Infection knowledge Deficit General care of clients following ear surgeries involve the above nursing diagnoses. The nurse must keep the client comfortable & should place emphasis on teaching the client ways to prevent infection and injury. Most of these clients will be treated in an outpatient setting.General care of clients following ear surgeries involve the above nursing diagnoses. The nurse must keep the client comfortable & should place emphasis on teaching the client ways to prevent infection and injury. Most of these clients will be treated in an outpatient setting.

98. Ear Care Nothing Smaller Than Your Elbow If It Sounds Too Loud--It Probably Is! This slide lists 2 or the most important ways that clients can protect their hearing.This slide lists 2 or the most important ways that clients can protect their hearing.

99. Ototoxic Medications “Mycin” drugs(Vancomycin, Erythromycin, Gentamycin, etc.) Salicylates Loop Diuretics, Diamox Quinine, Quinidine This slide lists some of the drugs that have the potential to cause hearing loss. Clients should be made aware of this when they are taking these drugs.This slide lists some of the drugs that have the potential to cause hearing loss. Clients should be made aware of this when they are taking these drugs.

100. Hearing Aid Care Turn Off When Not in Use Keep Extra Batteries Keep Clean DO NOT Get Wet DO NOT Wear During an Infection Many clients will be prescribed hearing aids. The nurse should instruct the client to turn off and protect the aids when not wearing them. Batteries should be removed at night and will only last 1 week so the client should keep an extra supply on hand. The ear mold should be kept clean and wax removed from the ear tip. Hearing aids should not be worn during an ear infection & should not be gotten wet. Clients should practice with the volume control so that they are comfortable adjusting it.Many clients will be prescribed hearing aids. The nurse should instruct the client to turn off and protect the aids when not wearing them. Batteries should be removed at night and will only last 1 week so the client should keep an extra supply on hand. The ear mold should be kept clean and wax removed from the ear tip. Hearing aids should not be worn during an ear infection & should not be gotten wet. Clients should practice with the volume control so that they are comfortable adjusting it.