Caring for Clients With Eye and Ear Disorders

1. 40 Caring for Clients With Eye and Ear Disorders

2. Learning Outcomes • Describe the pathophysiology and manifestations of common eye and ear disorders. • Describe nursing implications for drugs prescribed for clients with eye and ear disorders. • Provide appropriate nursing care for a client having eye or ear surgery.

3. Learning Outcomes • Use the nursing process to provide individualized care for clients with problems that affect vision or hearing. • Describe appropriate teaching content for the client with eye or ear disorders.

4. Anatomy of the Eye

5. Anatomy of the Eye

6. Blepharitis • Patho/Etiology: • Hypersecretion; Infectious agents • Assessment Findings: Inflamed lid margins; Patchy flakes; Missing eyelashes; Purulent drainage; itchy • Diagnostic Findings: Scraping lid margins; Microscopic examination • Medical Management: Topical antibiotic; Cleansing: Eye, face, and hair

7. Hordeolum: “Sty” • Patho/Etiology: Staphylococcus aureus • Assessment Findings: painful, swollen, red pustule • Medical, Surgical Management: Warm soaks; Topical antibiotic • Severe cases: Incision; Drainage • Nursing Management: separate towels, cleanliness

8. Figure 40-1(A) Hordeolum (sty); (Source: Sph Photo Researchers)

9. Chalazion: “Cyst” • Pathophysiology, Etiology: meibomian gland becomes obstructed and the release of sebaceous secretions is blocked • Assessment Findings: swollen, hard, can block vision if too large • Med/Surg Management: Warm soaks; massage

10. Figure 40-1 (continued) (B) Chalazion (Source: Custom Medical Stock Photos, Inc.)

11. Conjunctivitis: “Pink Eye” • Etiology: Bacterial,Viral • Direct contact • Trachoma: corneal damage; blindness • Assessment Findings: Redness; Tearing; Burning; Itching; Purulent drainage; Enlarged lymph nodes • Medical Management: Antibiotic, antiviral meds; Warm soaks, irrigations; Decongestants; Antihistamines

12. Figure 40-2 An eye with acute conjunctivitis. (Source: Buddy Crofton/Medical Images, Inc.)

13. Keratitis • Patho/Etiology: Corneal inflammation • trauma; infectious agents; lack of tears • Assessment Findings: Pain; Photophobia; Blurred vision; Tearing; Purulent discharge; Redness; Blepharospasm • Diagnostic Findings: Slit-lamp exam; • Nursing Management: no contact lens, keep eye clear of exudate

14. Corneal Ulcers • Causes • Infection • Trauma • Contact lens • Herpes virus (shingles) • Scarring causes clouding • Perforation – infection in internal eye; vision loss

15. Uveitis/Iritis • Uveitis - inflammation of vascular layer • Iritis - inflammation of iris • S/S: • Severe eye pain; photophobia; Blurred vision; Constricted pupil; red limbus • Medical management : • Anti-infectives, antihistamines, corticosteroids, mydriatic drops • Corneal transplant – cadaver

16. Infectious/Inflammatory Eye Disorders – Nursing Care • Assessment • Symptoms: local, systemic • Structures of the eye – slit lamp • Vision/corrective lens use • Snellen chart • Rosenbaum chart • Injury; exposure

17. Infectious/Inflammatory Eye Disorders – Nursing Care • Diagnoses • Risk for Disturbed Sensory Perception: Visual • Proper cleaning, no sharing towels, change contacts, cornea perforation • Risk for Injury • Depth perception/peripheral vision, no rubbing/scratching, eye sheild

18. Infectious/Inflammatory Eye Disorders – Nursing Care • Evaluation • Eye appearance/vision • Client’s psychomotor skills • Eye drops • Contact lens care • Eye cleansing

19. Eye Trauma: Corneal Abrasion • Scratch of the cornea • Contact lenses, eyelashes • Small foreign bodies, fingernails • Pain, photophobia, tearing

20. Eye Trauma: Burns • Chemical/thermal • Ammonia, drain cleaner/UV lights • Pain, vision changes • Swollen eyelids; red edematous conjunctiva • Cornea: cloudy/hazy

21. Eye Trauma: Perforation • Metal flakes; glass shards • Weapons • Guns, knives, arrows • Pain; partial or complete loss of vision • Possible bleeding, loss of eye contents

22. Blunt Eye Trauma • Sports injuries • Lid ecchymosis, subconjunctival hemorrhage • Hyphema (bleeding into anterior chamber) • reddish tint • Fractured orbit • Diplopia • Pain; enophthalomos (sunken eye)

23. Eye Trauma • Eye inspection/examination • Fluorescein staining • Opthalmoscopic examination • Facial x-rays/CT scan • Eye irrigations • Surgery

24. Eye Trauma – Nursing Care Eye Assessment

25. Eye Trauma – Nursing Care • Diagnoses: Impaired Tissue Integrity: Ocular, Pain, Anxiety • Evaluation • Vision • Client and/or family are able to verbalize: • Prevention • Irrigation procedure • Medications • Patches • Avoid  Intraocular pressure

26. Refractive Errors • Emmetropia: • Normal vision • Myopia • Hyperopia • Presbyopia • Natural degen. changes • Astigmatism *Table 40-1, p.1023

27. Refractive Errors Etiology - Inherited; Surgical error • Blurred vision; Recurrent headaches • Diagnostics: Snellen, Jaeger; Retinoscopy • Medical Management: Eyeglasses;Contacts • Surgical Management: LASIK • Nursing Management: • Disturbed Sensory Perception, Risk for Injury, Self-care deficits

28. Cataracts • Patho/Etiology: Aging process; Congenital; Lens injury; affect most over age 65 • Risk Factors • Exposure to sunlight • Cigarette smoking • Heavy alcohol use • Congenital conditions • Medications

29. Cataracts • Assessment Findings: Halos; Reduced vision; Clouding of the lens(immature, mature); Glare, dark/light adjustment problems • Diagnostic Findings: Lens changes; loss of red reflex • Elective surgery :Lens removal; IOL implant

30. Eye Surgery – Nursing Care • Preoperative care • Postoperative care • Vital signs, pain control • Dressings/patch/shield • Positioning • Prevent increase in intraocular pressure • Report sudden eye pain • Client/family teaching – Box 40-2 p.1025 X

31. Glaucoma • Patho/Etiology: Aqueous fluid imbalance; Elevated IOP • Open-angle:Obstruction of flow through canal, Slow onset, Painless, Gradual loss of peripheral vision, Blurred vision, Halos, Difficulty focusing on near objects • Acute angle-closure: Rapid onset, Acute severe eye pain, Blurred or cloudy vision, Halos, cornea clouded, nonreactive pupil; Hard, painful, sightless eyes; N/V; Red conjunctiva; “Steamy” cornea

32. Figure 40-7 Types of glaucoma. (A) Chronic open-angle glaucoma. Drainage of aqueous humor through the trabecular meshwork is impaired.

33. Figure 40-7 (continued) Types of glaucoma. (B) Angle-closure glaucoma. The angle between the cornea and iris closes, completely blocking aqueous humor drainage.

34. Glaucoma • Diagnostic tests • Tonometry, funduscopy, visual fields • Gonioscopy – depth of chamber; • Surgery • Laser trabeculoplasty • Laser iridotomy • Kava-kava causes dilation of pupil

35. Glaucoma - Medications • Medications (Table 40-2, p.1028) • Miotics – constrict pupil • Sympathomimetics • Beta blockers -  aqueous humor production • Prostaglandin analogs -  outflow of aqueous humor • Carbonic anhydrase inhibitors -  production of aqueous humor

36. Glaucoma – Nursing Care • Assessment • Identify clients at risk • Changes in vision • Family history of glaucoma • Inspection of eye structures • Visual fields

37. Glaucoma – Nursing Care • Diagnoses - Deficient Knowledge (Ocular Care), Risk for Injury, Anxiety • Evaluation • Client’s knowledge of medications • Instillation technique for drops • Safety issues with vision loss • Ability to perform ADL

38. Detached Retina • Etiology: Shrinking of the vitreous humor with age, Trauma - Hole/tear in retina; Certain disease processes • Patho: • Retina separates from choroid • Intact but separate, Folds back on self • Hole/tear - Fluid seeps between layers • S/S: Painless, Curtain/veil across vision, Floaters, Flashes of light

39. Detached Retina - Treatment • Medical emergency • Positioning (funky) • Gas into vitreous cavity to press detached portion against choroid • Laser or cryotherapy • Scleral buckling

40. Detached Retina – Nursing Care • Assessment: Sudden change in vision, Client knowledge level, Treatment planned • Diagnoses: Ineffective Tissue Perfusion: Retinal, Anxiety • Anxiety level • Client knowledge of: • Importance of positioning, Future detachments, Safety, Follow-up treatment

41. Macular Degeneration • Patho/etiology: atrophy of macula or separation, common cause of blindness in adults over 65 years • Assessment Findings • Blurred/ Distorted vision, Central vision affected, straight lines appear wavy • Management: • Treatment may slow degeneration, lifestyle changes to cope with altered vision

42. Diabetic Retinopathy • Leading cause of new blindness from age 20 to 74 • Disorder of capillaries supplying the retina • Microscopic aneurysms, hemorrhage into retina • Treatment (laser) may slow progression • Stress annual eye examination to treat changes early

43. Enucleation • Surgical Removal of an Eye due to • Injury; Disease, Tumor; Severe pain (damaged, sightless eye) • Medical, Surgical Management • Metal or plastic ball in capsule of connective tissue • Pressure dressing; Shell-shaped prosthesis • Nursing Management: Watch for hemorrhage, infection

44. Blindness Approximately 18 million people in the United States have some degree of visual impairment – which include approx 1 million who are legally BLIND

45. Blindness • Severely limited vision that cannot be corrected • Total blindness – see no light • Functional blindness – need help with ADL • Most blindness preventable with early recognition, treatment (i.e. cataracts, glaucoma) • Adapt nursing care to sensory deficit – • p. 1033

46. Anatomy of the Ear

47. External Ear Disorders • Infection or inflammation • Trauma • Obstruction of ear canal

48. External Otitis • “Swimmer’s ear” • Usually caused by bacteria • Severe pain and feeling of fullness; drainage • Treatment • Cleaning of ear canal • Topical antibiotic • Topical corticosteroids *Teach :dry ear canal, No cotton swabs

49. Impacted Cerumen and Foreign Bodies Patho/Etiology Interferes with sound carried on airwaves Assessment Findings Otalgia; Diminished hearing, fullness, tinnitus Treatment: Clear canal,Hydration; Irrigation; Removal (cerumen spoon) Nursing Management: Do not irrigate if foreign body is seed; may swell

50. Otitis Media Inflammation/infection of the middle ear Serous otitis media • Obstruction of eustachian tube • Negative pressure draws fluid • “Snapping,” “popping” • Retracted/bulging ear drum • Acute pain/bleeding in middle ear/ruptured drum