Care of Patients with Eye and Ear Disorders PDF

CARE OF PATIENTS WITH EYE AND EAR DISORDERS  OBJECTIVES BRIEFLY REVIEW OF THE ANATOMY AND PHYSIOLOGY OF THE EYE AND EAR ASSESS EYE AND EAR FUNCTION DISCUSS TREATMENT MODALITIES FOR PATIENTS WITH EYE AND EAR DISORDERS DESCRIBE MANAGEMENT OF PATIENTS WITH EYE AND...

CARE OF PATIENTS WITH EYE AND EAR DISORDERS  OBJECTIVES BRIEFLY REVIEW OF THE ANATOMY AND PHYSIOLOGY OF THE EYE AND EAR ASSESS EYE AND EAR FUNCTION DISCUSS TREATMENT MODALITIES FOR PATIENTS WITH EYE AND EAR DISORDERS DESCRIBE MANAGEMENT OF PATIENTS WITH EYE AND EAR DISORDERS EYE: LOW VISION/BLINDNESS, GLAUCOMA, CATARACTS, RETINAL DETACHMENT, MACULAR DEGENERATION, TRAUMA EAR: HEARING IMPAIRMENT, MÉNIÈRE’S DISEASE  EYE ANATOMY AND PHYSIOLOGY EXTERNAL STRUCTURES OF THE EYE CROSS SECTION OF THE EYE AND EXTRAOCULAR EYE MUSCLES NORMAL RETINA NYSTAGMUS VS STRABISMUS  ASSESSMENT AND EVALUATION OF VISION OCULAR HISTORY VISUAL ACUITY SNELLEN CHART: DISTANCE ROSENBAUM POCKET SCREENER: NEAR FINGER COUNT OR HAND MOTION EXAMINATION OF EYE STRUCTURES  EXAMINATION OF THE EYE STRUCTURES EXTERNAL IRRITATION, INFLAMMATORY PROCESS, DISCHARGE, ETC. EYELIDS AND SCLERA PUPILS AND PUPILLARY RESPONSE (USE DARKENED ROOM) NOTE GAZE AND POSITION OF EYES & EYELIDS ASSESS EXTRAOCULAR MOVEMENTS INTERNAL FUNDUS TONOMETRY: RISK FOR GLAUCOMA IMPAIRED VISION-REFRACTIVE ERRORS SNELLEN CHART  OPHTHALMIC MEDICATIONS ABILITY OF THE EYE TO ABSORB MEDICATION IS LIMITED SIZE OF THE CONJUNCTIVAL SAC CORNEAL MEMBRANE BARRIERS BLOOD–OCULAR BARRIERS TEARING, BLINKING, AND DRAINAGE TOPICAL MEDICATIONS (DROPS AND OINTMENTS) PREFERRED (1) __________________, (2) _____________________, & (3) _______________________  OPHTHALMIC MEDICATIONS TOPICAL ANESTHETICS MYDRIATICS (DILATE) AND CYCLOPLEGICS (PARALYZE) CONTRAINDICATED WITH NARROW ANGLES OR SHALLOW ANTERIOR CHAMBERS AND IN PATIENTS ON MONOAMINE OXIDASE INHIBITORS OR TRICYCLIC ANTIDEPRESSANT ANTI-INFECTIVE MEDICATIONS ANTIBIOTIC, ANTIFUNGAL, OR ANTIVIRAL PRODUCTS  OPHTHALMIC MEDICATIONS MEDICATIONS USED FOR GLAUCOMA INCREASE AQUEOUS OUTFLOW OR DECREASE AQUEOUS PRODUCTION MAY CONSTRICT THE PUPIL; MAY AFFECT ABILITY TO FOCUS THE LENS OF THE EYE; AFFECTS VISION MAY ALSO MAY PRODUCE SYSTEMIC EFFECTS ANTI-INFLAMMATORY DRUGS; CORTICOSTEROID SUSPENSIONS SIDE EFFECTS OF LONG-TERM TOPICAL STEROIDS: GLAUCOMA, CATARACTS, AND INCREASED RISK OF INFECTION. TO AVOID THESE EFFECTS: NSAID THERAPY MAY BE USED AS AN ALTERNATE TO STEROID USE OPHTHALMIC MEDICATIONS  LOW VISION AND BLINDNESS LOW VISION VISIONAL IMPAIRMENT THAT REQUIRES DEVICES AND STRATEGIES TO CORRECT VISION BEST CORRECTED VISUAL ACUITY (BCVA) OF 20/70 UP TO 20/200 BLINDNESS RANGE: BCVA 20/200 TO NO LIGHT PERCEPTION IMPAIRED VISION OFTEN IS ACCOMPANIED BY FUNCTIONAL IMPAIRMENT NURSING ASSESSMENT MUST INCLUDE: FUNCTIONAL ABILITY AND COPING ADAPTATION IN EMOTIONAL, PHYSICAL, AND SOCIAL AREAS  MANAGEMENT OF LOW VISION AND BLINDNESS SUPPORT COPING STRATEGIES, GRIEF PROCESSES, AND ACCEPTANCE OF VISUAL LOSS STRATEGIES FOR ADAPTATION TO THE ENVIRONMENT; PLACEMENT OF ITEMS IN ROOM “CLOCK METHOD” FOR TRAYS COMMUNICATION STRATEGIES COLLABORATION WITH LOW-VISION SPECIALIST, OCCUPATIONAL THERAPIST, OR OTHER RESOURCES BRAILLE OR OTHER METHODS FOR READING AND COMMUNICATION SERVICE ANIMALS  GLAUCOMA A CONDITION IN WHICH DAMAGE TO THE OPTIC NERVE IS RELATED TO INCREASED INTRAOCULAR PRESSURE (IOP) CAUSED BY CONGESTION OF THE AQUEOUS HUMOR NORMAL IOP = 10 – 21 MMHG INCREASED IOP  IRREVERSIBLE MECHANICAL OR ISCHEMIC DAMAGE TO THE OPTIC NERVE TYPES: WIDE ANGLE NARROW ANGLE  GLAUCOMA RISK FACTORS: CV DISEASE, DIABETES, OLDER AGE, PREVIOUS EYE TRAUMA, ETC. (REFER TO CHART 63-5) “SILENT THIEF”; UNAWARE OF THE CONDITION UNTIL THERE IS SIGNIFICANT VISION LOSS; PERIPHERAL VISION LOSS, BLURRING, HALOS, DIFFICULTY FOCUSING, DIFFICULTY ADJUSTING EYES TO LOW LIGHTING MAY ALSO HAVE ACHING OR DISCOMFORT AROUND EYES OR HEADACHE  GLAUCOMA TYPES WIDE ANGLE: MOST COMMON, FLUID DOES NOT DRAIN PROPERLY, SLOW INCREASE OF IOP, SLOW OPTIC NERVE DETERIORATION GRADUAL VISION LOSS NARROW ANGLE: BLOCKAGE OF FLUID AT BASE OF INTERIOR ANGLE BETWEEN IRIS AND CORNEA, IOP INCREASES RAPIDLY, MEDICAL EMERGENCY, PERMANENT VISION LOSS IF IOP UNTREATED FOR MORE THAN 24-48 HOURS  DIAGNOSTIC STUDIES-GLAUCOMA TONOMETRY TO ASSESS IOP OPHTHALMOSCOPY TO INSPECT THE OPTIC NERVE DISC PALLOR OF OPTIC NERVE: LACK OF BLOOD SUPPLY CUPPING OF OPTIC DISC: EXAGGERATING BENDING OF BLOOD VESSELS ACROSS THE OPTIC DISC NORMAL CUP APPEARS AS A BASIN CAUSED BY GRADUAL LOSS OF BLOOD SUPPLY CENTRAL VISUAL FIELD TESTING  TREATMENT-GLAUCOMA GOAL IS TO PREVENT FURTHER OPTIC NERVE DAMAGE MAINTAIN IOP WITHIN A RANGE UNLIKELY TO CAUSE DAMAGE PHARMACOLOGIC THERAPY: MIOTICS (PILOCARPINE), BETA BLOCKERS (TIMOPTIC), ALPHA2- AGONISTS, CARBONIC ANHYDRASE INHIBITORS, PROSTAGLANDINS PROVIDE EDUCATION REGARDING USE AND EFFECTS OF MEDICATIONS LASER PROCEDURES, SURGERY PROVIDE SUPPORT AND INTERVENTIONS TO AID THE PATIENT IN ADJUSTING TO VISION LOSS OR POTENTIAL VISION LOSS GLAUCOMA MEDICATIONS  CATARACTS AN OPACITY OR CLOUDINESS OF THE LENS INCREASED INCIDENCE WITH AGING; BY AGE 80 YEARS, MORE THAN HALF OF ALL AMERICANS HAVE CATARACTS A LEADING CAUSE OF DISABILITY IN THE UNITED STATES AGE: RISK FACTOR THREE TYPES TRAUMATIC CONGENITAL SENILE CATARACT  CATARACT MANIFESTATIONS PAINLESS, BLURRY VISION, SURROUNDINGS DIMMER SENSITIVITY TO GLARE REDUCED VISUAL ACUITY OTHER EFFECTS INCLUDE MYOPIC SHIFT; ASTIGMATISM; DIPLOPIA (DOUBLE VISION); AND COLOR SHIFTS, INCLUDING BRUNESCENS (COLOR VALUE SHIFT TO YELLOW-BROWN) DIAGNOSTIC FINDINGS INCLUDE DECREASED VISUAL ACUITY AND OPACITY OF THE LENS BY OPHTHALMOSCOPE, SLIT LAMP, OR INSPECTION  SURGICAL MANAGEMENT-CATARACTS IF REDUCED VISION DOES NOT INTERFERE WITH NORMAL ACTIVITIES, SURGERY IS NOT NEEDED SURGERY IS PERFORMED ON AN OUTPATIENT BASIS WITH LOCAL ANESTHESIA SURGERY USUALLY TAKES LESS THAN 1 HOUR, AND PATIENTS ARE DISCHARGED SOON AFTERWARD COMPLICATIONS ARE RARE BUT MAY BE SIGNIFICANT INFLAMMATION, INFECTION, PAIN, LIGHT SENSITIVITY, MACULAR EDEMA (SWELLING OF THE CENTRAL RETINA), OCULAR HYPERTENSION  NURSING MANAGEMENT-CATARACT SURGERY USUAL PREOPERATIVE CARE FOR AMBULATORY SURGERY DILATING EYE DROPS OR OTHER MEDICATIONS AS ORDERED POSTOPERATIVE CARE PATIENT EDUCATION: WRITTEN AND VERBAL DISCHARGE INSTRUCTIONS INSTRUCT PATIENT TO CALL PHYSICIAN IMMEDIATELY IF: VISION CHANGES; CONTINUOUS FLASHING LIGHTS APPEAR (PHOTOPSIA); REDNESS, SWELLING, OR PAIN INCREASE; TYPE AND AMOUNT OF DRAINAGE INCREASES; OR SIGNIFICANT PAIN IS NOT RELIEVED BY ACETAMINOPHEN  CATARACT SURGERY DISCHARGE INSTRUCTIONS AVOID LYING ON THE SIDE OF THE AFFECTED EYE THE NIGHT AFTER SURGERY KEEP ACTIVITY LIGHT (E.G., WALKING, READING, WATCHING TELEVISION). RESUME THE FOLLOWING ACTIVITIES ONLY AS DIRECTED BY THE OPHTHALMOLOGIST: DRIVING, SEXUAL ACTIVITY, UNUSUALLY STRENUOUS ACTIVITY AVOID LIFTING, PUSHING, OR PULLING OBJECTS HEAVIER THAN 15 LBS. AVOID BENDING OR STOOPING FOR AN EXTENDED PERIOD BE CAREFUL WHEN CLIMBING AND DESCENDING STAIRS SNEEZING IF NECESSARY SHOULD NOT BE HELD IN, IT SHOULD BE  RETINAL DETACHMENT SEPARATION OF THE SENSORY RETINA AND THE RPE (RETINAL PIGMENT EPITHELIUM) MANIFESTATIONS: SENSATION OF A SHADE OR CURTAIN COMING ACROSS THE VISION OF ONE EYE, BRIGHT FLASHING LIGHTS, SUDDEN ONSET OF FLOATERS DIAGNOSTIC STUDIES: ASSESS VISUAL ACUITY, ASSESSMENT OF RETINA BY INDIRECT OPHTHALMOSCOPE, SLIT LAMP, STEREO FUNDUS PHOTOGRAPHY, AND FLUORESCEIN ANGIOGRAPHY; TOMOGRAPHY AND ULTRASONOGRAPHY MAY ALSO BE USED  SURGICAL TREATMENT-RETINAL DETACHMENT SCLERAL BUCKLE COMPRESSES SCLERA VITRECTOMY INTRAOCULAR PROCEDURE GAS BUBBLE, SILICONE OIL, PERFLUOROCARBON AND LIQUIDS MAY BE INJECTED INTO VITREOUS CAVITY NURSING MANAGEMENT-RETINAL SURGERY PATIENT EDUCATION EYE SURGERY IS MOST OFTEN DONE AS AN OUTPATIENT PROCEDURE SO PATIENT EDUCATION IS VITAL SIGNS AND SYMPTOMS OF COMPLICATIONS, ESPECIALLY INCREASED IOP AND INFECTION PROMOTE COMFORT PATIENT MAY NEED TO LIE IN A PRONE POSITION  MACULAR DEGENERATION ACCOUNTS FOR 54% OF ALL BLINDNESS IN OLDER ADULTS TYPES DRY OR NONEXUDATIVE TYPE; MOST COMMON, 85- 90% SLOW BREAKDOWN OF THE LAYERS OF THE RETINA WITH THE APPEARANCE OF DRUSEN (DEBRIS OR WASTE UNDER THE RETINA) WET TYPE MAY HAVE ABRUPT ONSET PROLIFERATION OF ABNORMAL BLOOD VESSELS GROWING UNDER THE RETINA MACULAR DEGENERATION MACULAR DEGENERATION VS. GLAUCOMA  OCULAR CONSEQUENCES OF SYSTEMIC DISEASE DIABETIC RETINOPATHY DIABETES IS A LEADING CAUSE OF BLINDNESS IN PEOPLE AGED 20 TO 74 YEARS EYE CHANGES ASSOCIATED WITH HYPERTENSION OPHTHALMIC COMPLICATIONS ASSOCIATED WITH ADVANCED HIV/AIDS CMV retinitis Cotton wool spots  TRAUMA PREVENTION OF INJURY PATIENT AND PUBLIC EDUCATION EMERGENCY TREATMENT FLUSH CHEMICAL INJURIES DO NOT REMOVE FOREIGN OBJECTS PROTECT USING METAL SHIELD OR PAPER CUP POTENTIAL FOR SYMPATHETIC OPHTHALMIA CAUSING BLINDNESS IN THE UNINJURED EYE WITH SOME INJURIES SYMPATHETIC OPHTHALMIA: AN INFLAMMATORY CONDITION CREATED IN THE UNINJURED EYE BY THE AFFECTED EYE BLINDNESS IN THE UNINJURED EYE; TREATED WITH CORTICOSTEROIDS AND IMMUNOSUPPRESSANTS, OR ENUCLEATION IN EXTREME CASES  SAFETY MEASURES AND EDUCATION PREVENTION OF EYE INJURIES; EDUCATION TO PREVENT INJURIES SAFETY STRATEGIES FOR PATIENTS WITH LOW VISION IN THE HOSPITAL AND HOME SETTING PATIENT EDUCATION AFTER EYE SURGERY OR TRAUMA POTENTIAL COMPLICATIONS LOSS OF BINOCULAR VISION WITH PATCH OR VISION IMPAIRMENT OF ONE EYE; SAFETY USE OF EYE PATCH AND SHIELD EAR ANATOMY AND PHYSIOLOGY ANATOMY OF THE EAR  ASSESSMENT OF THE EAR AND HEARING EAR ASSESSMENT: INSPECTION & PALPATION OF EXTERNAL EAR OTOSCOPIC EXAMINATION HEARING ASSESSMENT: GROSS AUDITORY ACUITY WHISPER TEST WEBER TEST RINNE TEST WEBER AND RINNE TESTS  HEARING IMPAIRMENT PREVALENCE INCREASES WITH AGE; 50% OVER THE AGE OF 70 RISK FACTORS INCLUDE EXPOSURE TO EXCESSIVE NOISE LEVELS TYPES CONDUCTIVE: CAUSED BY EXTERNAL OR MIDDLE EAR PROBLEM SENSORINEURAL: CAUSED BY DAMAGE TO THE COCHLEA OR VESTIBULOCOCHLEAR NERVE MIXED: BOTH CONDUCTIVE AND SENSORINEURAL FUNCTIONAL (PSYCHOGENIC): CAUSED BY EMOTIONAL PROBLEM  HEARING IMPAIRMENT MANIFESTATIONS EARLY SYMPTOMS TINNITUS: PERCEPTION OF SOUND; OFTEN “RINGING IN THE EARS” INCREASED INABILITY TO HEAR IN A GROUP TURNING UP THE VOLUME ON THE TV AS HEARING LOSS INCREASES, PERSON MAY EXPERIENCE DETERIORATION OF SPEECH, FATIGUE, INDIFFERENCE, SOCIAL ISOLATION OR WITHDRAWAL  MÉNIÈRE’S DISEASE ABNORMAL INNER EAR FLUID BALANCE CAUSE BY MALABSORPTION OF THE ENDOLYMPHATIC SAC OR BLOCKAGE OF THE ENDOLYMPHATIC DUCT MANIFESTATIONS: EPISODIC VERTIGO, TINNITUS, HEARING LOSS. FEELING OF FULLNESS OR PRESSURE, NAUSEA, AND VOMITING MAY ALSO OCCUR. TREATMENT LOW-SODIUM DIET:1,000-1,500 MG/DAY; AVOID CAFFEINE, SMOKING CESSATION MEDS: MECLIZINE (ANTIVERT); TRANQUILIZERS-VALIUM, ANTIEMETICS- PROMETHAZINE, AND DIURETICS MAY ALSO BE USED SURGICAL MANAGEMENT TO ELIMINATE ATTACKS OF VERTIGO; ENDOLYMPHATIC SAC DECOMPRESSION, MIDDLE AND INNER EAR PERFUSION, AND VESTIBULAR NERVE SECTIONING  TREATMENT FOR HEARING IMPAIRMENT HEARING AIDS DEVICE TO AMPLIFY SOUND AND IMPROVE HEARING COCHLEAR IMPLANT AUDITORY PROSTHESIS USED FOR PEOPLE WITH PROFOUND SENSORINEURAL HEARING LOSS BILATERALLY WHO DO NOT BENEFIT FROM CONVENTIONAL HEARING AIDS VESTIBULAR REHABILITATION (OUTPATIENT CLINIC) A TYPE OF THERAPY FOCUSED ON IMPROVING BALANCE AND STABILITY FOR CONDITIONS AFFECTING THE INNER EAR.  GUIDELINES FOR COMMUNICATING WITH HEARING IMPAIRED PERSONS USE A LOW-TONE, NORMAL VOICE SPEAK SLOWLY AND DISTINCTLY REDUCE BACKGROUND NOISE AND DISTRACTIONS FACE THE PERSON AND GET THEIR ATTENTION SPEAK INTO THE LESS IMPAIRED EAR USE GESTURES AND FACIAL EXPRESSIONS IF NECESSARY, WRITE OUT INFORMATION OR OBTAIN A SIGN LANGUAGE TRANSLATOR