care of clients with problems in perception and coordination

8/8/2019 Care of Clients With Problems in Perception and Coordination

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` A detailed imaging and recording of the ocular

circulation by a series of photographs after the

administration of a dye

` This test is useful for assessing problems with

retinal circulation, such as those that occur in

diabetic retinopathy, retinal bleeding, and

macular degeneration to rule out intraoculartumors


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` Assess the client for allergies and previousreaction to dyes

` Obtain informed consent

` A mydriatic medication, which causes pupildilation, is instilled into the eye 1 hour before thetest

` Dye is injected into the vein of the clients arm


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` Inform the client that dye may cause the skin to

appear yellow for several hours after the testand is eliminated gradually through the urine

` Encourage rest after the procedure

` Encourage fluid intake to assist in eliminating

the dye

` Urine might appear bright green


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` Allows examination of the anterior ocular

structures under microscopic magnification

` The client leans on a chin rest to stabilize thehead while a narrowed beam light is aimed so

that it illuminates only a narrow segment of the

eye


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` Explain the procedure to the client

` Advise the client about the brightness of the light

and the need to look forward at a point over theexaminers ear


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` Is used to primarily assess for an increase of

IOP and potential glaucoma

` Normal IOP is 10 to 21 mmHg

` Client must be instructed to avoid rubbing the

eye following the examination if the eye has

been anesthetized because of the potential for

scratching the cornea


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` Assesses the mastoid, middle ear, and inner ear

structures

` Multiple radiographs of the head are obtained


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` All jewelry is removed

` Lead eye shields are used to cover the cornea

to diminish the radiation dose to the eyes

` The client must remain still in a supine position


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` Opacity of the lens that distorts the image

projected onto the retina and that can progressto blindness

` Causes include the aging process (senile

cataracts), inherited (congenital cataracts), andinjury (traumatic cataracts)

` Interventions is indicated when visual acuity hasbeen reduced to a level that the client finds to beunacceptable or adversely affects his or herlifestyle


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` Blurred vision and decreased color perceptionare early signs

`

Halos around lights

` Reduced visual acuity

` Presence of w white pupil

` Loss of vision


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` Surgical removal of the lens, one eye at a time

` Instruct the client regarding the postoperative

measures to prevent or decrease intraocularpressure

` Stress to the client that care after surgeryrequires instillation of different types of eyedrops several times a day for 2 to 4 weeks


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` Administer eye medications preoperatively,

including mydriatics and cyclopegics as

prescribed

` After the surgery, elevate the head of the bed 30

to 45 degrees

` Turn the client to the nonoperative side

` Maintain an eye patch as prescribed; orient the

client to the environment


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` Position the clients personal belongings to the

nonoperative side

` Use side rails for safety

` Assist with ambulation

` Use an eye shield at bed time


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` A group of ocular diseases resulting in increasedIOP

` Results form inadequate drainage of aqueoushumor from the canal of Schlemm or

overproduction of aqueous humor

` The condition damages the optic nerve and canresult in blindness

` Gradual loss of visual fields may go unnoticed


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` Acute closed-angle or narrow angleglaucoma results form obstruction to outflowof aqueous humor

` Chronic closed-angle glaucoma follows anuntreated attack of acute closed-angleglaucoma

` Chronic open-angle glaucoma results fromoverproduction or obstruction to the outflow ofaqueous humor


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` Acute glaucoma is a rapid onset of IOP

higher than 50 to 70 mmHg

` Chronic glaucoma is a slow progressive,

gradual onset ofIOP higher than 30 to 50 mmHg


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` Diminished accommodation and increased IOP

` Loss of peripheral vision

` Decreased visual acuity

` Halos around lights

` Headache or eye pain


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` Treat acute glaucoma as a medical emergency

` Administer medications as prescribed to lower

IOP

` Prepare the client for peripheral iridectomy,

which allows aqueous humor to flow from the

posterior to the anterior chamber


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` Administer miotics, carbonic anhydrase

inhibitors, and betablockers as prescribed

` Instruct the client of the need for lifelong

medication use

` Instruct the client to avoid anticholinergic

medications

` Instruct client to report eye pain and changes in

vision


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` Prepare the client for trabeculoplasty as

prescribed to facilitate aqueous humor drainage

` Prepare the client for trabeculectomy as

prescribed, which allows drainage of aqueous

humor into the conjunctival spaces by thecreation of an opening


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` Detachment or separation of the retina from the

epithelium

` Occurs when the layers of the retina separate

because of the accumulation of fluid between

them, or when both retinal layers elevate awayfrom the choroid as a result of a tumor

`

Partial detachment becomes complete ifuntreated, which can lead to blindness


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` Flashes of light

` Floaters or black spots (signs of bleeding)

` Increase in blurred vision

` Sense of curtain being drawn over the eye

` Loss of a portion of the visual field


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` Provide bed rest

` Cover both eyes with patches as prescribed

` Speak to the client before approaching

` Protect the client from injury

` Avoid jerky head movements


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` Minimize eye stress

` Prepare the client for a surgical procedure as

prescribed

` Scleral buckling, to hold the choroid and retina

togetehr with a splint until scar tissue forms,

closing the tear


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` An inflammatory disorder usually caused by an

infection of the middle ear occurring as a result

of a blocked Eustachian tube, which prevents

normal drainage

` Common complication of an acute respiratory

infection

` Infants and children are more prone


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` Fever

` Irritability and restlessness

` Loss of appetite

` Pulling on or rubbing the ear

` Ear pain

` Purulent drainage


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` Encourage fluid intake

` Feed infants in upright position t prevent reflux

` Lie with the affected ear down

` Dry the ear by wicking


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` Administer antipyretics as prescribed

` Administer antibiotics as prescribed

` Screen for hearing loss

` Instruct the parents about the procedure for

administering era medications


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` Also called as endolymphatic hydrops

` Dilation of the endolymphatic system byoverproduction or decreased reabsorption ofendolymphatic fluid

` Characterized by tinnitus, sensorineuralhearing loss, and vertigo

` Symptoms occur in attacks and last for severaldays, and the client becomes totallyincapacitated during the attacks


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` Initial hearing loss is reversible but as the

frequency of attacks continue, hearing loss

becomes permanent

` Damage to the cochlea cause increase fluid

pressure leads to permanent hearing loss

` Caused by viral and bacterial infections, allergic

reactions, vascular disturbance


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` Feelings of fullness in the ear

` Tinnitus

` Hearing loss

` Vertigo

` Nausea and vomiting

` Headaches


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` Prevent injury during vertigo attacks

` Provide bed rest in a quiet environment

` Provide assistance with walking

` Instruct the client to move the head slowly

` Initiate sodium and fluid restrictions asprescribed


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` Instruct the client to stop smoking

` Administer nicotinic acid (niacin) as prescribed

for vasodilatory effects

` Administer antihistamines as prescribed

` Administer antiemetics as prscribed

` Labyrinthectomy may be performed


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` Dilate the pupils (mydriasis) and relax the ciliary

muscles (cyclopegia)

` Used preoperatively or for eye examinations

` Contraindicated with glaucoma

` Tropicamide (Mydriacil, Tropicacyl, Opticyl)


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` Reduce IOP by constricting pupils and

contracting the ciliary muscle

` Open the anterior chamber angle and increasethe outflow of aqueous humor

` Pilocarpine hydrochloride (Isopto Carpine)


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` Interfere with the production of carbonic acid,

which leads to decreased aqueous humor

formation and decreased IOP

` Long term treatment for open angle glaucoma

` Acetazolamdie (Diamox)

care of clients with problems in perception and coordination

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