chapter 13 care of the patient with a visual or auditory disorder mosby items and derived items ©...
TRANSCRIPT
Chapter 13
Care of the Patient with a
Visual or Auditory Disorder
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• Anatomy of the eye Accessory structures of the eye
• Eyebrows• Eyelashes• Eyelids• Lacrimal apparatus
Slide 3Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 13-1Figure 13-1
Lacrimal apparatus.
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
Slide 4Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• Anatomy of the eye (continued) Structures of the eyeball
• Sclera• Cornea• Choroid• Ciliary body• Iris• Pupil• Retina
Slide 5Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• Anatomy of the eye (continued) Chambers of the eye
• Anterior chamber Aqueous humor
• Posterior chamber Vitreous humor
Slide 6Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 13-2Figure 13-2
Horizontal section through the left eyeball. The eye is viewed from above.
(From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.)
Slide 7Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• Anatomy of the ear External ear
• Auricle• External auditory canal• Tympanic membrane
Middle ear• Eustachian tube• Malleus• Incus• Stapes
Slide 8Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 13-3Figure 13-3
The ear. External, middle, and inner ear. (Not to scale.)
(From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.)
Slide 9Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• Anatomy of the ear (continued) Inner ear
• Labyrinth Bony labyrinth—filled with perilymph
o Semicircular canalso Vestibuleo Cochlea—organ of Corti
Membranous labyrinth—filled with endolymph
Slide 10Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 13-4Figure 13-4
The inner ear.
(From Thibodeau, G.A., Patton, K.T. [2005]. The human body in health and disease. [4th ed.]. St. Louis: Mosby.)
Slide 11Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• Other special senses Taste and smell
• Taste buds: salty, sweet, sour, bitter• Olfactory receptors: sense of smell
Touch• Tactile receptors
Position/movement• Proprioceptors
Slide 12Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Laboratory and Diagnostic ExaminationsLaboratory and Diagnostic Examinations
• Diagnostic eye tests Snellen test Color vision Refraction Ophthalmoscopy Tonometry Amster grid test Schirmer’s tear test
Slide 13Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Blindness and near-blindness Etiology/pathophysiology
• Loss of visual acuity• Congenital or acquired• Legal blindness
20/200 with corrective eyewear (normal 20/20) Visual field less than 20 degrees (normal 180)
Slide 14Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Blindness and near-blindness (continued) Clinical manifestations/assessment
• Diplopia• Pain• Floaters and light flashes• Pruritus; burning of the eyes• Loss of peripheral vision• Halos• Orbital pressure• Bulging of the eyes
Slide 15Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Blindness and near-blindness (continued) Medical management/nursing interventions
• Corrective eyewear• Canes• Seeing-eye dogs• Magnifying systems• Surgical procedures
Slide 16Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Refractory errors Etiology/pathophysiology
• Astigmatism—unequal curve in the shape of the cornea or lens
• Strabismus—inability of the eyes to focus in one direction; cross-eyed
• Myopia—nearsightedness; eyeball is too long• Hyperopia—farsightedness; eyeball is too short
Slide 17Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Refractory errors (continued) Clinical manifestations/assessment
• Diminished or blurred vision Medical management/nursing interventions
• Corrective lenses• Surgical correction
Radial keratotomy (RK) Photorefractive keratectomy (PRK) Laser-assisted in-situ keratomileusis (LASIK)
Slide 18Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Conjunctivitis Etiology/pathophysiology
• Inflammation of the conjunctiva• Bacterial or viral infection• Allergy• Environmental factors• Commonly called pink eye
Slide 19Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Conjunctivitis (continued) Clinical manifestations/assessment
• Erythema of the conjunctiva• Edema of the eyelid; crusting discharge• Pruritus; burning; excessive tearing
Medical management/nursing interventions• Warm compresses• Eye irrigations with normal saline• Antibiotic drops or ointment• Keep free from exudate
Slide 20Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Keratitis Etiology/pathophysiology
• Inflammation of the cornea• Injury, irritants, allergies, viral infection, or diseases• Pneumococcus, Staphylococcus, Streptococcus, and
Pseudomonas are most common types of bacterial causes
• Herpes simplex is most common viral cause
Slide 21Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Keratitis (continued) Clinical manifestations/assessment
• Severe eye pain• Photophobia• Tearing• Edema• Visual disturbances
Slide 22Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Keratitis (continued) Medical management/nursing interventions
• Pharmacological management Topical and systemic antibiotics Analgesics
• Pressure dressings• Warm or cold compresses• Epithelial debridement• Keratoplasty
Slide 23Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Dry eye disorders (keratoconjunctivitis sicca) Etiology/pathophysiology
• Lacrimal gland dysfunction from an autoimmune mechanism
Clinical manifestations/assessment• Complaints of sandy or gritty sensation in the eye
Medical management/nursing interventions• Artificial tear replacement• Punctal plugs or repair if injured
Slide 24Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Ectropion and entropion Etiology and pathophysiology
• Noninfectious disorders of the eye lid causing abnormal eyelid margins
Clinical manifestations• Abnormal direction of the eyelid• Corneal dryness
Medical management/nursing interventions• Topical medications to reduce conjunctival and corneal
drying• Surgery
Slide 25Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Cataracts Etiology/pathophysiology
• Noninfectious opacity or clouding of the lens• Congenital; acquired; senile
Clinical manifestations/assessment• Blurred vision• Diplopia• Photosensitivity• Decreased night vision• Opacity in the center portion of lens
Slide 26Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Cataracts (continued) Medical management/nursing interventions
• Surgical removal Lens implant or glasses
• Postoperative Avoid direct sunlight Bed rest with bathroom privileges (BRPs) Analgesics No bending down or straining Avoid coughing, sneezing, and blowing nose
Slide 27Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Diabetic retinopathy Etiology/pathophysiology
• Capillary microaneurysms, hemorrhage, exudates, and formation of new vessels and connective tissue in the retina
Clinical manifestations/assessment• Microaneurysms• Progressive loss of vision; “floaters”
Medical management/nursing interventions• Photocoagulation• Vitrectomy
Slide 28Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Macular degeneration Etiology/pathophysiology
• Slow, progressive loss of central and near vision due to aging retina
Clinical manifestations/assessment• Gradual and variable bilateral loss of vision• Color perception may also be affected
Medical management/nursing interventions• Usually no treatment• May use photocoagulation
Slide 29Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Retinal detachment Etiology/pathophysiology
• Separation of the retina from the choroid in the posterior area of the eye
Clinical manifestations/assessment• Flashes of light; floating spots• Loss of a specific field of vision
Medical management/nursing interventions• Photocoagulation; cryosurgery; diathermy• Scleral buckling
Slide 30Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 13-8Figure 13-8
Retinal break with detachment: surgical repair by scleral buckling technique.
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and management of clinical problems. [7th ed.]. St. Louis: Mosby.)
Slide 31Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Glaucoma Etiology/pathophysiology
• An abnormal condition of elevated pressure within an eye; obstruction of outflow of aqueous humor
Open-angle Closed-angle
Slide 32Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 13-9Figure 13-9
A, Chronic open-angle glaucoma. B, Acute-angle closure glaucoma.
(From Havener, W.H. [1997]. Synopsis of ophthalmology. St. Louis: Mosby.)
Slide 33Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Glaucoma (continued) Clinical manifestations/assessment
• Open-angle No signs or symptoms during early stages Tunnel vision Eye pain Difficulty adjusting to darkness Halos around lights Inability to detect colors
Slide 34Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Glaucoma (continued) Clinical manifestations/assessment
• Closed-angle Severe pain Decreased vision Nausea and vomiting Erythema of the sclera Enlarged and fixed pupil Halos around lights
Slide 35Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Glaucoma (continued) Medical management/nursing interventions
• Open-angle glaucoma Beta blockers Miotics Carbonic anhydrase inhibitors
• Closed-angle Osmotic diuretics Iridectomy
Slide 36Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Corneal injuries Etiology/pathophysiology
• Result from injuries to corneal layers of the eye Clinical manifestations/assessment
• Pain with movement of eye• Excessive tearing; pruritus• Erythema of conjunctiva
Slide 37Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the EyeDisorders of the Eye
• Corneal injuries (continued) Medical management/nursing interventions
• Flush with normal saline or water• Antibiotic drops or ointment• Penetrating wounds
Do not remove object if present
Slide 38Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Surgeries of the EyeSurgeries of the Eye
• Enucleation Surgical removal of the eyeball
• Keratoplasty (corneal transplant) Excision of the corneal tissue, followed by
implantation of a cornea from a donor• Photocoagulation
A laser is directed into a small spot on the retina• Vitrectomy
Removal of excess vitreous fluid caused by hemorrhage and replacement with normal saline
Slide 39Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Laboratory and Diagnostic ExaminationsLaboratory and Diagnostic Examinations
• Diagnostic ear tests Otoscopy Tuning fork tests
• Weber’s test• Rinne test
Autometric testing Vestibular testing
• Romberg test• Past-point testing
Slide 40Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 13-13Figure 13-13
Weber tuning fork test.
(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical examination. [5th ed.]. St. Louis: Mosby.)
Slide 41Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 13-14Figure 13-14
Rinne tuning fork test.
(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical examination. [5th ed.]. St. Louis: Mosby.)
Slide 42Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Loss of Hearing (Deafness)Loss of Hearing (Deafness)
• Hearing impairment Etiology/pathophysiology
• Decreased auditory acuity; partial or complete• Affects development of speech• Types
Conductive Sensorineural Mixed Congenital Functional Central
Slide 43Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Loss of Hearing (Deafness)Loss of Hearing (Deafness)
• Hearing impairment (continued) Clinical manifestations/assessment
• Requests for repeating information• Nonresponse• Delayed speech development
Medical management/nursing interventions• According to cause• Hearing aids• Surgical procedures• Cochlear implant
Slide 44Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Inflammatory and Infectious Disorders of the EarInflammatory and Infectious Disorders of the Ear
• External otitis Etiology/pathophysiology
• Inflammation or infection of the external canal Clinical manifestations/assessment
• Pain with movement of auricle or chewing• Erythema, scaling, pruritus, edema, watery discharge,
and crusting of the external ear Medical management/nursing interventions
• Oral analgesics; corticosteroids• Antibiotic or antifungal ear drops; oral antibiotics
Slide 45Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Inflammatory and Infectious Disorders of the EarInflammatory and Infectious Disorders of the Ear
• Otitis media Etiology/pathophysiology
• Inflammation or infection of the middle ear Clinical manifestations/assessment
• Fullness in the ear• Severe, deep, throbbing pain• Hearing loss• Tinnitus• Fever
Slide 46Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Inflammatory and Infectious Disorders of the EarInflammatory and Infectious Disorders of the Ear
• Otitis media (continued) Medical management/nursing interventions
• Pharmacological management Antibiotics Analgesics Nasal decongestants
• Local heat• Aspiration of fluid from behind eardrum• Myringotomy
Slide 47Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Inflammatory and Infectious Disorders of the EarInflammatory and Infectious Disorders of the Ear
• Labyrinthitis Etiology/pathophysiology
• Inflammation of the labyrinthine canals of the inner ear• Most common cause of vertigo• Viral infection from URI• Drugs and food• Tobacco and alcohol
Slide 48Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Inflammatory and Infectious Disorders of the EarInflammatory and Infectious Disorders of the Ear
• Labyrinthitis (continued) Clinical manifestations/assessment
• Severe and sudden vertigo; ataxic gait• Nausea and vomiting• Nystagmus; photophobia• Headache
Medical management/nursing interventions• Antibiotics• Dramamine or meclizine for vertigo• IV fluids if nausea and vomiting present
Slide 49Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Inflammatory and Infectious Disorders of the EarInflammatory and Infectious Disorders of the Ear
• Obstructions of the ear Etiology/pathophysiology
• Impaction of cerumen in canal; foreign bodies Clinical manifestations/assessment
• Tinnitus and pain in the ear• Slight hearing loss; tugging at ear
Medical management/nursing interventions• Removal of cerumen by irrigation• Foreign objects are removed with forceps• Carbamide peroxide to soften cerumen
Slide 50Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Noninfectious Disorders of the EarNoninfectious Disorders of the Ear
• Otosclerosis Etiology/pathophysiology
• Chronic, progressive deafness due to formation of spongy bone, especially around the oval window
Clinical manifestations/assessment• Slowly progressive conductive hearing loss• Tinnitus; dizziness to vertigo
Medical management/nursing interventions• Stapedectomy• Air conduction hearing aid
Slide 51Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Noninfectious Disorders of the EarNoninfectious Disorders of the Ear
• Ménière’s disease Etiology/pathophysiology
• Chronic disease of the inner ear• Increase in endolymph fluid
Clinical manifestations/assessment• Vertigo• Nausea and vomiting• Hearing loss; tinnitus• Diaphoresis• Nystagmus
Slide 52Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Noninfectious Disorders of the EarNoninfectious Disorders of the Ear
• Ménière’s disease (continued) Medical management/nursing interventions
• No specific treatment• Decrease fluid pressure
Fluid restriction; diuretics; low-salt diet• Dramamine, meclizine, and Benadryl• Surgery
Destruction of labyrinth Endolymphatic shunt Cryosurgery Vestibular nerve section
Slide 53Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Surgeries of the EarSurgeries of the Ear
• Stapedectomy Removal of the stapes of the middle ear
• Tympanoplasty Operative procedures on the eardrum or ossicles of
the middle ear to restore hearing• Myringotomy
Surgical incision of the eardrum• Cochlear implant
Surgical implantation of a hearing device for the profoundly deaf
Slide 54Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
• Nursing diagnoses Health maintenance, ineffective Anxiety Self-care deficit Fear Impaired environmental interpretation syndrome Impaired home maintenance Impaired social interaction Risk for injury Risk for loneliness Sensory perception, disturbed: auditory or visual
Nursing ProcessNursing Process
Ophthalmic Drugs
Categories Local anesthetics
Used in procedures such as tonometry, gonioscopy, cataract surgery, and removal of foreign objects from the cornea
Antiseptic ointments Prevent gonorrheal ophthalmia neonatorum in
newborn infants, used to treat common eye infections, germicidal and astringent action
Ophthalmic antiinfectives Treat eye infections caused by bacteria, fungi, or
viruses
55Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Ophthalmic Drugs (cont.)
Artificial tears Other preparations Antiglaucoma agentsUses To control acute narrow-angle glaucoma before
surgery Wide-angle glaucoma Secondary glaucoma Congenital glaucoma before surgery
56Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Glaucoma
Three Major Forms Primary glaucoma
Narrow-angle: person has a shallow anterior eye chamber, may be genetic; requires surgery
Wide-angle glaucoma: gradual onset, controlled with medications
Secondary glaucoma Result of other eye problems, treated with
medications Congenital glaucoma
Birth defect requiring surgical correction
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Antiglaucoma Medications
Sympathomimetics Produce vasoconstriction and decrease intraocular
pressure in open-angle glaucoma Beta blockers
Reduce intraocular pressure by reducing the formation of aqueous humor
Miotics, direct-acting Cholinergic agonists
58Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Antiglaucoma Medications (cont.)
Miotics, cholinesterase inhibitors Inactivates acetylcholinesterase
Carbonic anhydrase inhibitors Blocks action of an enzyme in the ciliary body,
causing a decrease in aqueous humor secretion
59Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Antiglaucoma Medications (cont.)
Mydriatic-Cycloplegics Block the action of acetylcholine
Mydriatics
60Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Otic Preparations
Control superficial infections of the ear Action is bacteriostatic or bactericidal
Prophylaxis for infections in swimmers Removing cerumen
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