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TRANSCRIPT
Sensory: Eye and Ear
Irene Owens, MSN, ARNP, FNP-BCFall 2010
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Chapter 49Assessment of the Eye and VisionAssessment of the Eye and Vision
Anatomy and Physiology Review
Layers of the eyeball Refractive structures and media External structures Muscles Nerves Blood vessels
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Refraction Emmetropia: the perfect refraction of
the eye Hyperopia: occurs when the eye does
not refract light enough Myopia: occurs when the eye
overrefracts or overbends the light Astigmatism: a refractive error caused
by unevenly curved surfaces on or in the eye, especially of the cornea
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Pupillary Constriction
Miosis is pupillary constriction. Mydriasis is pupillary dilation. Accommodation is the process of
maintaining a clear visual image when the gaze is shifted from a distant to a near object.
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Age-Related Structural Changes
Decreased eye muscle tone Ectropion and dry eye Arcus senilis Corneal changes Changes in color of sclera Less ability to dilate pupil More light needed for reading
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Age-Related Functional Changes
Lens yellows Accommodation is gradually lost Near point of vision increases
(presbyopia) Far point decreases Color perception decreases Intraocular pressure
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Physical Assessment
Inspection: exophthalmos, enophthalmos, ptosis, scleral and corneal assessment
Pupillary assessment: anisocoria, consensual response (brisk, sluggish, nonreactive or fixed)
(Continued)
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Go to medicalvideos.us eye exam
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Physical Assessment (Continued)
Tests for measurement of vision: acuity, near-vision testing, confrontation test Snellen chart and Rosenbaum
Assessment of extraocular muscle function
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Diagnostic Tests
Slit-lamp examination Corneal staining Tonometry Ophthalmoscopy Ultrasonography Fluorescein angiography Electroretinography
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Chapter 50Interventions for Clients with Eye
and Vision Problems
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Blepharitis Inflammation of the eyelid edges Itchy, red, and burning eyes Seborrhea of the eyebrows and eyelids
with greasy scales and mattering Control with eyelid care using warm,
moist compresses followed by gentle scrubbing with diluted baby shampoo
Avoidance of rubbing the eyes
Blepharitis
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Entropion
Turning inward of the eyelid causing the lashes to rub against the eye
Caused by eyelid muscle spasms, or result of trauma
Eyelid turned inward; red conjunctiva Surgical correction of eyelid position Instruction in procedure to instill
eyedrops
Entropion
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Ectropion
Turning outward and sagging of the eyelid
Caused by relaxation of the orbicular muscle
Reduced washing action of tears, leading to corneal drying and ulceration
Surgery to restore proper lid alignment
Ectropion
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Hordeolum
Stye can be external or internal. Treatment is with warm compresses
four times a day and antibacterial ointment, which may blur vision.
To remove ointment, close the eye and gently wipe the closed eyelid from the nasal side of the eye outward.
Hordeolum
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Chalazion
Inflammation of sebaceous gland in eyelid.
Most protrude on the inside of eyelid. Eye fatigue, light sensitivity, and
excessive tears result.(Continued)
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Chalazion (Continued)
Treatment consists of warm compresses for 15 minutes 4 times per day, followed by instillation of ophthalmic ointment.
Surgery is an option.
Chalazion
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Keratoconjunctivitis Sicca
Also called dry eye syndrome, results from changes in tear composition, lacrimal gland malfunction, or altered tear distribution
Artificial tears, lubricating ointment Surgery
Keratoconjunctivitis sicca
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Conjunctival Disorders
Hemorrhage Conjunctivitis Trachoma
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Corneal Disorders
Keratoconus is the degeneration of the cornea, deposits in the cornea, dystrophies, keratitis, or ulceration of the corneal surface
Reduce symptoms, restore corneal clarity, enhance client’s ability to use remaining vision
Antibiotics, antifungals, antivirals, steroids
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Cataract
Clouding of the lens, blurring of the lens distorts the image and color projected onto the retina.
As cataract matures, opacity makes it difficult to see the retina.
Visual acuity is restricted.
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Disturbed Sensory Perception: Visual
Interventions include:› Surgery to remove cataract and implant a
small, clear, plastic lens› Enhanced social interaction› Safety issues
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Postoperative Care—Cataract
Antibiotics given subconjunctivally. Eye is unpatched. Discharge usually
occurs within 1 hr with dark glasses. Instill antibiotic-steroid eyedrops. -
TobraDex Mild itching is normal. *bloodshot eye* Pain indicates a complication. Reduce IOP - Diamox Prevent infection. Assess for bleeding. *no ASA*
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Health Teaching
Report to surgeon: sharp, sudden pain in the eye, bleeding or increased discharge, lid swelling, decreased vision, or flashes of light or floating shapes.
Avoid activities that might increase IOP. Review procedure for use of eyedrops.
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Glaucoma
Group of ocular diseases resulting in increased IOP
Primary open-angle glaucoma Angle-closure glaucoma
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Clinical Manifestations
Cupping and atrophy of the optic disc, disc wider and deeper and turns white or gray
Visual field measurement Headache or brow pain, nausea and
vomiting, colored halos around lights, and sudden blurred vision with decreased light perception
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Diagnostic Tests
Tonometry Tonography Gonioscopy
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Drug Therapy for Glaucoma Pupillary constriction: miotics,
pilocarpine hydrochloride Inhibition of aqueous humor: timolol,
levobunolol, beta blockers, carbonic anhydrase inhibitors
Osmotic drugs part of emergency treatment for rapid reduction of IOP
No epinephrine used in angle-closure glaucoma because it dilates the pupil
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Eye Trauma
Hyphema Contusion Foreign bodies Lacerations Penetrating injuries
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Reduced Vision
Interventions include:› Communication regarding use of adaptive
items› Safety in familiar settings› Ambulation assisted with care› Self-care and independence promoted› Support for the difficulty of adapting to
loss of sight
Chapter 50Assessment of the Ear and
Hearing
Go to medicalvideos.us examination of the ear.
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Normal TM
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Anatomy and Physiology
Review of the structure of:› External ear› Middle ear› Inner ear
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Ear and Hearing Changes Associated with Aging
Drier, impacted cerumen Loss of tympanic membrane elasticity Decreased bony ossicle movement Degenerative changes of cochlea Disturbed vestibular function Diminished hearing acuity Decreased ability to hear high-
frequency sounds
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Assessment Techniques
Thorough history from client Demographic data, gender, age Family history and genetic risk Personal history of past hearing
involvement Socioeconomic status Current health problems
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Physical Assessment
External ear and mastoid assessment Otoscopic assessment Cultural considerations, including color
of the lining of the external ear canal and cerumen, which varies according to skin tone
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Auditory Assessment
Conductive hearing loss resulting from any physical obstruction of sound wave transmission
Sensorineural hearing loss resulting from a defect in the cochlea, the eighth cranial nerve, or the brain
Mixed conductive-sensorineural hearing loss, a profound hearing loss
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Tests
Voice test Watch test Audioscopy Weber tuning fork test Rinne tuning fork test
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Diagnostic Assessment
Laboratory tests Computed tomography Magnetic resonance imaging Auditory brainstem-evoked response Electronystagmography Caloric testing Dix-Hallpike test for vertigo
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Audiometry
Frequency is the highness or lowness of tones.
Intensity is expressed in decibels. Threshold is the lowest level of
intensity at which pure tones and speech are heard.
Pure tones are generated by an audiometer to determine hearing acuity.
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Tests Air conduction test Bone conduction test Speech audiometry Speech reception threshold Speech discrimination Tympanometry
Chapter 51Interventions for Clients with Ear
and Hearing Problems
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External Otitis
Painful condition caused when irritating or infective agents come into contact with the skin of the external ear
Commonly called swimmer’s ear Treatment focused on reducing
inflammation, edema, and pain with heat, bedrest, limited head movement, topical antibiotic and steroid therapy, and analgesics
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Furuncle
Localized external otitis caused by bacterial infection of a hair follicle
Hearing impaired if the lesion blocks the canal, most commonly cerumen (wax)
Treatment with local and systemic antibiotics, heat application, earwick to relieve pain, and possible incision and drainage
Perichondritis
Infection of the perichondrium, a tough fibrous tissue layer that surrounds the cartilage and gives shape to the pinna.
Goal is to eliminate the infection
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Cerumen or Foreign Bodies
Cerumen (wax) is the most common cause of an impacted canal.
Other blockages include vegetables, beads, pencil erasers, insects.
Irrigate canal with a mixture of water and hydrogen peroxide at body temperature for impacted cerumen; Cerumenex softens wax.
Carefully remove foreign object.
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Otitis Media
Three types of otitis media include:› Acute otitis media› Chronic otitis media› Serous otitis media
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Nonsurgical Management
Quiet environment Bedrest with limited head movement Heat and cold applications Systemic and topical antibiotic therapy Analgesics Antihistamines Decongestants
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Surgical Management
Myringotomy is a surgical opening of the pars tensa of the eardrum.
Operative procedure includes grommet (polyethylene tube) placed through the tympanic membrane.
Postoperative care: keep external ear and canal free of other substances while the incision is healing and keep head dry for several days.
Go to entusa.com Mayo clinic ear tubes
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Mastoiditis Infection of the mastoid air cells
caused by untreated or inadequately treated otitis media
Nonsurgical management: antibiotics
(Continued)
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Mastoiditis (Continued)
Surgical management: simple or modified radical mastoidectomy with tympanoplasty
Complications: damage to cranial nerves, vertigo, meningitis, brain abscess, chronic purulent otitis media, and wound infection
Pediatric Sensory
Conjunctivitus or pink eye is an inflammation of the conjunctival sac
S/S itching, burning, photophobia cratchy eyelids redness edema and thick discharge
Allergiy? Infection? infants could be from blocked lacrimal duct or most common chlamydia May have to use systemic abx. If chlamydia
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Conjuncitivis continued..
Treat the cause.. ABX or steroids for severe allergies
Nursing Considerations: No sharing of towels, washcloths correct administration of eye drops never share eye medications prevent injury to the eye no rubbing of the eye throw out eye make-up, do not wear contacts replace if possible.
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Pediatric: Strabismus
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Amblyopia
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External Otitis Media
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Serous Otitis Media
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