Sensory

Question 1

Eye trauma interventions include:

Answer 1

1. Determine mechanism of injury
2. Ensure ABC’s, assess for other injuries - eye is close to the airway!
3. Assess for chemical exposure - Ocular irrigation immediately if chemical exposure
4. Assess visual acuity - No pressure on eye!!
5. Tell pt do not blow their nose
6. Do not attempt to treat the injury (except flushing for chemical exposure)
7. Stabilize foreign objects
8. Cover with dry, sterile patch & protective shield
9. No food or fluids - In case they need surgery
10. HOB 45⁰

Question 2

Hordeolum

Answer 2

sty

warm/moist compresses - 4x/day; allow to dry
lid scrubs (maybe - if exudates or flaking)
antibiotics - topical ointments or drops (maybe)

Question 3

Chalazion

Answer 3

huge sty!!

warm/moist compresses - 4x/day; allow to dry
lid scrubs (maybe - if exudates or flaking)
antibiotics - topical ointments or drops (maybe)
may be surgically removed

Question 4

Blepharitis

Answer 4

bilateral inflammation

s/s: itching, burning, irritation, photophobia

Tx: antibiotic ointment (wash hands when using)
baby shampoo for removing scales/crusts

Question 5

Viral Conjunctivitis

Answer 5

S/S: Foreign body sensation, Mild photophobia

Tx: Topical steroids for relief (Does not cure, Eventualy goes away even without treatment)

Question 6

Chlamydial conjunctivitis

Answer 6

trachoma and adult inclusion

s/s: mucopurulent discharge, irritation, redness, lid swelling

Question 7

Allergic conjunctivitis treatment

Answer 7

avoid allergen
artificial tears
topical antihistamines and steroids

Question 8

Keratitis

Answer 8

inflammation of cornea

S/S: pain photophobia, foreign body sensation

Question 9

Bacterial keratitis treatment

Answer 9

topical antibiotics

subconjuctival injection of antibiotics

Question 10

Viral keratitis treatment

Answer 10

usually from Herpes

Antivirals can be oral, drops, and topical ointment
Topical steroids
Pain medication
Warm compresses

Question 11

Corneal Ulcer

Answer 11

infection of cornea

S/S: VERY PAINFUL
foreign body sensation
tearing, purulent discharge, redness, photophobia

Tx: AGGRESSIVE eye drops - q1hr for 24 hrs (antibiotic, antiviral, or antifungal)

Question 12

Nursing management of extraocular problems:

Answer 12

Assess ocular changes: edema, redness, decreased visual acuity, foreign body feeling, discomfort/pain

1. Psychosocial considerations
   a. Especially if vision is impaired
2. Careful asepsis: frequent hand washing
   a. don’t touch their eye or anything really
3. Avoid sources of ocular irritation (including contact lens issues)
4. Consider sexual mode of transmission
5. Warm or cool compresses
6. Darken room
7. Comfort measures
8. Medications as indicated: stagger if more than one eye drop
   a. if they have two meds, they could alternate them every half hour (if hourly)
9. Discard used cosmetics and open contact lens products
10. If vision impaired, address issues related to that (environment)

Question 13

Cataract causes

Answer 13

Opacity within the lens - May occur in one or both eyes

Causes/Etiology

1. Most are age related (senile cataracts)
2. Blunt or penetrating trauma
3. Radiation or UV light exposure
4. Systemic or long-term topical corticosteroids
   a. people with chronic conditions with inflammatory component are often on long term steroids (like prednisone)  cause cataracts
5. Ocular inflammation
6. Congenital
   a. Maternal rubella (German measles)
7. Diabetes

Question 14

Cataract symptoms

Answer 14

decrease in vision
abnormal color perception
glare

Question 15

Teaching for patient after cataract surgery

Answer 15

Hygiene & eye care - when using eye drops make sure to tell them not to touch tip of bottle to eye, wash hands before and after inserting eye drops

Monitor pain, pain meds & when to report

Eye drops

Eye patch/shield (Up to physician – protect the eye, Head positioning)

Follow-up appointments
2-3 times over next 6-8 weeks following surgery
New eyeglass prescription - Wait until eyes are healed (6-8 weeks)

Question 16

Retinal Detachment

Answer 16

retinal tear or hole - can cause PAINLESS loss of vision if untreated

emergency so may bump someone off surgical schedule

Risk Factors for Retinal Detachment

1. Increasing Age
2. Severe Myopia
3. Eye Trauma
4. Cataract Surgery
5. Family or personal hx retinal detachment (2-25% risk in other eye)
6. If untreated blindness almost always occurs

Question 17

Retinal Detachment symptoms

Answer 17

photopsia (light flashes)
floaters
vision changes: cobwebs, hairnet or ring in field of vision

Question 18

Retinal Detachment patient care

Answer 18

Emotional support – urgent situation, urgent surgery
(nursing diagnoses related to anxiety, risk for infection, deficient knowledge — look at interventions and rationales!)

Post-operative (Table 22-5)

1. Bed rest & positioning - positioning related to whether or not we use an air bubble
2. Eyedrops (antibiotics, antiinflammatory, dilating)
3. Activity (possible restrictions usually due to air bubble)
4. Pain management
5. Discharge planning – goes home a few hours after surgery; want to make sure we maximize visual acuity for the remaining vision; want to minimize injury, infection (mostly hand washing)

Question 19

Age Related Macular Degenerations (AMD)

Answer 19

degeneration of macula which is responsible for SHARP, CENTRAL VISION
2 Types - Dry (more common) and Wet (more severe)

Risk factors

1. *Aging
2. *Genetics
3. family history = MAJOR risk factor !
4. UV light exposure
5. Hyperopia
6. Cigarette smoking
7. Light-colored eyes
8. Nutritional deficiencies
9. Vitamin C, E, beta carotene, zinc - intake of dark, green leafy vegetables may help slow or prevent the progression

Question 20

AMD symptoms

Answer 20

blurred or darkened vision
scotomas (blind spots)
metamorphopsia (distorted vision)

Question 21

AMD collaborative care

Answer 21

1. Photodynamic therapy uses an IV dye & “cold” laser to excite the dye - destroys abnormal blood vessels without permanent damage
2. Medications injected into the vitreous cavity every 4-6 weeks (side effects = blurred vision, eye irritation, eye pain, and photosensitivity)
3. Vision will not improve, but treatment limits progression
4. no specific treatment for dry AMD except some supplements that may help slow vision loss
5. Vision enhancement techniques are useful so that the patient can utilize what vision they do have
   - Desktop video magnification, hand-held magnifiers, text-to-speech scanners, e-readers, computer tablets with magnification, brighter screens, voice recognition

Question 22

Glaucoma

Answer 22

increased intraocular pressure
2 types:
Primary Open Angle Glaucoma (POAG) -most common
Primary Angle Closure Glaucoma (PACG) - more severe

IOP:
normal 10 – 21mmHg
POAG 22-32 mmHg
PACG ≥50 mmHg

Question 23

POAG symptoms

Answer 23

Slow onset
No pain, no pressure
Eventually notice “tunnel vision”
increased pressure leading to loss of peripheral vision

untreated = painful, hard, sightless eye requiring enucleation

Question 24

PACG symptoms

Answer 24

Sudden, excruciating pain
Nausea & vomiting
Halos, blurred vision
Ocular redness

untreated = painful, hard, sightless eye requiring enucleation

Question 25

Glaucoma requires long term treatment with:

Answer 25

antiglaucoma medications Some medication concerns with beta-blocker agents: a. If taking a systemic beta-blocker, an additive effect may be experienced if prescribed a beta-blocking eye drop (cardiac issues) b. Also need to pay attention to those with COPD, asthma, heart failure, pulmonary edema i. limit systemic absorption of medication in eye c. Occlude puncta (bottom picture)

Question 26

Nursing Care of Glaucoma includes:

Answer 26

Prevention – educate eye exams! q 2-4 yrs 40-64yo; q 1-2 yrs if 65+; more for African American Acute (angle-closure) - Meds, surgery, Comfort Ambulatory & home care - Encourage compliance, Information, Follow up (routine checking of IOP — helps know if meds are working, if patient is being compliant, etc.)

Question 27

The most common problem of the middle ear is:

Answer 27

acute otitis media (ear infection). It can be bacterial or viral. The treatments include antibiotics and surgery (placing a tympaanoplasty tube).

Question 28

Risk factors for acute otitis media are:

Answer 28

1. Young age 2. Congenital abnormality 3. Immune deficiency 4. Cigarette smoke exposure 5. Family Hx 6. Recent URI 7. Male 8. Allergies

Question 29

Chronic otitis media and mastoiditis occur when:

Answer 29

there are untreated or repeated episodes of acute OM. Complications include perforation and a mass of tumor like cells that may need to be surgically removed (cholesteatoma)

Question 30

Chronic otitis post surgery patient teaching

Answer 30

1. Avoid sudden head movements. 2. Do not try to get out of bed w/o assistance. 3. Take drugs to reduce dizziness if prescribed. 4. Change positions slowly. 5. Avoid getting the head wet (including showering) until directed by surgeon. 6. Report fever, pain, an increase in hearing loss, or drainage from the ear. 7. Do not cough or blow the nose bc this causes increased pressure in the eustachian tube and middle ear cavity and disrupts healing. 8. In need to cough or sneeze, leave the mouth open to help reduce the pressure. 9. Avoid crowds where respiratory infections may be contracted. 10. Avoid situations where pressure or popping in the ears is normally experienced, such as high elevations or airplane travel.

Question 31

chronic otitis management:

Answer 31

``` Ear irrigations Oral, otic, or parenteral antibiotics Analgesics Antiemetics Surgery i. Tympanoplasty ii. Mastoidectomy ``` can put antibiotic beads, drain in behind the ear, etc; LAST RESORT

Question 32

Miniere's Disease symptoms

Answer 32

1. Episodic vertigo 2. Tinnitus 3. Hearing loss 4. Aural fullness 5. Fluid builds up and ear drum can rupture ``` Can be extremely debilitating SUDDEN severe attacks of vertigo, N/V, sweating, pallor “Drop Attack” Whirling in space Falling ``` Last hours to days and May occur several times a year!

Question 33

Miniere's Disease care

Answer 33

acute attack: medications and bed rest routine care: medications, possibly surgery nursing care: 1. quiet dark room, no sudden movements, ambulation assistance 2. minimize vertigo 3. maximize safety 4. can have frequent incapacitating attacks

Question 34

interpersonal care for hearing loss and deafness

Answer 34

1. control environmental noise like tv's 2. immunizations: some childhood diseases cause hearing loss 3. ototoxic substances: industrial 4. ototoxic drugs: salicylates, diuretics, antineoplastic drugs, antibiotics

Question 35

assistive devices for hearing loss

Answer 35

hearing aids, lip reading (allows for 40% understanding), sign language, cochlear implant, assistive listening devices (amplifiers, lighted alerts)

Question 36

when communicating with someone who has hearing loss do these 4 things:

Answer 36

speak slowly and normally - Do NOT shout simple sentences eye contact - don't cover mouth speak in "better" ear