Disorders of the Eye - Middlesex County Vocational and ...

Disorders of the Eye - Middlesex County Vocational and ...

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 1 Overview of Anatomy and Physiology Anatomy of the eye Accessory structures of the eye Eyebrows Eyelashes Eyelids

Lacrimal apparatus Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2 Figure 13-1 (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.) Lacrimal apparatus. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3 Overview of Anatomy and Physiology Anatomy of the eye (continued) Structures of the eyeball

Sclera Cornea Choroid Ciliary body Iris Pupil Retina Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4 Overview of Anatomy and Physiology Anatomy of the eye (continued)

Chambers of the eye Anterior chamber Aqueous humor Posterior chamber Vitreous humor Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5 Figure 13-2 (From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.) Horizontal section through the left eyeball. The eye is viewed from

above. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6 Overview of Anatomy and Physiology Anatomy of the ear External ear Auricle External auditory canal Tympanic membrane Middle ear

Eustachian tube Malleus Incus Stapes Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7 Figure 13-3 (From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.) The ear. External, middle, and inner ear. (Not to scale.) Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8 Overview of Anatomy and Physiology

Anatomy of the ear (continued) Inner ear Labyrinth Bony labyrinthfilled with perilymph o Semicircular canals o Vestibule o Cochleaorgan of Corti Membranous labyrinthfilled with endolymph Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9 Figure 13-4 (From Thibodeau, G.A., Patton, K.T. [2005]. The human body in health and disease. [4th ed.]. St. Louis: Mosby.)

The inner ear. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10 Overview 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11 Laboratory and Diagnostic Examinations Diagnostic eye tests Snellen test Color vision Refraction Ophthalmoscopy

Tonometry Amster grid test Schirmers tear test Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12 Disorders 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)

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13 Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14 Disorders of the Eye Blindness and near-blindness (continued) Medical management/nursing interventions Corrective eyewear Canes

Seeing-eye dogs Magnifying systems Surgical procedures Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15 Disorders of the Eye Refractory errors Etiology/pathophysiology Astigmatismunequal curve in the shape of the cornea or lens Strabismusinability of the eyes to focus in one direction; cross-eyed Myopianearsightedness; eyeball is too long Hyperopiafarsightedness; eyeball is too short Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 16 Disorders 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)

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17 Disorders of the Eye Conjunctivitis Etiology/pathophysiology Inflammation of the conjunctiva Bacterial or viral infection Allergy Environmental factors Commonly called pink eye Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 18 Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 19 Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 20

Disorders of the Eye Keratitis (continued) Clinical manifestations/assessment Severe eye pain Photophobia Tearing Edema Visual disturbances Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 21

Disorders 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

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 22 Disorders 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

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 23 Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 24 Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 25 Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 26 Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 27 Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 28

Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 29 Figure 13-8 (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.) Retinal break with detachment: surgical repair by scleral buckling technique. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 30 Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 31 Figure 13-9 (From Havener, W.H. [1997]. Synopsis of ophthalmology. St. Louis: Mosby.) A, Chronic open-angle glaucoma. B, Acute-angle closure glaucoma. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 32 Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 33 Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 34

Disorders of the Eye Glaucoma (continued) Medical management/nursing interventions Open-angle glaucoma Beta blockers Miotics Carbonic anhydrase inhibitors Closed-angle Osmotic diuretics Iridectomy

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 35 Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 36

Disorders 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 37 Surgeries 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 38 Laboratory and Diagnostic

Examinations Diagnostic ear tests Otoscopy Tuning fork tests Webers test Rinne test Autometric testing Vestibular testing Romberg test Past-point testing Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 39

Figure 13-13 (From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosbys guide to physical examination. [5th ed.]. St. Louis: Mosby.) Weber tuning fork test. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 40 Figure 13-14 (From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosbys guide to physical examination. [5th ed.]. St. Louis: Mosby.) Rinne tuning fork test. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 41 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 42 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 43 Inflammatory 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 44 Inflammatory 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 45 Inflammatory 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 46 Inflammatory 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 47 Inflammatory 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 48 Inflammatory 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 49

Noninfectious 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 50 Noninfectious Disorders of the Ear Mnires 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 51 Noninfectious Disorders of the Ear Mnires 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 52 Surgeries 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 53 Nursing Process 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 Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 54 Ophthalmic Drugs Categories Local anesthetics Antiseptic ointments Used in procedures such as tonometry, gonioscopy, cataract surgery, and removal of foreign objects from the cornea 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 Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 55 Ophthalmic Drugs (cont.) Artificial tears Other preparations Antiglaucoma agents Uses To control acute narrow-angle glaucoma before surgery Wide-angle glaucoma Secondary glaucoma Congenital glaucoma before surgery Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

56 Glaucoma Three Major Forms Primary glaucoma Secondary glaucoma Narrow-angle: person has a shallow anterior eye chamber, may be genetic; requires surgery Wide-angle glaucoma: gradual onset, controlled with medications Result of other eye problems, treated with medications Congenital glaucoma

Birth defect requiring surgical correction Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 57 Antiglaucoma Medications Sympathomimetics Beta blockers Produce vasoconstriction and decrease intraocular pressure in open-angle glaucoma

Reduce intraocular pressure by reducing the formation of aqueous humor Miotics, direct-acting Cholinergic agonists Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 58 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 Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 59 Antiglaucoma Medications (cont.) Mydriatic-Cycloplegics Block the action of acetylcholine Mydriatics

Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 60 Otic Preparations Control superficial infections of the ear Action is bacteriostatic or bactericidal Prophylaxis for infections in swimmers Removing cerumen Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 61

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