Ear And Eye Disorders

Front 1

A 60 y.o. pt is being prepared for outpatient cataract surgery. when obtaining admission data from the pt, the nurse would expect to find that the pt has a history of:

a. a painless, sudden severe loss of vision

b. blurred vision, colored halos around lights, and eye pain.

c. a gradual loss of vision w/ abnormal color perception and glare.

d. light flashes, floaters, and a "cobweb" in the field of vision with loss of central or peripheral vision.

Back 1

c. a gradual loss of vision w/ abnormal color perception and glare.

Front 2

Following a scleral buckling with a cryoprobe, the nurse plans postoperative care of the patient based on the knoweledge that

a. specific positioning and activity restrictions are likely to be required for several days

b. the pt is frequently hospitalized for 7 to 10 days on bed rest until healing is complete

c. pt experience little or no pain and development of pain indicates hemorrhage or infection

d. reattachment of the retina commonly fails and pts can be expected to grieve for loss of vision

Back 2

a.

Front 3

In caring for the pt w/ age-related macular degeneration (AMD), it is important for the nurse to

a. teach pt how to use eye drops for tx

b. emphasize the use of vision enhancement techniques to improve what vision is present.

c. encourage the pt to undergo laser tx to slow the deposit of extracellular debris.

d. explain that nothing can be done to save the pt's vision since there is no tx for AMD.

Back 3

b.

Front 4

List the triad of symptoms that occur with Meniere's disease

Back 4

tinnitus, vertigo, one sided sensorineural hearing loss

Front 5

An appropriate intervention for the pt during an acute attack of Meniere's disease includes providing

Back 5

a quiet, darkened room

Front 6

Associated with conductive loss or sensorineural loss

hearing loss may be caused by impacted cerumen

Back 6

C

Front 7

Associated with conductive loss or sensorineural loss

hearing aid is helpful

Back 7

C

Front 8

Associated with conductive loss or sensorineural loss

caused by noise trauma

Back 8

S

Front 9

Associated with conductive loss or sensorineural loss

associated w/ otosclerosis

Back 9

C

Front 10

Associated with conductive loss or sensorineural loss

presbycusis

Back 10

S

Front 11

Associated with conductive loss or sensorineural loss

Associated w/ Meniere's disease

Back 11

S

Front 12

Associated with conductive loss or sensorineural loss

Result of ototoxic drugs

Back 12

S

Front 13

Associated with conductive loss or sensorineural loss

Related to otitis media

Back 13

C

Front 14

T or F
Are-related cataract formation is associated w/ pain and eye redness

Back 14

False

it is associated w/ blurred vision, decreased color vision, diplopia, poor night vision

Front 15

T or F
Early manifestations include slightly blurred vision and decreased color perception

Back 15

True

Front 16

T or F
A cataract is an opacity of the lens that distorts the image projected onto the retina.

Back 16

True

Front 17

T or F
Cataracts develop in both eyes at the same rate.

Back 17

False

Front 18

T or F
Cataracts may be present at birth.

Back 18

True

Front 19

Your pt has had cataracts surgery and she is ready to go home. What activities should she avoid?

Back 19

bending from waist, sneezing, coughing, blowing nose, straining during BM, avoid tight shirt collars and ties, lifting >15 Ibs, sleeping/lying on operative side, stand in shower w/ face away, no driving until cleared by MD

Front 20

A pt who has had cararact surgery should know the s/s of complications. Which signs and symptoms shoult the pt report to her dr.?

Back 20

sharp, sudden pain in eye, bleeding or increased discharge, lid swelling, decreased vision, or flashes of light or floating shapes. yellow/green drainage.

Front 21

Which of the following statements about glaucoma are true? check all that apply.

a. glaucoma is actually a group of diseases resulting in increased intraocular pressure.

b. warning signs of glaucoma include gradual loss of central vision.

c. the most common form is acute glaucma, which has a sudden onset.

d. blindness may result from reduced blood flow to the optic nerve and retina.

Back 21

A&D

b.they are late signs
c.the most common is primary open-angle

Front 22

Following a sclera buckling procedure involving a gas bubble insertion, the pt should be placed in what position?

Back 22

prone with haed turned so that the opperative eye is facing up.

Front 23

a pt is told he has a retinal tear and it should be closed or sealed. what are the 3 main mechanisms for doing this?

Back 23

cryotherapy-freezing
photocoagulation-laser
diathermy-high frequency current

Front 24

the pt who has had a stapedectomy should be told which of the following? check all that apply

a. hearing is initially worse after surgery

b. success rate is high

c. there is a risk of total hearing loss on the affected side.

d.hearing is improved immediately after surgery.

Back 24

abc

Front 25

Describe a cataract

Back 25

clouding, 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

generally affects persons older than 65 y.o.

also caused by trauma, associated with other chronic disease (DM)

w/ aging the lens gradually loses water and increases in density.

from old age, exposure to toxic agents, occur w/ other diseases and occular disorders.

Front 26

clinical manifestations of a cataract

Back 26

-blurred vision
-decreased color vision: blue, green and purple appear gray
-diplopia
-poor night vision, halo appears around headlights
-clear lens changes to yellowish/brown adding brown tint to vision
-reduced visual acuity progressing to blindness
-late sign-presence of white pupil
-no pain or redness
-driving, reading, watching tv made difficult

Front 27

Diagnosis of a cataract

Back 27

visual acuity test-snellen chart

dilated eye exam

tonometry-maesure pressure in eye

Front 28

interventions for pt with a cataract

Back 28

-surgery to remove cataract and implant a sm, clear, plastic lens

-extracapsular-removal of the anterior portion of the capsule, posterior lens capsule remains(more common-b/c need an anchor)

-intracapsular-removal of the lens and entire capsule-greater risk for retinal detachment

Front 29

phacoemulsification

Back 29

uses sound waves to break the cataractous lens into sm pieces.

Front 30

post-op care for phacoemulsification, cataract surgery

Back 30

-antibiotics given subconjunctivally immediately post-op
-eye shield at night
-eye shield or sunglasses during day
-mild itching and blood shot appearance is normal
-pain indicates a complication, esp w/ N/V(hemorrhage, increased IOP)
-reduce IOP
-prevent infection-creamy white dry crusty discharge is normal
-yellow-green discharge, inc redness indicates infection
-assess for bleeding, vision changes, avoid ASA
-use cool compress to reduce itching

Front 31

Teach pt how to avoid increasing intraocular pressure

Back 31

avoid:
-bending at waist
-sneezing,coughing
-blowing nose
-straining for BM
-Vomitting
-tight shirt collar/tie
-lifting >15 Ibs
-sleeping/lying on operative side

Front 32

health teaching for post-op cataract surgery

Back 32

report to surgeon: sharp, sudden pain in the eye, bleeding or increased discharge, lid swelling, decreased vision, or flashes or light or floating shapes

avoit activities that might increase IOP

stand in shower w/ face away from showerhead

no driving until cleared by doctor

review procedure for use of eye drops

avoid vacuuming, gold, certain sports

Front 33

teach about instilling eye drops

Back 33

-supine position or sitting w/ neck slightly hyperextended
-look at ceiling
-apply gentle pressure to nasolacrimal duct if medication has sytemic effects.
-close eye gently to distribute medication.
-monitor pt for local,systemic and A.E. of medications.

Front 34

Glaucoma

Back 34

group of ocular disorders resulting in increased IOP
-normal IOP 10-21 mmHg
-maintain by balance between outflow and production of aqueous humor
-build up of aqueous humor decreases blood flow to optic nerve and retina leading to ischemia and death
-untreated results in blindness(starts in periphery)
-untreated results in blindness
-angle-closure (narrow-angle) glaucoma has sudden onset and treated as emergency
-painless, graducal loss of vision
-

Front 35

risk factors for glaucoma

Back 35

African Americans over age 40
-everyone over age 60 esp Mexican Americans
-Family Hx
-Early detection and tx best way to prevent blindness

Front 36

Primary open-angle glaucoma

casues

Back 36

develops slowly, w/o symptoms, most common form

aging, heredity, central retinal vein occlusion

-gradual loss of visual fields go unnoticed
-may have foggy vision, w/ reduced accomodation
-mild aching or HA
-tonometry readings between 22 & 32

Front 37

Angle-closure(closed angle, narrow, acute) glaucoma

Back 37

has sudden onset and treated as emergency

aging, heredity, central retinal vein occlusion

severe pain around eye, N/V, HA or brow pain, colored halos around lights, sudden blurred vision and decreased light perception

tonometry is 30mm or higher

Front 38

clinical manifestations of glaucoma

Back 38

early-incrased intraocular pressure, diminished accomodation

late-visual field losses, decreased visual acuity, colored halos around lights, slowly lose peripheral vision, headache or eye pain is excruciating and comes on suddenly in acute glaucoma

diagnosed w/ tonometry

Front 39

opthalmoscopic examination for glaucoma

Back 39

-cupping & atrophy or the optic disk
-disk becomes wider, deeper & turn white or gray

-chronic open-angle visual fields show small crescent shaped defect that gradually becomes a larger field defect


-in acute angle-closure-visual fields can quickly decrease
-sclera may appear reddened, upon visual exam the pupil is moderately dilated and nonreactive, aqueous chamber is shallow, aqueous humor is cloudy

Front 40

Drug therapy for glaucoma does what?

Back 40

focues on lowering IOP through:
-constricting pupil so that the ciliary muscle is contracted, allowing better circulation of the A.H. to site absorption
-decreased produciton of A.H.

Front 41

Drug therapy for glaucoma
general categories

Back 41

-pupillary constriction: miotics, pilocarpine hydrochloride
-Prostagladin antgonist (xalatan)
-inhibition of A.h.-timolol, levobunolol, beta blockers, carbonic anhydrase inhibitors (Diamox)
-osmotic drugs part of emergency tx for rapid reduction of IOP (osmitrol)

Front 42

Miotics

Back 42

-constict the pupil and contract ciliary muscle, increases flow of A.H.

-carbachol, humersol:open angle glaucoma

-Pilocarpine-chronic open angle glaucoma and angle closure glaucoma

S/E: hypotension, HA, nearsightedness, N&V,
vision in low light environments due to pupil constrictions makes it difficult for some pts to comply w/ tx.

Front 43

mydriatics

Back 43

dilate pupil, decrease a.h. production, increase outflow

propine, lipidine:chronic open-angle glaucoma

S/E: limited to ocular effects, burning, eye pain, lacrimation. systemic effects rare.

Front 44

selected beta blockers

Back 44

-Betoptic-chronic open angled glaucoma
-(timoptic)Timolol-open angle glaucoma
S/E-transient burning & discomfort, blurred vision, photophobia, lacrimation

-uncommon systemic effects-HA, dizziness, hypotension, cardiac irregularities & bronchospasm

-applying pressure to the inside corner of the eye when putting the drops into the eye prevents absorption (punctual occlusion)

Front 45

While taking Timolol, watch for...

Back 45

rash, dizziness, blurred vision, dry eyes.

Front 46

carbonic anhydrase inhibitors

Back 46

Diamox-chronic open angle glaucoma, given pre-op eye surgery to < IOP

truspot-open angle glaucoma
given orally

S/E: drowsiness, confusion, transient myopia, anorexia, N/V, polyuria

Front 47

osmotic diuretics

Back 47

give IV, orally or topically to reduce IOP
osmitrol-acute reduction of IOP
S/E: N/V, HA, fluid and lytes imbalance

Front 48

prostaglandin agonists

Back 48

xalantan-open angle glaucoma
s/e: foreign body sensation, stinging, blood shot eyes

systemic effects: occur in sm % include skin rxns, upper respiratory infections and HA

increase outflow of A. H.

Front 49

surgical management of glaucoma

Back 49

laser trabeculoplasty-loacal anesthesia, laser causes scars in meshwork, fiber tightening increases the spaces between the fibers thus increasing the outflow of a.h.

standard surgical therapy-makes a new opening for fluid to leave the eye, used after medicines and laser surgery have failed to control pressure

post-op care: cover eye w/ patch and shield, avoid ASA, avoid lying on operative side, report brow pain, severe eye pain, and nausea
choroidal hemorrhage is most serious complication-if IOP is too low fluid enters the suprachoroid space and causes a choroidal detachment-acute eye pain, decreased vision, VS changes

Front 50

macular degeneration

Back 50

-the macula, the area of central vision deteriorates
-degeneration can be atrophic age-related (dry) or exudative (wet)
-rod or cone photoreceptors die
-central vision declines; pt describes "mild-buring" and "distortion"

Front 51

Macular Degeneration

Back 51

-The macula, the area of central vision deteriorates
-Degeneration can be atrophic age-related dry or wet
-rod and cone photoreceptors die
-central vision declines;pt describes "mild-blurring" and "distortion."
-no pain

Front 52

Wet AMD

Back 52

-loss of central vision can occur quickly
-occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. The blood and fluid raise the macula from its normal place at the back of the eye.
-Wet AMD is considered to be an advanced AMD and is more severe than the dry form,
-an early symptom of wet AMD is that staight lines appear wavy

Front 53

Dry AMD

Back 53

dry AMD occus when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye.
-as dry AMD gets worse, pts may see a blurred spot in the center of your vision
-over time, as less of the macula functions, central vision in the affected eye can be lost gradually

Front 54

symptoms of dry AMD

Back 54

most common-slightly blurred vision
-difficulty recognizing faces
-need more light for reading and other tasks.
-generally affects both eyes, but vision can be lost in one eye while the other eye seems unaffected.
-one of the most common clinical symptoms-drusen, yellow deposits under the retina. They often are found in ppl over age 60.
-with advanced dry AMD, there is a breakdown of light-sensitive cells and supporting tissue in the macula
-breakdown can cause a blurred spot in the center of your vision. over time, the blurred spot may get bigger and darker, taking more of the central vision.

Front 55

acuses and risk factors of macular degeneration

Back 55

smoking, obesity, race, family hx, gender

Front 56

Dx of macular degeneration

Back 56

comprehensive eye exam, visual acuity test, dilated eye exam, tonometry, during an eye exam, an amsler grid may be used

Front 57

Tx and research of macular degeneration

Back 57

taking certain vitamins and minerals may reduce the risk of developing advanced AMD.
-wet AMD can be treated with laser surgery, photodynamic therapy, and injections into the eye. None of these tx is a cure.
-wet AMD can now be treated with new drugs that are injected into the eye (anti-VEGF threapy)

Front 58

interventions for reduced vision

Back 58

communication regarding use of adaptive items, safety in familar settings, ambulation assisted w/ care, self-care and independence promoted, support for the difficulty of adapting to loss of sight

Front 59

low vision aids

Back 59

magnifiers, monoculars, telescope, spectacle-mounted "magnifiers", video magnifiers, reading machines with voice output

Front 60

corneal disorders

Back 60

cornea must be transparent and intact for a sharp image to be focused on the retina
-corneal problems lead to visual impairments
-keratoconus is the degeneration of the cornea
-keratitis is irritation or infection
-ulceration can occur with mechanical or chemical injury, drying or infection

Front 61

treatment of corneal disorders

Back 61

reduce symptoms, restore corneal clarity, enhance pt's ability to use remaining vision
-antibiotics, anti-fungals, antivirals, steroids
-keratoplasty-surgical removal of diseased corneal tissue and replacement with new tissue from a human donor cornea -restores vision
-postoperative care: antibiotic ointment, pressure patch and protective shield to cover eye, reduce IOP

Front 62

retinal holes, tears and detachments

Back 62

retinal hole-break in integrity of peripheral sensory retina-associated with age or trauma
-retina tear-more jagged and irregularly shaped break in retina result of traction on retina
-retinal detachment-separation of the sensory retina from pigmented epithelium assoc. with tear or hole: trauma, uncontrolled DM, inflamm disorder, family hx, previous eye surgery

Front 63

clinical manifestations of retinal holes, tears and detachments

Back 63

bright flashes of light, esp in peripheral vision
-translucent specks of various shapes (floaters) in the eye
-blurred vision
-shadow or blindness in a part of the visual field of one eye
-opthalmoscopic exam reveals gray bulges or folds in the retina that quiver, holes or tears may also be seen at the site of detachment

Front 64

treatment of tears, holes and detachments

Back 64

-laser surgery may be used to seal the tears/holes in retina, which generally precede detachment.

-cryotherapy:freezing
-photocoagulation:laser
-diathermy:high frequency curent
-scleral buckling

Front 65

Scleral buckling
photocoagulation
encircling band

Back 65

repairs wrinkles, folds, places retina in contact w/ underlying structures (sclera)-Head elevated, no straining activities

pre-op:treat anxiety, provide info activity restriction, eye patch, topical drugs
-gas/silicone oil can be placed inside eye to promote retinal reattachment. Float up against retina and hole in place until healing occurs.

post-op:eye patch and shield are applied, monitor VS and inspect shield for drainage, if gas/oil used position pt on abdomen w/ affected eye up so the gas floats against the retina for several days, nausea and pain are common-antiemetics
-report sudden increase in pain or pain w/ nausea, avoid activities that increase IOP.

Front 66

vertigo and dizziness

Back 66

common manifestations of many ear disorders

advise pt to restrict head motions, move slowly, maintain adequate hydration, take antivertiginous drugs, prevent loss-of-balance accidents

Front 67

Meniere's Disease

Back 67

overproduction or decreased resorption of the endolymph fluid causing a distortion of the entire inner ear canal system

tinnitus-one-sided sensorineural hearing loss and vertigo occur in attacks that can last for several days

Front 68

Meniere's Disease accute attack

Back 68

caused by fluctuating pressure in the inner ear, tinnitus, hearing loss, vertigo, feeling of fullness in ear before an attack, N&V, nystagmus, severe HA

Front 69

interventions meniere's disease

Back 69

slow head movements, salt & fluid restrictions, cessation of smoking, mild diuretics, nicotinic acid-vasodilator effects, antihistamines-reduce severity and stop an acute attack (antivert)
antiemetics
valium-N&V
lower stimulation: dark room, no tv

Front 70

surgical mgt for meniere's disease

Back 70

last resort measure, labyrinthectomy-resection of the vestibular nerve or total removal of the labyrinth
-endolymphatic decompression with drainage and shunt placement
-hearing in the affected ear is ofter sacraficed

Front 71

hearing loss

Back 71

one of the most common physical handicaps in north america
-common causes of conductive hearing loss: any inflammation process (otitis media) or obstruction of the external of middle ear by cerumen (wax) of foreign objects and otosclerosis

-common causes of sensorineural hearling loss: loud noise, ototoxic drugs, presbycusis, athersclerosis, hypertension, prolonged fever, menier's disease, DM, ear surgery

Front 72

types of hearing loss

Back 72

conductive-resulting from any physical obstuction of sound wave transmission

sensorineural-resulting from a defect in the cochlea, the 8th cranial nerve, or the brain

mixed-both-a profound hearing loss

Front 73

tests

Back 73

air conduction test
bone conduction test
speech audiometry
speech reception threshold
speech discrimination
tympanometry

Front 74

audiometry

Back 74

-frequency is the highness of 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 determeine hearing acuity

Front 75

intervention for hearing loss

Back 75

-drug therapy-tx of infection, vertigo, nausea
-assistive devices-telephone amplifiers
hearing aids-less effective for sensorineural hearling loss
-cochlear implants-helpful in sensorineural hearing loss
-tympanoplasty-reconstructs the middle ear to improve hearing caused by conductive loss
-miringoplasty-reconstruction of the eardrum
-replacement of the ossicles
-stapedectomy-partial or complete with a prothesis, effective for hearling loss related to otosclerosis

Front 76

stapedectomy

Back 76

a partial or complete stapedectomy with a prothesis corrects hearing loss and is most effective for hearing loss r/t otosclerosis.
-hearing improvement may not occur until 6 wks after surgery
-damage to cranial nerves, vertigo, and nausea and vomitting are common after surgery
-pain medications and antibiotics are often used
-safety measures and antivertiginous drugs should be applied

post-op: antiseptic-soaked gauze packed in the ear canal
-clean dressing
-lie flat with head turned to the side and the operative ear facing up for at least 12 hours after surgery
-prescribed antibiotics
activity restrictions

Front 77

impaired verbal communication

Back 77

assistive devices for hearing
compensation
-lip reading, sign language
-managing anxiety
-measures to improve communication

Front 78

otic agents

Back 78

antibacterial/antifungal-chroamphenicol and gentamicin are most commonly used

antibiotic and steroid combinations-cortisporin otic solution

local anesthetic agents-pramoxine, benzocaine-reduce pain