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79 Cards in this Set
- Front
- Back
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Eye danger signals to report
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Continued pain
Persistent redness Crossing Visual problems (distorted, double, blur, halos, spots, flashes) Growths/swelling Unequal/distorted pupils |
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First aid for chemical eye burns
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Flush with H2O for at least 15 min. before moving
*Can use IV tubing |
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Daily care for Pt with eye problems
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Wash hands before touching eyes
Let Pt do AMAP (independence/self-esteem) |
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OD, OS, OU
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Right eye, Left eye, Both eyes
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Eye dressings…
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Never change till ordered
To remove: Pull all tape twds. eye, then lift straight up No pressure dressing unless ordered (use 2-3 pads if ordered) |
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Tonometry
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Measures intraocular pressure (Use topical anesthetic drop first)
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Fluorescein angiography
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Dye injected into antecubital vein – can be seen in retinal vessels
Pictures taken *Skin and urine may turn yellow for 24 hrs. |
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Often after age 40, ability of eye to accommodate…
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Gradually decreases (lens looses elasticity)
*Causes Presbyopia – a type of farsightedness |
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Myopia
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NEARSIGHTEDNESS – excessive refractory power, rays focus in front of retina
Normal near vision – poor distance vision |
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Hyperopia
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FARSIGHTEDNESS – insufficient refractory power, rays focus behind retina
Poor near vision – good distance vision MOST COMMON REFRACTORY PROBLEM |
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Medications for Glaucoma - decrease IOP:
Miotics-cholinergic agents… |
Pilocarpine, Carbachol:
Increase aqueous fluid outflow by causing miosis (pupil constriction) SE: blurred vision, pain, difficulty seeing in the dark, STINGS IMMEDIATELY |
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Medications for Glaucoma - decrease IOP:
Prostaglandin analogues… |
Latanoprost:
Increases aqueous fluid outflow SE: May change iris color; excessive eyelash growth |
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Medications for Glaucoma - decrease IOP:
Beta Blockers… |
Betaxolol, Timolol:
Decrease aqueous humor production |
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Medications for Glaucoma - decrease IOP:
Carbonic anhydrase inhibitors… |
Trus-opt drops, Diamox-po:
Decrease aqueous humor production |
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Medications for pupil dilation (for exams/surgery):
Mydriatics… |
Dilate pupil
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Medications for pupil dilation (for exams/surgery):
Cycloplegics… |
Paralyze iris sphincter to keep pupil dilated
*Dilations last three hours to several days |
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Examples of mydriatic/cycloplegic drops:
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Atropine
Scopolamine Homatropine Mydriacyl Cyclogyl **Contraindicated in – Glaucoma, MAOI/tricyclic users, |
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What anti-infectives/antibiotics might be used for eye problems?
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Gentamycin
Erythromycin |
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What are some types of and side effects of corticosteroids used to decrease inflammation/swelling of the eyes?
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Prednisolone
Cortisone Hydrocortisone SE: Can increase IOP and cause glaucoma, cataracts, adrenal suppression, impaired wound healing |
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What are some topical anesthetics used to decrease pain of eye exam or surgery?
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Pontocaine, Opthaine
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Why would an osmotic agent be used on the eyes?
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To make the plasma hypertonic (draw aqueous humor from the eyes)
This decreases IOP (often used pre-op) |
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What about conjunctivitis? Symptoms? Rx?
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It’s an inflammation of the conjunctiva (pink eye)
Symptoms: Redness, swelling, pain, lacrimation, D/C, foreign body sensation Rx: Warm compresses, antibiotic & maybe steroid drops |
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What about hordeolum (sty) Symptoms? Rx?
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It’s an infection of a superficial lid gland
Symptoms: Pain, swelling, redness, the small abscess Rx: Warm compresses, maybe incision/drainage or antibiotic drops |
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What about chalazia? Symptoms? Rx?
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It’s an inflammatory cyst of gland of eyelid
Symptoms: Small, hard, painless lump in lid Rx: Warm compresses, incision/drainage for cosmetics or if interferes with vision |
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What about blepharitis? Symptoms? Rx?
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It’s an inflammation of lid margins
Symptoms: Burning, itching, lid margins red and crusty Rx: Warm compresses (to soften and remove crusts); antibiotic ointment |
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Pathophysiology of glaucoma:
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Normally there’s a balance between fluid entering and leaving the eye…
In glaucoma, circulation is disturbed (increased production of aqueous humor and decreased outflow) -> increases IOP -> damages optic nerve -> visual loss or blindness (vision cannot be restored) |
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Most common type of glaucoma (90% of glaucomas)
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Open angle glaucoma
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How do you get open angle glaucoma?
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Heredity (affects older age group)
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In open angle glaucoma, what happens with the aqueous drainage channels?
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Degenerative changes in Schlemm’s canal or aqueous veins - fluid is unable to flow out of eye – Get increased IOP
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What about the onset of open angle glaucoma?
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It’s gradual and painless (increase in pressure over years)
May see halos around lights or headache (dull brow pain) |
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What about vision loss with open angle glaucoma?
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Peripheral vision gradually lost without notice
Decreased visual acuity and field only after irreversible eye damage |
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Medical treatment for glaucoma:
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Topical beta blockers initially (preferred)
May also use miotics (pilocarpine, carbachol) and carbonic anhydrase inhibitors (Trus-opt drops, Diamox-po) |
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What about closed angle glaucoma?
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It’s a medical emergency – unless treated, blindness in 2-3 days
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What happens in closed angle glaucoma?
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See sudden increase in IOP because of a blockage of the angle of the anterior chamber by the root of the iris.
Blocks off aqueous outflow (drainage channels are normal) |
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Symptoms of closed angle glaucoma:
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Sudden severe eye pain (eye, then other parts of the head)
Blurred vision Halos/rainbows around lights Eye red N/V Dilated pupil that does not respond to light |
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Rx for closed angle glaucoma:
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Decrease IOP: miotics, osmotics, carbonic anhydrase inhibitor
Decrease Pain and Nausea: Demerol (causes miosis and decreases pain) |
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Post op care for closed angle glaucoma
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Eye patch 24 hrs.
Antibiotic gtts 4-5 days Steroid gtts for weeks DON’T lay on operated side Progressive ambulation – no fast mvmt. No reading till OK w/ MD No driving 1 week Patient teaching |
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Teaching for patients with glaucoma
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Explain need for lifelong treatment (even if no symptoms)
Avoid sneezing, vomiting, coughing (increases IOP) No bending from waist (squat) – No gardening No straining (valsalva maneuver, lifting >5lbs.) Avoid emotional stress Avoid excessive fluid intake and tight clothing/collars Increase lighting at home Miotics cause difficulty seeing at night (driving, stairs) No reading for extended periods – No games w/ fast moving objects NO mydriatics or antihistamines (? any order for) |
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Some causes of cataracts
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Meds (long term steroid use)
Excessive sun exposure |
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Symptoms of cataracts
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Blurred or hazy vision
Objects distorted Diplopia Poor night vision Glare in bright light (sunglasses help) No pain Gradual vision loss Pupils: black->gray->white |
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What might help slow progression of cataracts?
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Protection from excessive sunlight
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Treatment for cataracts:
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Surgery (can’t be removed with laser)
**Done when poor vision interferes with life (postponing surgery has no effect on outcome) |
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What happens pre-op on AM of cataract surgery?
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Sedation
Mydriatic-Cycloplegic (facilitates removal when pupil dilated) Osmotic (to decrease IOP) Antimetic (to prevent vomiting which increases IOP) |
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What happens post-op for cataract surgery?
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Usually discharged after a few hrs.
Sleep on back or on unoperated side – HOB 45 degrees (to decrease IOP) NOT on operated side or abdomen Dressing on operated eye – first day only Antiemetic Avoid ANY increase in IOP for at least three weeks (see glaucoma) |
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Cataract eye meds:
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No lens implant: mydriatic or mydriatic-cycloplegic, antibiotic, steroid
Lens implant: miotic (to prevent it from dislodging), antibiotic, steroid |
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A replacement lens must be worn:
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All the time – needed for 1/3 focusing power
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What about an IO lens implant?
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Put in posterior chamber during surgery (95% - few complications)
Excellent chance of good vision No problem with magnification *Glasses still needed for distant or close vision if single focus lens used |
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What about contact lens replacement post op cataract surgery?
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Slight problem with magnification (lens close to retina)
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What about cataract glasses?
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Thick and heavy
Magnify things 25% (things appear closer than they are) Must learn to rejudge distances (driving, stairs, pouring liquids – often pour in front of glass) Central vision best Peripheral images are distorted, so turn head to see First given temporary glasses – Permanent ones given in 2-3 mos. *curve of cornea changes after healing |
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What to do about congenital cataracts
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Remove ASAP (often 6 mos.) to preserve vision
*Early years are critical for development of visual reflexes If monocular and not corrected early -> permanent blindness from amblyopia (lazy eye – unaffected eye used for vision) |
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What’s retinoblastoma? What are the symptoms?
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A congenital malignant tumor arising for the retina (usually unilateral)
May be present at birth or arise in the retina during the first 2 years of life Symptoms: Whitish glow in pupil (cat’s eye reflex); Strabismus (wandering eye); Red, painful eye; Often glaucoma Late sign – Blindness |
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What’s strabismus? Symptoms?
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Eyes are not straight or aligned bilaterally (so eyes see two different images)
Half have family history Most common cause: imbalance of intraocular muscles Long term effect: Amblyopia (due to suppression of images from deviating eye to avoid diplopia) *Ambylopia can cause permanent loss of vision Symptoms: Malalignment of eyes, compensatory tilt/squint, maybe headache, uncoordination |
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What’s the treatment for strabismus?
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Patching good eye, eye exercises (help only a small number), glasses.
Surgery on muscles when other Rx fails Post-op glasses to maintain alignment |
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The most common cause of visual loss after age 60
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Macular degeneration
*Amsler is used to Dx – Drusen (yellow spots appear in retina) |
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Symptoms of retinal detachment:
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Occur suddenly or gradually
Floaters (blood cells released into vitreous fluid by detachment) Flashes of light Blurred or sooty vision (“VEIL” drawn across eye w/ visual loss) **Untreated: Increased detachment -> Blindness |
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Pre-op care for retinal detachment:
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Immediate bedrest (prevent further detachment)
Bandages to both eyes (prevent eye mvmt. – let retina fall back into place AMAP) Lie so area of detachment is dependant (flat, sitting, etc.) |
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Post-op care for retinal detachment:
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Both eyes bandaged
Bedrest w/ assisted BRP If gas bubble – will order position – no flying till bubble gone Deep breathe Q2H Decrease head mvmt. No jarring Avoid activities the might increase IOP Restricted reading initially |
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What about enucleation? (removal of eyeball)
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Post-op pressure dressing for a week (reduce swelling)
Antibiotic ointment TID Prevent infection (some drainage first weeks, increase may mean infection) Remove and clean prosthesis per MD (can leave in for months w/ daily irrigation *Some recommend daily removal for cleaning |
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What about eye donation? Pre op? Post op?
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Pre op – Check for S/s of eye infection (antibiotic drops)
Post op – Pressure dressing & eye shield for one day; elevate HOB and lie on unoperated side; monitor for bleeding, infection, graft rejection, *RSVP: Redness, Swelling, Visual acuity (decreased), Pain |
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Causes of hearing loss
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Constant loud noise (machinery, jets, music)
Ototoxic drugs: Streptomycin, Gentamycin, Neomycin, Other aminoglycosides, ASA, Loop diuretics) Aging |
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Symptoms of hearing loss
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Infant: No babbling or stops babbling; little response to loud noise; delayed speech development
Adult: Speech deterioration (flat), fatigue, social withdrawal, false pride (pretends to hear), hogs conversation, disinterest |
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What’s conductive hearing loss?
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It results from impairment of outer or middle ear or both
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What’s sensorineural hearing loss?
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AKA “perceptive loss”
Disease of inner ear or nerve pathways *Can be caused by ototoxic drugs |
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What’s the Weber test?
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Tap fork and place in center of forehead or top of head
Compares bone conduction of both ears |
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What’s the Rinne test?
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Tap fork and place on mastoid bone until sound no longer heard, then next to ear
Usually heard again because air conduction normally longer |
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What should you know about communicating with the hearing impaired?
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Make sure they can see your face when you speak (lip reading)
Speak clearly and slowly (don’t shout) Rephrase or use written material if not understood Avoid one work answers Have room well-lit and quiet |
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Treatment for motion sickness
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Antihistamines (Dramamine, Antivert)
Anticholinergics (Scopolamine patches) *Meds often cause dry mouth or drowsiness |
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What’s Meniere’s disease? Symptoms?
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It’s a chronic inner ear (labyrinth) disease (often positive family history)
Abnormal inner ear fluid balance (malabsorption of the endolymphatic sac) Symptoms: “fullness” in ear, paroxysmal whirling vertigo, tinnitus (ringing), sensorineural hearing loss |
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What’s the treatment for Meniere’s disease?
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Often diuretics and a low Na diet
Antihistamines (to suppress the vestibular system) Antivert or Valium (to control vertigo) Antiemetics (Phenergan) Vasodilators (improve tinnitus) Limit alcohol and caffeine Avoid MSG and ASA meds (may increase symptoms) |
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Ways to relieve tinnitus
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Increase background noise (ie. Music)
Some say a white noise box is better |
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When does acute otitis media occur?
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Children: often with URI (R/T shortness, straightness of Eustachian tube)
Adults: Excessive nose blowing |
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Symptoms of acute otitis media
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Mild or severe:
Pain (if drum ruptures, pain gone) Pulling on ear Increased temp. Irritable Decreased hearing N/V, H/A Purulent drainage if ruptures Ear drum may be bright red or yellow |
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Treatment for acute otitis media
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Antibiotics (finish all)
Maybe decongestants (to shrink mucous membrane) Myringotomy – post op keep ear dependent to allow drainage Report: severe earache, COCA ear drainage, hearing loss Keep water out of ear *Normally tubes fall out in 6-18 mos. (just notify MD) |
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With chronic otitis media, symptoms of mastoiditis are…
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Fever
D/C Pain behind ear Facial paralysis Deafness *Can lead to meningitis or brain abscess |
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Post op care for inner ear or mastoid surgery
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Prevent infection (Antibiotics)
Sleep with operative ear up Blow nose gently, one side at a time and sneeze/cough with mouth open for a few wks. Report facial nerve injury (mouth droops, can’t move side of face, slurred speech) |
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What’s otosclerosis? Symptoms?
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Normal bone is replaced by spongy bone in labyrinth
Symptoms: Gradual hearing loss and tinnitus |
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What about external otitis media? Symptoms? Rx?
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Main symptom: Pain increased when move auricle
(With middle ear infection, mvmt. doesn’t increase pain) May also see yellow/green, foul smelling D/C Rx: Antibiotics, hot packs, analgesics *do not allow water in ear |
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Proper ear drop administration
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Straighten ear canal:
Adult: Up & back Child <5: Down & back |
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AU, AS, AD
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Both ears, Left ear, Right ear
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