Download Assessing Clients with Eye or Ear Disorders

Assessing Clients with Eye or Ear
Disorders
Chapter 40
Review of Anatomy and
Physiology
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Extraocular Structures
– eyebrows
– eyelids
– eyelashes
– conjunctiva
– lacrimal apparatus
– eye muscles
Review of Anatomy and
Physiology
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Intraocular Structures
– sclera
– iris
– pupil
– lens
– retina
– optic disc
– anterior and posterior cavity
Vision
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1. Light passes through the cornea and is focused
onto the retina by the lens.
Cells in the retina then transmit this information
through optic nerve to the vision area of the cortex.
Review of Anatomy and
Physiology
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Optic nerves
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Refraction
– bending of light rays
– Accommodation- Response of the pupil,
constrict and dilate.
The Ear and Hearing
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External Ear
– auricle or pinna
– external auditory canal
– tympanic membrane
– Acoustic antenna, focus
Sound waves.
Middle Ear
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The middle ear consists of:
– The inner part of the ear drum
– The hammer (malleus)
– The anvil (incus)
– The stirrup (stapes)
– Delivers sound to the inner ear where it is
processed into a signal that the brain can
recognize
The Ear and Hearing Inner Ear
The inner ear contains the most important parts of the hearing
mechanism - two chambers called the vestibular labyrinth and the
cochlea.
The vestibular labyrinth consists of elaborately formed canals (3 semicircular tubes that connect to one another),
which are largely responsible for the sense of balance.
The cochlea, which begins at the oval window, curves into a shape that resembles a snail shell. Tiny hairs line the
curves of the cochlea. Both the labyrinth and cochlea are filled with various fluids.
Inner Ear
Hearing and the Ear
Hearing and the Cochlea
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The cochlea as microphone
When sound waves from the world outside strike the eardrum, it
vibrates. These vibrations from the eardrum pass through the three
bones of the middle ear and into the inner ear through the oval
window. Action of the oval window causes fluids in the cochlea to
create waves where they disturb the basilar membrane. Inner hairs
attached to the basilar membrane convert the waves into electrical
impulses that are transmitted to the brain by the auditory nerve. The
hair cells are critical to hearing; it is the inner hairs that move in the
Organ of Corti fluids, and translate the fluid movements to chemical
messengers that can in turn be converted to electrical impulses that
the brain understands.
Assessment of Eye and Ear
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Health Assessment Interview
– ask about chief complaint
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Blurred vision?
Eye infection?
Halos?
Difficulty reading?
Difficulty hearing?
Ringing in ears?
Physical Assessment of Eye
and Vision
Snellen’s eye chart- Test for vision.
 Assessment of the pupils.
 Extra movements of the eyes nystagmus or non
Parallel movements strabismus, may indicate
disease, cranial nerve dysfunction or muscle weakness
and should be reported.
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Physical Assessment of Eye
and Vision
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Pupils, Equal Round Reactive to Light
and Accommodation (PERRLA)
– direct a beam of light into the pupil, look
for constriction
– hold object a few feet from client, pupils
should dilate, move closer pupils should
constrict
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Inspection - sclera, iris cornea and
internal structures
Physical Assessment of Ear
and Hearing
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Hearing
– Weber test
– Rinne test
– Whisper test
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Inspection
– auricle and external canal– Lesions, drainage, redness, pain.
– tympanic membrane- color.
Disorders of the Eye
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Eyelid disorders constantly exposed to the
environment.
Hordeolum- sty is an infection of the sebaceous
glands of the eyelid. Staphylococcus aureus.
Red and painful
Conjunctivitis- Inflammation of the conjunctiva is
common. Direct contact bacterial or viral
Also known as “Pink Eye”. Redness, itching, tearing
and discharge.
Gonorrhea and trachoma can damage cornea.
Eye Disorders
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Cornea- transmits and helps focus light and images
onto the retina. Protects the internal eye.
The cornea has no blood supply. Scarring or
ulceration of the cornea can lead to blindness.
Corneal ulcers caused by infection, trauma or contact
lens. Herpes viruses (shingles) can cause corneal
ulcers. Can lead to blindness.
Nr Care- Prompt treatment to preserve vision.
Diagnosed by history and examination of the eye.
Topical anti-infectives as eyedrops.
Eye disorders
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Corneal Transplant- Corneas taken from cadavers
under the age of 65 who died as a result of trauma
or noninfectious illness.
Transplant rejection is low cornea has limited blood
supply.
Graft is sutured in place, for one year.
Patch for 24 hours
Avoid increasing intraocular pressure.
Eye drops to reduce inflammation and prevent
infection.
Eye Disorders
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Soaking the eyelids with warm saline compresses
may remove exudates seen in conjunctivitis.
Eye irrigation with saline is used to remove purulent
discharge with conjunctivitis.
Local heat may treat sty.
Infectious eye disorders Nr care focus is on
prevention and immediate treatment!
Prevent complications promote healing. Reduce pain.
Careful and frequent handwashing, not sharing
towels, make-up. No contacts until healed.
Eye Trauma
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Foreign bodies, abrasions and lacerations most
common types of eye injury.
Corneal abrasion- scratch of the cornea
Burns- chemical, UV
Perforation- metal flakes, weapons
Blunt eye trauma- sports injury
The extent of the injury is determined by eye exam.
Topical anesthetic, irrigation, surgery
NR- Protecting the eye, preserving vision, prevention!
Refractive Errors
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Changes in the shape of the cornea, lens or eyeball
affect the focus of light on the retina.
Result= blurred or indistinct vision, also called
Refractive errors- Most common cause of impaired
vision.
Myopia- nearsightedness
Hyperopia- farsightedness
Detected routine vision screening
Corrected with glasses or contacts
Nr- Identify and seek treatment. Safety!!
Cataracts
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Clouding of the lens of the eye that impairs vision,
common over 65yrs.
As the lens ages its cells become less clear.
Mature cataract involves entire lens
Near and distant vision are affected.
Details become obscured
Pupil appears cloudy gray or white rather than black.
Dx: History and eye exam, the red reflex is lost.
Tx: Surgical removal incision through cornea
Intraocular lens is implanted to focus light &vision.
Glaucoma
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Increased intraocular pressure and gradual loss of
vision. Silent thief of vision.
Leading cause of blindness worldwide.
Normal intraocular pressure is 12-20 mm Hg is
maintained by a balance between aqueous humor
production and drainage, disrupted intraocular
pressure increases.
Open angle – drainage of the aqueous humor
through the trabecular meshwork is impaired
Angle-closure- Angle between the cornea and iris
closes, completely blocking aqueous humor drainage.
Glaucoma
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Manifestations: Discussion
Glaucoma if not treated can and will lead to
blindness.
Angle-closure glaucoma can recur thus avoid
medications that can dilate the pupil. One eye is at
risk for the other eye.
Atropine must be avoided in clients with history of
angle-closure glaucoma.
Glaucoma cannot be cured, chronic disease can be
controlled and vision preserved if it is dx and tx.
Routine eye examinations early detection.
Glaucoma
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Acute angle-closure glaucoma is an ocular emergency
that requires immediate intervention!
Surgery is indicated when chronic open-angle
glaucoma can not be controlled with medication.
Lower intraocular pressure.
Glaucoma is a chronic disease that requires lifelong
management. Can lead to blindness if not identified
and treated.
Nursing- Increased risk for injury, psychological
effects of a chronic disease= anxiety. Early vision
screening!!!!!!!
Detached Retina
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Retina contains neurons that allow us to see light and
images.
Retina separated from the choroid, the vascular layer
of the eye. Fluid seep between retina and choroid,
thus separating the layers. The neurons become
ischemic and die causing permanent vision loss.
Can occur spontaneously or from trauma as we age it
increases our risk for detached retina.
Medical emergency
CM- painless, floaters, flashes of light. Dx- eye
examination. Surgical procedures.
Detached retina
Early identification is a priority for the
nurse! May have gradual loss of vision.
 The affected area of the eye inferior to
maintain contact between the retina
and choroid.
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Macular Degeneration
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Neurons of the macula may atrophy with age or
separate from the choroid. May cause blindness.
Smoking, over 65 yrs, family hx.
Central vision becomes blurred, peripheral vision
remains intact. One eye common early symptom.
Any change in vision needs evaluation!!!!!! Nursing!
Laser treatment may slow the process. Early
treatment may help slow disease and preserve vision.
Diabetic Retinopathy
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85% of diabetics will develop
The capillaries of the retina are no longer able to
transport blood and oxygen to the retina.
Develops 15 years after being diagnosed either type
one or type 2 diabetes.
Initially venous capillaries dilate and develop
microscopic aneurysms may leak or rupture; thus
edema and small hemorrhages into the retina. Areas
become ischemic. New blood vessels form causing
more damage.
Nr- Education, yearly eye exam, spots, loss of vision.
Ear Disorders
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External otitis- or swimmers ear affect sound
conduction and hearing. Inflammation of the ear
canal
Risk; swimmers, divers surfers, hearing aids or
earplugs.
Caused by bacteria
Remove earwax and cleaning and drying ear canal.
CM- Pain, drainage, inflammation and swelling
Management- Discussion
Impacted Cerumen
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Older adults are at risk for impaced cerumen
Interferes with sound conduction and hearing.
Tinnitus is a clinical manifestation
Can be seen using an otoscope
Clearing with irrigation ear curet or forceps
Prevention is the focus of Nursing! No Q-tips.
Otitis Media
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Inflammation or infection of the middle ear.
Most common middle ear disorder.
Infants and young children. Adults too.
Organisms can enter the middle ear from the nose
and throat through the eustachian tube
Eardrum protects middle ear from the environment.
CM- Red, bulging tympanic membrane. Pain, with a
URI. Swelling of the ET impairs drainage of the
middle ear, fluid collects with bacteria. Fever.
Complications: discussion. DX- Otoscope eardrum.
Otosclerosis
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Genetic, hereditary disorder affects white females.
Abnormal bone forms in the stapes and causes a
conductive hearing loss.
CM- hearing loss begins in adolescence or early
adulthood. Tinnitus
Management- Surgical reconstruction of the middle
ear.
Nursing- Referral to appropriate community agencies
to evaluate hearing loss.
Inner Ear Disorders
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Occur less frequently than other ear disorders:
Labyrinthitis
Meniere’s disease.
Vertigo is the KEY symptom of inner ear disorders.
Contains the semicircular canals that help maintain
balance and neural receptors for hearing. Thus may
cause permanent hearing loss.
Labyrinthitis- inflammation of the inner ear
Bacterial or virus
CM- severe vertigo, NV, nystagmus. Falling!
Inner Ear disorders
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Meniere’s Disease- chronic inner ear disorder caused
by excess fluid and pressure in the labyrinth of the
inner ear.
Gradual or sudden
Vertigo, tinnitus and gradual hearing loss
No cure
TX- Decrease inner ear pressure hydrochlorothiazide.
Meds to relieve vertigo Vistaril, compazine.
Avoid caffeine, alcohol and tobacco.
May need surgery to relieve excess pressure .
Nr- discussion risk for injury! Evaluate vertigo, HL.
Hearing Loss
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10 million adults in the US are hearing impaired
70% of older adults
Conductive hearing loss- Anything that impairs
sounds transmission from the external opening of the
ear to the inner ear. Impacted cerumen most
common. Perforated eardrum, tumor of middle ear.
Hearing aid would be of benefit.
Hearing Loss
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Sensorineural Hearing Loss- Disorders that affect the
inner ear or the auditory pathways of the brain.
Trauma, infection, Meniere’s disease, ototoxic
medications, prenatal exposure to rubella.
US- Noise exposure is the major cause of
sensorineural hearing loss. Exposure to high level of
noise damages the hair cells of the inner ear.
Affects the ability to hear high-frequency sounds
more than low. Speech discrimination and
communication noisy places. Hearing aids may not
help. Why? Nr- Social isolation, type HL, finances. Ed