Chp 52- nursing care of pt’s with sensory disorders: vision and hearing – Flashcards
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conjunctivitis
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inflammation of the conjuctivia -most common type of acute infection of the eye -can be viral & bacterial -pink eye (bacterial)
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blepharitis
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-2 types -inflammation of the eyelid margins
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Hordeolum
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staphylococcal abscess in sebaceous gland -external -sty -uses of cosmetics can contribute to this
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chalazion
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abscess in meibomian glands -internal hordeolum -larger & puts pressure on cornea
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keratitis
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inflammation of the cornea (can cause blindness) -acute or chronic -superficial or deep -increase risks: contact lens (overnight) dry eyes
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refraction
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bending of light rays as they enter the eye
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ametropia
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refractive errors
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Emmetropia
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normal vision
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refractive errors
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-hyperopia = farsightedness -myopia = nearsightedness -astigmatism = unequal curvatures in cornea- blurred vision w/distortion -presbyopia = lenses lose elasticity, results in hyperopia- associated with aging
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blindness (visually impaired)
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the complete or almost complete absence of the sense of sight -obstacles to rays of light -disease of optic nerve or tract of brain connected with vision -can be permanent, transient, complete, partial or night.
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nursing diagnosis for blindness
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disturbed sensory perception self-care deficits risk for injury risk for impaired home maintenance interrupted family processes ineffective role performance deficient knowledge & diversional activity fear
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diabetic retinopathy
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disorder in which there are vascular changes in retinal blood vessels -microaneurysms -3stages *background= decrease in color discrimination & visual acuity ( due to microaneurysms leaking blood into retina or macula) *preproliferative= no symptoms ( swollen, irreg. dilated veins) *proliferative= vision loss, can cause retinal detachment (formation of new blood vessels)
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diagnosis & interventions of diabetic retinopathy
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Internal exam with opthalmoscope -laser photocoagulation -vitrectomy
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Retinal detachment
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separation of retina from choroid layer of eye that allows fluid to enter the space between the layers, sudden change in vision. -causes: pull, tear, or hole in retina fibrous tissue in vitreous humor fluid or exudate *PROMPT medical treatment
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s&s of retinal detachment
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-sudden change in vision -flashing lights or floaters -looking through a veil -curtain being lowered over vision -NO PAIN = the retina contains no sensory nerves *usually pt's have loss of peripheral vision and acuity*
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therapeutic intervention for retinal detachment
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-laser reattachment -cryosurgery -scleral buckling =surgical
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Glaucoma
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a group of eye diseases characterized by increase intraocular pressure, resulting in atrophy of the optic nerve & possibly leading to blindness *most common type is primary
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glaucoma facts
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-damage is silent, progressive, irreversible -Lifelong -peripheral vision loss followed by central vision loss & eventually blindness
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risk factors for glaucoma
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-over 40 -DM -family history
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Type of primary glaucoma
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Acute(closed) angle-closure = AACG Primary open-angle = POAG
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AACG
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anatomically predisposed to develop -narrowed angle @ the junction where iris meets cornea *narrowed angle becomes occluded & blocks aqueous fluid *MEDICAL Emergency *results in partial or total blindness if not treated
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S&S if Acute angle-closure glaucoma
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-severe eye pain -blurred vision -rainbows around lights -eye redness -steamy corneas -photophobia -tearing
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Primary Open-angle POAG
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-degeneration of drainage system blocks aqueous fluid -gradual and painless
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S&S of POAG
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-mild eye aching -headache -halos around lights -frequent visual changes
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Interventions for glaucoma
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Medications -miotics like Pilocar= used to constrict the pupil (increase aqueous fluid) -Agent to decrease aqueous fluid = Timolol (Timoptic) betablocker -steroid eye drops = reduce inflammation -osmotic diuretic = Mannitol (rapidly reduces IOP) used for acute attack of AACG
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IOP
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intraocular pressure -normal 12-20 mm Hg
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Mydriatics
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Benadryl & Vistaril ( anticholinergics) -contraindicated in Acute Angle closure glaucoma -can cause blindness *D= dilates *No D = constricts (miotic)
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glaucoma surgery
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to create area for aqueous fluid to flow; to prevent increase in IOP. (-TX for AACG = laser peripheral iridotomy, surgical iridectomy -TX for POAG = laser trabeculoplasty, trabeculectomy, cyclocryotherapy)
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Cataracts
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Opacity in eye lens causing loss of visual acuity -cloudy lens
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Risk factors for cataracts
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-age -UV lights -DM -smoking -nutritional deficiencies -alcohol consumption
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S&S of cataracts
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-halo around lights -difficulty reading -sensitivity to glare -double or hazy vision -decreased color vision -PAINLESS
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diagnosis cataracts
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-visual acuity is tested -opthalmoscope -slit-lamp microscope
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TX for cataracts
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surgical removal of cloudy lens
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Nursing diagnoses : eye surgery
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-disturbed sensory perception -risk for infections -risk for injury ( due to depth perception after eye surgery) -anxiety -fear
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Macular Degeneration
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degeneration of the macular area of the retina of the eye -2 types = wet & dry
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ARMD
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Age related macular degeneration (ARMD) *leading cause of visual impairment of older adults over 50
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Risk factors : macular
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-older than 60 -family h/o -DM -smoking
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wet macular degeneration
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-retinal tissue degenerates -sudden onset
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dry macular degeneration
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-makes up 70-90% of cases -photoreceptors in macula fail & aren't replaced R/T aging -progressive loss of vision
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S&S : macular degeneration
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-loss of central & near vision in both types -blurred vision -distortion of straight lines -dark spots in central area of vision
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Amsler grid
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used to diagnose macular degeneration -patient takes home and looks at it on a regular basis to monitor vision changes
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therapeutic interventions; macular degeneration
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-diet can prevent zinc supplements, increase fish, omega 3 fish oil -Wet laser treatment & antiangiogenesis ( prevents new blood vessels) -Dry NONE (eye vitamins can slow progression)
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nursing diagnosis: macular degeneration
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disturbed sensory perception
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Eye trauma
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Emergency -foreign bodies (most common) -burns -abrasions -lacerations -penetrating wounds (most serious) -do not remove object
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hearing loss
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most common disability in the US
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2 types of hearing loss
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conductive & sensorineural
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conductive hearing loss
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interference with sound conduction to external auditory canal, eardrum, middle ear. *does NOT involve inner ear* -mechanical problem
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conductive
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causes: -cerumen, foreign bodies, infections, perforation to tympanic, trauma, fluid in middle ear, cyst, tumor, otosclerosis.
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sensorineural hearing loss
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originates in the cochlea and involves the hair cells & nerve ending.
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sensorineural
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results from: - disease or trauma to the sensory components of the inner ear. -infections, ototoxic drugs (aspirin), trauma, noise, aging
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presbycusis
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aging process, degeneration of organ of Corti -inability to decipher high-frequency sounds -sensorineural hearing loss -harder to hear female voice (in aging process) & harder to hear in noisy environments
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therapeutic interventions for hearing loss
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-hearing aids -cochlear implants
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nursing diagnosis: hearing loss
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-disturbed sensory perception -impaired social interaction -disturbed body image
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External Ear Infections
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-External Otitis = most common infection due to moisture / swimmers ear. -ear canal furnucle = abscess from hair follicle infection -ostomycosis = fungal growth -perichondritis = infection of auricle *ACUTE PAIN
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impacted cerumen
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-normally ear is self-cleaning -older adults at risk for this -hearing loss -feeling of fullness
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interventions for external ear infections
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-topical antibiotics -irrigation -analgesics -incision or drainage
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Middle ear infection
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otitis media
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Otitis Media
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inflammation of the middle ear, mastoid & Eustachian tube. *red & bulgy ear drum TX = antibiotics & myringotomy
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S&S otitis media
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-fever -earache -feeling of fullness -pain -hearing loss
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Otosclerosis
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condition characterized by chronic progressive deafness, esp. low tones, hardening of stapes.
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otosclerosis facts
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-new bone growth along stapes -Conductive hearing loss -effects women more -Both ears -NO CURE -hereditary disease
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TX for otosclerosis
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-hearing aids -ossiculoplasty ( prosthesis) - Stapedectomy * tx of choice
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Nursing care: Stapedectomy
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-operative ear is upward when lying down -earplug to protect (to keep area aseptic) -antiemetics promptly ( for nausea, to prevent vomiting) -promote safety ( pt may be dizzy)
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stapedectomy
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instruct not to -cough, sneeze, blow nose, vomit, fly, lift heavy objects, shower. *if pt develops cold the physician should be informed
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ear trauma
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-tympanic membrane perforation -middle ear ossicle fracture *causes: blasting force, blunt injury to side of head, sudden changes in atmospheric pressure.
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Inner ear
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labyrinthitis, neoplastic disorder, meniere's disease are all associated with what part of the ear?
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Labyrinthitis
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inflammation or infection of Inner ear -viral or bacterial
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S&S of labyrinthitis
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-vertigo -tinnitus -sensorineural hearing loss
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TX for labyrinthitis
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antibiotics bed rest sedation`
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Neoplastic disorders
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acoustic neuroma = tumor of the 8th cranial nerve -benign -surgical removal & radiation *progressive hearing loss
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Meniere's Disease
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inner ear disease with recurrent episodes -balance disorder due to fluid disturbances -episodic bouts: 2-3x a year
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symptoms of Meniere's
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triad of sx -vertigo -hearing loss -tinnitus nausea & vomiting *can be severe to debilitating
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acute tx for meniere's
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-tranquilizers -vagal blockers -bed rest
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prophylatic tx for meniere's
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-salt-restricted diet -diuretics -antihistamines -vasodilators -avoid alcohol, caffeine & tobacco
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nursing diagnosis for inner ear
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-grieving the loss of hearing -impaired social interaction
