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CARE OF THE CLIENTS

WITH

EYE AND EAR

DISORDER

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Review of Systems

EYES

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Eyes

Supplies about 70% of all sensoryinformation of the brain.

Composed of:

External structures: Eyelid

conjunctiva (a thin, transparent mucousmembrane that lines the lid)

lacrimal apparatus (which lubricates andprotects the cornea and conjunctiva byproducing absorbing tears)

extraocular muscles (which hold the eyes toparallel to create binocular vision)

Eyeball

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Internal structures. Iris - gives color to the eye and

divides the space between the corneaand lens into anterior and posteriorchambers.

Cornea - works with the sclera to givethe eye its shape

Pupil - the circular aperture in the iristhat changes size as the iris adapts toamount of light entering the eye

Lensa biconvex, avascular,

colorless and transparent structure Vitreous bodya clear, transparent,

avascular, gelatinous fluid that fillsthe space in the posterior portion ofthe eye

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Retinaa thin semitransparentlayer of nerve tissue that linesthe eye wall

Retinal cones colordiscoloration

Retinal rods peripheral vision

Optic nerve - transmit visualimpulses from the retina to thebrain

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Disorders of Conjunctiva/CorneaConjunctivitis

Caused by viral, bacterial infections

Assessment: redness, swelling, lacrimation, pain,

itching, discharge from eyes

Corneal Ulceration

May result to corneal perforation, blindness

Causes: trauma, exposure, allergy, Vit def, infection

Corneal TransplantationDonor of cornea from cadavers

Cornea removed from body 2-4 hrs of death, 12

hrs if body is refrigerated, 48 hrs if cornea

is kept on sterile container

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Retinal Disorders

Retinal DetachmentSeparation of two layers of the retina

Causes

Trauma

Sudden, severe exertion in debilitated clients

Tumor

Exudates

Aphakia (absence of lens)

Assessment

floaters, flashes of lights

constriction of vision in one area

Vitreous cloudy in fundoscopy

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Collaborative ManagementKeep client quiet in bed with eyes covered

Head positioned so that retinal hole is in the lowest part of the eye

Early surgery; scleral buckling

Preop care: mydriatics as orderedPostop care

Position depends on extent and location of retinal detachment

Area affected should be in superior portion

Ambulation and activity to be prescribed by the surgeonPressure patch over the eye

Rest the eye and head immediate post op

Avoid increase in ICP

Hemorrhage is a common complication of the surgery

Sedentary activities in 3 wks, strenous activity in 2 months

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Glaucoma

Types:

Acute (Narrow Angle Glaucoma/Close Angle)

Chronic (Wide Angle Glaucoma/Open Angle)

Causes:

InfectionInjury

Hereditary

Narrowing of Canal of Schlemm

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Assessment

Chronic Glaucoma

Impaired peripheral vision (Tunnel Vision)

Insidous onsetno discomfort

Frequent bumps

Initially affects one eye

Dull eye pain in AM, persistentPoor discrimination of color, blurred vision

Rainbows or halos in VF

Headache, pain behind eyeballs, nausea & vomiting

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Assessment

Acute Glaucoma

Rapid onset of severe eye pain

Blurred vision, rainbows or halos around lights

Headache, nausea & vomiting

Inflamed eyes, fixed dilated pupils

Visual impairment

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Collaborative Management

Promote bedrest

Administered miotics as ordered

Administer acetazolamide, glycerol as orderedAvoid mydriatics ( Atropine)

Assess visual impairment & IOP (>20 mmHg)

Administer antiemetics and analgesics as ordered

Provide emotional support

Prepare for surgery as ordered

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Cataract

Clouding/blurring of lens leading to eventual loss of sight

Causes: old age, congenital, traumaClassification:

Senile: associated with aging

Traumatic: associated with injury

Congenital: occurs at birth

Secondary: associated with a systemic disease

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Collaborative Management

SURGERY

ECCE: Extracapsular Cataract ExtractionICCE: Intracapsular Cataract Extraction

Cryoextraction

Iridectomy

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Preop Care

General Care for Eye Surgeries

If both eyes are to be covered postop, client needs to be

oriented to the staff and the physical environmentprior to procedure

Child client should be practiced to have eyes covered to

decrease anxiety and restlessness postop

If both eyes will be covered or vision is severelyimpaired, place call light within reach of client

Preparation of the eyes prior to surgery may involve

instillation of eye medications.

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Postop Care

Eye/s is/are covered with eyepads and eyeshields

OOB 1 day after surgery

Daily change of dressing is done, removed on the 7-10thdayEyeshields at night for 1 month post op

Administer eyedrops as ordered

Temporary glasses may be prescribed for 1-4thweek,

permanent glasses in 6-12thweek when healing iscomplete

Intraocular lens implant may be installed at time of

surgery (better binocular vision)

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Review of Systems

EARS

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Diagnostic Tests for Auditory Acuity

Tuning Fork Test

Rhinnes

Weber

Whisper Voice Test

Audiometry

Pure Tone

SpeechTympanogram/Impedance Audiometry

Oculovestibular Test/Caloric Ice Water Test

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Assessment of Client with Hearing Loss

Irritable, hostile, hypersensitive in interpersonal relations

Has difficulty in following directions

Complains about people mumbling

Turns up volume of TV

Ask for frequent repetition

Answers questions inappropriately

Leans forward to hear betterHas abnormal articulation

Has unusually soft or loud voice

Experience social isolation

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Guidelines in Communicating

Talk directly to the person facing him/her

Speak clearly using normal tone of voice

Do not whisper to someone when in front of hearing impaired

Use gestures with speech

Do not avoid conversation with a person who has hearing loss

Do not show annoyance by careless facial expression

Move closer to the person toward the better earDo not smile, chew gum or cover mouth when talking

Encourage use of hearing aid when available

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Menieres Disease(Endolymphatic Hydrops)

Characterize by accumulation of endolymph in the

inner ear

It is chronic, with remissions and exacerbations

CausesVirus

Emotional Stress

Idiopathic

Assessment

Vertigo

Tinnitus

Hearing loss

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Collaborative Management

Bed rest

Low Na dietLimit fluids

Avoid reading in times of vertigo

Avoid alcohol, caffeine, tobacco

Stress therapy

Tranquilizers, vagal blockers, antihistamines,, vasodilators,

diuretics

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Different Types of Ear Surgeries

Myringoplasty: closure of perforated TM

Tympanoplasty: closure of TM if middle ear is involved

Myringotomy: simple incision in the TM

Ossiculoplasty: ossicular reconstruction

Stapedectomy: removal of stapes and replacement of

prosthesisStapedotomy: laser creating hole in footplate of stapes and

prosthesis replacement

Labyrinthectomy: removal of the membranous labyrinth

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Post op Care in Ear Surgery

Lie on unoperated side

Blow nose gently one side at a time

Sneeze or cough with mouth open for 1 week post op

Avoid physical activity for one week, exercise or sports for 3 weeks

Keep dry for 6 weeks post op

Do not shampoo hair for 1 week

Protect ear with 2 pieces of cotton, outer piece saturated with

petrolatum

Avoid plane travel for 1 week, equalize pressureReport any unusual drainage other than slight bleeding

Avoid straining of eyes for 1 week

Seek assistance when ambulating for the 1sttime