Eye and ear disorders PDF

Preview

Summary

Eye and ear disorders...

Description

Eye and Ear Disorders Impaired Sight 

Use a normal tone of voice when speaking to the client who has limited sight or is blind.



The nurse should alert the client to his or her approach.



Orient the client to the environment.



Allow the client to touch objects in the environment.



Use the clock placement of foods on the meal tray to orient the client, as appropriate.



Promote independence as much as possible.



Provide a radio, a television, and a clock that gives the time orally (or provide a Braille watch).



When ambulating, the nurse should allow the client to grasp his or her arm at the elbow; the nurse keeps the arm close to the body so that the client may sense the direction of movement; the nurse instructs the client to remain one step behind him or her when ambulating.



Instruct the client in the use of a cane for a blind client, which is differentiated from other canes by its straight shape and white color with red tip; the cane is held in the dominant hand, several inches off the floor, and the client sweeps the ground where his or her foot will be placed next to identify obstacles.

Cataracts 

An opacification of the lens that distorts the images that are projected onto the retina, resulting in difficulty seeing that may progress to complete loss of sight.



Intervention is indicated when visual acuity has been reduced to a level the client finds unacceptable or when diminished sight adversely affects the client’€™s lifestyle. Assessment findings include: 

Blurred vision and diminished color perception (early signs)



Diplopia, reduced visual acuity, absence of the red reflex, and the presence of a cloudy white pupil (late signs)



Age-related: pain and eye redness



Gradual loss of vision

Nursing Considerations 

The natural lens is surgically removed and (usually) replaced with an artificial lens, one eye at a time.



Administer preoperative eye medications; the client may need to administer the medications at home before the procedure.



After surgery, elevate the head of the client’€™s bed 30 to 45 degrees and turn the client on his or her back or to the unaffected side.



Have the client wear an eye patch and orient the client to the environment.



Position the client's personal belongings on the unaffected side.



Maintain safety.



Provide home care instructions.

Client Instructions After Cataract Surgery 

Avoid straining the eye. Avoid rubbing or placing pressure on the eye.



Avoid rapid movements, straining, sneezing, coughing, bending, vomiting, or lifting objects weighing more than 5 lb.



Advise the client to take measures to prevent constipation.



Teach the client to perform dressing changes and administer prescribed eye drops and medications.



Excess drainage or tearing should be gently wiped away with a sterile wet cotton ball from the inner to the outer canthus.



Instruct the client in the use of an eye shield at bedtime.



If a lens implant is not performed, the eye will not be able to accommodate, and glasses will have to be worn during client’€™s waking hours.



Cataract glasses act as magnifying glasses, replacing central vision only; objects will appear closer, and therefore the client must accommodate, judge distance, and climb stairs carefully.



Tell the client to report any decrease in visual acuity, severe eye pain, or increase in eye discharge.

Glaucoma 

It is a group of ocular diseases involving increased intraocular pressure resulting from inadequate drainage of or overproduction of aqueous humor. (Normal intraocular pressure is 10 to 21 mm Hg.)



The condition results in the optic nerve and may cause blindness.



The gradual loss of the visual field may go unnoticed, because central vision is unaffected.



Types include primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG).

Assessment findings vary with the type of glaucoma: 

Early signs include diminished accommodation and increased intraocular pressure.



POAG is painless, and vision changes are slow; the condition results in €œtunnel€• vision. PACG is marked by blurred vision, halos around lights, and ocular erythema.

Nursing Considerations Acute Glaucoma 

This condition, a medical emergency, is marked by sudden eye pain and possible nausea and vomiting.



Medications are administered to decrease intraocular pressure.



A peripheral iridectomy, which allows aqueous humor to flow from posterior to anterior chamber, or other procedure may be performed.

Nursing Considerations Chronic Glaucoma 

Medications that will decrease intraocular pressure will be prescribed. Explain to the client the possible need for lifelong medication use.



Instruct the client to avoid anticholinergic medications (prescribed for gastrointestinal conditions such as gastritis or ulcerative colitis; respiratory conditions such as asthma or chronic obstructive pulmonary disease; genitourinary conditions such as prostatitis or urethritis; and Parkinson disease) and to obtain permission from the physician before taking any over-thecounter medication.



Instruct the client to report eye pain, halos around lights, and changes in vision.



Tell the client that when maximal medical therapy has failed to halt progression of visual field loss and optic nerve damage, surgery will be recommended.

Retinal Detachment 

In this condition, the layers of the retina separate because fluid has accumulated between them or because both retinal layers have been elevated away from the choroid by a tumor.



Partial separation becomes complete if it goes untreated.



When detachment becomes complete, blindness results. Assessment findings include: 

Flashes of light



Floaters or black spots (signs of bleeding)



Blurred vision



A sense of that a curtain is being drawn over the visual field



Painless loss of a portion of the visual field

Nursing Considerations 

Institute bed rest.



Cover both of the client’€™s eyes with patches to help prevent further detachment; speak to the client wearing eye patches before approaching.



Position the client's head as prescribed.



Protect the client from injury.



Instruct the client to avoid rapid head movements and minimize eye stress.



Prepare the client for surgery to reattach the retina; procedures include laser photocoagulation, cryopexy, pneumatic retinopexy, vitrectomy, and scleral buckling.

Postoperative Intervention 

Maintain eye patches as prescribed.



Monitor the eyes for hemorrhage.



Take steps to prevent nausea and vomiting.



Monitor the client for sudden sharp eye pain and notify the physician if it occurs.



Encourage deep breathing but tell the client to avoid coughing.



Provide bed rest for 1 to 2 days as prescribed.



Position the client as prescribed; positioning depends on the location of the detachment.



Assist the client with activities of daily living.



Encourage the client to avoid sudden head movements or anything that increases intraocular pressure.



Instruct the client to limit reading for 3 to 5 weeks.



Instruct the client to avoid squinting, straining and constipation, lifting heavy objects, and bending from the waist.



Instruct the client to wear dark glasses during the day and an eye patch at night.



Encourage follow-up care because of the danger of recurrence or occurrence in the other eye.

Macular Degeneration 

Deterioration of the macula, the area of central vision—occurs in two types, age-related and exudative.



Atropic or age-related (dry) macular degeneration is caused by the gradual blockage of retinal capillaries, leading to an ischemic and necrotic macula; rod and cone photoreceptors die.



In the exudative (wet) type of degeneration, serous detachment of pigment epithelium in the macula occurs; fluid and blood collect under the macula, resulting in scar formation and visual distortion.



Assessment findings include a decline in central vision accompanied by blurred vision and distortion.

Nursing Considerations 

Initiate strategies to maximizing the remaining vision and maintain the client’€™s independence.



Provide referrals to community organizations. Therapies such as laser therapy or photodynamic therapy may be prescribed to seal leaking blood vessels in or near the macula.

Hearing Impairment Facilitating Communication 

Use the written word if the client is able to see, read, and write.



Provide plenty of light in the room.



Get the client’€™s attention before starting to speak.



Face the client when speaking.



Carry out conversation in a room without distracting noises.



Move close to the client and speak slowly and clearly.



Keep the hands and other objects away from the mouth when talking to the client so that he or she may watch the lips as an aid to comprehension.



Talk in normal tones; shouting is not helpful.

Facilitating Communication (cont.) 

Rephrase sentences and repeat information to ensure comprehension.



Encourage the client to read lips.



Encourage the client to wear glasses when talking to someone to improve vision for lip reading.



Use sign language, which combines speech with hand movements that signify letters, words, or phrases.



Encourage the use of a telephone amplifier.



Discuss the use of a flashing light that is activated by the ringing of a telephone or doorbell, or a specially trained dog, to ensure awareness of sounds and potential dangers.

Presbycusis 

This type of sensorineural hearing loss, associated with aging, involves degeneration or atrophy of the ganglion cells in the cochlea, loss of elasticity of the basilar membrane, and compromise of the vascular supply to the inner ear.



Hearing loss is gradual and bilateral.



The client may state that he or she has no problem hearing but cannot understand words; the client thinks that the speaker is mumbling.

Nursing Considerations 

A hearing aid will likely be prescribed for the client.

Mastoiditis 

Infection and consequent inflammation of the mastoid bone resulting from untreated or inadequately treated chronic or acute otitis media—may be acute or chronic. Assessment findings include: 

Swelling behind the ear



Pain with minimal movement of the head



Cellulitus on the skin or external scalp over the mastoid process



A reddened, dull, thick, immobile tympanic membrane, with or without perforation



Tender, enlarged postauricular lymph nodes



Low-grade fever

Nursing Considerations 

Antibiotic therapy will likely be prescribed. In severe cases the infected material is surgically removed.

Otosclerosis 

This disease of the labyrinthine capsule of the middle ear results in bony overgrowth of the tissue surrounding the ossicles.



Sclerotic bone forms on stapes, limiting its movement and leading to conductive hearing loss.



The condition may be genetic. Assessment findings include: 

Slowly progressing conductive hearing loss, sometimes bilateral



Constant ringing or roaring tinnitus



Loud sounds heard in the ear when the client chews



Pinkish discoloration (Schwartze sign) of the tympanic membrane, indicating vascular changes within the ear



A negative result on Rinne testing, indicating that the client hears as long (or even longer) by bone conduction as by air conduction



A Weber test finding showing lateralization of sound to the ear with the greater conductive hearing loss

Nursing Considerations 

Nonsurgical intervention (hearing aids) promotes improvement of hearing through amplification.



Stapedectomy (surgical removal of the bony growth that is causing hearing loss) with prosthesis insertion (fenestration) may be performed.



If surgery is performed, provide postoperative instructions to the client.

Care after Stapedectomy Surgery 

Explain that hearing is initially worse after surgery because of swelling and that noticeable improvement in hearing may not occur for as long as 6 weeks.



Maintain safety; help the client walk.



Administer antibiotics and antivertigo and pain medications.



Assess the client for facial nerve damage, weakness, changes in tactile sensation, changes in taste sensation, vertigo, and nausea and vomiting.



Instruct the client to move the head slowly when changing position to help prevent vertigo.



Instruct the client to avoid people with upper respiratory tract infections.



Instruct the client to avoid showering and getting the head and wound wet.



Instruct the client to avoid rapid or extreme changes in pressure caused by quick head movement, sneezing, nose-blowing, straining, and changes in altitude.



Instruct the client to avoid changes in middle ear pressure (e.g., that which occurs during flying), which could dislodge a prosthesis.

Meniere’s Syndrome 

A€” dilation of the endolymphatic system resulting from overproduction or decreased reabsorption of endolymphatic fluid. It” occurs when normal fluid and electrolyte balance in the ear is disrupted.



The disorder is characterized by tinnitus, unilateral sensorineural hearing loss, and vertigo.



Symptoms occur in attacks that last several days; the client may be incapacitated during an attack.



Initial hearing loss is reversible, but, as the frequency of the attacks increases, resulting in repeated damage to the cochlea as a result of increased fluid pressure, hearing loss becomes permanent.

Meniere’s Syndrome Assessment findings include: 

Tinnitus



Vertigo



Hearing loss



Headache



Nausea and vomiting



A feeling of fullness in the affected ear

Nursing Considerations 

Management is focused on controlling symptoms.

Nonsurgical Interventions 

Maintain the client’€™s safety.



Restrict the client to bed rest in a quiet environment.



Instruct the client to move the head slowly to prevent worsening of the vertigo.



Administer antiemetics, anticholinergics, diuretics, and vasodilators as prescribed.



Teach the client dietary measures (e.g., avoiding salt, monosodium glutamate, caffeine, sugar, and alcohol) and stress the need to refrain from smoking.

Surgical Interventions 

Surgery is performed when medical therapy is ineffective and the client’€™s function has been diminished significantly.



Endolymphatic drainage and insertion of a shunt may be performed to aid drainage of excess fluid.



Resection of the vestibular nerve or labyrinthectomy (removal of the membranous labyrinth) may also be performed....