MedicalSurgical Nursing Concepts Practice 3 rd edition Chapter

The Eyes Structures of the eye Functions of the eye structures Changes associated with

Structures of the Eye Copyright © 2017, Elsevier Inc. All rights reserved. 3

Visual Pathway Copyright © 2017, Elsevier Inc. All rights reserved. 4

Muscles of the Eye Extrinsic (skeletal) muscles Ø Ø Ø Superior rectus Inferior rectus

Muscles of the Eye (Cont. ) Intrinsic (smooth) muscles Ø Ø Ø Ciliary Iris,

Arcus Senilis From Swartz M: Textbook of physical diagnosis: history and examination, ed. 6,

Ectropion From Albert DM, Jakobiec FA: Principles and practice of ophthalmology, vol. 3, Philadelphia,

Eye Disorders Causes Prevention Ø Ø Ø Basic eye care Vitamins and antioxidants “Dry

Danger Signals of Eye Disease Persistent redness of the eye Continuing pain or discomfort

Danger Signals of Eye Disease (Cont. ) Growths on the eye or eyelids or

Visual Loss Retinopathy associated with diabetes mellitus and hypertension Diabetic retinopathy and open-angle glaucoma

The Tono-Pen Used to Check Intraocular Pressure Copyright © 2017, Elsevier Inc. All rights

Slit-Lamp Ocular Examination Copyright © 2017, Elsevier Inc. All rights reserved. 14

Examination of the Eye with an Ophthalmoscope Copyright © 2017, Elsevier Inc. All rights

Copyright © 2017, Elsevier Inc. All rights reserved. 1

Assessment (Data Collection) History taking and systemic disorders Physical examination Copyright © 2017, Elsevier

Abnormalities of Eyelid Position Entropion Ectropion Ptosis Copyright © 2017, Elsevier Inc. All rights

Xanthelasma From Bolognia JL, Schaffer JV, Duncan KO, Ko CJ: Dermatology essentials, St. Louis,

Expected Outcomes The patient will Ø Ø Ø Compensate for decreased visual acuity and

Nursing Interventions for the Visually Impaired Patient When communicating with these patients, remember that

The Ears Structures of the ear Functions of the ear structures Changes associated with

Structures of the Ear Copyright © 2017, Elsevier Inc. All rights reserved. 24

Hearing Loss Sensorineural hearing loss Conductive hearing loss Causes and prevention Ø Ø Ø

Common Causes of Conductive Hearing Loss Obstruction by impacted cerumen Infection with labyrinthitis Otosclerosis

Common Causes of Sensorineural Hearing Loss Presbycusis Heredity with congenital loss Ototoxic drugs Loud

Dangers of Ototoxic Drugs Assess frequently when receiving a potentially ototoxic drug. Signs of

Diagnostic Tests and Examinations Visual examination Tuning fork tests Ø Weber test and Rinne

Examination of the Ear with an Otoscope From Jarvis C: Physical examination and health

Irrigating the External Ear Canal Copyright © 2017, Elsevier Inc. All rights reserved. 31

General Goals for the Patient with Problems of the Ear or Hearing Promote knowledge

Communicating with the Hearing. Impaired Person If the person uses a hearing aid, encourage

Communicating with the Hearing. Impaired Person (Cont. ) The best distance for speaking to

Communicating with the Hearing. Impaired Person (Cont. ) Use short, simple sentences. If the

When a Hearing Aid Does Not Work Check that the switch is “on. ”

When a Hearing Aid Does Not Work (Cont. ) Replace the battery. Batteries last

Cleaning the Hearing Aid Turn off the hearing aid. Wash the ear mold with

Common Problems of Patients with Ear Disorders Hearing impairment Dizziness and vertigo Tinnitus Rehabilitation

Cochlear Implant Copyright © 2017, Elsevier Inc. All rights reserved. 40

Community Care Public education on the dangers of loud noise and music Encourage thorough

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Muscles of the Eye Extrinsic (skeletal) muscles Ø Ø Ø Superior rectus Inferior rectus Medial rectus Lateral rectus Superior oblique Inferior oblique Copyright © 2017, Elsevier Inc. All rights reserved. 5

Danger Signals of Eye Disease Persistent redness of the eye Continuing pain or discomfort about the eye, especially after injury Disturbance of vision Colored light flashes Crossing of the eyes, especially in children Copyright © 2017, Elsevier Inc. All rights reserved. 10

Danger Signals of Eye Disease (Cont. ) Growths on the eye or eyelids or opacities visible in the normally transparent portion of the eye Continuing discharge, crusting, or tearing of the eyes Pupil irregularities, either unequal size of the two pupils or distorted shape Copyright © 2017, Elsevier Inc. All rights reserved. 11

Visual Loss Retinopathy associated with diabetes mellitus and hypertension Diabetic retinopathy and open-angle glaucoma among Latinos Visual screening and check-up Copyright © 2017, Elsevier Inc. All rights reserved. 12

Expected Outcomes The patient will Ø Ø Ø Compensate for decreased visual acuity and not experience sensory deprivation. Not experience injury. Verbalize decreased fear as treatment begins to help condition. Seek assistance with home maintenance within 7 days. Explore other means of diversion than reading and watching television. Demonstrate proper instillation of eye drops and will verbalize the schedule for the eye drops. Copyright © 2017, Elsevier Inc. All rights reserved. 21

Nursing Interventions for the Visually Impaired Patient When communicating with these patients, remember that the person has a vision impairment; the person is not deaf. Prevention of accidents Pity is neither expected nor appreciated by visually impaired people. Most patients prefer to feed themselves, if at all possible. If a guide dog is present, don’t interfere with it or pet it because it is working. Copyright © 2017, Elsevier Inc. All rights reserved. 22

Hearing Loss Sensorineural hearing loss Conductive hearing loss Causes and prevention Ø Ø Ø Noise-induced hearing impairment Amplified music exposure Medications and older adults Copyright © 2017, Elsevier Inc. All rights reserved. 25

Common Causes of Conductive Hearing Loss Obstruction by impacted cerumen Infection with labyrinthitis Otosclerosis Trauma and scarring of the tympanic membrane Congenital malformation of the outer or middle ear Copyright © 2017, Elsevier Inc. All rights reserved. 26

Common Causes of Sensorineural Hearing Loss Presbycusis Heredity with congenital loss Ototoxic drugs Loud noise exposure Tumor (acoustic neuroma) Ménière’s disease Severe infection such as measles, mumps, meningitis Rubella in utero Copyright © 2017, Elsevier Inc. All rights reserved. 27

Dangers of Ototoxic Drugs Assess frequently when receiving a potentially ototoxic drug. Signs of ototoxicity: ringing in the ears, subtle changes in hearing ability, and difficulty in hearing Teach importance of immediate reporting of symptoms. Copyright © 2017, Elsevier Inc. All rights reserved. 28

General Goals for the Patient with Problems of the Ear or Hearing Promote knowledge to protect hearing. Prevent infection and injury. Promote effective communication. Promote coping with hearing loss. Copyright © 2017, Elsevier Inc. All rights reserved. 32

Communicating with the Hearing. Impaired Person If the person uses a hearing aid, encourage its use and see that it is situated, turned on, and adjusted before beginning speaking. Be certain you have the person’s attention before beginning speaking. Sit facing the person with the light on your face rather than from behind you. Ask permission to turn down the volume or turn off the television or radio. Copyright © 2017, Elsevier Inc. All rights reserved. 33

Communicating with the Hearing. Impaired Person (Cont. ) The best distance for speaking to a hearingimpaired person is 2½ to 4 feet. Place yourself at eye level with the person. Do not speak directly into the person’s ear because this prevents the person from obtaining visual cues while you are speaking. Do not smile, chew gum, or cover your mouth while speaking. Copyright © 2017, Elsevier Inc. All rights reserved. 34

Communicating with the Hearing. Impaired Person (Cont. ) Use short, simple sentences. If the patient does not appear to understand or responds inappropriately, state the message again using different words. Try to limit each sentence to one subject and one verb. Give the person time to respond to questions. Ask for oral or written feedback to make certain your message is understood. Avoid using the intercom system because it may distort sound. Copyright © 2017, Elsevier Inc. All rights reserved. 35

When a Hearing Aid Does Not Work Check that the switch is “on. ” Examine the ear mold for attached wax or dirt; clean the sound hole. Check the battery to see that it is inserted correctly. Check the connection between the ear mold and the receiver. Copyright © 2017, Elsevier Inc. All rights reserved. 36

When a Hearing Aid Does Not Work (Cont. ) Replace the battery. Batteries last an average of 12 to 14 days depending on the type of hearing aid. Check placement of the ear mold in the ear; it should fit snugly. Adjust the volume. If all else fails, take the hearing aid to an authorized service center for repair. Copyright © 2017, Elsevier Inc. All rights reserved. 37

Cleaning the Hearing Aid Turn off the hearing aid. Wash the ear mold with mild soap and warm water; do not submerge in water. Use a pipe cleaner or toothpick to gently cleanse the opening or short tube that fits into the ear. Dry the mold completely before turning on the aid or before reattaching it to the hearing aid (if it is separate). Copyright © 2017, Elsevier Inc. All rights reserved. 38

Common Problems of Patients with Ear Disorders Hearing impairment Dizziness and vertigo Tinnitus Rehabilitation for hearing loss Ø Ø Ø Lip reading (speech reading) Sign language Hearing aids Cochlear implant Hearing-assistive devices Copyright © 2017, Elsevier Inc. All rights reserved. 39