Chapter 11 Care of the Eye and Ear

Patient-Centered Care Prosthetic devices must fit and work properly if patients are to function optimally. Know patient’s preferences for care of any prosthetic device. Without visual or hearing aids, patients have altered communication, social isolation, and greater dependence on others. Learn how a change in vision and/or hearing is perceived in terms of the patient’s culture.

Safety Identify how the sensory alteration places the patient at risk for injury. Orient the patient to any new environment. Regularly clean and handle any prosthetic device with care. Patients with visual impairments may have difficulty with tasks requiring visual detail.

Skill 11.1 Eye Irrigations Irrigation flushes out exudate, irritating solutions, or foreign bodies. Irrigate with large amounts of cool water or prescribed irrigating solution for at least 15 minutes. Thoroughly assess the condition of the eye and the level of visual acuity. Assess pain status. Assess the patient’s ability to cooperate and keep the eye open.

Skill 11.1 Eye Irrigations (cont’d) Remove contact lens before beginning irrigation. Clean eyelid margins/eyelashes from inner to outer canthus with saline-moistened 4×4 gauze. Assist patent to side-lying position on same side as affected eye. Hold irrigating syringe, dropper, or intravenous (IV) tubing approximately 2.5 cm (1 inch) from inner canthus. Irrigate with prescribed solution, volume, or time until secretions are cleared. Assess pain and visual acuity after irrigation.

Procedural Guideline 11.1 Eye Care for the Comatose Patient Comatose patients are at increased risk for corneal abrasion and infection. Clean eye gently with washcloth or cotton balls moistened with water or saline. Clean from inner to outer canthus. Instill prescribed lubricant. Apply eye patches if ordered. Remove eye pad/patches every 4 hours. Observe for and report irritation or infection.

Procedural Guideline 11.2 Caring for an Eye Prosthesis Remove prosthesis. Retract lower lid against lower orbital ridge, exert slight pressure below eyelid, and slide prosthesis out. Clean with mild soap and water; inspect. Gently irrigate socket with sterile normal saline. Remove excess moisture with gauze pads. Replace moistened prosthesis in correct orientation. Observe patient performing care of prosthesis. Instruct patient and family when to call oculist.

Skill 11.2 Ear Irrigation Irrigation addresses presence of foreign bodies, local inflammation, or buildup of cerumen in the ear canal. Risks include scratching lining of outer ear canal, rupture of tympanic membrane, and infection. Assess for contraindications to irrigation: Vegetable matter or insect present in the canal Ruptured tympanic membrane Presence of otitis externa, myringotomy tubes, or mastoid cavity or auditory canal surgery

Skill 11.2 Ear Irrigation (cont’d) Assess: Condition of external ear and auditory canal. Patient’s ability to hear. Presence of ear pain. Use warm irrigation solution (37° C [98.6° F]). Clear the outer canal of cerumen or debris. Straighten the external ear canal. Adult and child over 3 years (pull pinna up and back). Child under 3 years (pull pinna down and back). Instill irrigation fluid slowly and continuously. Drain excessive fluid and dry outer canal.

Skill 11.3 Care of a Hearing Aid Hearing aids have a microphone, amplifier, receiver, and power source. Programmable aids adjust frequencies for an individual patient. Types include in- and behind-the-ear and canal aids. Determine the patient’s ability to care for the device. Determine if the aid is working. Close the battery case and turn the volume slowly to high. Cup hand over the hearing aid. If a squealing sound (feedback) is heard, the aid works. If no sound is heard, replace batteries and test again.

Skill 11.3 Care of a Hearing Aid (cont’d) Turn the hearing aid off before removing from the ear. Wipe off the outer surface of the aid and clean out the opening to remove cerumen. Inspect the ear mold for rough edges. Clean the ear canal with a moistened washcloth. Open the battery door and allow it to air dry. Store the aid in a labeled container with a drying agent.