Nursing Care of Patients with Sensory Disorders — Vision and Hearing Chapter 52 Nursing Care of Patients with Sensory Disorders — Vision and Hearing

Eye Infections and Inflammation Conjunctivitis: Inflammation of the Conjunctiva Blepharitis: Inflammation of the Eyelid Margins Hordeolum: Staphylococcal Abscess in Sebaceous Gland

Eye Infections and Inflammation (cont’d) Chalazion: Abscess in Meibomian Glands Keratitis: Inflammation of the Cornea

Nursing Diagnoses Acute Pain Disturbed Sensory Perception Risk for Injury Risk for Infection Deficient Knowledge

Refractive Errors Emmetropia: Normal Vision Hyperopia: Farsightedness Myopia: Nearsightedness Astigmatism: Unequal Curvatures in Cornea Presbyopia: Loss of Lens Elasticity

Refractive Errors (cont’d)

Blindness Obstacle to Rays of Light Disease of Optic Nerve or Tract of Brain Connected with Vision

Visual Field Abnormalities

Nursing Diagnoses Disturbed Sensory Perception Self-Care Deficit Risk for Injury Risk for Impaired Home Maintenance Interrupted Family Processes Ineffective Role Performance

Nursing Diagnoses (cont’d) Deficient Knowledge Deficient Diversional Activity Fear

Diabetic Retinopathy Vascular Changes in Retinal Blood Vessels Microaneurysms Preproliferative Retinopathy Therapeutic Interventions Laser Photocoagulation Vitrectomy

Diabetic Retinopathy (cont’d) Nursing Diagnoses Impaired Home Maintenance Ineffective Therapeutic Regimen Management Disturbed Sensory Perception

Retinal Detachment Separation of Retina from Choroid Layer of Eye

Retinal Detachment (cont’d) Signs and Symptoms Sudden Change in Vision Flashing Lights, Floaters Looking Through a Veil Curtain Being Lowered Over Vision No Pain

Retinal Detachment (cont’d) Therapeutic Interventions Laser Reattachment Cryosurgery Scleral Buckling

Glaucoma Abnormal Pressure Within Eyeball Damage is Silent, Progressive, Irreversible Lifelong Diagnosis with Tonometry

Glaucoma (cont’d) Acute Angle-closure Narrowed Angle Blocks Aqueous Fluid Medical Emergency

Glaucoma (cont’d) Acute Angle-closure Severe Eye Pain Blurred Vision Rainbows Around Lights Eye Redness, Steamy Cornea Photophobia, Tearing

Glaucoma (cont’d) Primary Open-angle Degenerate of Drainage System Blocks Aqueous Fluid Gradual and Painless

Glaucoma (cont’d) Primary Open-angle Mild Eye Aching Headache Halos Around Lights Frequent Visual Changes

Glaucoma (cont’d) Medications Miotics Agents to Decrease Production of Aqueous Fluid Mannitol

Glaucoma (cont’d) Contraindicated in Acute Angle-closure Mydriatics Can Cause Blindness!

Glaucoma (cont’d) Surgery Laser Peripheral Iridotomy Surgical Iridectomy Laser Trabeculoplasty Trabeculectomy Cyclocryotherapy

Flow of Aqueous Humor After Trabeculoplasty

Glaucoma (cont’d) Nursing Diagnoses Pain Disturbed Sensory Perception Self-Care Deficit Anxiety

Glaucoma (cont’d) Nursing Diagnoses (cont’d) Risk for Injury Impaired Home Maintenance Deficient Knowledge

Cataracts Opacity in Eye Lens Causing Loss of Visual Acuity Halos Around Lights, Difficulty Reading, Sensitivity to Glare, Double Vision, Decreased Color Vision

Cataracts (cont’d) Surgical Removal of Lens

Nursing Diagnoses: Eye Surgery Disturbed Sensory Perception Deficient Knowledge Risk for Infection Risk for Injury Anxiety

Macular Degeneration

Macular Degeneration (cont’d) Deterioration in Macula Wet Dry Slow, Progressive Loss of Central/Near Vision Amsler Grid Detects

Amsler Grid

Macular Degeneration (cont’d) Therapeutic Interventions Wet Laser Treatment Dry None

Nursing Diagnoses: Macular Degeneration Disturbed Sensory Perception Self-Care Deficit Risk for Injury Risk for Impaired Home Maintenance Interrupted Family Processes Ineffective Role Performance

Eye Trauma Emergency Foreign Bodies Burns Abrasions Lacerations Penetrating Wounds

Eye Trauma (cont’d) Therapeutic Interventions Foreign Object Chemicals Irrigate Normal Saline Chemicals 15- to 20-Minute Irrigation

Eye Trauma (cont’d) Therapeutic Interventions Penetrating Object Do Not Remove Antibiotic Ointment Surgery

Eye Trauma (cont’d) Enucleation Entire Eyeball Removal

Nursing Diagnoses: Eye Trauma Acute Pain Risk for Infection Anxiety Deficient Knowledge

Hearing Loss Conductive Hearing Loss Interference with Sound Conduction to External Auditory Canal, Eardrum, Middle Ear

Hearing Loss (cont’d) Sensorineural Hearing Loss Involves Hair Cells and Nerve Endings

Hearing Loss (cont’d) Presbycusis Aging Process Degeneration of Organ of Corti Inability to Decipher High-Frequency Sounds

Hearing Loss (cont’d) Therapeutic Interventions Hearing Aid Cochlear Implants

Hearing Aids

Nursing Diagnoses: Hearing Loss Disturbed Sensory Perception Impaired Verbal Communication Impaired Social Interaction Disturbed Body Image Ineffective Coping Deficient Knowledge

External Ear Infections External Otitis Ear Canal Furuncle Ostomycosis Perichondritis

External Ear (cont’d) Impacted Cerumen Normally Ear Self-cleaning Older Adult at Risk Hearing Loss Feeling of Fullness

External Ear (cont’d) Masses Trauma

Therapeutic Interventions Topical Antibiotics Irrigations Analgesics Incision and Drainage

Nursing Diagnoses: External Ear Acute Pain Disturbed Sensory Perception Risk for Injury Deficient Knowledge

Middle Ear Infection Otitis Media Fever, Earache, and Feeling of Fullness Antibiotics Myringotomy

Otosclerosis New Bone Along Stapes Conductive Hearing Loss Women Than in Men Both Ears Hereditary Disease No Cure

Otosclerosis (cont’d) Treatment Hearing Aids Ossiculoplasty Stapedectomy

Nursing Care: Otosclerosis Operative Ear is Upward When Lying Earplug to Protect Antiemetics Promptly Promote Safety

Nursing Care: Otosclerosis (cont’d) Teach Not to Cough, Sneeze Blow Nose Vomit Fly Lift Heavy Objects Shower

Ear Trauma Tympanic Membrane Perforation Middle Ear Ossicle Fracture

Ear Trauma (cont’d) Nursing Diagnoses Acute Pain Risk for Infection Deficient Knowledge

Inner Ear Labyrinthitis Inflammation or Infection of Inner Ear Vertigo, Tinnitus, Sensorineural Hearing Loss Antibiotics Sedation Bedrest

Inner Ear (cont’d) Neoplastic Disorders Acoustic Neuroma Tumor of the Eighth Cranial Nerve Benign

Ménière’s Disease Balance Disorder Due to Fluid Disturbance Triad of Symptoms Vertigo Hearing Loss Tinnitus Episodic Bouts: 2 to 3 Times/Year

Ménière’s Disease (cont’d) Acute Treatment Tranquilizers Vagal Blockers Bedrest

Ménière’s Disease (cont’d) Prophylactic Treatment Salt-restricted Diet Diuretics Antihistamines Vasodilators

Ménière’s Disease (cont’d) Prophylactic Treatment (cont’d) Avoid Alcohol Caffeine Tobacco

Nursing Diagnoses: Inner Ear Anxiety Fear Ineffective Role Performance Impaired Social Interaction Grieving Risk for Injury

Nursing Diagnoses: Inner Ear (cont’d) Deficient Fluid Volume Imbalanced Nutrition: Less Than Body Requirements Deficient Knowledge