Nursing Management: Visual and Auditory Problems Chapter 22 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Visual Problems Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Correctable Refractive Errors Nonsurgical Corrections Corrective glasses Contact lenses Corneal molding Surgical Therapy Laser Implant Thermal procedures Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Uncorrectable Visual Impairment Levels of Visual Impairment Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Uncorrectable Visual Impairment Table 22-2. Definition of Legal Blindness in the United States. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Management: Visual Impairment Nursing Assessment Nursing Diagnoses Planning Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Management: Visual Impairment Nursing Implementation Health promotion Acute intervention Ambulatory and home care Optical devices for vision enhancement Nonoptical methods for vision enhancement Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Gerontologic Considerations: Visual Impairment Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Eye Trauma Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Extraocular Disorders Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Inflammation and Infection Hordeolum Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Inflammation and Infection Fig. 22-1. Hordeolum (sty) on the upper eyelid caused by staphylococcal infection. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Inflammation and Infection Chalazion Blepharitis Conjunctivitis Bacterial infections Viral infections Chlamydial infections  Allergic conjunctivitis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Inflammation and Infection Keratitis Bacterial infections Viral infections Other causes of keratitis  Corneal ulcer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Inflammation and Infection Fig. 22-2. Corneal ulcer. Infection associated with poor contact lens care. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Management: Inflammation and Infection Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health promotion Acute intervention Ambulatory and home care Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Dry Eye Disorders Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Strabismus Fig. 22-3. Strasbismus with right exotropia and fixation of the left eye. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Corneal Disorders Corneal Scars and Opacities Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Corneal Disorders Fig. 22-4. Sutures on a donated cornea after penetrating keratoplasty (corneal transplant). Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Corneal Disorders Keratoconus Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Intraocular Disorders Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cataract Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cataract Collaborative Care Nonsurgical therapy Surgical therapy Preoperative phase Intraoperative phase Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cataract Fig. 22-5. Intraocular lens implant after cataract surgery. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cataract Collaborative Care Surgical therapy, continued Postoperative phase Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Management: Cataracts Nursing Assessment Nursing Diagnoses Planning Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Management: Cataracts Nursing Implementation Health promotion Acute intervention Ambulatory and home care Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Gerontologic Considerations: Cataracts Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Retinopathy Fig. 22-6. Diabetic retinopathy. Intraretinal dot or blot hemorrhages. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Retinal Detachment Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Retinal Detachment Table 22-7. Risk Factors for Retinal Detachment. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Retinal Detachment Clinical Manifestations Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Retinal Detachment Collaborative Care Surgical therapy Laser photocoagulation and cryopexy Scleral buckling Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Retinal Detachment Fig. 22-7. Retinal break with detachment: surgical repair by scleral buckling technique. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Retinal Detachment Collaborative Care Surgical therapy, continued Intraocular procedures Postoperative considerations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Age-related Macular Degeneration Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Glaucoma Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Glaucoma Fig. 22-8. A, In the normal eye, the optic cup is pink with little cupping. B, In glaucoma, the optic disc is bleached and optic cupping is present. (Note the appearance of the retinal vessels, which travel over the edge of the optic cup and appear to dip into it.) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Glaucoma Collaborative Care Chronic open-angle glaucoma Acute angle-closure glaucoma Secondary glaucoma Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Management: Glaucoma Nursing Assessment Nursing Diagnoses Planning Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Management: Glaucoma Nursing Implementation Health promotion Acute intervention Ambulatory and home care Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Gerontologic Considerations: Glaucoma Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Intraocular Inflammation and Infection Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Ocular Tumors Fig. 22-9. Uveal melanoma. A large tumor in the choroid, the most common location in the eye for melanoma. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Enucleation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Ocular Manifestations of Systemic Diseases Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Auditory Problems Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. External Ear and Canal Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Trauma Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. External Otitis Etiology Clinical Manifestations and Complications Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Management: External Otitis Table 22-12. Patient and Caregiver Teaching Guide. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Cerumen and Foreign Bodies in External Ear Canal Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Malignancy of External Ear Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Middle Ear and Mastoid Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acute Otitis Media Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Otitis Media With Effusion Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Chronic Otitis Media and Mastoiditis Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Chronic Otitis Media and Mastoiditis Fig. 22-10. Perforations of the tympanic membrane. A, Small central perforation (hearing is usually good). B, Large central perforation around the handle of the malleus (hearing is usually poor). C, Marginal perforation of Shrapnell’s membrane (hearing is usually good). Cholesteatomas commonly occur in patients with a marginal perforation that does not heal. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Chronic Otitis Media and Mastoiditis Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Chronic Otitis Media and Mastoiditis Table 22-13. Collaborative Care. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Chronic Otitis Media and Mastoiditis Collaborative Care, continued Surgical therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Management: Chronic Otitis Media Following Tympanoplasty Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Management: Chronic Otitis Media Table 22-14. Patient and Caregiver Teaching Guide. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Otosclerosis Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Otosclerosis Table 22-15. Collaborative Care. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Management: Otosclerosis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Inner Ear Problems Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Ménière’s Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing and Collaborative Management: Ménière’s Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Benign Paroxysmal Positional Vertigo Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acoustic Neuroma Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Hearing Loss and Deafness Fig. 22-11. Causes of hearing loss. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Hearing Loss and Deafness Types of Hearing Loss Conductive hearing loss Sensorineural hearing loss Mixed hearing loss Central and functional hearing loss Classification of hearing loss Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing and Collaborative Management: Hearing Loss and Deafness Health Promotion Environmental noise control Immunizations Ototoxic substances Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing and Collaborative Management: Hearing Loss and Deafness Assistive Devices and Techniques Hearing aids Speech reading Sign language Cochlear implant Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing and Collaborative Management: Hearing Loss and Deafness Fig. 22-12. Cochlear implant. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing and Collaborative Management: Hearing Loss and Deafness Assistive Devices and Techniques, continued Assisted listening devices Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Gerontologic Considerations: Hearing Loss Table 22-20. Classification of Presbycusis. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.