Linda S. Williams / Paula D. Hopper Copyright © F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 52 Nursing Care of Patients with Sensory Disorders — Vision and Hearing

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Eye Infections and Inflammation  Conjunctivitis: Inflammation of the Conjunctiva  Blepharitis: Inflammation of the Eyelid Margins  Hordeolum: Staphylococcal Abscess in Sebaceous Gland

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Eye Infections and Inflammation (cont’d)  Chalazion: Abscess in Meibomian Glands  Keratitis: Inflammation of the Cornea

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Acute Pain  Disturbed Sensory Perception  Risk for Injury  Risk for Infection  Deficient Knowledge

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Refractive Errors  Emmetropia: Normal Vision  Hyperopia: Farsightedness  Myopia: Nearsightedness  Astigmatism: Unequal Curvatures in Cornea  Presbyopia: Loss of Lens Elasticity

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Refractive Errors (cont’d)

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Blindness  Obstacle to Rays of Light  Disease of Optic Nerve or Tract of Brain Connected with Vision

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Visual Field Abnormalities

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Disturbed Sensory Perception  Self-Care Deficit  Risk for Injury  Risk for Impaired Home Maintenance  Interrupted Family Processes  Ineffective Role Performance

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses (cont’d)  Deficient Knowledge  Deficient Diversional Activity  Fear

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diabetic Retinopathy  Vascular Changes in Retinal Blood Vessels  Microaneurysms  Preproliferative Retinopathy  Therapeutic Interventions  Laser Photocoagulation  Vitrectomy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diabetic Retinopathy (cont’d)  Nursing Diagnoses  Impaired Home Maintenance  Ineffective Therapeutic Regimen Management  Disturbed Sensory Perception

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Retinal Detachment Separation of Retina from Choroid Layer of Eye

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition 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

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Retinal Detachment (cont’d)  Therapeutic Interventions  Laser Reattachment  Cryosurgery  Scleral Buckling

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glaucoma  Abnormal Pressure Within Eyeball  Damage is Silent, Progressive, Irreversible  Lifelong  Diagnosis with Tonometry

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glaucoma (cont’d)  Acute Angle-closure  Narrowed Angle Blocks Aqueous Fluid  Medical Emergency

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glaucoma (cont’d)  Acute Angle-closure  Severe Eye Pain  Blurred Vision  Rainbows Around Lights  Eye Redness, Steamy Cornea  Photophobia, Tearing

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glaucoma (cont’d)  Primary Open-angle  Degenerate of Drainage System Blocks Aqueous Fluid  Gradual and Painless

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glaucoma (cont’d)  Primary Open-angle  Mild Eye Aching  Headache  Halos Around Lights  Frequent Visual Changes

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glaucoma (cont’d)  Medications  Miotics  Agents to Decrease Production of Aqueous Fluid  Mannitol

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glaucoma (cont’d)  Contraindicated in Acute Angle-closure  Mydriatics  Can Cause Blindness!

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glaucoma (cont’d)  Surgery  Laser Peripheral Iridotomy  Surgical Iridectomy  Laser Trabeculoplasty  Trabeculectomy  Cyclocryotherapy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Flow of Aqueous Humor After Trabeculoplasty

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glaucoma (cont’d)  Nursing Diagnoses  Pain  Disturbed Sensory Perception  Self-Care Deficit  Anxiety

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glaucoma (cont’d)  Nursing Diagnoses (cont’d)  Risk for Injury  Impaired Home Maintenance  Deficient Knowledge

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cataracts  Opacity in Eye Lens Causing Loss of Visual Acuity  Halos Around Lights, Difficulty Reading, Sensitivity to Glare, Double Vision, Decreased Color Vision

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cataracts (cont’d)  Surgical Removal of Lens

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Eye Surgery  Disturbed Sensory Perception  Deficient Knowledge  Risk for Infection  Risk for Injury  Anxiety

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Macular Degeneration

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Macular Degeneration (cont’d)  Deterioration in Macula  Wet  Dry  Slow, Progressive Loss of Central/Near Vision  Amsler Grid Detects

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Amsler Grid

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Macular Degeneration (cont’d)  Therapeutic Interventions  Wet  Laser Treatment  Dry  None

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Macular Degeneration  Disturbed Sensory Perception  Self-Care Deficit  Risk for Injury  Risk for Impaired Home Maintenance  Interrupted Family Processes  Ineffective Role Performance

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Eye Trauma  Emergency  Foreign Bodies  Burns  Abrasions  Lacerations  Penetrating Wounds

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Eye Trauma (cont’d)  Therapeutic Interventions  Foreign Object  Irrigate  Normal Saline  Chemicals  15- to 20-Minute Irrigation

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Eye Trauma (cont’d)  Therapeutic Interventions  Penetrating Object  Do Not Remove  Antibiotic Ointment  Surgery

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Eye Trauma (cont’d)  Enucleation  Entire Eyeball Removal

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Eye Trauma  Acute Pain  Risk for Infection  Anxiety  Deficient Knowledge

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hearing Loss  Conductive Hearing Loss  Interference with Sound Conduction to External Auditory Canal, Eardrum, Middle Ear

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hearing Loss (cont’d)  Sensorineural Hearing Loss  Involves Hair Cells and Nerve Endings

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hearing Loss (cont’d)  Presbycusis  Aging Process  Degeneration of Organ of Corti  Inability to Decipher High-Frequency Sounds

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hearing Loss (cont’d)  Therapeutic Interventions  Hearing Aid  Cochlear Implants

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hearing Aids

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Hearing Loss  Disturbed Sensory Perception  Impaired Verbal Communication  Impaired Social Interaction  Disturbed Body Image  Ineffective Coping  Deficient Knowledge

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition External Ear  Infections  External Otitis  Ear Canal Furuncle  Ostomycosis  Perichondritis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition External Ear (cont’d)  Impacted Cerumen  Normally Ear Self-cleaning  Older Adult at Risk  Hearing Loss  Feeling of Fullness

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition External Ear (cont’d)  Masses  Trauma

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Topical Antibiotics  Irrigations  Analgesics  Incision and Drainage

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: External Ear  Acute Pain  Disturbed Sensory Perception  Risk for Injury  Deficient Knowledge

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Middle Ear Infection  Otitis Media  Fever, Earache, and Feeling of Fullness  Antibiotics  Myringotomy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Otosclerosis  New Bone Along Stapes  Conductive Hearing Loss  Women Than in Men  Both Ears  Hereditary Disease  No Cure

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Otosclerosis (cont’d)  Treatment  Hearing Aids  Ossiculoplasty  Stapedectomy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Care: Otosclerosis  Operative Ear is Upward When Lying  Earplug to Protect  Antiemetics Promptly  Promote Safety

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Care: Otosclerosis (cont’d)  Teach Not to  Cough, Sneeze  Blow Nose  Vomit  Fly  Lift Heavy Objects  Shower

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Ear Trauma  Tympanic Membrane Perforation  Middle Ear Ossicle Fracture

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Ear Trauma (cont’d)  Nursing Diagnoses  Acute Pain  Risk for Infection  Deficient Knowledge

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Inner Ear  Labyrinthitis  Inflammation or Infection of Inner Ear  Vertigo, Tinnitus, Sensorineural Hearing Loss  Antibiotics  Sedation  Bedrest

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Inner Ear (cont’d)  Neoplastic Disorders  Acoustic Neuroma  Tumor of the Eighth Cranial Nerve  Benign

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Ménière’s Disease  Balance Disorder Due to Fluid Disturbance  Triad of Symptoms  Vertigo  Hearing Loss  Tinnitus  Episodic Bouts: 2 to 3 Times/Year

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Ménière’s Disease (cont’d)  Acute Treatment  Tranquilizers  Vagal Blockers  Bedrest

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Ménière’s Disease (cont’d)  Prophylactic Treatment  Salt-restricted Diet  Diuretics  Antihistamines  Vasodilators

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Ménière’s Disease (cont’d)  Prophylactic Treatment (cont’d)  Avoid Alcohol  Caffeine  Tobacco

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Inner Ear  Anxiety  Fear  Ineffective Role Performance  Impaired Social Interaction  Grieving  Risk for Injury

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Inner Ear (cont’d)  Deficient Fluid Volume  Imbalanced Nutrition: Less Than Body Requirements  Deficient Knowledge