1. Nursing Care of Clients with Eye and Ear Disorders
Chapter 40

2. Physical Assessment of Eye and Vision
Snellen chart or E chart for testing visional acuity
20 feet
Cardinal fields
test for extraocular eye movements
Cover-uncover test
test for stabisms

3. Physical Assessment of Ear and Hearing
Weber test
Rinne test
Whisper test

4. Eye Disorders Age Related Vision Changes Physical changes
flatting of the cornea
pupillary constriction
decrease in lens elasticity
loss of sensory cells
Physical changes
inversion, eversion of lid, decreased tear secretion, “hollowed-eyed”

5. Conjunctivitis-red, pain, itchy, sticky drainage

6. Eye Disorders Inflammatory Disorders Treatment conjunctivitis
inflammation of the conjunctiva
bacterial or viral
Treatment
topical anti-infectives
anti-inflammatories

7. Eye Disorders Corneal Infections/Inflammations Treatment
corneal scarring and ulcerations are a major cause of world-wide blindness
Treatment
Corneal Transplant

9. The Client with Eye Trauma
Corneal Abrasion
Burns
Penetrating Trauma
Blunt Trauma
Treatment
topical anesthesia
facial X-rays or C-T Scans

10. The Client with Eye Trauma
Foreign body removal
sterile saline irrigation
Eye irrigation
chemical burn
Surgery
penetrating wound

11. The Client with Cataracts
a clouding of the lens of the eye
interferes with light transmission and the ability to perceive images clearly
Significant cause of visional problems in the elderly (50-70%)
Senile Cataracts
normal aging process

12. The Client with Cataracts
Treatment
Surgical removal of cataract and lens
Implantation of intraocular lens
Post-operative Nursing Care
assessment
eye patch
semi-folwer’s

13. Post-operative Nursing Care
Avoid coughing, sneezing straining
these increase intraocular pressure
Assess for post-op pain
Assess for surgical complications
Approach from unaffected side
Teach Home Care
meds., symptoms to report, photophobia

14. Glaucoma
Characterized by increased intraocular pressure and gradual loss of vision
“Silent” thief of vision
Narrowing of visual fields
2 Types
Open Angle and Closed Angle

15. Glaucoma - inner eye pressure

16. Glaucoma Open Angle Pathophysiology common (90%)
>35yrs, genetic link, African-American
Pathophysiology
impaired aqueous outflow
increased intraocular pressure
usually bilateral

17. Glaucoma Clinical Manifestations none frequent lens changes in glasses
impaired night vision
halos
reduction of vision field, become narrow
increased intraocular pressure (tonometry)

18. Glaucoma Treatment miotics - pilocarpine
Laser Surgery (trabeculoplasty)
cause scar tissue to create tension to stretch opening to drain aqueous fluid

19. Glaucoma Stage 4

20. Diabetic Retinopathy
Leading cause of new blindness between ages of 20-74
84% of diabetics will develop some form
depends of length of time you have diabetes
Vascular disorder that affects the retina
capillaries become sclerotic

21. Diabetic Retinopathy Management Yearly ophthalmologic exams
Laser photocoagulation
Focus is educational
vision changes -blurred
black spots (Floaters)
flashing lights
sudden loss of vision

22. Diabetic Retinopathy - vision

23. Ear Disorders External Otitis swimmers ear
pseudomonas, bacteria, fungus or trauma
Treatment
cleansing
antibiotics - local and systemic
education

24. Ear Disorders Otitis Media Treatment inflammation of middle ear
common in infants and young children
Red bulging tympanic membrane
Treatment
antibiotics
myringotomy

25. Ear Infection check up

26. Inner Ear Disorders Meniere’s Disease Treatment chronic
recurrent attack of vertigo with tinnitus
progressive hearing loss
Treatment
antivert

27. The Client with Hearing Loss
Affects 24% of older adults
Affects 39% of those over age 75
2 Types
Conductive
disruption transmission of sound
obstructions - cerum, scarring, tumors
Sensorineural
inner ear, auditory nerve or pathways

28. The Client with Hearing Loss
Treatment
Amplification
hearing aids
Surgery
reconstruct the middle ear - tympanoplasty
cochlear implant
Nursing Care
Sensory/Perceptual Alteration: Auditory, Impaired communication, Social isolation

29. What are your interventions?

30. What kind of pt. teaching will you provide?

31. What’s your post-op nursing care?

32. What is happening here?

33. What about this vision