1. Elsevier items and derived items © 2006 by Elsevier Inc.

3.  Layers of the eyeball  Refractive structures and media  External structures  Muscles  Nerves  Blood vessels Elsevier items and derived items © 2006 by Elsevier Inc.

4.  Emmetropia: the perfect refraction of the eye  Hyperopia: occurs when the eye does not refract light enough  Myopia: occurs when the eye overrefracts or overbends the light  Astigmatism: a refractive error caused by unevenly curved surfaces on or in the eye, especially of the cornea Elsevier items and derived items © 2006 by Elsevier Inc.

5.  Miosis is pupillary constriction.  Mydriasis is pupillary dilation.  Accommodation is the process of maintaining a clear visual image when the gaze is shifted from a distant to a near object. Elsevier items and derived items © 2006 by Elsevier Inc.

6.  Decreased eye muscle tone  Ectropion and dry eye  Arcus senilis  Corneal changes  Changes in color of sclera  Less ability to dilate pupil  More light needed for reading Elsevier items and derived items © 2006 by Elsevier Inc.

7.  Lens yellows  Accommodation is gradually lost  Near point of vision increases (presbyopia)  Far point decreases  Color perception decreases  Intraocular pressure Elsevier items and derived items © 2006 by Elsevier Inc.

8.  Inspection: exophthalmos, enophthalmos, ptosis, scleral and corneal assessment  Pupillary assessment: anisocoria, consensual response (brisk, sluggish, nonreactive or fixed) (Continued) Elsevier items and derived items © 2006 by Elsevier Inc.

9.  Go to medicalvideos.us eye exam Elsevier items and derived items © 2006 by Elsevier Inc.

10.  Tests for measurement of vision: acuity, near-vision testing, confrontation test Snellen chart and Rosenbaum  Assessment of extraocular muscle function Elsevier items and derived items © 2006 by Elsevier Inc.

11.  Slit-lamp examination  Corneal staining  Tonometry  Ophthalmoscopy  Ultrasonography  Fluorescein angiography  Electroretinography Elsevier items and derived items © 2006 by Elsevier Inc.

14.  Inflammation of the eyelid edges  Itchy, red, and burning eyes  Seborrhea of the eyebrows and eyelids with greasy scales and mattering  Control with eyelid care using warm, moist compresses followed by gentle scrubbing with diluted baby shampoo  Avoidance of rubbing the eyes Elsevier items and derived items © 2006 by Elsevier Inc.

16.  Turning inward of the eyelid causing the lashes to rub against the eye  Caused by eyelid muscle spasms, or result of trauma  Eyelid turned inward; red conjunctiva  Surgical correction of eyelid position  Instruction in procedure to instill eyedrops Elsevier items and derived items © 2006 by Elsevier Inc.

18.  Turning outward and sagging of the eyelid  Caused by relaxation of the orbicular muscle  Reduced washing action of tears, leading to corneal drying and ulceration  Surgery to restore proper lid alignment Elsevier items and derived items © 2006 by Elsevier Inc.

20.  Stye can be external or internal.  Treatment is with warm compresses four times a day and antibacterial ointment, which may blur vision.  To remove ointment, close the eye and gently wipe the closed eyelid from the nasal side of the eye outward. Elsevier items and derived items © 2006 by Elsevier Inc.

22.  Inflammation of sebaceous gland in eyelid.  Most protrude on the inside of eyelid.  Eye fatigue, light sensitivity, and excessive tears result. (Continued) Elsevier items and derived items © 2006 by Elsevier Inc.

23.  Treatment consists of warm compresses for 15 minutes 4 times per day, followed by instillation of ophthalmic ointment.  Surgery is an option. Elsevier items and derived items © 2006 by Elsevier Inc.

25.  Also called dry eye syndrome, results from changes in tear composition, lacrimal gland malfunction, or altered tear distribution  Artificial tears, lubricating ointment  Surgery Elsevier items and derived items © 2006 by Elsevier Inc.

27.  Hemorrhage  Conjunctivitis  Trachoma Elsevier items and derived items © 2006 by Elsevier Inc.

28.  Keratoconus is the degeneration of the cornea, deposits in the cornea, dystrophies, keratitis, or ulceration of the corneal surface  Reduce symptoms, restore corneal clarity, enhance client’s ability to use remaining vision  Antibiotics, antifungals, antivirals, steroids Elsevier items and derived items © 2006 by Elsevier Inc.

29.  Clouding of the lens, blurring of the lens distorts the image and color projected onto the retina.  As cataract matures, opacity makes it difficult to see the retina.  Visual acuity is restricted. Elsevier items and derived items © 2006 by Elsevier Inc.

30.  Interventions include: › Surgery to remove cataract and implant a small, clear, plastic lens › Enhanced social interaction › Safety issues Elsevier items and derived items © 2006 by Elsevier Inc.

31.  Antibiotics given subconjunctivally.  Eye is unpatched. Discharge usually occurs within 1 hr with dark glasses.  Instill antibiotic-steroid eyedrops. - TobraDex  Mild itching is normal. *bloodshot eye*  Pain indicates a complication.  Reduce IOP - Diamox  Prevent infection.  Assess for bleeding. *no ASA* Elsevier items and derived items © 2006 by Elsevier Inc.

32.  Report to surgeon: sharp, sudden pain in the eye, bleeding or increased discharge, lid swelling, decreased vision, or flashes of light or floating shapes.  Avoid activities that might increase IOP.  Review procedure for use of eyedrops. Elsevier items and derived items © 2006 by Elsevier Inc.

33.  Group of ocular diseases resulting in increased IOP  Primary open-angle glaucoma  Angle-closure glaucoma Elsevier items and derived items © 2006 by Elsevier Inc.

34.  Cupping and atrophy of the optic disc, disc wider and deeper and turns white or gray  Visual field measurement  Headache or brow pain, nausea and vomiting, colored halos around lights, and sudden blurred vision with decreased light perception Elsevier items and derived items © 2006 by Elsevier Inc.

35.  Tonometry  Tonography  Gonioscopy Elsevier items and derived items © 2006 by Elsevier Inc.

36.  Pupillary constriction: miotics, pilocarpine hydrochloride  Inhibition of aqueous humor: timolol, levobunolol, beta blockers, carbonic anhydrase inhibitors  Osmotic drugs part of emergency treatment for rapid reduction of IOP  No epinephrine used in angle-closure glaucoma because it dilates the pupil Elsevier items and derived items © 2006 by Elsevier Inc.

37.  Hyphema  Contusion  Foreign bodies  Lacerations  Penetrating injuries Elsevier items and derived items © 2006 by Elsevier Inc.

38.  Interventions include: › Communication regarding use of adaptive items › Safety in familiar settings › Ambulation assisted with care › Self-care and independence promoted › Support for the difficulty of adapting to loss of sight Elsevier items and derived items © 2006 by Elsevier Inc.

40.  Go to medicalvideos.us examination of the ear. Elsevier items and derived items © 2006 by Elsevier Inc.

42.  Review of the structure of: › External ear › Middle ear › Inner ear Elsevier items and derived items © 2006 by Elsevier Inc.

43.  Drier, impacted cerumen  Loss of tympanic membrane elasticity  Decreased bony ossicle movement  Degenerative changes of cochlea  Disturbed vestibular function  Diminished hearing acuity  Decreased ability to hear high- frequency sounds Elsevier items and derived items © 2006 by Elsevier Inc.

44.  Thorough history from client  Demographic data, gender, age  Family history and genetic risk  Personal history of past hearing involvement  Socioeconomic status  Current health problems Elsevier items and derived items © 2006 by Elsevier Inc.

45.  External ear and mastoid assessment  Otoscopic assessment  Cultural considerations, including color of the lining of the external ear canal and cerumen, which varies according to skin tone Elsevier items and derived items © 2006 by Elsevier Inc.

46.  Conductive hearing loss resulting from any physical obstruction of sound wave transmission  Sensorineural hearing loss resulting from a defect in the cochlea, the eighth cranial nerve, or the brain  Mixed conductive-sensorineural hearing loss, a profound hearing loss Elsevier items and derived items © 2006 by Elsevier Inc.

47.  Voice test  Watch test  Audioscopy  Weber tuning fork test  Rinne tuning fork test Elsevier items and derived items © 2006 by Elsevier Inc.

48.  Laboratory tests  Computed tomography  Magnetic resonance imaging  Auditory brainstem-evoked response  Electronystagmography  Caloric testing  Dix-Hallpike test for vertigo Elsevier items and derived items © 2006 by Elsevier Inc.

49.  Frequency is the highness or lowness of tones.  Intensity is expressed in decibels.  Threshold is the lowest level of intensity at which pure tones and speech are heard.  Pure tones are generated by an audiometer to determine hearing acuity. Elsevier items and derived items © 2006 by Elsevier Inc.

50.  Air conduction test  Bone conduction test  Speech audiometry  Speech reception threshold  Speech discrimination  Tympanometry Elsevier items and derived items © 2006 by Elsevier Inc.

52.  Painful condition caused when irritating or infective agents come into contact with the skin of the external ear  Commonly called swimmer’s ear  Treatment focused on reducing inflammation, edema, and pain with heat, bedrest, limited head movement, topical antibiotic and steroid therapy, and analgesics Elsevier items and derived items © 2006 by Elsevier Inc.

53.  Localized external otitis caused by bacterial infection of a hair follicle  Hearing impaired if the lesion blocks the canal, most commonly cerumen (wax)  Treatment with local and systemic antibiotics, heat application, earwick to relieve pain, and possible incision and drainage Elsevier items and derived items © 2006 by Elsevier Inc.

54.  Infection of the perichondrium, a tough fibrous tissue layer that surrounds the cartilage and gives shape to the pinna.  Goal is to eliminate the infection Elsevier items and derived items © 2006 by Elsevier Inc.

55.  Cerumen (wax) is the most common cause of an impacted canal.  Other blockages include vegetables, beads, pencil erasers, insects.  Irrigate canal with a mixture of water and hydrogen peroxide at body temperature for impacted cerumen; Cerumenex softens wax.  Carefully remove foreign object. Elsevier items and derived items © 2006 by Elsevier Inc.

56.  Three types of otitis media include: › Acute otitis media › Chronic otitis media › Serous otitis media Elsevier items and derived items © 2006 by Elsevier Inc.

57.  Quiet environment  Bedrest with limited head movement  Heat and cold applications  Systemic and topical antibiotic therapy  Analgesics  Antihistamines  Decongestants Elsevier items and derived items © 2006 by Elsevier Inc.

58.  Myringotomy is a surgical opening of the pars tensa of the eardrum.  Operative procedure includes grommet (polyethylene tube) placed through the tympanic membrane.  Postoperative care: keep external ear and canal free of other substances while the incision is healing and keep head dry for several days. Elsevier items and derived items © 2006 by Elsevier Inc.

59.  Go to entusa.com  Mayo clinic ear tubes Elsevier items and derived items © 2006 by Elsevier Inc.

60.  Infection of the mastoid air cells caused by untreated or inadequately treated otitis media  Nonsurgical management: antibiotics (Continued) Elsevier items and derived items © 2006 by Elsevier Inc.

61.  Surgical management: simple or modified radical mastoidectomy with tympanoplasty  Complications: damage to cranial nerves, vertigo, meningitis, brain abscess, chronic purulent otitis media, and wound infection Elsevier items and derived items © 2006 by Elsevier Inc.

62.  Conjunctivitus or pink eye is an inflammation of the conjunctival sac  S/S itching, burning, photophobia cratchy eyelids redness edema and thick discharge  Allergiy? Infection? infants could be from blocked lacrimal duct or most common chlamydia May have to use systemic abx. If chlamydia Elsevier items and derived items © 2006 by Elsevier Inc.

63.  Treat the cause.. ABX or steroids for severe allergies  Nursing Considerations: No sharing of towels, washcloths correct administration of eye drops never share eye medications prevent injury to the eye no rubbing of the eye throw out eye make- up, do not wear contacts replace if possible. Elsevier items and derived items © 2006 by Elsevier Inc.