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

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physical assessment of eye and vision
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
physical assessment of ear and hearing
Physical Assessment of Ear and Hearing
  • Hearing
    • Weber test
    • Rinne test
    • Whisper test
eye disorders
Eye Disorders
  • Age Related Vision 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”
eye disorders6
Eye Disorders
  • Inflammatory Disorders
    • conjunctivitis
      • inflammation of the conjunctiva
      • bacterial or viral
  • Treatment
    • topical anti-infectives
    • anti-inflammatories
eye disorders7
Eye Disorders
  • Corneal Infections/Inflammations
    • corneal scarring and ulcerations are a major cause of world-wide blindness
  • Treatment
    • Corneal Transplant
the client with eye trauma
The Client with Eye Trauma
  • Corneal Abrasion
  • Burns
  • Penetrating Trauma
  • Blunt Trauma
  • Treatment
    • topical anesthesia
    • facial X-rays or C-T Scans
the client with eye trauma10
The Client with Eye Trauma
  • Foreign body removal
    • sterile saline irrigation
  • Eye irrigation
    • chemical burn
  • Surgery
    • penetrating wound
the client with cataracts
The Client with Cataracts
  • Cataract
    • 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
the client with cataracts12
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
post operative nursing care
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
glaucoma
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
glaucoma16
Glaucoma
  • Open Angle
    • common (90%)
    • >35yrs, genetic link, African-American
  • Pathophysiology
    • impaired aqueous outflow
    • increased intraocular pressure
    • usually bilateral
glaucoma17
Glaucoma
  • Clinical Manifestations
    • none
    • frequent lens changes in glasses
    • impaired night vision
    • halos
    • reduction of vision field, become narrow
    • increased intraocular pressure (tonometry)
glaucoma18
Glaucoma
  • Treatment
    • miotics - pilocarpine
    • Laser Surgery (trabeculoplasty)
      • cause scar tissue to create tension to stretch opening to drain aqueous fluid
diabetic retinopathy
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
diabetic retinopathy21
Diabetic Retinopathy
  • Management
    • Yearly ophthalmologic exams
    • Laser photocoagulation
    • Focus is educational
      • vision changes -blurred
      • black spots (Floaters)
      • flashing lights
      • sudden loss of vision
ear disorders
Ear Disorders
  • External Otitis
    • swimmers ear
    • pseudomonas, bacteria, fungus or trauma
    • Treatment
      • cleansing
      • antibiotics - local and systemic
      • education
ear disorders24
Ear Disorders
  • Otitis Media
    • inflammation of middle ear
    • common in infants and young children
    • Red bulging tympanic membrane
  • Treatment
    • antibiotics
    • myringotomy
inner ear disorders
Inner Ear Disorders
  • Meniere’s Disease
    • chronic
    • recurrent attack of vertigo with tinnitus
    • progressive hearing loss
  • Treatment
    • antivert
the client with hearing loss
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
the client with hearing loss28
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