Visual or Auditory Disorder Mosby items and derived items 2011 2007 by Mosby Inc an affiliate of Elsevier Inc Overview of Anatomy and Physiology Anatomy of the eye Accessory structures of the eye ID: 774658
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Slide1
Chapter 13
Care of the Patient with a Visual or Auditory Disorder
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide2Overview of Anatomy and Physiology
Anatomy of the eye
Accessory structures of the eye
Eyebrows
Eyelashes
Eyelids
Lacrimal apparatus
Slide3Figure 13-1
Lacrimal apparatus.
(From Thibodeau, G.A., Patton, K.T. [2007].
Anatomy and physiology.
[6
th
ed.]. St. Louis: Mosby.)
Slide4Overview of Anatomy and Physiology
Anatomy of the eye
(continued)
Structures of the eyeball
Sclera
Cornea
Choroid
Ciliary body
Iris
Pupil
Retina
Slide5Overview of Anatomy and Physiology
Anatomy of the eye
(continued)
Chambers of the eye
Anterior chamber
Aqueous humor
Posterior chamber
Vitreous humor
Slide6Figure 13-2
Horizontal section through the left eyeball. The eye is viewed from above.
(From Thibodeau, G.A., Patton, K.T. [2008].
Structure and function of the body.
[13
th
ed.]. St. Louis: Mosby.)
Slide7Overview of Anatomy and Physiology
Anatomy of the ear
External ear
Auricle
External auditory canal
Tympanic membrane
Middle ear
Eustachian tube
Malleus
Incus
Stapes
Slide8Figure 13-3
The ear. External, middle, and inner ear. (Not to scale.)
(From Thibodeau, G.A., Patton, K.T. [2008].
Structure and function of the body.
[13
th
ed.]. St. Louis: Mosby.)
Slide9Overview of Anatomy and Physiology
Anatomy of the ear
(continued)
Inner ear
Labyrinth
Bony labyrinth—filled with perilymph
Semicircular canals
Vestibule
Cochlea—organ of Corti
Membranous labyrinth—filled with endolymph
Slide10Figure 13-4
The inner ear.
(From Thibodeau, G.A., Patton, K.T. [2005].
The human body in health and disease.
[4
th
ed.]. St. Louis: Mosby.)
Slide11Overview of Anatomy and Physiology
Other special senses
Taste and smell
Taste buds: salty, sweet, sour, bitter
Olfactory receptors: sense of smell
Touch
Tactile receptors
Position/movement
Proprioceptors
Slide12Laboratory and Diagnostic Examinations
Diagnostic eye tests
Snellen test
Color vision
Refraction
Ophthalmoscopy
Tonometry
Amster grid test
Schirmer’s tear test
Slide13Disorders of the Eye
Blindness and near-blindness
Etiology/pathophysiology
Loss of visual acuity
Congenital or acquired
Legal blindness
20/200 with corrective eyewear (normal 20/20)
Visual field less than 20 degrees (normal 180)
Slide14Disorders of the Eye
Blindness and near-blindness
(continued)
Clinical manifestations/assessment
Diplopia
Pain
Floaters and light flashes
Pruritus; burning of the eyes
Loss of peripheral vision
Halos
Orbital pressure
Bulging of the eyes
Slide15Disorders of the Eye
Blindness and near-blindness
(continued)
Medical management/nursing interventions
Corrective eyewear
Canes
Seeing-eye dogs
Magnifying systems
Surgical procedures
Slide16Disorders of the Eye
Refractory errors
Etiology/pathophysiology
Astigmatism—unequal curve in the shape of the cornea or lens
Strabismus—inability of the eyes to focus in one direction; cross-eyed
Myopia—nearsightedness; eyeball is too long
Hyperopia—farsightedness; eyeball is too short
Slide17Disorders of the Eye
Refractory errors
(continued)
Clinical manifestations/assessment
Diminished or blurred vision
Medical management/nursing interventions
Corrective lenses
Surgical correction
Radial keratotomy (RK)
Photorefractive keratectomy (PRK)
Laser-assisted in-situ keratomileusis (LASIK)
Slide18Disorders of the Eye
Conjunctivitis
Etiology/pathophysiology
Inflammation of the conjunctiva
Bacterial or viral infection
Allergy
Environmental factors
Commonly called
pink eye
Slide19Disorders of the Eye
Conjunctivitis
(continued)
Clinical manifestations/assessment
Erythema of the conjunctiva
Edema of the eyelid; crusting discharge
Pruritus; burning; excessive tearing
Medical management/nursing interventions
Warm compresses
Eye irrigations with normal saline
Antibiotic drops or ointment
Keep free from exudate
Slide20Disorders of the Eye
Keratitis
Etiology/pathophysiology
Inflammation of the cornea
Injury, irritants, allergies, viral infection, or diseases
Pneumococcus
,
Staphylococcus
,
Streptococcus
, and
Pseudomonas
are most common types of bacterial causes
Herpes simplex is most common viral cause
Slide21Disorders of the Eye
Keratitis
(continued)
Clinical manifestations/assessment
Severe eye pain
Photophobia
Tearing
Edema
Visual disturbances
Slide22Disorders of the Eye
Keratitis
(continued)
Medical management/nursing interventions
Pharmacological management
Topical and systemic antibiotics
Analgesics
Pressure dressings
Warm or cold compresses
Epithelial debridement
Keratoplasty
Slide23Disorders of the Eye
Dry eye disorders (keratoconjunctivitis sicca)
Etiology/pathophysiology
Lacrimal gland dysfunction from an autoimmune mechanism
Clinical manifestations/assessment
Complaints of sandy or gritty sensation in the eye
Medical management/nursing interventions
Artificial tear replacement
Punctal plugs or repair if injured
Slide24Disorders of the Eye
Ectropion and entropion
Etiology and pathophysiology
Noninfectious disorders of the eye lid causing abnormal eyelid margins
Clinical manifestations
Abnormal direction of the eyelid
Corneal dryness
Medical management/nursing interventions
Topical medications to reduce conjunctival and corneal drying
Surgery
Slide25Disorders of the Eye
Cataracts
Etiology/pathophysiology
Noninfectious opacity or clouding of the lens
Congenital; acquired; senile
Clinical manifestations/assessment
Blurred vision
Diplopia
Photosensitivity
Decreased night vision
Opacity in the center portion of lens
Slide26Disorders of the Eye
Cataracts
(continued)
Medical management/nursing interventions
Surgical removal
Lens implant or glasses
Postoperative
Avoid direct sunlight
Bed rest with bathroom privileges (BRPs)
Analgesics
No bending down or straining
Avoid coughing, sneezing, and blowing nose
Slide27Disorders of the Eye
Diabetic retinopathy
Etiology/pathophysiology
Capillary microaneurysms, hemorrhage, exudates, and formation of new vessels and connective tissue in the retina
Clinical manifestations/assessment
Microaneurysms
Progressive loss of vision; “floaters”
Medical management/nursing interventions
Photocoagulation
Vitrectomy
Slide28Disorders of the Eye
Macular degeneration
Etiology/pathophysiology
Slow, progressive loss of central and near vision due to aging retina
Clinical manifestations/assessment
Gradual and variable bilateral loss of vision
Color perception may also be affected
Medical management/nursing interventions
Usually no treatment
May use photocoagulation
Slide29Disorders of the Eye
Retinal detachment
Etiology/pathophysiology
Separation of the retina from the choroid in the posterior area of the eye
Clinical manifestations/assessment
Flashes of light; floating spots
Loss of a specific field of vision
Medical management/nursing interventions
Photocoagulation; cryosurgery; diathermy
Scleral buckling
Slide30Figure 13-8
Retinal break with detachment: surgical repair by scleral buckling technique.
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007].
Medical-surgical nursing: assessment and management of clinical problems.
[7
th
ed.]. St. Louis: Mosby.)
Slide31Disorders of the Eye
Glaucoma
Etiology/pathophysiology
An abnormal condition of elevated pressure within an eye; obstruction of outflow of aqueous humor
Open-angle
Closed-angle
Slide32Figure 13-9
A, Chronic open-angle glaucoma. B, Acute-angle closure glaucoma.
(From Havener, W.H. [1997].
Synopsis of ophthalmology
. St. Louis: Mosby.)
Slide33Disorders of the Eye
Glaucoma
(continued)
Clinical manifestations/assessment
Open-angle
No signs or symptoms during early stages
Tunnel vision
Eye pain
Difficulty adjusting to darkness
Halos around lights
Inability to detect colors
Slide34Disorders of the Eye
Glaucoma
(continued)
Clinical manifestations/assessment
Closed-angle
Severe pain
Decreased vision
Nausea and vomiting
Erythema of the sclera
Enlarged and fixed pupil
Halos around lights
Slide35Disorders of the Eye
Glaucoma
(continued)
Medical management/nursing interventions
Open-angle glaucoma
Beta blockers
Miotics
Carbonic anhydrase inhibitors
Closed-angle
Osmotic diuretics
Iridectomy
Slide36Disorders of the Eye
Corneal injuries
Etiology/pathophysiology
Result from injuries to corneal layers of the eye
Clinical manifestations/assessment
Pain with movement of eye
Excessive tearing; pruritus
Erythema of conjunctiva
Slide37Disorders of the Eye
Corneal injuries
(continued)
Medical management/nursing interventions
Flush with normal saline or water
Antibiotic drops or ointment
Penetrating wounds
Do not remove object if present
Slide38Surgeries of the Eye
Enucleation
Surgical removal of the eyeball
Keratoplasty (corneal transplant)
Excision of the corneal tissue, followed by implantation of a cornea from a donor
Photocoagulation
A laser is directed into a small spot on the retina
Vitrectomy
Removal of excess vitreous fluid caused by hemorrhage and replacement with normal saline
Slide39Laboratory and Diagnostic Examinations
Diagnostic ear tests
Otoscopy
Tuning fork tests
Weber’s test
Rinne test
Autometric testing
Vestibular testing
Romberg test
Past-point testing
Slide40Figure 13-13
Weber tuning fork test.
(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003].
Mosby’s guide to physical examination
. [5
th
ed.]. St. Louis: Mosby.)
Slide41Figure 13-14
Rinne tuning fork test.
(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003].
Mosby’s guide to physical examination
. [5
th
ed.]. St. Louis: Mosby.)
Slide42Loss of Hearing (Deafness)
Hearing impairment
Etiology/pathophysiology
Decreased auditory acuity; partial or complete
Affects development of speech
Types
Conductive
Sensorineural
Mixed
Congenital
Functional
Central
Slide43Loss of Hearing (Deafness)
Hearing impairment
(continued)
Clinical manifestations/assessment
Requests for repeating information
Nonresponse
Delayed speech development
Medical management/nursing interventions
According to cause
Hearing aids
Surgical procedures
Cochlear implant
Slide44Inflammatory and Infectious Disorders of the Ear
External otitis
Etiology/pathophysiology
Inflammation or infection of the external canal
Clinical manifestations/assessment
Pain with movement of auricle or chewing
Erythema, scaling, pruritus, edema, watery discharge, and crusting of the external ear
Medical management/nursing interventions
Oral analgesics; corticosteroids
Antibiotic or antifungal ear drops; oral antibiotics
Slide45Inflammatory and Infectious Disorders of the Ear
Otitis media
Etiology/pathophysiology
Inflammation or infection of the middle ear
Clinical manifestations/assessment
Fullness in the ear
Severe, deep, throbbing pain
Hearing loss
Tinnitus
Fever
Slide46Inflammatory and Infectious Disorders of the Ear
Otitis media
(continued)
Medical management/nursing interventions
Pharmacological management
Antibiotics
Analgesics
Nasal decongestants
Local heat
Aspiration of fluid from behind eardrum
Myringotomy
Slide47Inflammatory and Infectious Disorders of the Ear
Labyrinthitis
Etiology/pathophysiology
Inflammation of the labyrinthine canals of the inner ear
Most common cause of vertigo
Viral infection from URI
Drugs and food
Tobacco and alcohol
Slide48Inflammatory and Infectious Disorders of the Ear
Labyrinthitis
(continued)
Clinical manifestations/assessment
Severe and sudden vertigo; ataxic gait
Nausea and vomiting
Nystagmus; photophobia
Headache
Medical management/nursing interventions
Antibiotics
Dramamine or meclizine for vertigo
IV fluids if nausea and vomiting present
Slide49Inflammatory and Infectious Disorders of the Ear
Obstructions of the ear
Etiology/pathophysiology
Impaction of cerumen in canal; foreign bodies
Clinical manifestations/assessment
Tinnitus and pain in the ear
Slight hearing loss; tugging at ear
Medical management/nursing interventions
Removal of cerumen by irrigation
Foreign objects are removed with forceps
Carbamide peroxide to soften cerumen
Slide50Noninfectious Disorders of the Ear
Otosclerosis
Etiology/pathophysiology
Chronic, progressive deafness due to formation of spongy bone, especially around the oval window
Clinical manifestations/assessment
Slowly progressive conductive hearing loss
Tinnitus; dizziness to vertigo
Medical management/nursing interventions
Stapedectomy
Air conduction hearing aid
Slide51Noninfectious Disorders of the Ear
M
é
ni
è
re’s disease
Etiology/pathophysiology
Chronic disease of the inner ear
Increase in endolymph fluid
Clinical manifestations/assessment
Vertigo
Nausea and vomiting
Hearing loss; tinnitus
Diaphoresis
Nystagmus
Slide52Noninfectious Disorders of the Ear
M
é
ni
è
re’s disease
(continued)
Medical management/nursing interventions
No specific treatment
Decrease fluid pressure
Fluid restriction; diuretics; low-salt diet
Dramamine, meclizine, and Benadryl
Surgery
Destruction of labyrinth
Endolymphatic shunt
Cryosurgery
Vestibular nerve section
Slide53Surgeries of the Ear
Stapedectomy
Removal of the stapes of the middle ear
Tympanoplasty
Operative procedures on the eardrum or ossicles of the middle ear to restore hearing
Myringotomy
Surgical incision of the eardrum
Cochlear implant
Surgical implantation of a hearing device for the profoundly deaf
Slide54Nursing diagnosesHealth maintenance, ineffectiveAnxietySelf-care deficitFearImpaired environmental interpretation syndromeImpaired home maintenanceImpaired social interactionRisk for injuryRisk for lonelinessSensory perception, disturbed: auditory or visual
Nursing Process
Slide55Ophthalmic Drugs
CategoriesLocal anestheticsUsed in procedures such as tonometry, gonioscopy, cataract surgery, and removal of foreign objects from the corneaAntiseptic ointmentsPrevent gonorrheal ophthalmia neonatorum in newborn infants, used to treat common eye infections, germicidal and astringent actionOphthalmic antiinfectivesTreat eye infections caused by bacteria, fungi, or viruses
55
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Slide56Ophthalmic Drugs (cont.)
Artificial tearsOther preparationsAntiglaucoma agentsUsesTo control acute narrow-angle glaucoma before surgeryWide-angle glaucomaSecondary glaucomaCongenital glaucoma before surgery
56
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Slide57Glaucoma
Three Major FormsPrimary glaucomaNarrow-angle: person has a shallow anterior eye chamber, may be genetic; requires surgeryWide-angle glaucoma: gradual onset, controlled with medicationsSecondary glaucomaResult of other eye problems, treated with medicationsCongenital glaucomaBirth defect requiring surgical correction
57
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Slide58Antiglaucoma Medications
SympathomimeticsProduce vasoconstriction and decrease intraocular pressure in open-angle glaucomaBeta blockersReduce intraocular pressure by reducing the formation of aqueous humorMiotics, direct-actingCholinergic agonists
58
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Slide59Antiglaucoma Medications (cont.)
Miotics, cholinesterase inhibitorsInactivates acetylcholinesterase Carbonic anhydrase inhibitorsBlocks action of an enzyme in the ciliary body, causing a decrease in aqueous humor secretion
59
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Slide60Antiglaucoma Medications (cont.)
Mydriatic-CycloplegicsBlock the action of acetylcholineMydriatics
60
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Slide61Otic Preparations
Control superficial infections of the earAction is bacteriostatic or bactericidalProphylaxis for infections in swimmersRemoving cerumen
61
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
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