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eye and auditory
| Question | Answer |
|---|---|
| lacrimal apparatus | manufactures and drains tears to keep the eyeball moist,sweeps away debris. |
| what are tears composed of? | salt,mucus and a bactericidial called lysozymes |
| what is the conjuctiva? | thin mucous membrane that lines the inner aspect of the eyelids and the anterior surface of the eyeball to the edge of the cornea |
| bloodshot eyes | the blood vessels of the conjuctiva become dilated due to irritation or congestion |
| sclera | thick,white,opaque connective tissue of the eye. gives shape and protects inner eye structures |
| what is the central anterior portion of the sclera | cornea |
| what is the purpose of the cornea? | 1st to refract light, covers the iris and allows light rays to enter the inner portion of the eye. |
| which nerve innervates the cornea | trigeminal nerve |
| aqueus humor | watery fluid in front of the lens in the anterior chamber of the eye. |
| is corneal curvature more or less pronounced in youth than advanced age? | corneal curvature is more pronounced |
| what is the vascular tunic? | middle layer of the eyeball which contains choroid,ciliary body and the iris. |
| the posterior portion of the vascular tunic | choroid=thin, dark brown membrane that lines the most internal area of the sclera |
| what is the function of the vascular tunic? | supplies nutrient to the retina |
| what is Accommodation | Evaluation of the eye as it adjusts to seeing objects at various distances. |
| what is Exophthalmos: | Protrusion of the eyeballs |
| Miotic | Substance that contracts the pupil |
| Mydriatic | Substance that dilates the pupil |
| Sjogren’s (pronounce: Shogren’s) Syndrome: | Decreased tear secretion and increased tear evaporation with dry mouth. |
| Snellen’s Test | For screening visual acuity; Use chart with eye patch or cover; Pt stands 20 feet away from the chart |
| Snellen’s Test | ; If abnormal findings, pt should seek further testing |
| Amsler’s Grid Test | Used to detect defects of the macular area of the retina; Fixate eyes on center dot and record any abnormalities of grid lines, such as wavy, missing, or distorted |
| Exophthalmometry | Equipment used to measure the degree of forward placement of the eye |
| Slit-lamp | Used to examine the conjunctiva, lens, vitreous humor, iris and cornea |
| Radial keratotomy | Surgery that uses partial thickness, radial incisions in the cornea, leaving an uncut optical cente |
| Retinal detachment | Separation of the retina from the choroid |
| Tonometry | Measurement of intraocular pressure to detect tumors and glaucoma |
| Schirmer tear test | Measures tear volume produced during a fixed time period |
| Ophthalmoscopy | Evaluation of underlying structures of the eye |
| Retinoscopy | Refraction through retinoscope or sample lens; Measurement of visual acuity to determine refractory errors |
| Myopia | nearsightedness |
| Hyperopia | farsightedness |
| Presbyopia | inability to focus on close objects |
| Astigmatism | blurred vision due to curvature defects in the cornea |
| Assessing a Patient with a Visual Disorder | Eye pain; Pruritis; Excessive tearing; Floaters; Light flashes; Discharge; Visual changes; Blind spots; History of allergies; |
| Elevated pressure in eye may be caused by | glaucoma, bending, coughing, sneezing, blow nose, lifting, or straining |
| Blindness & Near Blindness | Individuals with a maximum visual acuity of 20/200 with corrective eyewear and/or visual field sight reduced by 20 degrees (normal is 180). |
| Blindness & Near Blindness Assessment: Subjective | Early onset may be blurred vision; Determine onset, duration, and severity; Determine factors that relieve symptoms |
| Blindness & Near Blindness Objective: | Note rubbing and squinting; Use of compensating measures; Use of assistive eyewear |
| Blindness & Near Blindness Diagnostic | Snellen’s test;Amsler’s chart;Exopthalmometry;Slit-lamp;Tonometry;Schmirmer tear test;Opthalmoscopy;Retinoscopy |
| Blindness & Near Blindness Medical Management | Corrective lens;Assistive devices: canes,guide dogs,magnifying devices;Surgical correction |
| Blindness & Near Blindness Nursing Management | Assist with ADLs;Use protective devices;Alter surroundings to promote safety;Arrange objects in a room one way & don’t rearrange;Encourage blind person to touch objects |
| Astigmatism Clinical Manifestations | Blurring of vision |
| Astigmatism Diagnostic tests | Opthalmoscope, retinoscopy, visual acuity & refractory tests |
| Astigmatism Medical Management | Corrective lens; Surgery |
| Strabismus | Inability to focus the eyes in the same direction, commonly called cross eyed |
| Strabismus | result from neurological or muscular dysfunction |
| Esotropia | Eye turns in the direction of the nose. |
| Exotropia | Eye turns outward |
| Exotropia Diagnostic tests | Ophthalmoscope; Retinoscopy; Visual acuity tests; Refractory tests. |
| Exotropia Medical Management | Corrective lens; Surgery |
| Exotropia Nursing diagnosis | Risk of injury; Orient to surroundings; Arrange objects in certain way |
| Hordeolum | Stye= Acute infection of eyelid margin or sebaceous glands of the eyelashes |
| Hordeolum | Anti-infective agents;Drainage of stye;NS compresses 10-20 min,2-4 q day;No more tears shampoo to cleanse lids |
| Blepharitis | Inflammation of eyelid margins, Caused by psoriasis, seborrhea or allergic reaction |
| Blepharitis | C/O itchy eyes, lids adhere together during sleep, |
| Conjunctivitis Medical Management | No mascara 3-6 months |
| Sulamyd (sulfacetamide sodium) | antiinfective(used for ocular infections;conjunctivitis;corneal ulcer;trachoma;chlamydia)Garamycin (gentamycin sulfate)antibiotic |
| Keratitis | Inflammation of the cornea,may result from trauma,allergens, viral infections,dirty contact lenses or diseases such as Congenital syphilis or Smallpox. |
| Keratitis Objective | Facial grimacing, lacrimation, photophobia |
| Keratitis Diagnostic Tests | C&S; Flourescein staining & gram’s staining; Ophthalmoscopic examination |
| Keratitis Medical Management | Topical&systemic antibiotic;Cycloplegic-mydriatic&pain meds;Pressure dressings;Epithelial debridement of loose tissues;(corneal transplant,keratoplasty). |
| Dry (gritty) Eyes | noninfectious disorder of the lacrimal gland,decreased tear secretion or increased tear film evaporation |
| Keratoconjunctivitis sicca | lacrimal gland dysfunction from an autoimmune mechanism |
| primary “Sjogren’s syndrome | the patient with Keratoconjunctivitis sicca associated dry mouth, |
| Keratoconjunctivitis sicca Medical Management | Liquifilm Forte(polyvinyl alcohol);Visine;plugs to close tear ducts;HRT for menopausal women;Decrease/avoid dry eye med as a side effects;filtering machine to reduce environmental irritants; Surgery. |
| Ectropion | In the older patient it is common for the orbicularis oculi muscle to be relaxed (as with Bell’s palsy). |
| Ectropion | eyelid laceration and burns of the conjunctival |
| Entropion | Caused by atrophy of the eyelid tissue,spasm of the orbicularis oculi muscle,or scarring of the tarsal plate(congenital or trauma) |
| Intracapsular | Removal of the lens with its capsule |
| Extracapsular, | Removal of the lens leaving posterior portion of its capsule (preferred). |
| Intracapsular,Extracapsular | Preoperative: Instill eye drops as prescribed wearing gloves |
| Intracapsular,Extracapsular | Postoperative: Instill prescribed (mydriatic, cyclopegic, corticosteroid) eye drops into the conjunctival sac, wearing gloves |
| Intracapsular,Extracapsular | avoid sudden head movement, heavy lifting, bending over, coughing, sneezing, straining(bowel movement) & vomiting |
| Diabetic retinopathy | retinal blood vessels characterized by capillary microaneurysms,hemorrhages, exudates,creation of new blood vessels&connective tissue |
| Diabetic retinopathy | total retinal detachment & blindness; Appears 10 years after onset of DM, causes by poorly controlled DM, results in vision loss and floaters |
| Vitrectomy | done when photocoagulation is not possible |
| Macular Degeneration | Condition of aging retina with slow loss of central and near vision |
| Wet type or neovascular degeneration | new growth in the macular region; macula is displaced & scarred |
| Dry type or nonexudative or nonvascular degeneration | light deposits occur |
| Gradual loss of bilateral central vision | Color perception is affected |
| Retinal Detachment | Separation of the retina from the choroid,Caused by trauma;Aging; Severe physical exertion (inflammation). |
| Retinal Detachment Clinical Manifestations | Sudden or gradual development of flashes of light, floating spots; Loss of specific field of vision. |
| Cryosurgery | To freeze the borders of retinal hole with a frozen-tipped probe. |
| Diathermy | To burn a retina break using ultrasonic probe |
| Scleral buckling | Extraocular surgical procedure that indents the globe so the pigment epithelium, choroids & sclera move toward the detached retina |
| Scleral buckling | MD sutures a silicone implant against the sclera,causing sclera to buckle,helps seal the retinal tear. |
| Scleral buckling | cycloplegicmydriatic & anti-infective eye drops; Eye patch(es) Rest for 1-2 days; Dark glasses (reduces photophobia). |
| Glaucoma | elevated pressure within the eye,obstruction of the outflow of aqueous humor;Associated with progressive loss of peripheral vision |
| Chronic simple glaucoma (Open-angle glaucoma) | beta-blockers: mitotics, carbonic anhydrase inhibitors |
| Trabeculectomy | removes the corneoscleral tissue, canal of Schlemm & trabecular meshwork. |
| Acute glaucoma | Treats with Osmotic diuretics (Mannitol)Iridectomy,Iridotomy |
| Iridectomy | (removes part of the iris) |
| Iridotomy | (an incision in the iris to create an opening for the aqueous flow). |
| Chronic or Open-angle glaucoma | tunnel vision, eye pain, difficulty in adjusting to darkness, halos seen around lights, and inability/failure to detect color. |
| Chronic or Open-angle glaucoma | Reduce intraocular pressure by decreasing aqueous humor.Treat with beta-blockers: mitotics, carbonic anhydrase inhibitors |
| Acute glaucoma | Schiotz tonometry,Intraocular pressure, optic disc cupping |
| Trabeculectomy | (removes the corneoscleral tissue, canal of Schlemm & trabecular meshwork) |
| Keratoplasty | Excision of the corneal tissue, followed by surgical implantation of cornea from another human donor |
| Keratoplasty | On back or non-operative side;Activity restriction to avoid eye injury;Safety measures until pt can ambulate; No bending,lifting or straining x 1 month |
| Keratoplasty | Systemic & topical medication administered; strict aseptic technique with dressing changes; avoid irritants that may cause sneezing |
| Photocoagulation | A nonsurgical procedure in which a laser, a small, intense beam of light is directed into a small spot on the retina. The light converts to heat energy, coagulates tissue protein, and cauterizes hemorrhaging vessels |
| Vitrectomy | Removes excess vitreous fluid caused by hemorrhage and replaces with normal saline |
| Eye Medications Anti-infective agent Sulamyd (Sulfacetamide sodium): | Treatment of ocular infections |
| Eye Medications Steroid: Decadron (Dexamethasone) | Antiinflammatory For Ocular inflammation,it may mask infection |
| Eye Medications Timolol (Timolol maleate): | Open angle glaucoma, |
| Eye Medications Osmotic diuretic | For Glaucoma; Decreases IOP-ICP,IV administration;last 1-3 hrs; VS q 1 hr, I&O, weight, and K+ level. |
| Eye Medications Artificial tears: Liquifilm Forte (Polyvintyl | Dry eyes and eye irritations |
| Eye Medications Bactericidal antibiotic: Garamycin (Gentamycin sulfate) | For Blepharitis and conjunctivitis |
| Pinna or auricle | external auditory canal |
| Tinnitus: | A subjective noise sensation heard in one or both ears; ringing or tinkling sounds in the ear |
| Vertigo (dizziness): | The sensation that the outer world is revolving (spinning) about oneself or that one is moving in space. |
| Weber's test: | placing the stem of a vibrating tuning fork in the center of the patient's forehead or on the maxillary incisors |
| Changes in the Ear with Aging,(Presbycusis, | Deterioration of the nerve fibers and breakdown of the cells in the organ of Corti; |
| Presbycusis | hearing loss caused by aging); This results in: Distortion of speech |
| Otoscopy | Direct visualization of the external auditory canal and the eardrum |
| Tuning fork test | Used to determine hearing loss (auditory acuity) and type of hearing loss (conductive or sensorineural loss) |
| Rinne test | Fork is placed half inch away from ear; While one ear is tested the other is masked. |
| Audiometric testing | test of hearing acuity. determine the lowest intensity of sound at which an individual can perceive auditory stimulus (hearing threshold), hear frequencies, and distinguish speech tones |
| Vestibular testing | Measures balance and equilibrium. |
| Rombert test | Measures the patient's ability to perform specific tasks with eyes open and then with eyes closed |
| Past-point testing | patient’s ability or inability to place a finger accurately on a selected point on the body. Inability to correctly perform the test indicates lack of coordination in voluntary movements |
| Loss of Hearing (Deafness): | Hearing impairment is a state of decreased auditory acuity that ranges from partial to complete hearing loss. |
| Types of Hearing Loss | Conductive; Sensorineural, Mixed, Congenital, and Functional hearing loss |
| Conductive hearing loss: | Caused by any disease or injury that interferes with conduction of sound waves to the inner ear; Sound is inadequately delivered through the external or middle ear to the inner ear. |
| Sensorineural hearing loss (nerve deafness): | Sound heard longer from air conduction; Results from malfunction of the inner ear, vestibulocochlear nerve, or auditory center of the brain. |
| Mixed Hearing Loss | A combination of conductive and sensorineural hearing loss |
| Congenital Hearing Loss | Anoxia,trauma during delivery; Rh incompatibility; Using of ototoxics during pregnancy, Mother’s exposure to syphilis or rubella may also be causes |
| Functional Hearing Loss | A loss of hearing in which there is no organic cause. It is also known as psychogenic or Nonorganic hearing loss. |
| Central hearing loss | the brain’s auditory pathways are damaged, a in cerebrovascular accident |
| Assessment of the Ear | of ear drainage,tinnitus,),vertigo, wax buildup, pressures, pain and pruritus. |
| Hearing Diagnostic Tests | Conductive hearing loss produces lateralization of sound to the deaf ear in Weber’s test |
| Hearing Diagnostic Tests | Sensorineural hearing loss produces lateralization of sound to the better ear in Weber’s test. |
| Hearing Diagnostic Tests | Rinne test=sounds transmitted through bone conduction are heard longer than or equal to sounds transmitted through air conduction.less than sensorineural |
| Hearing aids or Cochlear implants | Cochlear implantation is performed in individuals with profound bilateral sensorineural hearing loss |
| Otitis Externa | The most common cause is contact with contaminated water |
| Otitis Media | Fluid collects in the middle ear as a result of obstruction of the auditory tube; May be caused by infection, allergy or tumors; |
| Mastoiditis | Infection of one of the mastoid bones, from an untreated or inadequately treated middle-ear infection |
| Cholesteatoma | Occurs when a tympanic membrane perforation allows Squamous epithelium of the external auditory canal to enter and grow in the middle ear. Enlargement is slow, but the mass can expand into the mastoid antrum and destroy adjacent structures |
| Labyrinthitis | An inflammation of the labyrinthine canals of the inner ear; A common cause is a viral upper respiratory infection |
| Otosclerosis | formation of spongy bone, especially around the oval window, ankylosis of the stapes, causing tinnitus and deafness; replacement of normal bone in the otic capsula by highly vascular otosclerotic bone occurs; |
| Meniere’s Disease | A disturbance of the semicircular canals (inner ear) that results in recurrent episodes of vertigo, tinnitus, and progressive unilateral deafness |
| Stapedectomy | Removal of the stapes of the middle ear and insertion of the graft and prosthesis,sound waves through the oval window |
| Stapedectomy Postoperative teaching | Teach patient to open mouth when sneezing or coughing |
| Tympanoplasty | Any operative procedures on the eardrum or ossicles of the middle ear designed to restore or improve hearing in patients with conductive hearing loss. |
| Myringotomy: | A surgical incision of the eardrum performed to relieve pressure and release purulent exudates from the middle ear |
| Amoxicillin; Trade name: Amoxil; | Systemic penicillin antibiotic used in acute otitis media |
| Carbamide peroxide 6.5%: Trade name: Debrox | : Softens cerumen; Removal of dry cerumen by irrigation or cerumen spoon. |
Created by:
SGT.MOSS
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