VISION

1
VISION HEARING PROBLEMS

• STC Associate Degree Nursing Program
• Common Concepts of Adult Health - RNSG 1341
• Instructor Karen Fuqua Esmeralda Garza

2
Review AP on your own.
3
CORNEAL DISORDERS
4
(No Transcript)
5
Corneal Disorders

• For visual acuity to occur the cornea must be
  transparent and clear
• Leading cause of visual impairment.
• Specific disorders include keratoconus,
  keratitis and corneal ulcerations.

6
Pathophysiology

• Keratoconus non-inflammatory protrusion of the
  central part of the cornea with degeneration of
  the cornea.
• Causes include
• Autosomal recessive trait (a pattern of
  inheritance resulting from the transmission of a
  recessive allele on an autosome)
• Down syndrome (congenital condition characterized
  by mental retardation and multiple defects
  caused by the presence of an extra chromosome 21)
• Aniridia (rare, congenital, hereditary,
  bilateral, extreme form of iris hypoplasia
  partial or complete absence of iris causing
  visual loss over time)
• Marfan syndrome (hereditary condition that
  affects the musculoskeletal system and
  associated with abnormalities of the CV system
  and the eyes)
• Atoptic allergy (a form of allergy that afflicts
  persons with a genetic predisposition to
  hypersensitivity to certain allergens)
• Retinitits pigmentosa (a group of diseases, often
  hereditary, characterized by bilateral primary
  degeneration of the retina, beginning in
  childhood and progressing to blindness by middle
  age)

7
Pathophysiology

• Keratitis inflammation of corneal.
• Causes include
• Ectropion/Entropion (ectropion - eversion of the
  eyelid, exposing the conjuntival membrane lining
  the eyelid and part of the eyeball entropion
  condition in which the eyelid turns inward toward
  the eye)
• Exophthalmos (an abnormal condition characterized
  by a marked protrusion of the eyeballs)
• Neurologic deficits
• Protozoal infection

8
Pathophysiology

• Corneal Ulcers - the rubbing off of the outer
  layers of the cornea
• Causes include
• Mechanical injury
• Chemical injury
• Drying
• Infection

9
(No Transcript)
10
Signs Symptoms of Corneal Disorders

• Pain
• Altered vision
• Photophobia
• Cloudy or purulent eye drainage
• Cornea may look hazy or cloudy
• Altered corneal light reflex
• Cornea is not intact

• What safety precaution should you use?
• What is the name of the paper used to check
  for this? What color will scratched areas of the
  eye appear?

11
(No Transcript)
12
Medical Management of Corneal Disorders

• Cultures or scrapings
• Drug therapy antibiotics, antifungals,
  antifungals, sterioids (via eye drops, injected
  subconjunctivally, or IV)
• Keratoplasty corneal transplant (diseased
  cornea is removed and replaced with donor
  cornea)

• What material is donor cornea made of?
• Does transplant restore sight?
• How are donor corneas obtained?

13
Medical Management of Corneal DisordersKeratoplas
ty

• Client is awake during procedure with some
  conscious sedation.
• Eye is localized with regional anesthetic around
  and behind the eye to numb it.
• Surgeon removes diseased area (7-8mm). .
• Excision is performed with a trephine (circular
  knifelike a cookie cutter).
• The donors cornea is cut with the same trephine
  and the excised cornea is grafted to the clients
  eye.
• Immediately after surgery, a subconjunctival
  antibiotic injection is given and antibiotic
  ointment instilled.
• When the eye is anesthetized can the client see?
  Can they move their eye? Can they move or see
  out their non-operative eye?

14
Before and after corneal surgery
15
Nursing Management of Corneal Disorders

• Obtain eye culture and send to lab.
• Assist with a corneal scraping.
• Prevent falls.
• Assess for photophobia.
• How do you do an eye culture?
• What equipment is needed for a corneal scraping?
• How are you going to prevent falls?
• What can you do for photophobia?

16
Nursing Management of Corneal DisordersKeratoplas
ty (corneal transplant)Preoperative Care

• Assess anxiety level.
• Approach client calmly.
• Assess knowledge of the surgery.
• Review preop and postop routines.
• Assess eyes for signs of infection.
• Instill eye medications.
• Start IV.

• What behaviors may indicate you client is
  anxious?
• What routines are these?
• What are the signs of infection?
• How do you instill eye drops?
• Where do we start the preop IV?

17
Nursing Management of Corneal DisordersKeratoplas
ty (corneal transplant)Postoperative Care

• Cover eye with a pressure patch and shield. .
• Assess VS drainage.
• Instruct client to lie on nonoperative side.
• Instruct client to on how to change dressing on
  discharge.
• 1st month PO, wear shield at HS.

• Who can change the eye dressing? What is
  required?
• How often are VS taken?
• Why shouldnt client lie on operative site?
• What other times should client wear shield?
• What complications can occur PO?

18
Keratoplasty (corneal transplant)What do you
know?

• Does the cornea have a blood supply?
• What causes the donor site to reject?
• What does the cornea look like when it is being
  rejected?
• What medications are used to prevent inflammation
  and rejection?
• Can donors be alive?

19
When a client dies what should the nurse do if
client is a potential corneal donor?

• Client must be free of infection or cancer.
• Raise the HOB 30 degrees.
• Instill antibiotic eyedrops (Neosporin or
  tobramycin).
• Closes the eyes and apply a small ice pack to the
  closed eyes.
• Contact the family and physician to discuss eye
  donation.

20
CATARACTS
21
(No Transcript)
22
CATARACT

• Is an opacity of the lens that distorts the image
  projected onto the retina. .
• The amount of altered vision depends on where the
  opacity is and how dense it is.
• It can occur in the lens or lens capsule.
• What is the lens capsule?
• When should a cataract be remove?

23
Pathophysiology

• With age the lens loses water and __ density.
• __ density is the result of compressed old lens
  fibers by the growth of new fibers.
• Lens proteins precipitate and form crystals.
• Is a cataract painful?
• Are cataracts usually unilateral or bilateral?
• Do they progress at the same rate?

24
Etiology

• Common causes of cataracts
• Age-related cataracts
• Lens water loss and fiber compaction
• Traumatic cataracts
• Blunt injury to eye or head
• Penetrating eye injury
• Intraocular foreign bodies
• Radiation exposure, therapy

25
Etiology (continued)

• Common causes of cataracts
• Toxic cataracts
• Corticosteroids
• Phenothiazine derivatives
• Miotic agents
• Complicated cataracts
• Retinitis pigmentosa
• Glaucoma
• Retinal detachment

26
Etiology (continued)

• Common causes of cataracts
• Associated cataracts
• Diabetes mellitus
• Hypoparathyroidism
• Down syndrome
• Chronic sunlight exposure

27
Signs Symptoms of cataracts

• Slightly blurred vision (early)
• ?color perception (early)
• Blurred and double vision (late)
• Blindness (late)
• Red reflex is absent (late)

• What is the medical term for double vision?
• What is the red reflex?

28
Medical Management of cataracts

• Only permanent treatment is cataract removal.
• Client/physician determine when cataract is
  removed.
• Usually when there is significant alteration in
  ADLs.
• Surgery is on an outpatient basis.

29
Types of cataract Surgery

• Extracapsular Extraction
• ECCE (extracapsular cataract extraction)
• Incision is made in anterior lens capsule.
• Anterior lens capsule and lens is removed (lens
  cortex and nucleus and any remaining lens
  material).
• Posterior lens capsule remains.
• Most common.

30
Types of cataract Surgery

• Intracapsular cataract Extraction
• Lens and complete capsule is removed.
• Removal of posterior capsule puts client at risk
  for detached retina.

31
Replacement Lens

• With lens removed, the eye cannot accommodate or
  refract (aphakia).
• Replacement lens is needed to focus light ray in
  the retina.
• Lens is made of clear, high-density plastic and
  is implanted at the time of surgery.

32
Replacement Lens (continued)

• Lenses allow for correction of specific
  refractive errors.
• Distant vision can be restored to 20/20.
• May need glasses for reading.
• Newer replacement lens can correct for distance
  refractive errors so glasses or contacts are not
  necessary.

33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
Before and after cataract surgery
37
(No Transcript)
38
Nursing Management of cataract Client

• Assess all clients.
• Using inspection, Snellen chart, ophthalmoscope,
  direct visualization, etc.

39
Nursing Management of cataract Client

• Protect from falls.
• Perform a psychosocial assessment.
• Fears, social isolation, vanity, etc.
• Identify knowledge deficits.
• Determine self-care deficits.

40
Nursing Management of Client Experiencing a
cataract Extraction Preoperative Care

• Educate client about surgery and PO care.
• Start immediate education on admission.
• Start IV infusion.

• Why do you start discharge instructions on
  admission?

41
Nursing Management of Client Experiencing a
cataract Extraction Preoperative Care (continued)

• Administer sedative preop and oral acetazolamide
  (Diamox)

• What is Diamox and why is it given peroperatively?

42
Nursing Management of Client Experiencing a
cataract Extraction Preoperative Care (continued)

• Instill
• sympathomimetic drugs -- phenylephrine
  (Neo-Synephrine)
• Parasympatholytic drugs -- tropicamide
  (Mydriacyl) or cyclopentolate HCl (Cycologyl)

• What is a sympatho-mimetic drug and why is it
  given in this case?
• What is a para-sympatholytic drug and why is it
  given in this case?

43
Nursing Management of Client Experiencing a
cataract Extraction Introperative Care

• Local anesthetic is given behind the eye to
  achieve anesthesia and ensure eye paralysis.
• May receive conscious sedation such as midazolam
  (Versed).

44
Nursing Management of Client Experiencing a
cataract Extraction Postoperative Care

• Immediately after surgery, the nurse administers
  an antibiotic subconjunctivally, and antibotic
  drops and steroid ointment.
• An eye patch and shield may or may not be applied.

45
Nursing Management of Client Experiencing a
cataract Extraction Postoperative Care

• Place client in a semi-Fowlers position or on
  the nonoperative side.
• Observe dressing for drainage report any
  external drainage immediately.
• If dressing is used, physician usually changes
  1st dressing.

46
Nursing Management of Client Experiencing a
cataract Extraction Postoperative Care

• Antibiotic-steroid drops, such as tobramycin
  combined with dexamethasone (TobraDex) are
  instilled.
• Cool compresses may ease itching from small
  stitches.
• Eye discomfort is usually controlled by mild
  analgesics (Tylenol, Percocet, Tylox).

47
Nursing Management of Client Experiencing a
cataract Extraction Postoperative Care

• AVOID GIVING ASA! WHY??
• Pain in early PO period should be reported
  immediately. WHY??

48
Nursing Management of Client Experiencing a
cataract Extraction Postoperative Care

• Be alert for the major complications of surgery
• IOP
• Infection
• Bleeding

49
Nursing Management of Client Experiencing a
cataract Extraction Postoperative Care

• Instruct client to avoid activities that will ?
  IOP
• Bending at waist
• Sneezing, coughing
• Blowing nose
• Straining to have BM
• Vomiting
• Sexual intercourse
• Keeping the head in a dependent position
• Wearing tight shirt collars

• What can be done to prevent
• ? IOP for each of these?

50
Nursing Management of Client Experiencing a
Cataract Extraction Postoperative Care

• ADLs the client is allowed
• Wash hair a day or 2 after surgery, but only with
  the head tilted back.
• When showering stand with face away from shower
  head.
• Cooking/light housekeeping OK, but no vacuuming
  for several weeks.
• Refrain from driving, operating machinery,
  participating in sports until given permission.

51
Nursing Management of Client Experiencing a
cataract Extraction Postoperative Care

• Eyedrops are usually prescribed for 4-6 weeks
  after surgery.

52
Nursing Management of Client Experiencing a
Cataract Extraction Postoperative Care

• Instruct client to report
• Sharp, suddent pain
• Bleeding or ? drainage
• Lid swelling
• Decreased vision
• Flashes of light or floating shapes

53
GLAUCOMA
54
Glaucoma

• Is a group of ocular diseases that result in
  increased IOP.
• Common cause of blindness in industrialized
  world.
• Age related (10 of people older than 80 y.o. are
  affected).

55
Pathophysiology of Glaucoma

• IOP puts pressure on the retina. blood vessels of
  the eye and optic nerve.
• Nerve tissue becomes ischemic and dies.
• Tissue damage usually begins in the periphery and
  moves inward toward the fovea centralis.
• Blindness occurs if not relieved.

56
Pathophysiology of Glaucoma

• IOP is the fluid pressure within the eye.
• Normal IOP is 10-21 mmHg
• The balance between production and outflow of eye
  fluid.

• What is the name of the fluid within the eye?

57
Pathophysiology of Glaucoma

• What can cause increased IOP?
• Decreasing the outflow of aqueous fluid through
  the anterior chamber.
• Overproduction of aqueous humor.

58
Types of Glaucoma

• Glaucoma is classified as
• Primary most common
• Secondary
• Associated

59
Types of Glaucoma (continued)

• Common causes
• Primary
• Aging
• Heredity
• Central retinal vein occlusion

60
Types of Glaucoma (continued)

• Common causes
• Secondary
• Uvetitis
• Iritis
• Neovascular disorders
• Trauma
• Ocular Tumors
• Degenerative disease
• Eye surgery

61
Types of Glaucoma (continued)

• Common causes
• Associated
• Diabetes mellitus
• Hypertension
• Severe myopia
• Retinal detachment

62
Primary Open-Angle Glaucoma (POAG)

• Most common type of primary glaucoma.
• Gradual process.
• Usually bilaterally.
• Asymptomatic in early stages.
• Reduced outflow of aqueous humor through the
  chamber angle.
• Because the fluid cant leave fast enough to keep
  up with production, pressure increases.

63
(No Transcript)
64
(No Transcript)
65
Angle-Closure Glaucoma

• Also called closed-angle glaucoma, narrow-angle
  glaucoma, or acute glaucoma.
• Less common.
• SUDDEN ONSET, WITHOUT WARNING!!!
• MEDICAL EMERGENCY!!!

66
Angle-Closure Glaucoma (continued)

• Basic problems are
• Narrowed angle and forward displacement of the
  iris.
• The iris against the cornea narrows or closes the
  chamber angle.
• This obstructs the aqueous humor movement.

67
Secondary Glaucoma

• Results from ocular disease that cause a narrowed
  angle or an increased production of aqueous
  humor.
• This type can also occur suddenly and without
  warning.

68
Sign Symptoms of Glaucoma

• Ophthalmoscopic exam reveals
• Cupping and atrophy of optic disk.
• Disk becomes wider and deeper and turns white or
  gray.

69
Signs Symptoms of Chronic Open-Angle Glaucoma

• Visual fields initially appear small
  crescent-shaped that gradually progresses to a
  larger field defect.

70
Signs Symptoms of Acute Closed-Angle Glaucoma

• Visual fields can quickly decrease.
• Symptoms are acute.
• Sudden, excruciating pain around eyes that can
  radiate.
• HA or brow ache
• N, V, and abdominal discomfort
• Colored halos around lights and sudden blurred
  vision with decreased light perception.

71
Medical Management of Glaucoma

• Visual fields are measure to determine extent of
  peripheral field loss.
• Looking for blind spots.
• Diagnostics include tonometry, tonography and
  goniscopy.

72
Medical Management of Glaucoma

• Prevention is the key!
• Prevention by
• Early detection
• Lifelong treatment
• Commitment to close monitoring and follow-up care.

73
Medical Management of Glaucoma

• Drug therapy focuses on ? IOP by
• Physically constricting the pupil so that the
  ciliary muscle contracts and this allows for
  better circulation of aqueous humor.
• Inhibiting the production of aqueous humor.

74
Drug Therapy for Glaucoma

• Miotics
• Constrict the pupil.
• Contract the ciliary muscle.
• Allowing aqueous humor to flow.
• Specific drugs
• pilocarpine HCl (Isopto Carpine, Pilocar)
• carbachol (Isopto Carbachol, Miostat)
• Echothiophate iodide (Phospholine Iodide)
• Miotics cause blurred vision for 1-2 hours

75
Drug Therapy for Glaucoma

• Beta Blockers
• They reduce aqueous humor production without
  causing pupillary constriction.
• Specific drugs
• Timolol (Timoptic)
• Levobunolol (Betagan)

76
Drug Therapy for Glaucoma

• Carbonic Anhydrase Inhibitors
• Reduce aqueous humor production.
• Specific drugs
• Acetazolamide (Diamox)
• Methazolamide (Neptazane)

77
Drug Therapy for Glaucoma

• Osmotic Agents
• Taken orally or IV
• Usually for emergency treatment
• Specific durgs
• Mannitol (Osmitrol)
• Glycerin (Osmoglyn)

78
Surgical Management of Glaucoma

• Laser Surgery
• Called trabeculoplasty.
• Laser burns the trabecular meshwork, which causes
  scarring and the fibers tighten.
• These tightened fibers increases the size of the
  space between the fibers and allows for better
  outflow of aqueous humor.
• Used when medical regimen for open-angle glaucoma
  is ineffective.
• Topical or local anesthesia is used.
• Client commonly has a temporary increase in IOP.

79
Laser Surgery

• Also indicated in angle-closure glaucoma.
• Laser makes a hole near the edge of the iris.
• This allows aqueous humor to flow between the
  anterior and posterior chambers and throughout
  the eye.

80
Nursing Management of Glaucoma Surgery

• Preoperative Care
• Informing client about laser technology, expected
  sights and sounds heard during this procedure,
  and expected outcomes.

81
Nursing Management of Glaucoma Surgery

• Postoperative Care
• Client must be driven home.
• Because it can temporarily increase IOP, the
  pressure is check 1 hour PO and before discharge.
• Drugs prescribed
• Prednisolone acetate (Ocu-Pred)

82
If Laser Surgery or Drugs Fail Standard Surgery
Is Performed

• This surgery either creates a new drainage
  channel for aqueous humor or destroys the
  structures responsible for its production.

83
Standard Glaucoma Surgery

• Performed in hospital or outpatient.
• LOS is several hours to several days.
• PO antibiotics are instilled subconjunctivally
  antibiotic-steroid ointment inserted and
  protective shield applied.
• No ASA, no lying on operative side
• Report brow pain, severe eye pain or nausea.

84
A Normal Macula
85
MACULAR DEGENERATION
86
Macular Degeneration

• Is deterioration of the macula, the area of
  central vision.
• Can be atrophic (r/t age or dry) or exudative
  (wet).

87
Macular Degeneration

• Atrophic Degeneration
• Characterized by sclerosing of retinal
  capillaries.
• Macular cells become ischemic and necrotic.
• Rod and cone photoreceptors die.

88
Signs Symptoms of Macular Degeneration

• Atrophic MD
• Declining central vision.
• Mild blurring and distortion.
• More common and progresses at a faster rate among
  smokers.

89
Signs Symptoms of Macular Degeneration

• Exudative MD
• Sudden decrease in vision after a serious
  detachment of pigment epithelium in the macula.
• Blood vessels invade this injured area and cause
  fluid and blood to accumulate under the macula
  (blister), causing scar formation.
• Results in progressive distortion of vision.

90
Nursing Management of Macular Degeneration

• Current research indicates nutrition can reduce
  risk for MD.
• A diet high in antioxidants and carotenoids
  lutein and zeaxanthin.
• Suggest alternatives for decreasing central
  visionlike books with large print, public
  transportation, and other adaptive equipment.

91
Medical Management of Macular Degeration

• Goal of atrophic MD is to maximize remaining
  vision.
• Goal of exudative MD is slow the process of
  vision loss.
• Fluid and blood may reabsorb in a small of
  clients.
• Laser therapy to seal leaking blood vessels in or
  near the macula can limit the damage.

92
RETINAL DETACHMENT
93
(No Transcript)
94
(No Transcript)
95
(No Transcript)
96
Retinal Detachment

• Is the separation of the sensory retina from the
  pigmented epithelium.
• They are classified as
• Rhegmatogenous
• Traction
• Exudative

97
Pathophysiology of Retinal Detachment

• Rhegmatogenous Detachment
• Occurs following a hole or tear in the retina
• Caused by mechanical force
• Creates an opening for the vitreous fluid to
  infiltrate the subretinal space.
• When enough fluid accumulates the retina detaches.

98
Pathophysiology of Retinal Detachment

• Traction Detachment
• Occurs when the retina is pulled away from the
  epithelium by bands of fibrous tissue in the
  vitreous.

99
Pathophysiology of Retinal Detachment

• Exudative Detachment
• Caused by fluid accumulation in the subretinal
  space.
• Associated with a systemic disease or ocular
  tumor.
• NO RETINAL BREAK OCCURS.

100
Signs Symptoms of Detached Retina

• Onset is usually sudden
• Painless
• May see bright flashes of light (photopsia) or
  floating dark spots
• May describe the sensation of a curtain being
  pulled over part of their visual field.
• The visual field loss corresponds with the area
  of detachment.

101
(No Transcript)
102
Signs Smptoms of Retinal Detachment

• Ophthalmoscopic examination appear as gray
  bulges or folds in the retina that quiver with
  movement.
• Normal retinal appearance is flat pink-orange
  color with movement.
• Depending on detachment, a hole or tear also may
  be seen at the edge of the attachment.

103
(No Transcript)
104
(No Transcript)
105
(No Transcript)
106
Medical Management of Retinal Detachment

• Treatment is closure or sealing of the hole or
  tear.
• Aim is to create an inflammatory response that
  will bind the retina and choroid together around
  the break.
• Inflammatory response is created by external
  application of cryotherapy (freezing),
  photocoagulation (laser), or diathermy
  (high-frequency current).

107
Cryotherapy, Diathermy, Sclearal Buckling
Components
108
Medical Management of Retinal Detachment

• Spontaneous reattachment is rare.
• Surgical repair is required to place the retina
  in contact with the underlying structures.
• Surgical repair is a scleral buckling.

109
Scleral Buckling

• Performed under general anesthesia.
• Wrinkles or folds are repaired in the retina so
  it regains it original smooth position.
• A small piece of silicone is placed against the
  sclera and held in place by a encircling band.
• A gas such as sulfahexafluoride (SF6) or silicone
  oil can be used to help with reattachment. They
  hold the retina in place.

110
Nursing Management Scleral Buckling PreOp Care

• Assess for fear or anxiety.
• Provide information about procedure.
• Depending on location and size of detachment
  activity may be limited.
• An eye patch is placed over the affected eye.
• Topical drugs to inhibit accommodation and
  constriction of the pupil are given before
  surgery.

111
(No Transcript)
112
(No Transcript)
113
(No Transcript)
114
Nursing Management Scleral Buckling PostOp Care

• Maintain eyes patch and shield.
• Monitor VS and check for eye drainage.
• Client may experience N, V and pain.
• What drugs will be given for these?
• Report any sudden increase in pain or pain
  accompanied by N.
• Avoid activities that increase IOP.

115
Nursing Management Scleral Buckling PostOp Care

• Positioning client
• If gas or oil has been used, position the client
  on their abdomen to allow the gas to float
  against retina.
• Client lies with head turned so the operative eye
  is facing up, for several days or until the gas
  has been absorbed.
• Or client can sit on the side of the bed and
  place the head on an over-the-bed table.
• BRP when client is alert and oriented.

116
Nursing Management Scleral Buckling PostOp Care

• In the 1st week after surgery the client should
  avoid reading, writing, and close work.
• Educate client in SS to report associated with
  infection and detachment.

117
The ear
118
(No Transcript)
119
Menieres Disease

• Cause is unknown but associated with viral or
  bacterial infections, allergic reactions, and
  biochemical disturbances that increase fluid
  imbalance. Mild long-term stress also may cause
  it.
• 3 distinct characteristics
• Tinnitus (constant, low-pitched roar or humming
  sound, worsens just before and during attack)
• Unilateral sensorineural hearing loss
• Vertigo (whirling)

120
Pathophysiology of Menieres

• Pathologic changes are either over-production or
  decreased reabsorption of endolymphatic fluid,
  causing a distortion of the entire inner-canal
  system.
• Leading to decreased hearing from dilation of the
  cochlear duct, vertigo because of damage to the
  vestibular system, and tinnitus from unknown
  cause.
• Initial hearing loss is reversible but with
  repeated damage to inner ear structures, leads to
  permanent hearing loss.

121
Signs Symptoms of Menieres Disease

• Symptoms occurs at ages 20-50 years.
• Seen more often in men and Caucasians.
• Recurrent exacerbations and remissions early in
  illness.
• Before vertigo occurs, client may experiences HA,
  increasing tinnitus, and feeling of fullness in
  ear.
• Unilateral in 60-70 of the cases.
• Hearing loss is initially low-frequency but
  worsen to all levels.
• Vertigo may cause fall so intense that client
  must lie down and they hold the bed or ground to
  prevent whirling. Usually last 3-4 hours, but
  dizzy many last after attack.
• N, V are common
• Rapid eye movement.

122
Nursing Management of Menieres

• Non-surgical
• Instruct client to move slow head movements.
• Dietary and lifestyle changes (salt and fluid
  restriction, stop smoking).
• SR up during episode.
• Darken room during HA with minimal external
  stimuli.

123
Medical Management of Menieres

• Drug Management
• Mild diuretics.
• Nicotinic acid because of its vasodilatory
  effects.
• Antihistamines to reduce the severity of or stop
  an acute attack (Benadryl, Dramamine).
• Antiemetics to control N V (Thorazine,
  Inapsine, Tigan).
• Valium controls vertigo, N, V and promotes rest
  during attack.

124
Medical Management of Menieres

• Surgical Management
• Controversial because the hearing in the affected
  ear is often sacrificed.
• Used when medical treatment fails.
• Labyrinthectomy surgery
• Endolymphatic decompression procedure

125
Medical Management of Menieres

• Labyrinthectomy
• Most radical.
• Resect the vestibular nerve or total removal of
  the labyrinth.
• Performed via transcanal route.
• The footplate of the stapes is removed through
  the oval window .

126
Medical Management of Menieres

• Endolymphatic Decompression
• Performed early in disease.
• Involves a shunt for drainage.
• Some say it relieves vertigo and preserves their
  hearing.
• PO there is vertigo if the vestibular structures
  were manipulated.
• Reassure client vertigo is temporary.

127
Know the following

• AP of eye and ear..
• What does 20/20 vision mean?
• Diagnostic assessment tools for eye and ear
  (slit-lamp, corneal staining, tonometry,
  ophthalmscopy,US, MRI, fluoresceine angiography
  electroretinography)
• Know difference between miotics, mydriatics,
  cycloplegics, beta blockers, adrenergics and why
  used with eye.

128
Know the following

• How to perform a ocular irrigation, Blindness
• Define legally blind
• Causes of
• How do you feed a blind client
• How do you ambulate
• How do you encourage self-care
• What can you do support?
• How should you enter a blind clients room to let
  them know you are there?

129
Know the following

• Know which drugs cause significant impact on
  hearing,
• How to perform an otocopic assessment
• Diagnostic tests (voice test, watch test,
  audioscopy, tuning fork esp. Webber and Rinne
  tests,CT, MRI, auditory brainstem-evoked
  response, electronystagmography, caloric testing,
  Dix-Hallpike test, audiometry, air and bone
  conduction test, speech discrimination,
  typanometry)

130
Know the following

• Causes of hearing loss
• Groups affected by hearing loss
• Way to prevent hearing loss
• What is a tympanoplasty/stapedectomy and nursing
  nursing management
• Identify assistive devices for the visually and
  hearing impaired.

131
(No Transcript)
132
(No Transcript)
133
(No Transcript)
134
(No Transcript)
135
(No Transcript)
136
(No Transcript)
137
(No Transcript)
138
(No Transcript)
139
(No Transcript)
140
(No Transcript)
141
(No Transcript)
142
(No Transcript)
143
(No Transcript)
144
(No Transcript)
145
(No Transcript)
146
(No Transcript)
147
(No Transcript)
148
(No Transcript)
149
(No Transcript)
150
(No Transcript)
151
(No Transcript)