Assessing%20Clients%20with%20Eye%20or%20Ear%20Disorders

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Assessing Clients with Eye or Ear Disorders

• Chapter 40

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Review of Anatomy and Physiology

• Extraocular Structures
• eyebrows
• eyelids
• eyelashes
• conjunctiva
• lacrimal apparatus
• eye muscles

3
Review of Anatomy and Physiology

• Intraocular Structures
• sclera
• iris
• pupil
• lens
• retina
• optic disc
• anterior and posterior cavity

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Vision

• 1. Light passes through the cornea and is focused
  onto the retina by the lens.
• Cells in the retina then transmit this
  information through optic nerve to the vision
  area of the cortex.

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Review of Anatomy and Physiology

• Optic nerves
• Refraction
• bending of light rays
• Accommodation- Response of the pupil, constrict
  and dilate.

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The Ear and Hearing

• External Ear
• auricle or pinna
• external auditory canal
• tympanic membrane
• Acoustic antenna, focus
• Sound waves.

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Middle Ear

• The middle ear consists of
• The inner part of the ear drum
• The hammer (malleus)
• The anvil (incus)
• The stirrup (stapes)
• Delivers sound to the inner ear where it is
  processed into a signal that the brain can
  recognize

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The Ear and Hearing Inner Ear

• The inner ear contains the most important parts
  of the hearing mechanism - two chambers called
  the vestibular labyrinth and the cochlea.
• The vestibular labyrinth consists of elaborately
  formed canals (3 semicircular tubes that connect
  to one another), which are largely responsible
  for the sense of balance.
• The cochlea, which begins at the oval window,
  curves into a shape that resembles a snail shell.
  Tiny hairs line the curves of the cochlea. Both
  the labyrinth and cochlea are filled with various
  fluids.

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Inner Ear
10
Hearing and the Ear
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Hearing and the Cochlea

• The cochlea as microphoneWhen sound waves from
  the world outside strike the eardrum, it
  vibrates. These vibrations from the eardrum pass
  through the three bones of the middle ear and
  into the inner ear through the oval window.
  Action of the oval window causes fluids in the
  cochlea to create waves where they disturb the
  basilar membrane. Inner hairs attached to the
  basilar membrane convert the waves into
  electrical impulses that are transmitted to the
  brain by the auditory nerve. The hair cells are
  critical to hearing it is the inner hairs that
  move in the Organ of Corti fluids, and translate
  the fluid movements to chemical messengers that
  can in turn be converted to electrical impulses
  that the brain understands.

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Assessment of Eye and Ear

• Health Assessment Interview
• ask about chief complaint
• Blurred vision?
• Eye infection?
• Halos?
• Difficulty reading?
• Difficulty hearing?
• Ringing in ears?

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Physical Assessment of Eye and Vision

• Snellens eye chart- Test for vision.
• Assessment of the pupils.
• Extra movements of the eyes nystagmus or non
• Parallel movements strabismus, may indicate
• disease, cranial nerve dysfunction or muscle
  weakness and should be reported.

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Physical Assessment of Eye and Vision

• Pupils, Equal Round Reactive to Light and
  Accommodation (PERRLA)
• direct a beam of light into the pupil, look for
  constriction
• hold object a few feet from client, pupils should
  dilate, move closer pupils should constrict
• Inspection - sclera, iris cornea and internal
  structures

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Physical Assessment of Ear and Hearing

• Hearing
• Weber test
• Rinne test
• Whisper test
• Inspection
• auricle and external canal-
• Lesions, drainage, redness, pain.
• tympanic membrane- color.

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Disorders of the Eye

• Eyelid disorders constantly exposed to the
  environment.
• Hordeolum- sty is an infection of the sebaceous
  glands of the eyelid. Staphylococcus aureus.
• Red and painful
• Conjunctivitis- Inflammation of the conjunctiva
  is common. Direct contact bacterial or viral
• Also known as Pink Eye. Redness, itching,
  tearing and discharge.
• Gonorrhea and trachoma can damage cornea.

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Eye Disorders

• Cornea- transmits and helps focus light and
  images onto the retina. Protects the internal
  eye.
• The cornea has no blood supply. Scarring or
  ulceration of the cornea can lead to blindness.
• Corneal ulcers caused by infection, trauma or
  contact lens. Herpes viruses (shingles) can cause
  corneal ulcers. Can lead to blindness.
• Nr Care- Prompt treatment to preserve vision.
• Diagnosed by history and examination of the eye.
• Topical anti-infectives as eyedrops.

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Eye disorders

• Corneal Transplant- Corneas taken from cadavers
  under the age of 65 who died as a result of
  trauma or noninfectious illness.
• Transplant rejection is low cornea has limited
  blood supply.
• Graft is sutured in place, for one year.
• Patch for 24 hours
• Avoid increasing intraocular pressure.
• Eye drops to reduce inflammation and prevent
  infection.

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Eye Disorders

• Soaking the eyelids with warm saline compresses
  may remove exudates seen in conjunctivitis.
• Eye irrigation with saline is used to remove
  purulent discharge with conjunctivitis.
• Local heat may treat sty.
• Infectious eye disorders Nr care focus is on
  prevention and immediate treatment!
• Prevent complications promote healing. Reduce
  pain.
• Careful and frequent handwashing, not sharing
  towels, make-up. No contacts until healed.

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Eye Trauma

• Foreign bodies, abrasions and lacerations most
  common types of eye injury.
• Corneal abrasion- scratch of the cornea
• Burns- chemical, UV
• Perforation- metal flakes, weapons
• Blunt eye trauma- sports injury
• The extent of the injury is determined by eye
  exam.
• Topical anesthetic, irrigation, surgery
• NR- Protecting the eye, preserving vision,
  prevention!

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Refractive Errors

• Changes in the shape of the cornea, lens or
  eyeball affect the focus of light on the retina.
• Result blurred or indistinct vision, also called
  
• Refractive errors- Most common cause of impaired
  vision.
• Myopia- nearsightedness
• Hyperopia- farsightedness
• Detected routine vision screening
• Corrected with glasses or contacts
• Nr- Identify and seek treatment. Safety!!

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Cataracts

• Clouding of the lens of the eye that impairs
  vision, common over 65yrs.
• As the lens ages its cells become less clear.
• Mature cataract involves entire lens
• Near and distant vision are affected.
• Details become obscured
• Pupil appears cloudy gray or white rather than
  black.
• Dx History and eye exam, the red reflex is lost.
• Tx Surgical removal incision through cornea
• Intraocular lens is implanted to focus light
  vision.

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Glaucoma

• Increased intraocular pressure and gradual loss
  of vision. Silent thief of vision.
• Leading cause of blindness worldwide.
• Normal intraocular pressure is 12-20 mm Hg is
  maintained by a balance between aqueous humor
  production and drainage, disrupted intraocular
  pressure increases.
• Open angle drainage of the aqueous humor
  through the trabecular meshwork is impaired
• Angle-closure- Angle between the cornea and iris
  closes, completely blocking aqueous humor
  drainage.

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Glaucoma

• Manifestations Discussion
• Glaucoma if not treated can and will lead to
  blindness.
• Angle-closure glaucoma can recur thus avoid
  medications that can dilate the pupil. One eye is
  at risk for the other eye.
• Atropine must be avoided in clients with history
  of angle-closure glaucoma.
• Glaucoma cannot be cured, chronic disease can be
  controlled and vision preserved if it is dx and
  tx.
• Routine eye examinations early detection.

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Glaucoma

• Acute angle-closure glaucoma is an ocular
  emergency that requires immediate intervention!
• Surgery is indicated when chronic open-angle
  glaucoma can not be controlled with medication.
• Lower intraocular pressure.
• Glaucoma is a chronic disease that requires
  lifelong management. Can lead to blindness if not
  identified and treated.
• Nursing- Increased risk for injury, psychological
  effects of a chronic disease anxiety. Early
  vision screening!!!!!!!

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Detached Retina

• Retina contains neurons that allow us to see
  light and images.
• Retina separated from the choroid, the vascular
  layer of the eye. Fluid seep between retina and
  choroid, thus separating the layers. The neurons
  become ischemic and die causing permanent vision
  loss.
• Can occur spontaneously or from trauma as we age
  it increases our risk for detached retina.
• Medical emergency
• CM- painless, floaters, flashes of light. Dx- eye
  examination. Surgical procedures.

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Detached retina

• Early identification is a priority for the nurse!
  May have gradual loss of vision.
• The affected area of the eye inferior to maintain
  contact between the retina and choroid.

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Macular Degeneration

• Neurons of the macula may atrophy with age or
  separate from the choroid. May cause blindness.
• Smoking, over 65 yrs, family hx.
• Central vision becomes blurred, peripheral vision
  remains intact. One eye common early symptom.
• Any change in vision needs evaluation!!!!!!
  Nursing!
• Laser treatment may slow the process. Early
  treatment may help slow disease and preserve
  vision.

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Diabetic Retinopathy

• 85 of diabetics will develop
• The capillaries of the retina are no longer able
  to transport blood and oxygen to the retina.
• Develops 15 years after being diagnosed either
  type one or type 2 diabetes.
• Initially venous capillaries dilate and develop
  microscopic aneurysms may leak or rupture thus
  edema and small hemorrhages into the retina.
  Areas become ischemic. New blood vessels form
  causing more damage.
• Nr- Education, yearly eye exam, spots, loss of
  vision.

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Ear Disorders

• External otitis- or swimmers ear affect sound
  conduction and hearing. Inflammation of the ear
  canal
• Risk swimmers, divers surfers, hearing aids or
  earplugs.
• Caused by bacteria
• Remove earwax and cleaning and drying ear canal.
• CM- Pain, drainage, inflammation and swelling
• Management- Discussion

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Impacted Cerumen

• Older adults are at risk for impaced cerumen
• Interferes with sound conduction and hearing.
• Tinnitus is a clinical manifestation
• Can be seen using an otoscope
• Clearing with irrigation ear curet or forceps
• Prevention is the focus of Nursing! No Q-tips.

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Otitis Media

• Inflammation or infection of the middle ear.
• Most common middle ear disorder.
• Infants and young children. Adults too.
• Organisms can enter the middle ear from the nose
  and throat through the eustachian tube
• Eardrum protects middle ear from the environment.
• CM- Red, bulging tympanic membrane. Pain, with a
  URI. Swelling of the ET impairs drainage of the
  middle ear, fluid collects with bacteria. Fever.
• Complications discussion. DX- Otoscope eardrum.

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Otosclerosis

• Genetic, hereditary disorder affects white
  females.
• Abnormal bone forms in the stapes and causes a
  conductive hearing loss.
• CM- hearing loss begins in adolescence or early
  adulthood. Tinnitus
• Management- Surgical reconstruction of the middle
  ear.
• Nursing- Referral to appropriate community
  agencies to evaluate hearing loss.

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Inner Ear Disorders

• Occur less frequently than other ear disorders
• Labyrinthitis
• Menieres disease.
• Vertigo is the KEY symptom of inner ear
  disorders.
• Contains the semicircular canals that help
  maintain balance and neural receptors for
  hearing. Thus may cause permanent hearing loss.
• Labyrinthitis- inflammation of the inner ear
• Bacterial or virus
• CM- severe vertigo, NV, nystagmus. Falling!

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Inner Ear disorders

• Menieres Disease- chronic inner ear disorder
  caused by excess fluid and pressure in the
  labyrinth of the inner ear.
• Gradual or sudden
• Vertigo, tinnitus and gradual hearing loss
• No cure
• TX- Decrease inner ear pressure
  hydrochlorothiazide.
• Meds to relieve vertigo Vistaril, compazine.
• Avoid caffeine, alcohol and tobacco.
• May need surgery to relieve excess pressure .
• Nr- discussion risk for injury! Evaluate vertigo,
  HL.

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Hearing Loss

• 10 million adults in the US are hearing impaired
• 70 of older adults
• Conductive hearing loss- Anything that impairs
  sounds transmission from the external opening of
  the ear to the inner ear. Impacted cerumen most
  common. Perforated eardrum, tumor of middle ear.
• Hearing aid would be of benefit.

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Hearing Loss

• Sensorineural Hearing Loss- Disorders that affect
  the inner ear or the auditory pathways of the
  brain.
• Trauma, infection, Menieres disease, ototoxic
  medications, prenatal exposure to rubella.
• US- Noise exposure is the major cause of
  sensorineural hearing loss. Exposure to high
  level of noise damages the hair cells of the
  inner ear.
• Affects the ability to hear high-frequency sounds
  more than low. Speech discrimination and
  communication noisy places. Hearing aids may not
  help. Why? Nr- Social isolation, type HL,
  finances. Ed