Upgrade to remove ads
Only $2.99/month

Med Surge Chapter 49 & 51

Terms in this set (38)

Med Surge Chapter 49 & 51
Exam 5
Care of Patients with Eye and Vision Problems
Blepharitis
Inflammation of the eyelid edges occurs most often in the older adult and those with dry-eye syndrome
S/S - Itchy, red, and burning eyes
Seborrhea (greasy, itchy scaling) of the eyebrows and eyelids is often present along with greasy scales and mattering where the eyelashed exit the eyelid
Blepharitis - care
is controlled with eyelid care using warm, moist compresses followed by gentle scrubbing with diluted baby shampoo.
Avoid rubbing the eyes because if infection is present this action will spread the infection.
Entropion
Turning inward of the eyelid causing the lashes to rub against the eye
Caused by eyelid muscle spasms , trauma, aging
Corneal Abrasion may occur from constant irritation
Surgical correction of eyelid position
Demonstate instillation of eyedrops, and evaluate the patient's ability to instill the drops
Ectropion
Turning outward and sagging of the eyelid, often occurs with aging
Caused by relaxation of the orbicular muscle
Reduced washing action of tears, leading to corneal drying and ulceration
Surgery to restore proper lid alignment
Hordeolum (Stye)
can be external or internal
external stye is an infection of the sweat glands in the eyelid at the place where the eyelashes exit from the eyelid.
internal stye is an infection of the seabaceous glands.
Hordeolum - treatment
warm compresses four times a day and antibacterial ointment, which may blur vision.
To remove ointment, close the eye and gently wipe the closed eyelid from the nasal side of the eye outward.
Chalazion
Inflammation of sebaceous gland in eyelid. Painless
Most protrude on the inside of eyelid.
Eye fatigue, light sensitivity, and excessive tears result.
Treatment consists of warm compresses for 15 minutes 4 times per day, followed by instillation of ophthalmic ointment.
Surgery is an option.
Keratoconjunctivitis Sicca
Also called dry eye syndrome, results from changes in tear composition, lacrimal gland malfunction, or altered tear distribution
Artificial tears, lubricating ointment
Surgery
Conjunctival Hemorrhage
Small, well-defined area of hemorrhage that is bright red under the conjunctiva
-No pain
-No visual impairment
-Resolves in 14 days without treatment
Conjunctivitis
is an inflammation or infection of the conjunctiva.
Caused by allergens or irritants, is not contagious
S/S - edema, a sensation of burning, engorgement of blood vessels (blood-shot appearance), excessive tears and itching
Treatment: vasoconstrictors and corticosteroid eyedrops. (no makeup)
Usually benign and self-limiting
Seldom affects vision
If chronic, may signal degenerative changes or damage from repeated acute attacks
Conjunctivitis: infection
occurs with bacterial or viral infection and is readily transmitted from person to person
Acute bacterial (pink eye) lasts about 2 weeks
Chronic viral conjunctival infections may last 2-3 weeks and may produce severe disability
S/S - blood vessel dilation, mild conjunctival edema, tears, and discharge
Trachoma
Chronic, bilateral scarring form of conjunctivitis caused by Chlamydia trachomatis
Chief cause of preventable blindness in the world
NI - Infection control
Corneal Disorders
Corneal Abrasion - a scratch or scrape
Corneal Ulceration - deeper disruption of the corneal epithelium, extending into the stromal layer - emergency
Corneal Disorders - S/S
Pain, photophobia, eye secretions,
purulent fluid on eyelids/lashes, reduced
vision.
--Cornea appears cloudy with ulceration
Corneal disorders - treatment
Reduce symptoms, restore corneal clarity, enhance patient's ability to use remaining vision.
Antibiotics, antifungals, antivirals, steroids.
Stress the importance of applying the drug as often as prescribed, even at night.
Eye Donation - keratoplasty
Corneal tissue from donors free of infectious disease or cancer at the time of their deaths.
Care of potential eye donors at death:
Raise head of bed 30 degrees.
Apply antibiotic eyedrops.
Close the eyelids, and apply small ice pack.
Discuss donation with family and physician.
Conditions of the Eye
Cataract: Opacity of the lens of the eye
Causes - Age, trauma
Incidence - 5 - 10 million worldwide every year
Characteristics - painless, gradual vision loss, glare; milky white pupil
Complications
Cataract: Postoperative Care
Antibiotics & steroid ointments are given subconjunctivally.
Eye is unpatched.
Discharge usually occurs within 1 hr with dark glasses.
Wear dark glasses outdoors or in bright lights until pupil responds to light
Cataract: Postoperative Care
Instill antibiotic-steroid eyedrops.
Mild itching is normal.
Pain indicates a complication.
Reduce IOP (interocular pressure).
Prevent infection.
Assess for bleeding.
Health Teaching
Report to surgeon—sharp, sudden pain in the eye, bleeding or increased discharge, lid swelling, decreased vision, or flashes of light or floating shapes.
Avoid activities that might increase IOP.
Review procedure for use of eyedrops.
Glaucoma
is a group of disorders characterized by high intraocular pressure (IOP) and optic nerve damage
Primary Open Angle Glaucoma
(POAG) Most common, usually affects both eyes and is asymptomatic in the early stages
Angle-Closure Glaucoma
closed-angle glaucoma, narrow angle glaucoma, acute glaucoma - is less common, has a sudden onset, and is an emergency.
Glaucoma - Treatment
Medication
Alerts
Nursing considerations:
Give medications, as ordered (topicals, pain)
Prepare client for surgery, if indicated
Encourage ambulation immediately after surgery
Encourage client to express concerns related to chronic condition
Monitor VS, response to tx, and visual acuity
Glaucoma - Pt. Teaching
Cover disorder, diagnostic studies, and treatment
Need for meticulous compliance with prescribed drug therapy
All procedures and treatments, especially surgery
Lost vision cannot be restored, but treatment can usually prevent further loss
Modification of environment for safety
S/S that require immediate attention (i.e. eye pain or sudden change in vision)
Importance of screening for early detection and prevention
Avoid emotional upsets, constrictive clothing
Conditions of the Eye
Diabetic Retinopathy: disorder of the blood vessels of the eye; small aneurysms; occurs in 60-65% of diabetics.
Symptoms: floaters and vision loss

Macular Degeneration: due to an aging retina; cause unknown
Symptoms: central vision loss and decrease in color discrimination
Tx: None available
Conditions of the Eye
Detached Retina: Retina separates from the choroid (vascular layer) and vitreous humor flows between the layers
Can be caused by trauma, severe physical exertion, after cataract surgery, hemorrhage
Onset: sudden & painless
Conditions of the Eye - Detached Retina
Assessment reveals:
Gaps in vision - flashes of light
Spots - floaters
Curtain over field of vision
Blindness, if not treated
Interventions:
Immediate bed rest
Positioning to keep retina next to choroid
Detached Retina
Surgical intervention: scleral buckling; scarring by heat, cold, or laser
Post-op care: Bedrest with both eyes bandaged
Avoid jarring or bumping head
No coughing
Give antiemetis to prevent N/V.
Positioning to keep retina next to choroid—may be on operative side
Detached Retina
Client teaching: Report pain or pain & N/V: report to MD immediately
Avoid reading, writing, close work for 1st week pot-op
Monitor for eye infection
s/s of detachment: sudden reduced visual acuity, eye pain, pupil that does not respond to light by constricting. Call MD immediately.
Conditions of the Ear - Meniere's Disease
Assessment: Vertigo, tinnitus, ear feels full, nystagmus
Intervention: Instruct pt to move slowly to prevent injury from dizziness
avoid bright or glaring lights
Move head slowly
STOP smoking
Avoid caffeine
Low Na diet & fluid restriction
Medications
Surgical Intervention
Conditions of the Ear - Hearing Loss: Deafness
hearing is non-functional for activities of daily living
Conductive (transmission deafness): impacted cerumen (wax), foreign body in external auditory canal defects (thickening; scarring) of eardrum: perforation of tympanic membrane
Otitis media with effusion: mostly in children
Otosclerosis of ossicles: overgrowth of soft bony tissue (scars, tumors) from previous ear surgeries
Conditions of the Ear - Hearing Loss: Deafness
Sensorineural (perceptive or nerve deafness)
Arteriosclerosis
Infectious diseases (mumps, measles, meningitis)
Drug toxicities: gentamycin
Tumors
Head traumas
High-intensity noises
Meniere's Disease
Deafness
Central deafness:
Tumors
Stroke (brain attack)
Noise-Induced or occupational noise hearing loss:
Blast injury
Firearms
Loud music or machinery
Aging
Care of the Client with Diminished Hearing
Only good for the conductive hearing loss
Care of client with hearing aid:
Keep it dry
Turn off and remove battery when not in use
Check and replace battery frequently. Keep extras.
If not working, check on-off switch and volume control,
Change battery, and check plastic tubing for cracks and loose connections.
When not in use, store in a covered container to prevent dust/water from damaging the mechanism
Wipe clean with soap and water (do not immerse)
Conditions of the Ear
Care of client with Diminished Hearing:Communication: Attract client attention by raising hand or arm
Face client when speaking
Speak slowly and distinctly without shouting
Use low-pitched voice when possible
Check with client to be sure instructions are understood
To make lip reading easier, make sure the client's view of your mouth is not obstructed and you are not standing with your back to a bright light
Age-Related Structural Changes
Decreased eye muscle tone
Ectropion and dry eye
Arcus senilis
Corneal changes
Changes in color of sclera
Less ability to dilate pupil
More light needed for reading
THIS SET IS OFTEN IN FOLDERS WITH...