Sensory med surg exam 5

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what is Amsler's grid test used for?
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-Patient stands or sits 20 ft from the chart (snellen's chart) -patient covers one eye -ask patient to read above or below the 20/20 line -repeat step 3 using the other eye -document findings-Procedure for Snellen's testBlindness is- a loss of visual acuity that ranges from partial to total loss of sightTotal blindness is-defined as no light perception and no usable vision.Functional blindness is present when the patient-has some light perception but no usable visionLegal blindness-refers to individuals with a maximum visual acuity of 20/200 with corrective eyewear and/or visual field slight capacity of reduced to 20 degreesThe normal visual range is-180 degreescongenital blindness results from-various birth defects- diplopia - pain - presence of floaters and light flashes - pruritus and burning of the eyes -loss of peripheral vision - halos [rainbow colors around light] - sense of orbital pressure - bulging of the eyes - difference in appearance of the eye structure such as the pupilwhat are the sign and symptoms of blindesssubjective data of blindness- complaints of blurred vision is an early sign of the disorder -onset, severity, duration and factors that relieve themObjective data of blindness-observation of eye squinting and rubbing -patient compensation measures such as use of magnifying glass - determine the use of and effectiveness of assistive of the eyewear-corrective eyewear -canes -guide dogs -magnifying systems and telescopic lenses -surgical proceduresare the medical management for blindnessCanes are the most frequently used device- for partially or totally blind personGuidelines for communicating with Blind people-announce presence when entering the room -talk in a normal tone of voice -do not try to avoid common phrases such as "see what I mean" -introduced self with each contact -explain any activity that is occurring in the room -announce when you are leaving the room, so the blind person is not put in the position of talking to someone that is no longer there.nursing intervention for blind people-normal tone of voice -alert client when approaching -orient client to environment -allow client to touch object -promote independence -check placement of food -provide radios that tell time -teach them how to use the cane and -allow them to grasp the nurses armDiagnostics test for common refractory errors are:-opthalmoscopy -retinoscopy -visual acuity test and -refraction testpreferred treatment for refractory error is-surgical correctionWhat is Astigmatism?-defect in the curvature of the eyeball surface -occurs when the light rays cannot be focused clearly on a point on the retina because the spherical curve of the cornea is not equal in all meridians **blurring vision ***complaints of eye discomfort, difficulty in focusing, blurred visionWhat is Strabismus-inability of the eye to focus in the same direction commonly called cross eyed. -Esotropia> turns eye in the direction of the nose -Exotropia> turns eye outward ***eyeball position is not symmetrical ****states difficulty in following objectsMyopia- condition of nearsightedness -elongation of the eyeball ***inability to see objects at a distance ****difficulty seeing far away objectsHyperopia-condition of far sightedness -results from error of refraction in which the rays of light entering the eye are brought into focus behind the retina ****inability to see objects at a close range ****difficulty seeing near objects-Radial Keratotomy -photorefractive keratotomy -ketorefractive surgery -photorefractive keratectomyare procedures for myopia to markedly improve vision under continued study for long term complicationtypes of refractory errors-astigmatism -strabismus -myopia -hyperopiaLaser in situ keratomileusis [Lasik]a procedure in which first corneal flap is folded back and an excimer laser removes some of the internal layers of the corneaHordeolum or Stye- acute infection of the eyelid margin or sebaceous glands of the eyelashesStye is-caused by staphylococcussign and symptom of the stye-localized to base of eyelashes with edema of lidChalazioninflammatory cyst on the meibomian gland at the eyelid margin, may require weeks to develop into a cystchalazion is caused by-infection associated with diabetes mellitus, gout and anemiasign and symptoms of Chalazion-discomfort -mass on eyelid -edema and -visual disturbancesBlepharitis-inflammation of the eyelid marginsblepharitis is caused by infection usually-staphylococcal organisms **for non-ulcerative** caused by -psoriasis -seborrhea or -allergic responsesign and symptoms of blepharitis-pruritus -erythema of the eyelid -photophobia -excessive tearingwhat is conjunctivitis?-inflammation of the conjunctiva caused by bacterial or viral infection, allergy or environmental factors -it is commonly called "PINKEYE"acute bacterial conjunctivitis is usually transmitted by-the hands after direct contact with a contaminated objectPeumococcal staphylococcal streptococcal haemophilus influenzae gonococcal and chlamydial organisms are the-major causative agents for conjunctivitis or pink eyewhat are the sign and symptoms of conjunctivitis-erythema of the conjunctiva -edema of the lid -mucopurulent crusting discharge on the lids and cornea -if untreated this infection leaves the eye scarred with granulation that invades the cornea resulting in loss of visionNursing intervention for conjunctivitis-lid and the lashes cleansed of exudate w/ normal saline -warm compress are applied 2-4 times a day -when allergies are present, cold compress to control edema and pruritus -eye irrigation w/ normal saline or lactated ringers -administer topical antibiotics and adrenocorticosteroid medicationpatient teaching for pink eye-instruct patient and family to avoid contact with the eyes of solid materials when infection is present -individual wash cloths and towels are to be used -wash hands before and after treatment administration -avoid noxious fumes or smokewhat is Keratitis-inflammation of the cornea; may result from injury, irritants, viral infections or diseases such as; congenital syphilis, smallpox and some nervous disorders -layers of the eyes are inverted and causes acute painclinical manifestation for keratitis-severe eye pain -photophobia -tearing -edema -visual disturbancescyclophelgic-mydriatic drugs-paralysis the ocular muscles of accommodation and dilate the pupilmedical management for keratitis-cyclphlegic mydriatic drugs -corneal debridement followed Vira-A or Viroptic -acyclovir -pressure dressing to relax muscle and decrease discomfort -warm and cold compresses -corneal transplant known as KERATOPLASTYwhat is Keratoplasty?- is the removal of the full thickness of the patient's cornea followed by surgical implantation of a cornea from a human donorwhat is Sjoren syndrome- an immunologic disorder characterized by deficient fluid production by the lacrimal glands, resulting in abnormal dryness of the mouth, eyes and other mucous membranewhat is Ectropion-is the outward turning of the eyelid margin -in older patient it is common for the orbicularis oculi muscle to be relaxed -paralytic ectropion occurs when orbicularis muscle is disturbed as w/ bell's palsyCataract-is a crystalline opacity or clouding of the lens -pt may have cataract in one or both eyesclinical manifestation of cataract-painless but include blurred vision -difficulty reading fine print -diplopia -photo sensitivity -glare -abnormal color perception and difficulty driving at nighttwo methods surgery for cataracts-Intracapsular [involves removing the lens and its entire capsule] -Extracapsular extraction [ anterior capsule is opned and the nucleus & cortex are removed; leaving the capsular bag intact; healing is rapid with this method]nursing teaching for post-op cataract surgery?- avoid activities that increases IOP -no heavy lifting, bending, stooping, coughing, sneezing, vomiting and straining with elimination which increases IOP -avoid lying on the side of the affected eye on the night of the surgerynursing intervention for post op cataract-remove environmental barriers, ensure safety -keep side rails up at all times -position patient in unaffected eye, -elevate head of the head 30 degrees as prescribed NCLEX- *bed rest *can't lay down on operative side *get a driver *no sunlight *no bending down *stool softener *analgesics *avoid coughingDiabetic retinopathy-is a disorder of retinal blood vessels characterized by capillary microaneurysms, hemorrhage, exudates & the formation of the new vessels and connective tissuessign and symptoms of diabetic retinopathy-microaneurysm -vision loss and the presence of floatersmedical management for diabetes retinopathy-photocoagulation -cryotherapy -vitrectomyPhotocoagulation-uses a laser beam to destroy new blood vessels, seal leaking vessels and help prevent retinal edemaA vitrectomy or cryotherapy-may be performed when photocoagulation is not possibleAge Related Macular Degeneration [ARMD] of the aging retina is-characterized by slow, progressive loss of central and near vision -most common of vision loss in people over 60 yrstwo types of macular degeneration-wet type> also called neovascular degeneration -dry type> nonexudate or nonneovascular degenerationDry type [nonneovascular degeneration]-occurs in 90% of macular degeneration ***patient reports** -sometimes I see the image, sometimes it sorts of blinks at me, like I have a short circuit- -macular cells have waisted and atrophiedhallmark sign of ARMD is the-appearance of drusen (yellow deposit in the retina) **the main symptom of macular degeneration is gradual and variable bilateral loss of central visionPhotodynamic therapy is a new treatment used for-wet ARMD photocoagulation was the old treatment; but it also destroys photoreceptor so it is replaced with photodynamic -no treatment for the dry type of MDWhat is Retinal detachment?-is the separation of the retina from the choroid in the posterior area of the eyeretinal detachment results from-a hole in the retina that allows vitreous humor to leak between between the choroid and the retinapatient had keratoplasty; What is the correct body position after surgery?-position on the back; non operated side until the physician's allow turning to the operated sidespelling of Glucoma-G-L-A-U-C-O-M-Atypes of hearing loss?-Conducive -sensorineural -mixed -congenital -functional (psychogenic) -centralvision changes as we get older;what things are affected with aging process?-changes in accommodation (presbyopia) -decreased color perception -poor adaptation to changes in light -alteration in depth perception -decrease secretions in tears -increased incidence of moving particles or floatersvisual acuity using Snellen's chart;know what they are specifically looking for with that test-Refraction errorsways to communicate with someone who is hearing impaired-if patient wears hearing aid, make certain it is in place, tuned and functioning properly -get the person attention by raising the arm -ask permission to turn off the television or radio -start with light on your face face the person when talking -speak clearly -do not overaccentuate words -speak in a normal tone -if the person does not understand word, explain it in a different waywhat is the likely cause of hearing loss in the older adult?-cerumen builduppatients with permanent visual impairment:-may experience the same grieving process that is associated with other lossesa 32 year old construction worker suffered from a penetrating wound to the eye. The best intervention for anyone at the scene is to:-cover the object with a paper cup and tapea 71 year old patient complains of being severely dizzy. The nurse should encourage the patient to-avoid sudden movementsa surgical procedure for the treatment of retinal detachment is-scleral bucklingthe ------- --------is a surgically implanted hearing device for the profoundly deaf person whose sensorineural hearing loss is either congenital or acquiredCochlear Implantsign and symptoms of Retinal detachment-gradual development of flashes & lights -followed by floating "spots or cobweb" a "hairnet" - loss of specific field vision -curtain being pulled downmedical management for retinal detachment are:-Laser photocoagulation [burns localized tears] -Cryotherapy [freezes the borders] -ElectroDiathermy [burns retinal break, ultrasonic] -Scleral buckling [extraocular surgical procedure]Glaucoma is not a disease but a group of-disorders characterized by: 1. increased intraocular pressure 2.optic nerve atrophy loss of peripheral vision -found in people who are middle age and oldertwo types of glaucoma- Primary Open Angle Glaucoma {POAG} -Acute Angle Closed Glaucoma [AACG]Open angle glaucoma also known as POAG- represents 90% of the cases -outflow of the aqueous humor is decreased in the trabercular meshwork -drainage channel becomes occluded and cloggedClosed angle glaucoma also known as AACG-occurs if there is an abrupt angle change in iris, causing rapid vision loss.In POAG sign and symptoms are-loss of peripheral vision [tunnel vision] -eye pain -difficulty adjusting to darkness -halo around lights -Inability to detect colors -IOP's are elevatedAACG sign and symptoms-produces excruciating pain in or around the eye -decreased vision -nausea and vomiting -sclera is erythematous -pupil is enlarged and fixed -sees colored halos around lights and an acute increase pressure in the IOPAcute angle pressure is a-medical emergencymedical management for glaucoma-keeping the IOP low enough to prevent the patient from developing optic nerve damage is the primary focus of glaucoma therapyPOAG is medically treated by the use of- betablocker (betopic) -miotics (pilocarpine) -carbonic anhydrase inhibitorsPanretinal photocoagulation (PRP)-is used primarily for patients with proliferative diabetic retinopathy. It is also effective at reducing the risk of vision loss in patients with occlusivenursing intervention for macular degenerative-stressing the sight saving nature of the drops -helping the patient identify the most convenient time for medication administration -advocating the change in therapy if the patient reports unacceptable side effectsEye Enucleation is the-surgical removal of the eyeballchemical burns are medically treated with-flush the eye with water immediately for 15-20 minsweber test is a- method of assessing auditory acuity; - especially useful in determining whether defective hearing in an ear is a conductive loss cause by a middle ear problem or sensorineural loss resulting from disorder in the inner ear or auditory nerve systemRinne test is amethod of distinguishing conductive from sensorineural hearing loss -this test is performed with tuning fork placed 1/2 inch from external auditory meatusAudiometry is a test ofhearing acuity -beneficial for determining the degree and type of hearing lossconductive hearing loss-sound is inadequately conducted through external or middle ear to the sensorineural apparatus of the inner earsensorineural hearing loss- sound is conducted through external and middle ear in a normal way -defects results in its distortionmixed hearing loss-combination of conductive and sensorineural hearing losscongenital hearing loss- present from birth of early infancyfunctional hearing loss- has no organic cause -also known as psychogenic or non organic hearing losswhat is the proper way to speak to a patient that has hearing impairment in one ear only- move closer toward the better earexternal otitis- called swimmer's earotitis media-infection of the middle earsign and symptoms of otitis media-throbbing pain behind the tympanic membrane -tinnitus -ringing or tinking sounds -feverlabyrinthitis-inflammation of the labyrinth canals of the inner ear -most common cause of VERTIGOS/S of labyrinthitis-nausea and vomiting -nystamus -photophobia -headache and ataxic gait -loss of balanceear canal obstruction is usually caused by-impacted cerumen -foreign bodies including insectsnursing intervention for vertigo-keep side rails up -supervise ambulation -explore patients feelings reinforce MD's treatment's order -low salt diet -lie down during attack -pull over when attackoccurs -lie immobile and hold head in one position until vertigo is over -seek medical attention