Chapter 22 Visual and Auditory Problems

Question 1

Correctable Refractive Errors

Answer 1

This defect prevents light rays from converging into a single focus on the retina
Result of irregularities of the corneal curvature
Focusing power of the lens
Length of the eye
Major symptom is blurred vision
Additional symptoms: ocular discomfort, eyestrain, or headaches

Question 2

Myopia

Answer 2

(nearsightedness)
Inability to accommodate for objects at a distance
Causes light rays to be focused in front of the retina
May occur because of excessive light refraction by the cornea or lens or because of an abnormally long eye

Question 3

Hyperopia

Answer 3

Hyperopia (farsightedness)
Inability to accommodate for near objects
Causes light rays to be focused behind the retina
May occur because the cornea or lens does not have adequate focusing power or when the eyeball is too short

Question 4

Presbyopia

Answer 4

(loss of accommodation due to age)
As the eye ages, the lens becomes larger, firmer, & less elastic
Inability to focus on near objects

Question 5

Astigmatism

Answer 5

(an irregular corneal curvature)
Causes the incoming light rays to be bent unequally
Light rays do not come to a single point of focus on the retina
Aphakia is the absence of the lens (absent congenitally or removed during cataract surgery)
Replaced with an intraocular lens (IOL) implant

Question 6

Corrective Glasses

Answer 6

Myopia, hyperopia, presbyopia (reading glasses) & astigmatism
Combined corrective glasses (presbyopic correction is in the lower portion of the spectacle lens); “bifocals”
Distance focusing in the top two thirds & near focus in the bottom one third of the lens

Question 7

Contact Lens

Answer 7

Pattern of wear (daily versus extended)
Microbial keratitis – poor hand or lens case hygiene
Patient education key for the prevention of sight-threatening complications

Question 8

Laser

Answer 8

(laser-assisted in situ keratomileusis – LASIK)
Creates a flap in the cornea, flap is folded back on the middle section, or stroma of the cornea
Laser pulses vaporize a part of the stroma
Flap is then repositioned

Question 9

Implant

Answer 9

Refractive intraocular lens implantation is an option for patients with a high degree of myopia or hyperopia
Removal of the patient’s natural lens
Risk of complications is higher
Phakic intraocular lens implantation
Implanted into the eye without removing the eye’s natural lens, placed in front of the eye’s lens
Preserves the eye’s ability to focus for reading vision

Question 10

Uncorrectable Visual Impairment

Answer 10

In the U.S., 6.5 million people over the age 65 have severe visual impairment
inability to read newsprint even with glasses
9% have no useful vision
91% are partially sighted
Total blindness – no light perception & no usable vision
Functional blindness – some light perception & no usable vision
Legal blindness – central visual acuity of 20/200 or less in the better eye with correction, or a peripheral visual field of 20 degrees or less
1.3 million people in the U.S. are legally blind

Question 11

Assessment

Answer 11

How the patient’s visual impairment affects functioning
Personal feelings & meaning
Support System

Question 12

Planning

Answer 12

Successful Adjustments
Coping Strategies
Goals

Question 13

Implementation

Answer 13

Health Promotion
Acute Intervention
Patient & Family
Respect & Communication
Sight-guide technique
Ambulatory & Home Care
Rehabilitation services
American Foundation for the Blind (www.afb.org)
ADLs
Optical Devices for Visual Enhancement
Nonoptical Methods for Visual Enhancement

Question 14

Evaluation

Answer 14

Expected outcomes
No further loss of vision
Use adaptive coping strategies
Maintain self-esteem or social interactions (no decrease)
Function safely within environment (personal & outside the home)

Question 15

Gerontologic Considerations

Answer 15

Older adults is at increased risk for vision loss caused by eye disease
Other deficits (cognitive impairment, limited mobility) may further affect the older adult’s function in usual ways
Higher risk for falls
Diminished self- esteem and independence
Decreased manual dexterity may cause difficulty with eyedrops instillation

Question 16

Eye Trauma

Answer 16

In the U.S. approximately 2.5 million eye injuries occur each year
More than 10% will lose useful vision in the affected eye
Most common ocular injuries occur in the home
Followed by sport and work-related injuries
Eye trauma often is a preventable injury
Protective eyewear
Role of Nursing – patient and community education

Question 17

Herdeolum

Answer 17

(sty)- infection in sebaceous glands in lid margin
Most common - Staph aureus
May evolve into inflammation of gland → Chalazion
Apply warm, moist compresses at least four times a day
If no improvement refer to ophthalmologist for lancing or removal

Question 18

Chalazion

Answer 18

chronic inflammatory granuloma of the meibomian (sebaceous) glands in the lid

Question 19

Blepharitis

Answer 19

Bilateral infection of the lid margins
Lids are red rimmed with scales or crusts on the lid margins and lashes
May experience burning, irritation and photophobia
Ophthalmic ointment
Emphasize thorough cleaning practices of skin & scalp – baby shampoo

Question 20

Bacterial Conjunctivitis

Answer 20

most common
Commonly occurs in children due to poor hygienic habits
Irritation, tearing, redness, drainage
Antibiotics and hand washing

Question 21

Viral Conjunctivitis

Answer 21

Tearing, foreign body sensation, redness
Adenovirus conjunctivitis: contaminated swimming pools, direct contact
Good hygiene and palliative care

Question 22

Chlamydial Conjunctivitis

Answer 22

Due to increase in sexually-transmitted chlamydia
Irritation, discharge, redness, lid swelling
Treated with ointment
Pt. may have concurrent genital chlamydia as well and may need systemic antibiotic
Educate for both ocular and STI

Question 23

Allergic Conjunctivitis

Answer 23

Caused by exposure to some allergen
Defining symptom – itching
Other symptoms – burning, redness, tearing
Artificial tears, antihistamines, corticosteriods

Question 24

Keratitis

Answer 24

Infection of the cornea due to disruption of the epithelial layer
Can be caused by bacteria, virus or fungi
Topical antibiotics, antiviral or antifungal advised, if not successful, subconjunctival injections or IV
Corneal ulcer – infectious keratitis – aggressive treatment

Question 25

Strabismus

Answer 25

``` Cannot focus both eyes on the same object simultaneously May deviate: In (esotropia) Out (extropia) Up (hypertropia) Down (hypotropia) May be caused by: thyroid disorder, neuromuscular of the eye, retinal detachment repair, cerebral lesions Pt. may c/o double vision ```

Question 26

Intraocular Disorders - Cataracts

Answer 26

Opacity with the lens May be in one or both eyes May have better vision in one than the other Cataract removal is most common surgical procedure in the US

Question 27

Cataracts

Answer 27

``` Age related (senile cataracts) Develops due to altered metabolic process within the lens that creates a accumulation of water and alterations in the lens fiber structure Trauma, congenital factors, drugs such as steroids, DM ```

Question 28

Nursing Diagnosis

Answer 28

Self-deficits related to visual deficit | Anxiety related to lack of knowledge about the surgical and postoperative experience

Question 29

Expected Outcomes

Answer 29

Pre-op Make informed decisions regarding therapeutic options Experience minimal anxiety Post-op: Understand and comply with postoperative therapy Maintain an acceptable level of physical and emotional comfort Remain free of infection and other complications Nursing Interventions Pre-op teaching concerning procedure Administering mydriatic & cycloplegic agents Post-op Patient and family teaching Eye patched for 24 hours May take 1-2 weeks for visual acuity to reach adequate level Home care Table 22-3 – Teaching Plan Post-op Patient and family teaching Eye patched for 24 hours May take 1-2 weeks for visual acuity to reach adequate level Home care Table 22-3 – Teaching Plan

Question 30

Retinopathy

Answer 30

Process of microvascular damage to the retina Can develop slowly or rapidly – leads to blurred vision – progressive vision loss Most associated in adults with diabetes mellitus & hypertension

Question 31

Retinal Detachment

Answer 31

Separation of the sensory retina and the underlying pigment epithelium, with fluid accumulation between the two layers. Almost all patients with untreated detached retina become blind in the involved eye Retinal Breaks- break in full thickness of retinal tissue Retinal Holes- atrophic, spontaneous Retinal Tears- vitreous humor shrinks during aging and pulls at the retina

Question 32

Clinical Manifestations - Retinal Detachment

Answer 32

Photopsia- light flashes Floaters and “cobweb” or “hairnet” or ring in the field of vision Painless loss of peripheral or central vision “curtain”

Question 33

Treatment - Retinal Detachment

Answer 33

``` Expected Outcomes Seal retinal breaks Relieve inward traction on the retina Surgery Laser photocoagulation & cryopexy Scleral buckling Intraocular procedures ```

Question 34

Laser Photorefractive Keratectomy

Answer 34

(PRK) Good option for patients with insufficient corneal thickness for a LASIK flap Only epithelium removed Laser sculpts the cornea to correct the refractive error Laser-assisted subepithelial keratomileusis (LASEK) Similar to PRK except epithelium is replace

Question 35

Cataracts Symptoms

Answer 35

Decreased vision Abnormal color perception Glare Vision loss is gradual, varies from pt. to pt. Secondary Glaucoma can develop if the enlarging lens causes an increased IOP Treatment is surgical with removal and replacement of the lens

Question 36

Age-Related Macular Degeneration

Answer 36

Two classic forms Dry (atrophic, 90%) Wet (exudative, more severe) Most common cause of vision loss in persons over 55 Related to retinal aging Hallmark sign – drusen in the fundus Symptoms – blurred vision, scotomas or metamorphopsia

Question 37

Collaborative Care

Answer 37

Laser photocoagulation – leaves blind spot Photodynamic therapy (PTD) Permanent loss of central vision p. 388 Nursing management of the patient with visual impairment

Question 38

Glaucoma

Answer 38

Group of disorders characterized by: Increased IOP Optic nerve atrophy Peripheral visual field loss May present as primary disease or secondary to other ocular or systemic conditions Primary open-angle glaucoma (POAG)= 90% of cases of primary glaucoma

Question 39

Main Focus of Glaucoma Treatment

Answer 39

Keep IOP low enough to prevent the patient from developing optic nerve damage Prevention Focus Exam 2-4 years for ages 40-64 Exam 1-2 years for ages 65 and up African-Americans in ever age category should have exams more often

Question 40

Primary Open-Angle Glaucoma

Answer 40

Develops slowly & without symptoms Outflow of aqueous humor is decreased in the trabecular meshwork - Drainage channels become blocked S/S: “Tunnel vision”

Question 41

Acute Angle Closure

Answer 41

Sudden, excruciating pain Nausea/vomiting Colored halos around lights, blurred vision, ocular redness

Question 42

Collaborative Care

Answer 42

``` Diagnostic Tests/Collaborative Therapy Table 22-9 Drug Therapy Table 22-7 β – Adrenergic Blockers α – Adrenergic Agonists Cholinergic Agents (Miotics) Carbonic Anhydrase Inhibitors ```

Question 43

Nursing Diagnosis

Answer 43

Noncompliance related to the inconvenience and side effects of medications Risk for injury related to visual acuity deficits Self-care deficits related to visual acuity deficits Acute pain related to pathophysiologic process and surgical correction

Question 44

Patient Expected Outcomes

Answer 44

No progression of visual impairment Understand the disease process and rationale for therapy Comply with all aspects of therapy, including medication administration & follow-up care No postoperative complications

Question 45

Acute Otitis Media

Answer 45

Most common problem of the middle ear Bacteria – predominant etiologic agents Signs/symptoms – pain, fever, malaise, headache, & reduced hearing Amoxicillin current therapy of choice Myringotomy (incision in tympanum) for those who do not respond to treatment Tympanostomy tube may be placed

Question 46

Meniere's Disease

Answer 46

Characterized by: Episodic vertigo, tinnitus, fluctuating sensorineural hearing loss & aural fullness Cause of disease unknown Causes significant disability Duration of attacks may be hours or days Hearing recovery is often less complete with each episode leading to progressive permanent hearing loss

Question 47

Meniere's Disease - Acute Nursing Management

Answer 47

``` Medications Sedatives Benzopdiazepines Anticholinergics Antihistamine Antiemetics Low sodium diet – avoid caffeine, nicotine, alcohol, MSG Surgical intervention ```

Question 48

Miner's Disease - Acute Nursing Management (expected outcomes and nursing interventions)

Answer 48

``` Expected Outcomes Minimize vertigo Provide for patient safety Nursing Interventions Quiet, dark room Avoid sudden head movements or position changes No fluorescent/flickering lights or watching TV Emesis basin available Side rails up and bed in low position Medications and fluids given I & O Assist patient with ambulation ```

Question 49

Types of Hearing Loss

Answer 49

Conductive – occurs in outer & middle ear; impairs sound being conducted from outer to inner ear Sensorineural - impairment of function of the inner ear or CN VIII Mixed – combo of above two Central & Functional Central – problems in CNS Functional – emotional/psychologic factor

Question 50

Health Promotion in Hearing

Answer 50

Environmental Noise Control Immunizations Ototoxic Drugs

Question 51

Assisting Devices and Techniques for Hearing

Answer 51

Hearing Aids Speech Reading/ Sign Language Cochlear Implant Assisted Listening Devices

Question 52

Presbycusis

Answer 52

``` Hearing loss associated with aging Types Sensory Neural Metabolic Cochlear Older adults reluctant to wear hearing aids ```

Question 53

Communication with Hearing Impaired Patient

Answer 53

Non-verbal aids and verbal aids