Exam 2 Sensory Flashcards
(116 cards)
1
Q
Blepharitis
A
Inflammation of the eyelid. Can be seen with conjunctivitis or other infections.
Causes itching and occasionally red and burning eyes.
Crusting, scales and exudate can be seen.
2
Q
Types of blepharitis
A
Two main types: bacterial and seborrheic
3
Q
Treatment for blepharitis
A
Keep it clean
4
Q
Entropion overview
A
Inward turning of the eyelid, most commonly the lower lid. Scratches the cornea.
Causes: trauma, muscle spasm, or inflammation
Main concern is corneal abrasion.
5
Q
Entropion treatment
A
Treatment: inform healthcare provider. Eye drops will be used for temp releif. Need to see an ophthalmologist.
6
Q
Ectropion
A
Outward turning or drooping of the eyelid, most usually the lower lid.
Usually caused by aging or strokes.
Leads to corneal drying and ulceration because the eye dries out.
7
Q
Hordeolum
A
Sty, usually of staph or strep. Arises from glands in the lid becoming infected, and the pores which allow the glandular material to escape becoming clogged.
Treat with warm compresses and antibiotic ointment to keep clean. Warm compress increases circulation. Eye drops can be helpful for antibiotic measures.
8
Q
Keratoconjunctivitis sicca
or Dry Eye Syndrome
A
Three different processes the body uses to make tears. If any of the three processes are messed up, there will be dry eye problems.
9
Q
Diagnostic method for keratoconjunctivitis sicca
A
litmus paper in the eye to see how much your eye tears up.
Due to an alteration in tear production, composition or tear distribution.
10
Q
Causes of keratoconjunctivitis sicca
A
medications, autoimmune diseases such as RA, lupus or Sjogrens, radiation or chemical burns or nerve damage.
11
Q
Signs and symptoms of keratoconjunctivitis
A
Eye pain, burning, itching, photophobia, mucus and corneal changes.
12
Q
Treatment for keratoconjunctivitis
A
depends on severity: Eye drops or ointments. Restasis-immunosuppressant that works in the area around the eye to decrease inflammatory response. Lacralube: highly refined petroleum jelly… not helpful by way of eye sight.
13
Q
Subconjunctival Hemorrhage
A
Usually due to coughing, sneezing or straining.
It may be a complication of hypertension or a clotting problem.
Usually resolves without treatment in one to two weeks.
14
Q
Conjunctivitis
A
Inflammation or infection of the conjunctiva. Highly contagious. Can be due to many different things.
15
Q
s/s of conjunctivitis
A
itching, burning, edema, excessive tearing and engorgement of blood vessels.
Document and treat underlying cause.
16
Q
Treatment of conjunctivitis
A
educate on hand hygeine. Don’t share towels, or keep makeup that you used before the infections. Rx for eyedrops or ointments. Shouldn’t be experiencing photophobia,
Note drainage:
17
Q
conjunctivitis drainage according to type of infection
A
viral=clear, bacterial=purulent
18
Q
Trachoma
A
You’ll see this on medical missions
Leading cause of preventable blindness, especially in third world countries.
Chronic, bilateral conjunctival infection by Chlamydia trachomatis
Edema, entropion (things curl in and scar the cornea), conjunctivitis, tearing, photophobia, corneal scarring.
Treated with antibiotics. Handwashing is important. Educate people to complete their round of antibiotics
19
Q
Cataracts
A
An opacity or cloudiness of the lens that interferes with the focusing of light, and a clear image forming on the retina, resulting in blurry or distorted vision
20
Q
Cataracts: Causes
A
Age related: the most common, some formation is expected over the age of 70.
Trauma: blunt trauma to head or eye, foreign bodies, or radiation exposure.
Toxic exposure to chemicals and pollutants, sunlight, or medications.
Associated with other diseases (diabetes).
Complications of other eye diseases.
21
Q
Key features of cararacts
A
NO PAIN or REDNESS is associated with cataract formation.
Blurred vision, glare from sun or headlights
Decreased color perception
color of pills can get people’s medications mixed up
Diplopia and reduced visual acuity
Absence of red reflex
White appearing pupil and eventual blindness.
22
Q
Cataract Treatment
A
Surgery, with lens removal and implantation is the only “cure” for cataracts.
Pre op evaluation and pre and post op education is key to a successful experience.
If on flomax, you need to stop the drug before surgery
23
Q
Cataract: Education
A
Regarded as one of the safest and most successful of all surgeries.
A tiny incision is made and an instrument is then used to disintegrate the clouded lens into tiny pieces which are then suctioned away.
A new artificial lens is inserted
24
Q
Cataract Post op Care
A
Call the doctor for: RSVP
R: Increased redness.
S: Extreme sensitivity to light.
V: Decreased vision: especially flashes of light.
P: Severe pain, purulent drainage (or bleeding).
25
Patient Instructions post op for cataracts
Avoid activities that increase intraocular pressure: sneezing, coughing, bending from the waist, vomiting, intercourse, vomiting or carrying more than 15 lbs. People don't think about this, because they do it everyday.
Instruct Pt. on proper application of eye drops.
They may gently clean the eye with water on a cotton ball, but do not get water in the eye.
Arrange for someone to drive them home and assist with care for a few days.
Avoid NSAIDS or anything that will incrase bleeding.
Sleep on opposite side of surgery.
Wear eye patch when sleeping for the first week to a month depending on Doctor’s instruction.
Wear sunglasses when outside.
Wash hands well before touching the eyes.
Bring all eye drops to follow up appointments.
Do not use make up or lotions around the eye until advised to do so.
Sleep on their back or turn to non-operative side for 3 to 4 weeks.
26
Glaucoma
One of the leading causes of preventable blindness in the US. Interior fluid oxygenates the area of the eye.
Progressive degeneration of optic nerve fibers associated with an increase in intra-ocular pressure do to an imbalance between production and outflow of aqueous humor or an obstruction of outflow.
See table 49-2 on page 1291
27
Glaucoma: Two Major Types
Primary open angle glaucoma
| Acute closed angle glaucoma
28
Primary open angle glaucoma
It is usually bilateral and is due to reduced outflow of aqueous humor. Usually asymptomatic in early stages. Blind spot progress to blindness if untreated. 10% of people over 80 have this.
29
Acute closed angle glaucoma
A medical EMERGENCY. Sudden onset with impaired vision, severe eye pain, N/V. Can be caused by trauma, iritis, or uvitis. Suddenly development of pressure above 50 or 70.
30
Open-Angle Glaucoma: Symptoms
Increased IOP
Diminished accommodation
Blind spots/decreased peripheral vision
Halos around light
Dull morning headache due to vision changes
See box 49-3 on page 1290 for the progression of glaucoma.
31
Glaucoma:Assessment
Tonometry
Opthalmoscopic exam
Tonography
32
Tonometry
measures intraocular pressure.
33
Opthalmoscopic exam
cupping and atrophy of optic disc.
34
Tonography
measures outflow of aqueous humor.
35
Glaucoma: Non-surgical Treatment
Drug therapy: Works to decrease intraocular pressure by either constricting the pupil (ciliary muscle) or by reducing the production or increasing the reabsorption of aqueous humor.
reduce fluid production, or
increase drainage
36
Glaucoma Drug Therapy
Pupillary Constriction:
Miotics:
IProstaglandin agonists:
Aqueous Humor Inhibitors:
Beta blockers: timolol (Timoptic) or levobunolol (Betagan)
Carbonic anhydrase inhibitors:
acetazolamide (Diamox) and
methoazolamide (Neptazane).
37
Miotics
sopto Carpine, Pilocar, Miostat--These cause blurred vision for 1 to 2 hrs.
38
Iprostaglandin agonists
latanoprost (Xalatan), travoprost (Travatan), bimatoprost (Lumigan) and unoprostone (Rescula).
39
Glaucoma: Surgical Treatment
Laser Surgery: trabeculoplasty, the trabecular meshwork is burned and removes part of the trabecular network thus improving outflow.
40
Hypertensive Retinopathy
Hypertension leads to narrowing of the blood vessels, leakage of blood and exudate, ischemic areas and retinal detachment.
May have headaches and vertigo.
Damage rated from 1-4 (4 is the greatest)
41
Diabetic Retinopathy
Damage to the blood vessels of the retina that worsens as blood glucose worsens.
Causes areas of bleeding/scarring that affect vision.
Leading cause of visual disability and blindness among adults in the United States.
42
Diabetic Retinopathy: Two Types
Background
Proliferative
43
Background diabetic retinopathy
Microaneurysms and vessel death cause leakage of blood and scarring, retinal ischemia and macular edema. Capillaries can no longer carry oxygen and nutrients.
44
Proliferative diabetic retinopathy
In response to ischemia new fragile blood vessels grow. The new vessel leak and they grow onto the retina and iris. Can lead to retinal detachment.
45
Diabetic Retinopathy: Treatment
Laser Photocoagulation: A high energy laser beam burns and creates small scars, sealing leaks and aneurysms and destroying new vessel networks.
Vitrectomy: Done to remove large unresolved hemorrhage or scar tissue. Fluid and tissue volume is replaced using a saline solution. Used in extreme cases due to increased risk of blindness.
46
Macular Degeneration
Goal is to keep current vision as much as you can.
| Two types: Wet and Dry
47
Dry macular degeneration
Age-related degeneration is caused by gradual blockage of retinal capillaries leading to ischemic death of photoreceptors
48
wet macular degeneration
leads to more rapid deteriation
| Dreusen material like a plaque
49
Macular Degeneration
| Symptoms:
Loss of central vision, blurred words when reading print, warped or bent lines on an Amsler grid.
The aim is to work to maintain current vision.
Age Related Macular Degeneration
50
Reduce risk of macular degeneration
- Stop smoking
- Treat hypertension
- Eat low cholesterol low fat diet
- Treat high cholesterol
- Protect eyes from UV rays/sunlight
51
Nutritional Treatment for macular degeneration
- Diets rich in antioxidant vitamins D and E
- Carotinoids: lutein, zeaxanthin, and beta-carotin.
- Minerals: Zinc, selenium, magnesium.
52
Exudative or Wet
| Macular Degeneration
Laser treatments are done to seal leaking blood vessel.
FDA has just recently approved drugs: Bevacizumab (Avastin), Ranibizumab (Lucentis), Pegaptanib (Macugen) that are injected directly into the eye every 4 weeks to shrink blood vessels.
53
Retinitis Pigmentosa
An inherited progressive degeneration of the retinal nerve cells leading to growth of pigmented cells into the sensory areas of the retina.
54
Refractory Errors
Myopia
astigmatism
hyperopia
presbiopia
55
myopia
nearsightedness-images fall short of the retina
56
astigmatism
curve of the cornea is uneven
57
hyperopia
farsightedness-images focus behind the retina
58
presbiopia
lens stiffens-hard to adjust to close work
59
Corneal Disorders
Any disorder that alters the clearness or integrity of the cornea
Pain, decreased vision, photophobia and increased secretions
Goals: reduce symptoms, restore clarity, & enhance remaining vision.
60
Age related Changes
Arcus senilus
Iris has decreased ability to dilate. Elderly require more light to read.
Cornea flattens, ocular muscle strength weakens, tear production diminishes.
61
Blindness
Legal blindness is a level of visual impairment that has been defined by law to determine eligibility for benefits. It refers to central visual acuity of 20/200 or less in the better eye with the best possible correction, as measured on a Snellen vision chart, or a visual field of 20 degrees or less.
***If you have a blind patient, always introduce yourself and announce your arrival. Orient them. Keep a clear path to the bathroom.***
62
Uveitis/Iritis
Uvea consist of the iris, the ciliary body and the choroid.
The iris is the most common place for inflammation.
Approximately 15 cases per 100,000 people in US.
Need to see an eye doc within 24 hours. Treat underlying cause.
Avoid bright lights.
63
Iritis: Symptoms
```
Unilateral
Extremely painful
Red eye, especially around the iris
Blurred vision
Photophobia
Tearing
```
64
Blunt trauma: Contusion
Impact from an object causes sudden compression of the eye. Young males are most at risk.
Leads to edema of the eyelid, hemorrhage, corneal edema and hyphema.
Head trauma: orbital fractures, increased pressures, concussions
Nursing considerations: ABCs/LOC/is vision affected?/edema/fractured/flashing lights?
65
Vitreous Hemorrhage
Bleeding into the vitreous cavity due to aging, systemic disease, trauma or it may occur spontaneously.
Usually absorbs slowly with no treatment.
66
Hyphema
Hemorrhage in the anterior chamber.
Protect the eye with a patch and shield.
Elevate the head of the bed 30 to 40º
Avoid analgesics like aspirin.
Associated with a rapid increase in IOP.
Assess areas of secondary problems.
67
Retinal Tears and Detachment
Retinal detachment is an emergency.
About 28,000 cases each year in the US.
Symptoms: Flashes of light, shower of floaters, vision loss “like a curtain”, filmy, wavy or cloudy visual defects.
Can occur spontaneously
68
Retinal Holes, Tears & Detachments
More common in people who are myopic, older and who have had cataract removal.
Detected on ophthalmoscopic exam.
Treatment: Depends on type, location and size of detachment. Laser therapy or cryotherapy, intraocular gas, and scleral buckling are usually done as an outpatient.
You want these people into the doc as soon as possible
69
Retinal Detachment: treatments
Position patient to keep the bubble against the tear.
Avoid lifting/straining
Driving and air travel may be restricted until the bubble or tear resolve.
Remember RSVP
70
Corneal Abrasion/Foreign Objects
Any foreign object can irritate or damage the cornea.
Sensation of something in the eye, pain, tearing, blurred vision, photophobia.
Evaluation of vision is ALWAYS done prior to treatment.
Fluorescein stain into eye (can't put contacts back in) then view the eye with a fluorescent lamp to see the scratched cornea.
Antibiotic drops or ointments to avoid infection because you will be susceptible
71
Lacerations & Penetrating Objects
We are worried about vision. We don't know how far it goes, so cover it and don't apply pressure. Sharp objects and projectiles
EMERGENCY: Eye content may prolapse through the laceration
Do not remove the object: It may be holding the eye structures in place.
72
Priorities of Care - #1 PRIORITY IS ALWAYS ASSESSMENT OF VISUAL ACUITY!!
Upright positioning, cycloplegia, and patching
Application of ice, slit lamp examination
Fluorescein exam, irrigation with Morgan lens, patching
Antibiotics, microsurgery; in severe cases, corneal transplant or enucleation may be required
Updated tetanus, antibiotics, imaging (MRI contra-indications), surgical removal of foreign body
73
The Normal Ear
```
Eardrum is nice and shiny
taught and intact
grey
inner ear: cochlea gives us balance
Hearing and balance.
Hearing is the sense that never sleeps.
```
74
Cerumen Impaction
Cerumen is slightly acidic and can kill bacteria, and slowly moves out of the ear to keep it clean.
Impaction occurs when earwax becomes wedged in and block the canal. Q-tips push earwax in more.
Common in the elderly-reduces hearing and decreases mental status.
75
Ear Irrigation
* DO NOT IRRIGATE if there is perforation of the eardrum or otitis media!
Do not occlude ear. Allow space for the irrigant to escape.
* Use body temperature water ONLY.
76
Otitis Externa
Can get this from wearing ear buds or from swimming. "swimmer's ear"
Inflammation and/or infection of the external ear canal.
Redness, swelling, tenderness and discharge.
Excessive moisture and trauma.
77
treatment for otitis externa
3-5 days of drops
Blow dryer to keep it dry
acetic acid
78
Acute Otitis Media
Retracted eardrum with redness
Caused by immunosuppression/severe allergies or sinusitis that presses on the eardrums
Rapid onset of ear pain, pressure and diminished hearing.
Inflamed tympanic membrane, fluid or pus in the middle ear.
79
Chronic Otitis Media
Retracted or bulging eardrum will redness
Worried it will spread to the brain and get meningitis
Chronic or recurrent infection or inflammation of the middle ear.
Earache or pressure, ear drum rupture or bulging, purulent drainage, hearing loss.
80
Treatment for chronic otitis media
antihistamine
treat infections with antibiotics
might culture fluid
clear ears
81
Serous Otitis Media
Accumulation of fluid in the middle ear most often due to eustachian tube dysfunction.
Due to infections, allergies, adenoids or other obstruction.
Treatment:
draining with an irrigant
tubes (mostly in children)
82
Myringotomy
Tubes in the ears.
Usually only performed on Pts. with intractable pain.
Done as outpatient.
The grommet will usually fall out on it’s own, or they can be removed.
Don’t get water in the ear. Hard for kids to stay calm and not cause problems.
83
Tympanic Perforation
Usually the result of infection, but may be due to trauma or overly aggressive ear cleaning.
Usually heals on its own in 1 to 2 weeks. Ear drum will make scar tissue, affecting the hearing.
Hearing loss depends on size of opening and what underlying structures are moved.
pain
bleeding
purulent drainage
Nursing considerations:
No water in ear
84
Barotrauma
Traumatic inflammatory disorder of the middle ear caused by sudden, severe negative pressure. Flying/diving
* Causes sudden severe pain, hyperemia of the ear drum, sometimes with fluid in the middle ear and hearing loss.
Usually resolves spontaneously within several hours.
85
Mastoiditis
Acute or chronic infection of the mastoid air cells in the temporal bone due to untreated or poorly treated otitis media. Untreated with antibiotics/antibiotic
Pain is not relieved by a myringotomy.
86
s/s mastoiditis
```
Swelling and cellulitis behind the ear,
fever,
malaise,
ottorhea,
tender enlarged lymph nodes,
otitis media on ear exam,
and hearing loss.
```
87
Treatment for mastoiditis
IV antibiotics & surgical excision of infected bone and tympanoplasty.
bone infections are really hard to treat
88
Tinnitus
* Ringing or noise in the ear audible only to the patient.
Can be whining, roaring or ringing.
Noticed most at night because it's quiet.
Focus on treatment of underlying cause, masking the noise, aiding with sleep and depression.
*Needs to be investigated. If patient mentions it, look at drug list.
89
classic cause of tinnitus
gentamyacin (ototoxic antibiotics)
90
Common Drugs that cause Tinnitus
```
Aminoglycoside antibiotics like Gentamyacin
Caffeine
Salycilates: high aspirin therapy
Qunidine/Quinine
Indomethacin
Propanolol: beta blockers
Levodopa
Aminophylline
Cisplatniin
```
91
Vertigo vs. Dizziness
Vertigo: A feeling that the world is moving around you.
Usually accompanied by nausea, vomiting, nystagmus, falling and headache.
* Benign Positional Vertigo
Dizziness: An altered feeling of a person's relationship to space.
May also be described as feeling faint or light headed.
92
Vertigo questions
```
Ask:
what brought it on
medications
dietary
describe sensation (bed spins, the earth is moving)
Check BP
History of migranes
```
93
Benign Paroxysmal Positional Vertigo
Accumulation of canalith in the inner ear. (Canalith=calcium carbonate crystals.)
Incapacitating vertigo associated with changes in position.
Hearing is not affected.
94
Diagnosis of benign paroxysmal positional vertigo
Hallpike maneuver: goggles on to check for nystagmus while leaning back
Common in people who are older or in patients on bed rest
Occurs in women 2:1 or people older than 50
Treatments:
PT will reposition crystals on a tilt table
95
Labyrinthitis
Infection of the labyrinth. Can be due to viral infection of inner ear.
Risk for meningitis causing the infection, or the infection causing meningitis
96
s/s of labyrinthitis
```
hearing loss,
tinnitus,
nystagmus to the affected side,
vertigo,
nausea, vomiting.
```
97
treatment of labyrinthitis
Anti-virals or antibiotics. antiemetics, and antivertigo meds along with dark, quiet room and bed rest.
98
Meniere’s Disease
Technical name: endolymphatic hydrops (endolymph of the innner ear is overproduced or decreased reabsorption.)
Sensory hearing loss vs. conductive hearing loss (know this)
A chronic, recurrent disorder of the inner ear. Dilation of the cochlear duct by either over production or decreased reabsorption of endolymph lead to progressive sensorineural hearing loss.
Occurs in incapacitating attacks that last from hours to days
99
s/s of Meniere's disease
```
* fluctuating hearing loss,
vertigo,
tinnitus,
ear fullness,
nausea, vomiting
nystagmus (during and attack)
falling episodes.
```
100
Meniere's disease Nursing Diagnoses:
```
Risk for injury (falls)
anxiety,
sleep disturbance,
ineffective coping,
auditory and sensory/perceptual alteration.
```
101
patient goals for meniere's disease
Provide safety and comfort during attacks, patient education, minimize number of attacks.
Position Pt. lying down with affected ear up.
102
Treatment fir Meniere's disease
Strict adherence to a VERY low sodium diet (
103
Vertigo: Dealing with an attack
* Stop all activity and get to a safe place immediately.
Reduce environmental stimuli and lie down on a firm surface.
Take antivertigo medication.
* Stay as motionless as possible.
Don’t stand up, crawl with your head down.
After an attack, patients will feel exhaused.
104
Acoustic Neuromas
Slow growing benign tumor of the acoustic nerve.
Slowly progressive unilateral hearing loss, tinnitus, disequilibrium, facial weakness and possible vertigo.
Nondescript s/s.
surgeon has to be very careful
105
Hearing Loss
Conductive Loss: “loss occurs when sound waves are blocked from contact with inner-ear nerve fibers.”
Due to external or middle ear disorders.
Sensorineural: Inner ear nerve (sensory) fibers that lead to the cerebral cortex are damaged.
Cranial nerve VIII-the auditory nerve.
106
Presbycusis
hearing loss associated with aging. Loss gradual and bilateral.
Get testing to see if there's anything that can be done to prevent further loss.
Risk factors for hearing loss: aging, infection, medications, ototoxicity, trauma, tumors, autoimmune diseases and NOISE.
107
Otosclerosis
Genetic component for most of the cases. Bones remodel constantly... In these patients, bones remodel with unhelpful bone and fuse together.
* Slow progressive conductive hearing loss and tinnitus, usually bilateral. 25% unilateral.
Vertigo or unsteadiness in about 25% of cases
* Metabolic bone disease of reabsorption and replacement.
108
Treatment for otosclerosis
surgery. Sometimes cures the tennitis.
| Stapedectomy
109
Stapedectomy
Ear drum is carefully opened and movement of middle ear bones are tested.
New bone growth and/or old stapes removed and prosthesis placed.
110
Post stapidectomy: When should I call the doctor?
```
Call the doctor immediately if:
You develop a fever.
You cannot stand up because of dizziness.
You have drainage from your ear.
You have uncontrollable pain.
```
111
Hearing Aids
Does not improve ability to discriminate words.
Requires ear exam and audiometry.
Requires education for best use and longevity.
Last 3 to 5 years.
On average, $3000.
Nursing considerations
don't lose them!
112
FDA Hearing Aid Regulations
Ear exam prior to first purchase especially if you have:
Ear pain, hx of drainage w/in the last 90 days, acute or chronic dizziness
Visible congenital or traumatic injury
Sudden onset or rapidly progressing hearing loss w/in the last 90 days.
Evidence of cerumen or foreign body w/in the ear
113
Tips for Hearing Aid Wearers
May need adjustment when new and take up to a year to adjust to it.
* Keep extra batteries on hand and remove them when not in use.
Avoid shock, temperature extremes and moisture.
* Keep ear molds clean of cerumen.
www.hearingloss.org or www.hear-it.org
114
Cochlear Implants
About $30,000. Strictly for bilateral hearing loss, but mostly just on one ear.
An implanted electrical device that is usually only placed in one ear and directly stimulates the auditory nerve.
A 2 to 3 hour procedure under general anesthesia.
Screening to make sure there is no infection. Psyche evaluation prior to
115
Communicating with the Hearing Impaired
```
Stand directly in front of the client
Be sure the room is well lighted.
Get their attention before you speak.
Remove all distracting noises.
Speak clearly, slowly and don’t shout.
Keep it simple and ask for feedback and not just a nod.
```
116
WWYD if someone has had sudden bleeding from their ear?
If they've had trauma?
Are you on blood thinners?
Purulent?
Has it affected your hearing?
