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Good lighting Rest eyes on distant object
Meds only by MD; discard old meds; maintain
sterility Avoid bright light exposure
Goggles
Dont rub eyes
Under 40, test every 3-5 yrs; over 40, every 2years
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Report to MD: sudden sharp eye pain, deepeye pain; photophobia; blurred or doublevision; loss of part of visual field; halosaround lights; floaters; excess tearing;
drainage from eye
Clean eye from inner to outer canthus
Vitamins A & B are important
Wear contacts appropriately
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Client is blind, not deaf Treat as adults
Speak when entering or leaving room
Inform before touching Determine amount of help needed
Let person take your arm when walking
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Independence fostered by: Braille
Special cane
Seeing eye dog Keep bed low position
Eliminate noise
Room free of clutter
Reduce glare
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Ophthalmoscopy Look into eye-see retina, optic disk,blood vessels
May see changes with eye disorders May see changes with diabetesmellitus
Visual field Peripheral vision
Important in some eye diseases
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Refraction Look into series of refractors-lenses
Client chooses the clearest vision
Tonometry Measures eye pressure
Pneumotonometer uses puff of air
Normal pressure 12-21 mm Hg
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Snellen eye chart
Visual acuity Normal is 20/20
Example: 20/30the person sees at20 feet what a person with normalvision sees at 30 feet
20/70 is visual impairment
20/200 is legally blind
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Eye lid, conjunctiva, sclera Any discharge, signs of inflammation or
infection
Visual acuity PERLA
Current and past medical Hx RT eyes
Dry, red, edema
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Change from medical problems Diabetes mellitus
Neurological damage
Hypertension Eye injury
Family history
Corticosteroid use Occupation
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Keratitis Inflammation of cornea
From infection, irritation, injury, allergy
Symptoms: severe eye pain, red watery
eye, photophobia May cause reduced vision, rash
Treatment: anesthetics, mydriatics, darkglasses, antibiotics
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pustular inflammation of eyelash follicle orsebaceous gland on lid margin
Staphylococcal organism
Symptoms: pain, redness, swelling
Treatment: warm compress; topical antibiotic
May need I&D if severe
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Cyst of meibomian glands Hard, filled with fatty material
Painless
Develops over weeks Treatment: surgical excision if infected,interferes with sight
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Inflammation of conjunctiva frombacteria, virus, ricketsia, allergen, irritant
Symptoms: burning, itching eyes,
discharge, edema, pain, redness Treatment: WMC, antibiotic, antiviralointments; if allergy, treat allergy
Is contagious-use infection control
measures
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Myopia: nearsightedness Light focuses on front of retina
Starts with children
Hyperopia: farsightedness. Light focusesbehind the retina
Astigmatism: hard to see small objects. Lightrays distorted
Presbyopia: poor accommodation
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Preoperatively
Orient to room if bilateral eye patch, veryimportant
Consent form
NPO Expectations postoperatively
Eye drops
Report any S/S of infections
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Safe environment
HOB up 30-45 degrees NO cough, lifting, stooping over,straining, laying on affected side
If nausea, get antiemetic order Avoid constipation
Eye shield, esp. at night
Report any eye pain STAT
Report any bloody drainage
PO meds for mild to moderate pain
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Mydriatics: dilate the pupil Cycloplegics: paralyze muscles of
accommodation
Both used in diagnostic eye procedures,eye surgery
Anticholinergics: dilate the pupil; paralyzemuscle of accommodation
Relax ciliary & dilator muscles by blockingacetylcholine
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Examples: Atropine sulfate (cycloplegic);Propine for open angle glaucoma;epinephrine for eye surgery or openangle glaucoma
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Opacity or clouding of lens Congenital, chemical, traumatic,
mechanical, or degenerative
Assessment: subjectiveC/O cloudyvision, seeing spots or ghost images;floaters
Gradual loss of vision
Advanced: can see milky white lens
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Extract lens, implant new one Outpatient status, go home 2-3 hrs. postop
Mild sedative, local anesthesia Preop: mydriatic, cycloplegic
Post op: avoid increasing IOP
Do not drive car until released to doso
Wear dark glasses
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Separation of retina from choroid layer Collection of fluid between sensory andpigmented layer
From: trauma, degenerative changes;secondary to other surgeries
Myopic clients at more risk
Assessment: C/O flashes of bright lights
or floaters
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Cloudy vision No pain
May have sudden blindness
Objective data Loss of peripheral vision
Loss of acuity of vision
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Treatment Prompt medical attention needed
Laser reattachment: adhesion formed
Cryosurgery: cold used to adhere layers Scleral buckling: silicon implant used toband retina
Pneumatic retionopexy: use air or gas to
hold retina in place
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Abnormal pressure within the eyeball Damages cells of optic nerve bydecreasing blood flow
Most common form: primary open angle
glaucoma Incidence increases over 40 years, familyhistory; more prevalent in African
Americans
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Drainage of eye system blocked-trabecular meshwork and canal ofSchlemm
Bilateral condition
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Acute angle-closure glaucoma Highest incidence in Asians, women over40, nearsighted
Unilateral Narrowed angle at the junction where irismeets cornea
Iris protrudes into anterior chamber,
occludes angle
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Loss of peripheral vision cardinal symptom Other complaints: blurred vision, halos
around lights, complaints of tired eyes
Glaucoma painless, untreated = blindness
Diagnosis: tonometry
Pupils should be dilated first
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Treatment: first lineopening aqueous flow
Use miotics (Pilcar) Constricts pupil, iris pulls away fromdrainage canal
Diamox: decreases production ofaqueous
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Timoptic: beta blocker, decreasesproduction
Steroids if inflammation
Must use meds BID or TID for life
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Narrow angle glaucoma Avoid anticholinergics: Atropine
Avoid antihistamines: Benadryl, Vistaril
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Laser surgery: laser emits an intenseconcentrated ray of light Can cauterize, create holes in tissue, seal layers of
tissue
Cryotherapy Use of frozen probe: retinal tear or cataract
Enucleation Removal of entire eyeball
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Inability of sound to reach inner ear Can occur because of cerumen,perforated tympanic membrane, fixation
of one or all of ossicles Hearing aids useful
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Inner ear or cochlear portion of cranialnerve VIII unable to function
Occurs from: tumor, infection, trauma,
exposure to noise, some medications Presbycusis: unable to hear high pitchedsounds
Cochlear implant helpful
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Turn up volumes Ask What did you say?
Learn forward, turn head to one side
Cup hands around ears
Speaks unusually softly or loudly C/O people mumbling Answers questions inappropriately, not at all
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Difficulty with: f, s, k, sh Cannot filter background sounds
Avoids group activities
Appears to not be paying attention
Seems aloof
C/O ringing, buzzing, roaring noise
May have paranoia or social isolation
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Bone fixation of stapes Begins in adolescence
Hereditary
Conductive hearing loss
Young, Caucasian, female, 40
Bilateral hearing loss
Hears own voice well
C/O tinnitus
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Hearing aid Reconstruct ossicles
Stapedectomy
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Operative ear up Ear plug for asepsis
Treat Nausea/Vomitting
Safety measures Dont dislodge prosthesis
No cough, sneeze, blowing of nose,
vomiting, flying, lifting, showering If gets a cold: call MD
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Edema and congestion in mucousmembrane of cochlea and semicircularcanals
2 million people
Assessment: classic S/S unilateralhearing loss, vertigo
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Attacks at regular intervals, havedizziness, unsteadiness on feet
Tinnitus occurs during attack
Classic triad Progressive hearing loss with eachattack
Vertigo
Tinnitus
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Usually occurs in 40-60 year old Men more than women
Interventions
Bed rest during acute phase Low sodium diet
Avoid alcohol, caffeine, tobacco
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Antihistamines
Antiemetics
Vasodilators
Diuretics
Surgical intervention Severing of acoustic nerve (8thcranial nerve)
labyrinthectomy