1 Nursing Eye-Ear Diseases

8/8/2019 1 Nursing Eye-Ear Diseases

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EENTEENT-- The EyeThe Eye

Medical SurgicalNursing


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G

laucoma Increased intra-ocular pressure


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G

laucomaTwo types

1. Open angle

2. Closed angle


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G

laucoma


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GLAU

COMA

PATHOPHYSIOLOGY

1. Direct mechanism direct pressure

damages retina

2. Indirect mechanism high IOP

compresses the microcirculation in the

optic head resulting to nerve injury and

death


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G

laucoma Classification ofGlaucoma

1. Open-angle glaucoma the anterior

chamber angle is open and appears normal

2. Angle-closure glaucoma the AH

outflow is obstructed due to partial or

complete closure of the angle


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G

laucoma ASSESSMENT

1. Blurred vision

2. Halos around the lights

3. Loss of peripheral vision

4. Headache

5. Discomfort around the eyes


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G

laucoma DIAGNOSTIC TEST

1. Tonometry to measure the IOP

2. Ophthalmoscopy to inspect the optic

nerve

3. Gonioscopy to examine the angle

4. Perimetry to detect visual field changes


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G

laucoma MEDICAL MANAGEMENT

1. Laser surgery

2. Drug therapy to lower Increased IOP

A. MiOtics to cause cOnstriction

B.A

drenergics, beta-blockers and CA

I tocause reduced production


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G

laucomaNURSING INTERVENTION

1. Teach patient about glaucoma care

2. Use of medications can slow the

progression but not cure it

Information about instilling eye drops

Information as to the corrective SURGERY to

prevent irreversible blindness!!!


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GLAU

COMA

NURSING INTERVENTION

3. Reduce anxiety and Agitation

Familiar, noise free, less stimulating

environment

Remain calm, and unhurried during agitation

attacks


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CA

TARA

CTS A lens opacity or cloudiness


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Cataract

Risk factors

1. Aging, DM, Toxic factors, aging, etc

causes lens opacification

2. Visual impairment progresses as the

opacification blocks the visual field


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Cataract

ASSESSMENT

Clinical manifestations

1. painless, blurry vision

2. patient perceives that surroundings are

dimmer

3. reduced visual acuity


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Cataract

DIAGNOSTIC TEST

1. Snellen chart for visual acuity

2. ophthalmoscopy

3. slit-lamp to establish the degree of

cataract formation


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Cataract

MEDICALAND SURGICAL

MANAGEMENT

Cataract surgery- intracapsular extraction,

extracapsular extraction,

phaecoemulsification and lens replacement

No useful drug to combat cataract


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Cataract


1.Provide pre-operative care

Withhold aspirin therapy for 5-7 days,

NSAIDS for 3-5 days andWarfarin until

PT of 1.5

Dilating drops are administered every 10

minutes for 4 doses at least 1 hour before

surgery


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Cataract


1. Provide pre-operative care

Dilating agents include:

Atropine

Phenylephrine


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Cataract


2.Provide Post-operative care

POSITION: Place patient side lying onthe UNAFFECTED side

Administer pain medication, topical

antibiotics and anti inflammatory agents Advise to wear glass x 24 hours or metal

shield nightly x 1-4 weeks


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Cataract


Clean eyes with single stroke from inner to

outer canthus

Avoid lifting, pushing or pulling >15

pounds

Avoid prolonged stooping and bending


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EENTEENT-- EarEar

Medical Surgicalnursing


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Anatomy of the ear

External ear

PinnaEardrum


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Anatomy of the ear

Middle Ear

3 bones Malleus

Incus

Stapes


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Anatomy of the ear

Inner ear

CochleaSemicircular canal


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Assessment of Ear

Inspection of the ear

Adults: Pull pinna BACKWARD and

UPWARD

Pedia: Pull pinna BACKWARD and

DOWNWARD


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Assessment of Ear

Otoscopy

Eardrum is conical. Pearly gray and shiny


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Assessment of Ear

Audiometer

Test of hearing

Measured in decibels

30 decibels= critical level of loudness


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Nursing Modalities for the ear

Ear irrigation

Use of peroxide or normal saline

Solution should be warmed

With a steady stream, direct the stream of

solution against the roof of the canal

Position on the irrigated side to promotedrainage


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Nursing Modalities for the ear

Eardrops instillation

Use warm solution

Position patient on the side with the affected

ear uppermost

Straighten the ear by pulling pinna up and

backHold position for 5 minutes


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Otitis Media

Inflammation of the

MIDDLE ear


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Otitis Media

Etiologic Factors:

Strep pneumonia

Hemophilus influenzae

Moraxela catarrhalis


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Otitis Media

Pathophysiology

Inflammation

Exudative formation


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Otitis Media

Assessment findings

Ear pain

Ear itchiness

Sense of fullnessTinnitus/Vertigo


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Otitis Media

Assessment findings

Decreased hearing

Redness

Drainage of exudates


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Otitis Media

Complications

Abscess

Meningitis

MastoiditisConductive Hearing loss


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Otitis Media

Medical Management

IF CHRONICCASE:Myringotomy,

tympanoplastyand mastoidectomy


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Otitis Media

Nursing Interventions

1. Manage the infection Giving antibiotics

cleansing of the ear Instillation of ear drops


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Otitis Media

Nursing Interventions

2. Perform ear irrigation Never done if tympanic

membrane is

PERFORATED!!!

3. Promote safety


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Menieres Disease

Endolymphatic hydrops


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Menieres Disease

Pathophysiology

There is INCREASED pressure of the fluid in

the cochlea

There is INCREASED fluid pressure in the

semicircular ducts


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Menieres Disease

PathophysiologyPathophysiology

INCREASED pressure attacks of

VERTIGO, TINNITUS and

HEARING LOSS


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Menieres Disease

ASSESSMENT findings

Vertigo- whirling sensation

Unilateral or bilateral hearing loss

Vomiting

Diaphoresis

Nystagmus


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Menieres Disease

Medical management

1.Diuretics (acetazolamide,furosemide) are given toREDUCE

the fluid pressure and decrease

sodium2. LOW salt diet

3. Antihistamine and anti-vertigo


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Menieres Disease

Nursing Management

1. Assist patient DURING attack Stand in front

Encourage to change position slowly

Advise to lie down Avoid bright lights

Support patient when ambulating


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Menieres Disease

Nursing Management

2. Administer medications asprescribed

diuretics

anti-emetics


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Menieres Disease

Nursing Management

3. Prevent the attacks of Menieres Provide low salt diet

Encourage to stop smoking

Take medications as prescribed

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