Eyes & Ears Ppt

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Eyes & Ears Powerpoint presentation

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  • 1. NEUROSENSORY SYSTEM
  • 2. ANATOMY & PHYSIOLOGY EYES
    • EXTERNAL STRUCTURES
    • EYELIDS
    • CONJUNCTIVA
      • PALBEBRAL
      • BULBAR
    • LACRIMAL APPARATUS
      • LACRIMAL GLAND, DUCTS & PASSAGES
    • 6 EXTRAOCULAR MUSCLES
    • Levator palpebrae muscle
  • 3. ANATOMY & PHYSIOLOGY EYES
    • ORBIT
    • EYEBALL : 3 LAYERS:
    • OUTER
      • SCLERA
      • CORNEA
    • MIDDLE
      • CHOROID
      • CILIARY BODY
      • IRIS
    • INNER
      • RODS
        • SENSITIVE TO LIGHT
        • PERIPHERAL VISION
      • CONES
        • FINE
        • DESCRIMINATION
        • COLOR VSION
  • 4. EYES
  • 5. ANATOMY & PHYSIOLOGY EYES
    • LENS – FOCUS IMAGE
    • FLUIDS OF THE EYE:
      • AQUEOUS HUMOR
        • ANTERIOR & POSTERIOR CHAMBERS
        • ANTERIOR EYE CAVITY
        • NUTRIENTS TO LENS & CORNEA
        • INTRAOCULAR PRESSURE MAINTENANCE
          • 20-25 mmHg
      • VITREOUS HUMOR
        • POSTERIOR EYE CAVITY
        • TRANSPARENCY & FORM OF THE EYE
  • 6. EYES
  • 7. VISUAL PATHWAYS RETINA OPTIC NERVE OPTIC CHIASM OPTIC TRACT OCCIPITAL LOBE
  • 8. Physical Examination-EYE
    • VISUAL ACUITY : SNELLEN’S CHART
    • VISUAL FIELDS: PERIMETRY
    • EXTERNAL STRUCTURES
      • POSITION & ALIGNMENT OF EYES
      • PUPILS (PERRLA)
    • EXTRAOCULAR MOVEMENTS
      • PARALYSIS
      • NYSTAGMUS
    • CORNEAL REFLEX
  • 9. Don’t look at me…
  • 10. DIAGNOSTIC TESTS
    • SNELLEN
    • OPHTHALMOSCOPE
    • BIOMICROSCOPE / SLITLAMP
      • EXAMINE THE ANTERIOR SEGMENT OF THE EYE
    • TONOMETER
      • 14-20 mmHg
    • BJERRUM’S TANGENT SCREEN
      • CENTRAL FIELD OF VISION
    • ISHIHARA COLOR PLATE TEST
      • IDENTIFY 3 PRIMARY COLORS
    • GONIOSCOPY
      • ANGLE OF ANTERIOR CHAMBER
  • 11. PLANNING FOR HEALTH PROMOTION
    • CARE OF THE EYES
    • EYEDROPS, DISCOURAGED
    • PRINTED MATTER: 14 INCHES AWAY
    • TV: 10-12 FT AWAY
    • READ WITH ILLUMINATION: 100-150 WATTS
    • LIGHT FROM BEHIND
    • TEACH ABOUT DANGER SIGNALS OF VISUAL DISORDER
    • PERSISTENT REDNESS
    • CONTINUED DISCOMFORT & PAIN ESP
    • FOLLOWING INJURY
    • CHILDREN: CROSSING OF EYES
    • BLURRED VISION/ SPOTS BEFORE THE EYES
    • GROWTH ON THE EYE/ OPACITIES
    • CONTINUAL DISCHARGE, CRUSTING OR
    • TEARING
    • PUPIL IRREGULARITIES
  • 12. PLANNING FOR HEALTH MAINTENANCE & RESTORATION
    • INSTILLATION OF EYEDROPS
      • LOWER CUL-DE-SAC
      • JUST CLOSE EYES, NOT SQUEEZE
    • INSTILLATION OF EYE OINTMENT
      • FROM INNER CANTHUS, OUTWARD
    • HOT/ COLD COMPRESS
    • EYE IRRIGATIONS
      • REMOVE CHEMICALS OR SECRETIONS
    • MASSAGE THE EYEBALL
      • IN GLAUCOMA ESP AFTER OPERATIONS
    • CARE OF CONTACT LENS
      • NOT TO WEAR WITH SWIMMING
  • 13. DISORDERS - EYE
    • INJURIES & TRAUMA
    • INFECTIONS
    • CATARACT
    • GLAUCOMA
    • DETACHMENT OF THE RETINA
    • REFRACTIVE ERRORS
  • 14. INJURIES & TRAUMA
    • EMERGENCY:
    • TREAT THE PATIENT, LEAVE THE EYE ALONE, EXCEPT IN CHEMICAL INJURY - FLUSH EYES STAT
    • FOREIGN BODIES: FLUSH WITH WATER FOR 15 MIN WHILE GOING TO THE DOCTOR; DON’T TOUCH CORNEA
    • MAY USE CARBONATED DRINKS IF WATER IS NOT AVAILABLE
  • 15. INFECTIONS
    • HORDEOLUM/ STY -Zeis gland in the follicle
    • CHALAZION –meibomian glands
    • CONJUNCTIVITIS – pink eye
      • bacterial infection, allergy, trauma
    • UVEITIS - iris
    • KERATITIS - cornea
    • PTERYGIUM – triangular fold
      • From white of the eye to the cornea
  • 16. CATARACT
    • Opacity of the lens & its capsule which interferes with transparency
    • S/SX:
    • Dimness in visual acuity
    • Rapid & marked cxs of refraction error
    • CLASSIFICATION:
    • Primary/ senile
    • Secondary/ traumatic
    • Congenital
    • TREATMENT:
    • Intracapsular extraction – lens & capsule
    • Extracapsular extraction – lens only
    • Cryoextraction – probe cooled below 0 o C
    • Phacoemulsification – probe vibrates
    • Enzymatic zonulysis – alphachemotrypsin:
    • fibrinolytic & proteolytic, to anterior chamber
    • Intraocular lens – synthetic; distant vision
    • for aphasic patient
  • 17. EYE SURGERY
    • NURSING CARE PRE-OP
    • Orient to new environment
    • Teach deep breathing & how to close eyes without squeezing
    • Eye antibiotics preop
    • Mydiatrics if ordered
  • 18. EYE SURGERY
    • NURSING CARE POST-OP
    • Reorient patient to his surroundings
    • Prevent increase in IOP & stress on the suture line
    • ACTIVITIES THAT INCREASE IOP:
      • Coughing
      • Brushing
      • Shaving
      • Vomiting
      • Bending
      • Stooping
    • Promote comfort of the patient:
      • mild analgesic to control pain
  • 19. EYE SURGERY
    • NURSING CARE POST-OP
    • Observe & treat complications
      • COMPLICATIONS:
      • NAUSEA & VOMITING
        • Antiemetics
        • Cold compress
      • HEMORRHAGE
        • Sudden pain of the eye
      • PROLAPSE OF THE IRIS
        • Most common postop complication
        • Can precipitate glaucoma
    • Promote the rehab of the patient
      • Encourage the patient to become
      • independent- walk with him when he first
      • become ambulatory
      • Health teachings
  • 20. EYE SURGERY
    • HEALTH TEACHINGS:
    • 1-4 wks : dark glasses; temporary corrective lenses
    • 6-8 wks: permanent lenses
    • It will take time to learn distances & climb stairs
    • Color slightly changed
    • Use one eye at a time unless with contact lens
    • Decreased peripheral vision
  • 21. GLAUCOMA
    • INCREASED IOP
    • PROGRESSIVE LOSS OF PERIPHERAL VISION
    • CAUSE: OBSTRUCTION TO CIRCULATION OF AQUEOUS HUMOR
    • TYPES:
    • CHRONIC/ SIMPLE/ OPEN-ANGLE
    • ACUTE ANGLE CLOSURE
    • Congenital
    • Secondary – trauma, uveitis, postop
    • Absolute – uncontrolled- enucleation
  • 22. EYES CORNEA IRIS CILIARY BODY ANTERIOR CHAMBER LENS CANAL OF SCHLEMM ZONULES OPEN-ANGLE GLAUCOMA
  • 23. EYES CORNEA IRIS CILIARY BODY ANTERIOR CHAMBER LENS CANAL OF SCHLEMM ZONULES ACUTE-ANGLE CLOSURE GLAUCOMA
  • 24. OPEN ANGLE GLAUCOMA
    • S/SX:
    • Loss of peripheral vision (tunnel)
    • Difficulty in adjusting to darkness
    • Failure to detect changes in color
    • Headache, pain behind the eyeball
    • Halos
    • Nausea & vomiting
  • 25. OPEN ANGLE GLAUCOMA
    • MANAGEMENT:
    • Conservative :
    • Miotics : pupillary constriction
    • draw iris smooth muscle away from the canal
    • Given early am
    • Acetazolamide : decrease aqueous production
    • Fluid restriction
    • Aggressive:
    • Principle: improve drainage of aqueous
    • Iridocleisis- anterior chamber & subconjunctival space
    • Corneoscleral trephening – junction of cornea & sclera
    • Trabeculotomy
    • Laser therapy to meshwork
  • 26. Acute Angle Glaucoma
    • CAUSE:
    • Pupillary dilation by mydiatrics
    • Abnormal anterior displacement of iris
    • S/SX:
    • Severe eye pain
    • Nausea & vomiting
    • Blurred vision
    • Colored halos around lights
    • Dilated pupils
    • Increased IOP
    • MANAGEMENT:
      • Miotics
      • Diamox
      • Osmotic agents – glycerol
      • Surgery - iridectomy
  • 27. GLAUCOMA
    • NURSING CARE – SURGERY
    • PRE-OP
    • Explain that vision lost cannot be restored, but further loss can be prevented
    • POST-OP
    • Flat 24H- prevent iris prolapse
    • Narotics or sedatives
    • Liquid diet until 1 st dressing
    • Turn to unoperative site
    • LONG TERM CARE:
    • No restriction on the use of the eyes
    • No fluid restriction; exercise permitted
    • Medical follow up needed for life
  • 28. RETINA CHOROID SCLERA OPTIC NERVE RETINAL DETACHMENT
  • 29. RETINAL DETACHMENT
    • Fluid accumulation
    • Tumor
    • CAUSE:
    • Myopic degeneration
    • Trauma
    • Aphakia
    • S/SX:
    • Floating spots or opacities before the eye
    • Casts shadows on the retina
    • BrightFlashes of light
    • Progressive constriction of vision in 1 eye
    • MANAGEMENT:
    • Conservative :
    • Quiet in bed with eyes covered
    • Head: positioned so that retinal holes lower
    • Photocoagulation – small burn to retina
    • Cryotherapy – cold probe to freeze retina
    • Surgical:
    • Scleral buckling- sealing break & reattaching
    • retina
  • 30. RETINAL DETACHMENT
    • POST-OP NURSING CARE:
    • Cover eyes
    • Area of detachment, dependent
    • Mydiatrics
    • Discharge instructions:
      • No strenuous exercises & acivity x 6mos
      • Contact sports restricted
      • No sudden jarring head motion
      • No restriction with use of eyes
  • 31.  
  • 32. REFRACTIVE ERRORS
    • REFRACTION – bending of light rays
    • ACCOMMODATION – ability to adjust from near to far vision
    • ADAPTATION – ability to see light from darkness
    • COMMON ERRORS:
    • Myopia
    • Hyperopia
    • Presbyopia
    • Astigmatism
    • Blindness
  • 33. myopia
    • NEAR-SIGHTED
    • Long A-P dimension of the eyeball
    • Light rays focus infront of the retina
    • Good vision for near distances
    • Concave lenses
  • 34. hyperopia
    • FAR-SIGHTED
    • Eyeball A-P dimension too short
    • Light rays focus behind the retina
    • Good vision for far distances
    • Convex lenses
  • 35. presbyopia
    • FARSIGHTEDNESS OF OLD AGE
    • Gradual loss of accommodation
    • Loss of lens elasticity
    • Inability to rad without holding the material more than 13 ft from the eye
    • Bifocal lenses
  • 36.
    • ASTIGMATISM
    • Asymmetry or irregular curvature of the cornea
    • Cylindrical lenses
    • BLINDNESS
    • Vision: 20/200
  • 37.
    • Severus, 42y.o, is receiving cryotherapy for repair of a detached retina. When taking history from him, which symptom would the nurse expect him to have?
    • Diplopia
    • Severe eye pain
    • Sudden blindness
    • Bright flashes of light
  • 38. ANATOMY & PHYSIOLOGY EARS
    • EXTERNAL EAR
    • AURICLE
    • PINNA
    • TYMPANIC MEMBRANE
    • MIDDLE EAR
    • OSSICLES: MALLEOUS, INCUS, STAPES
    • EUSTACHIAN TUBE
  • 39. EAR
  • 40. ANATOMY & PHYSIOLOGY EARS
    • INNER EAR
    • ORGAN OF CORTI
      • HEARING
    • VESTIBULAR APPARATUS
      • BALANCE
      • 3 SEMICIRCULAR CANALS
      • UTRICLE
  • 41. EAR
  • 42. ANATOMY & PHYSIOLOGY EARS SOUND WAVES TO TYMPANIC MEMBRANE OSSICLES IN MOTION VIBRATION FROM STAPES TO OVAL WINDOW COCHLEA : ORGAN OF CORTI CRANIAL NERVE 8 TO TEMPORAL LOBE
  • 43. HEARING
  • 44.  
  • 45. AUDITORY ASSESSMENT
    • EXTERNAL EAR EXAMINATION
    • Inspection & palpation of auricle
    • Visualization: straighten the auditory canal:
      • PULL AURICLE UP, & BACK
    • NORMAL EARDRUM:
      • slightly conical
      • Shiny
      • pearly gray in color
  • 46. AUDITORY ASSESSMENT
    • HEARING TEST:
    • Tests for acuteness of hearing or degree of deafness:
    • Whisper or spoken voice test
    • Audiometer :
      • Pure tone – mx loudness in decibel
      • Speech – ability to understand & descriminate
    • Watch tick test
    • Tuning fork test
  • 47. AUDITORY ASSESSMENT
    • HEARING TEST:
    • Test to localize cause of deafness:
    • Schwabach’s
    • Rinne’s
    • Weber’s
    • SCHWABACH’S
    • Bone conduction vs normal hearing
    • Tuning fork @ px’s mastoid until the patient
    • hears no sound.
    • TF transferred to examiner’s ear
    • N = no sound heard
    • ABN = sensorineural hearing loss
    • RINNE’S TEST
    • Sound heard better: air vs bone
    • N = positive; air conduction is better
    • ABN: negative: bone conduction better
    • conductive hearing loss
    • WEBER’S
    • TF top midline of the head
    • Sound heard: normal ear vs affected ear
    • Better in affected ear: conductive
    • Better in normal ear : sensorineural
  • 48. AUDITORY ASSESSMENT
    • TEST FOR VESTIBULAR FUNCTON
    • CALORIC TEST
      • Check direction of nystagmus
      • COWS ( cold-opposite; warm-same side of stimulated ear)
    • ROTATION (BARANY) TEST
      • Rotating chair
      • Nystagmus is opposite to the direction of rotation
  • 49. HEALTH PROMOTION
    • EAR PROTECTION
    • Noise over 70 decibels is potentially damaging to hearing
    • Most common & impt type of occupational hearing is caused by LOUD NOISE
  • 50. GENERAL EAR CARE
    • Ear is self-cleaning
    • Cerumen-lubricant; traps dirt
    • Keep eyes, mouth & both nostrils while blowing the nose
    • Cleanse the external ear reached by vision
  • 51. NURSING INTERVENTIONS
    • EAR DROPS
    • Warm
    • After adm’n, head should remain tilted
    • SOFTENING & REMOVING IMPACTED CERUMEN
    • Few drops of hydrogen peroxide/ warm glycerine
    • Irrigate the ear
  • 52. NURSING INTERVENTIONS
    • EAR IRRIGATION
    • To clean the external canal
    • Remove impated cerumen
    • Caloric test
    • Apply antiseptic solutions
    • Remove foreign bodies
  • 53.  
  • 54. COMMON EAR PROBLEMS
    • OTOSCLEROSIS
    • MENIERE’S DSE
    • HEARING IMPAIRMENT
  • 55. OTOSCLEROSIS
    • Normal bone is replaced by spongy bone
    • Ankylosis of the footplate of the stapes
    • Impaired vibration system
  • 56. OTOSCLEROSIS
    • ASSESSMENT
    • Gradual hearing loss
    • Difficulty hearing a whisper
    • Own voice is loud
    • Paracusis : hear better in loud environment
    • Rinne’s test: bone conduction better
  • 57. OTOSCLEROSIS
    • PLANNING & IMPLEMENTATION
    • Hearing aid
    • Surgery – primary form of tx
      • Stapedectomy
      • Stapes mobilization operation
      • Fenestration operation : new window is created
  • 58. EAR SURGERY
    • PRE-OP CARE;
    • Hair shampoo
    • Inform client:
      • Head still during surgery
      • Post op: get out of bed with assistance
      • avoid nose blowing until 1 week
  • 59. EAR SURGERY
    • POST OP
    • Promote comfort & safety
    • Promote psychological well-being
    • Prevent complications
    • COMFORT & SAFETY
    • 24h bed rest
    • No TV
    • Pain reliever
    • Gradual ambulation with assistance
    • PSYCHOLOGICAL WELL-BEING
    • Reassurance about decreased hearing from
    • swelling & dressing
    • Slushing within the ear- report to physician
    • COMPLICATIONS;
    • Facial nerve involvement
      • Facial paralysis, facial weakness
      • Inability to show teeth, wrinkle forehead,
      • raise eyebrows or close eyes
    • Meningitis – bacterial
      • Report signs & symptoms
    • Bleeding
  • 60. EAR SURGERY
    • DISCHARGE PLANNING
    • Discharged with dressing
    • Sudden head movement, avoided
    • No elevators
    • No hair washing at least 2 weeks
    • Avoid people with URTI
  • 61. MENIERE’S DSE
    • Chronic
    • Increase in endolymphatic pressure
    • ASSESSMENT:
    • Tinnitus
    • Unilateral hearing loss
    • Vertigo
  • 62. MENIERE’S DSE
    • PLANNING & IMPLEMENTATION
    • CONSERVATIVE: palliative
      • Bed rest
      • Meds
        • Sedative :Phenobarbital
        • Antihistamine
        • Antiemetics
      • Low salt diet
  • 63. MENIERE’S DSE
    • PLANNING & IMPLEMENTATION
    • SURGERY- delayed until client’s hearing below the serviceable level
      • Destruction of the labyrinth
      • Decompression of endolymphatic sac
      • Sectioning of the vestibular nerve
      • Cryosurgery of the labyrinth
  • 64. HEARING IMPAIRMENT
    • TYPES OF HEARING LOSS
    • CONDUCTIVE
      • Damage to the conducting system
      • Hearing aid is useful
    • SENSORINEURAL
      • Damage to the:
      • Organ of Corti
      • Cochlear nerve
      • Acoustic branch of the auditory nerve
  • 65. COMMUNICATING WITH HEARING-IMPAIRED CLIENTS
    • Avoid use of gestures without speech
    • Do not shout
    • Speak distinctly & as close to the client
    • Use short phrases
    • Do not communicate with someone else in front of a hearing-impaired client
    • Hearing impairment goes with visual problems in elderly
  • 66. SOUND AMPLIFICATION
    • TYPES OF HEARING AIDS;
    • Post-auricular
    • Body-type
    • In-the ear model
    • Select hearing aid that has cotrollable volume & is properly fitted
  • 67.
    • Albus, 62 yo, has a stapedectomy. Which of the following is the most important for the nurse to include in the post-op care plan?
    • Checking the gag reflex
    • Encouraging independence
    • Instruct not to blow nose
    • Position on the operative side
  • 68. “ that’s all folks”