Eyes & Ears Ppt

29,328 views

Published on

Eyes & Ears Powerpoint presentation

Published in: Health & Medicine, Technology
2 Comments
12 Likes
Statistics
Notes
No Downloads
Views
Total views
29,328
On SlideShare
0
From Embeds
0
Number of Embeds
101
Actions
Shares
0
Downloads
1,161
Comments
2
Likes
12
Embeds 0
No embeds

No notes for slide

Eyes & Ears Ppt

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

×