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Nursing of Adults with Medical & Surgical Conditons Eyes, Ears, and Special Senses.

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Presentation on theme: "Nursing of Adults with Medical & Surgical Conditons Eyes, Ears, and Special Senses."— Presentation transcript:

1 Nursing of Adults with Medical & Surgical Conditons Eyes, Ears, and Special Senses

2 Layers of the Eyeball zOuter Layer ySclera xTough, white fibrous, protective layer xAnterior portion is the cornea transparent Eyes Window lies over the colored part (iris) of the eye xRemainder is white, and is commonly known as the white of the eye.

3 Layers of the Eyeball zMiddle Layer yChoroid coat xContains the blood vessels that supply the eye xAnterior portion has three separate structures Iris –the colored part of the eye –shaped like a donut –attaches to the ciliary body –opening in the middle is called the pupil Ciliary Body –muscular ring that alters the shape of the iris Suspensory Ligament –structure that holds the lens in place

4 Layers of the Eyeball zInner Layer yRetina xThe camera of the eye receives image formed by the lens xOnly in the posterior portion of the eye xconsists of specialized nerve tissue for the reception of light xStructure upon which light rays come to focus xContains tiny receptors rods - night vision cones - day vision xOptic Nerve conducts impulses from the receptors to the brain

5 Humors of the Eyeball zAqueous Humor yWatery, transparent liquid that circulates through the anterior cavity of the eye. yMaintains intraocular pressure zVitreous Humor yClear, jelly-like fluid in the posterior cavity yFills the vitreous body to give shape to the eye

6 Eye Muscles zExtrinsic Eye Muscles yAttach to the outside of the eyeball and to the bones of the orbit yVoluntary muscles yMove the eyeball in any desired direction yFour are straight muscles xsuperior rectus, inferior rectus, medial rectus, lateral rectus yTwo are oblique muscles xsuperior oblique, inferior oblique

7 Eye Muscles zIntrinsic Eye Muscles yLocated inside the eyeball yTwo involuntary muscles xIris donut shaped sphincter muscle regulates the size of the pupil; amount of light entering eye xCiliary Body flattened ring the size of the iris alters the shape of the iris changes the focus of the lens; adjusts the eye for distant and close-up vision

8 Accessory Structures of the Eye zEyebrows and Eyelashes xProtect against foreign objects entering the eye zEyelids xLocated in front of the eyeball xBlink as a result of sensory stimuli xConsist of voluntary muscle and skin xConjunctiva mucous membrane lining eyelids transparent and is continuous over the surface of the eye xPalpebral Fissure Opening between the eyelids xInner and Outer Canthus angles at the ends of the eyelids

9 Accessory Structures of the Eye zLacrimal Glands and Ducts xSecrete tears keep anterior surface moist and free from irritating particles xSize of small almonds xLocated in the upper, outer portion of each orbit xNasolacrimal Ducts small tubes extending from the lacrimal sacs into the nose to drain tears from the eye to the nose

10 Parts of the Ear zExternal Ear yPinna (auricle) xThe outer, extended portion xComposed of cartilage and covered with skin yExternal Auditory Canal xAbout 1 inch in length xContains cerumenous glands yTympanic Membrane (eardrum) xStretches across the end of the auditory canal xSeparates the external ear from the middle ear

11 Parts of the Ear zMiddle Ear ySmall air cavity located in the temporal bone yContains three ossicles xMalleus (hammer) attached to tympanic membrane xIncus (anvil) attached to the head of the malleus xStapes (stirrup) fits in the oval window yAllows transmission of sound by the vibrations of the ossicles yEustachian Tube Connects the middle ear with the nasopharynx Allows equalization of air pressure on both sides of the eardrum

12 Parts of the Ear zInternal Ear yContains essential organs for hearing and equilibrium ySends equilibrium and hearing sensations to the auditory nerve yMembranous Labyrinth xLies within the bony labyrinth xFilled with fluid (endolymph) xContains receptors for equilibrium sense of position sense of head movement hearing

13 Parts of the Ear yBony Labyrinth xCochlea resembles the shape of a snail filled with fluid (perilymph) contains receptors for hearing Organ of Corti –hearing sense organ –sends sensations to the cochlear nerve xSemi-circular Canals Three canals placed at right angles to each other Filled with fluid (endolymph) Contain receptors for equilibrium Movement of fluid stimulates the receptors; send the message to the brain xVestibule Between the cochlea and the semi-circular canals Maintain a sense of up and down.

14 Conduction zAir Conduction yOccurs in the external ear ySound waves come through the external auditory meatus and set the tympanic membrane in vibration zBone Conduction yOccurs in the middle ear yThe chain of ossicles transmits the vibration of the tympanic membrane to the inner ear zFluid Conduction yOccurs in the inner ear yVibration of the ossicles sets the fluid system into motion yMovement of fluid in the cochlea stimulates the Organ of Corti; to the auditory nerve; to the brain

15 Process of Hearing

16 Special Senses zSmell yOlfactory sense yOrgan of Smell xNose yReceptors for the olfactory nerve lie in the mucosa of the upper part of the nasal cavity yAdaptation to odors is very rapid xreceptors become fatigued

17 Special Senses zTaste yGustatory Sense yOrgan of taste xTongue yReceptors are the taste buds located in the papillae of the tongue yFour fundamental taste sensations xSalty - tip of the tongue xSweet - tip of the tongue xSour - sides of the tongue xBitter - back of the tongue

18 Taste Receptors

19 Special Senses zTouch yTactile receptors yLocated throughout the integumentary system yRespond to touch, pressure, and vibration zPain yPain receptors yLocated in the skin and viscera yGives warning of potentially harmful environmental changes

20 Touch and Pain Receptors

21 Disorders of the Eye

22 Diagnostic Tests zSnellens Test yPurpose xAssessment of visual aculity xUsed as screening test yProcedure xPt stands 20 ft from chart xCovers one eye xReads above or below the 20/20 line


24 Snellens Test

25 zColor Vision yPurpose xAssess ability to see color xPrerequisite for drivers license yProcedure xColor dots are reflected on a background of mixed colors. xPt identifies color patterns on the test field

26 Color Vision

27 zRefraction yPurpose xMeasure visual acuity to determine refractory errors such as: myopia, hyperopia, presbyopia, and astigmatism yProcedure xOphthalmologist asks pt to indicate clear/blurred vision with each lens change in the retinoscope.

28 zOphtalmoscopy yPurpose xEvaluation of underlying structures of the eye xRoutine screening yProcedure xMydriatic drops are applied Dilates pupils xRoom is darkened xPt is asked to focus on stationary object xExaminer uses ophthalmoscope to view internal eye structure

29 Ophthalmoscopy

30 zTonometry yPurpose xMeasurement of intraocular pressure xDetermine tumors and glaucoma yProcedure xExaminer places tonometer on cornea xPressure readings are obtained xNormal intraocular pressure ranges from 10 to 22 mm Hg

31 Tonometer

32 zAmster Grid Test yPurpose xDiagnose and monitor macular problems yProcedure xPatient fixates on center dot and records any abnormalities of the grid lines, such as wavy, missing, or distorted areas.

33 Amster Grid

34 zSchimirmer Tear Test yPurpose xMeasures tear volume produced throughout fixed time period yProcedure xOne end of lacrimal filter paper is placed in lower cul-de-sac xArea of tear saturation is measured after 5 minutes

35 Blindness and Near Blindness zEtiology/Pathophysiology yLoss of visual acuity yCongenital or acquired yLegal blindness x20/200 with corrective eyewear (normal 20/20) xvisual field less than 20 degrees (normal 180)

36 Blindness and Near Blindness zSigns & Symptoms yDiplopia xdouble vision yPain yFloaters and light flashes yPruritus yBurning of the eyes yLoss of peripheral vision yHalos yOrbital pressure yBulging of the eyes

37 Blindness and Near Blindness zTreatment yCorrective eyewear yCanes ySeeing eye dogs yMagnifying systems ySurgical procedures

38 Refractory Errors yAstigmatism yStrabismus yMyopia yHyperopia

39 Refractory Errors zEtiology/Pathophysiology yAstigmatism -unequal curve in the shape of the cornea or lens

40 Refractory Errors yStrabismus -inability of the eyes to focus in one direction -cross-eyed

41 Refractory Errors yMyopia xNearsightedness xEyeball is too long

42 Refractory Errors yHyperopia xFarsightedness xEyeball is too short

43 Refractory Errors zSigns & Symptoms yDiminished or blurred vision zTreatment yCorrective lenses ySurgical correction

44 Conjunctivitis zEtiology/Pathophysiology yInflammation of the conjunctiva yBacterial or viral infection yAllergy yEnvironmental factors yCommonly called pink eye

45 Conjunctivitis zSigns & Symptoms yErythema of the conjunctiva yEdema of the eyelid yCrusting discharge yPruritus yBurning yExcessive tearing

46 Conjunctivitis zTreatment yWarm compresses yEye irrigations with normal saline yAntibiotic drops or ointment yKeep free of exudate

47 Keratitis zEtiology/Pathophysiology yInflammation of the cornea yInjury, irritants, allergies, viral infection, or diseases yPneumoccoucs, staphylococcus, streptococcus and Pseudomonas are most common types of bacterial causes. yHerpes simplex is most common viral cause.

48 Keratitis zSigns & Symptoms ySevere eye pain yPhotophobia yTearing yEdema yVisual disturbances

49 Keratitis zTreatment yTopical antibiotic therapy ySystemic antibiotics yAnalgesics yPressure dressings xrelax eye muscle and decrease discomfort yWarm or cold compresses yEpithelial debridement yKeratoplasty xcorneal transplant

50 Cataracts zEtiology/Pathophysiology yNoninfectious opacity or clouding of the lens yCongenital yAcquired ySenile xassociated with older adults xmost common

51 Cateracts

52 Cataracts zSigns & Symptoms yBlurred vision yDiplopia xdouble vision yPhotosensitivity yDecreased night vision yOpacity in the center portion of lens

53 Cataracts zTreatment ySurgical removal yLens implant or glasses

54 zPost-Op yAvoid direct sunlight yBedrest with BRPs yAnalgesics yNo bending down or straining yAvoid coughing, sneezing, and blowing nose

55 Diabetic Retinopathy zEtiology/Pathophysiology yDisorder of retinal blood vessels yCapillary microaneurysms, hemorrhage, exudates and formation of new vessels and connective tissue yUsually occurs approximately 10 years after onset of DM

56 Diabetic Retinopathy zSigns & Symptoms yMicroaneurysms xidentified by ophthalmoscopy yProgressive loss of vision yfloaters

57 Diabetic Retinopathy zTreatment yPhotocoagulation xdestroys new blood vessels xseals leaking vessels xhelps prevent retinal edema yVitrectomy xused if photocoagulation is not possible xRemoval of vitreous and replaces it with saline

58 Macular Degeneration zEtiology/Pathophysiology ySlow, progressive loss of central and near vision due to aging retina

59 Macular Degeneration zSigns & Symptoms yGradual and variable bilateral loss of vision yColor perception may also be affected

60 Macular Degeneration zTreatment yUsually no treatment yMay use photocoagulation if new vessels have not involved the macular retina

61 Retinal Detachment zEtiology/Pathophysiology ySeparation of the retina from the choroid in the posterior area of the eye yUsually results from a hole in the retina that allows vitreous humor to leak between the choroid and the retina xTrauma xAging xInflammation

62 Retinal Detachment zSigns & Symptoms ySudden or gradual development of flashes of light, followed by floating spots and loss of a specific field of vision

63 Retinal Detachment zTreatment yPhotocoagulation xburn localized tears or breaks yCryosurgery xfreeze the borders of a retinal hole yDiathermy xburns retina break using ultrasonic probe yScleral buckling xpulls the choroid and sclera back together using an encircling band around the outside of the eyeball

64 Glaucoma zEtiology/Pathophysiology yAn abnormal condition of elevated pressure within an eye yObstruction of outflow of aqueous humor yCauses damage to optic nerve yTwo types xOpen-angle slowly progressive; results from degeneration xClosed-angle occurs if there is an abrupt angle change of the iris

65 Glaucoma zSigns & Symtoms yOpen-angle xNo s/s during early stages xTunnel vision xEye pain xDifficulty adjusting to darkness xHalos around lights xInability to detect colors yClosed-angle xSevere pain xDecreased vision xNausea and vomiting xErythema of the sclera xEnlarged and fixed pupil xHalos around lights

66 Glaucoma zTreatment yOpen-angle glaucoma xBeta-blockers Betoptic reduces intraocular pressure xMiotics Piolcarpine causes the pupil to constrict; drawing the iris away from the cornea; allowing drainage of aqueous humor xCarbonic anhydrase inhibitors Diamox decreases production of aqueous humor

67 Glaucoma yClosed-angle xOsmotic diuretics Mannitol, carbonic anhydrase inhibitors, and miotics xIridectomy removal of part of the iris restores drainage of the aqueous humor

68 Corneal Injuries zEtiology/Pathophysiology yResult from injuries to corneal layers of the eye yForeign bodies are the most common cause xdust particles, propellants, and eyelashes yBurns xchemical irritants yAbrasions and lacerations xusually superficial caused by fingernails or clothing yPenetrating wounds xmay cause blindness

69 Corneal Injuries zSigns & Symptoms ypain with movement of eye yexcessive tearing yerythema of conjunctiva ypruritis

70 Corneal Injuries zTreatment yFlush with normal saline or water yAntibiotic drops or ointment yPenetrating wounds xdo not remove object if present xcover both eyes may need to use a cup to cover object xseek medical attention

71 Disorders of the Ear

72 Diagnostic Tests zOtoscopy yVisualize external canal and eardrum

73 zTuning Fork Tests yWebers Test xAssesses auditory acuity xUses tuning forks xDistinguishes conductive from sensorineural loss xTuning fork is placed on the center of the patients forehead

74 yRinne Test xDistinguishes conductive from senorineural hearing loss xUses tuning forks xTuning fork is placed close to the external auditory meatus

75 zAudiometric Testing xAssesses frequencies and tones

76 zVestibular Testing yRomberg Test xMeasures ability to perform specific tasks with eyes open and then closed xAssesses balance yPast-point Test xAbility to place a finger accurately on a selected point on the body xAssesses coordination

77 Hearing Loss (Deafness) zEtiology/Pathophysiology yDecreased auditory acuity yPartial yComplete yMost common disability in the U.S. yAffects development of speech and conceptual ability

78 Hearing Loss (Deafness) ySix types of hearing loss xConductive Sound is inadequately conducted through the external or middle ear Common cause is buildup of cerumen xSensorineural Defect in inner ear results in distortion Trauma, infectious processes, age, or exposure to ototoxic drugs Destruction of cochlear hair by intense noise xMixed Combined conductive and sensorineural

79 Hearing Loss (Deafness) xCongenital Present from birth or early infancy Anoxia or trauma during delivery Rh incompatibility Mothers exposure to syphilis or rubella, or exposure to ototoxic drugs xFunctional No known cause for loss xCentral Brains auditory pathways are damaged CVA

80 Hearing Loss (Deafness) zSigns & Symptoms yRequests for repeating information yNonresponse yDelayed speech development

81 Hearing Loss (Deafness) zTreatment yAccording to cause yHearing aids ySurgical procedures yCochlear implant



84 External Otitis zEtiology/Pathophysiology yInflammation or infection of the external canal ySwimmers Ear yAllergy, bacteria, fungi, viruses, and trauma

85 External Otitis zSigns & Symptoms yPain with movement of auricle or chewing yErythema, scaling, pruritus, edema, watery discharge and crusting of the external ear

86 External Otitis zTreatment yOral analgesics yCorticosteroids yAntibiotic or antifungal ear drops ySystemic antibiotics

87 Otitis Media zEtiology/Pathophysiology yInflammation or infection of the middle ear yOccurs most often in children (6-36 months) xshorter and straighter eustachian tubes yBacterial, viral, allergies

88 Otitis Media zSigns & Symptoms yFullness in the ear ySevere, deep, throbbing pain xmay disappear if tympanic membrane ruptures yHearing loss yTinnitus yFever

89 Otitis Media zTreatment yAntibiotics xorganism specific yAnalgesics yLocal heat yNasal decongestants yAspiration of fluid from behind eardrum yMyringotomy xsurgical incision of the tympanic membrane xmay also place tubes

90 Labyrinthitis zEtiology/Pathophysiology yInflammation of the labyrinthine canals of the inner ear yMost common cause of vertigo yViral infection from URI yDrugs and food yTobacco and alcohol

91 Labyrinthitis zSigns & Symptoms ySevere and sudden vertigo yNausea and vomiting yNystagmus xinvoluntary movement of eyes yPhotophobia yHeadache yAtaxic gait

92 Labyrinthitis zTreatment yAntibiotics yDramamine or Meclizine for vertigo yIV fluids if N/V

93 Obstructions of the Ear zEtiology/Pathophysiology yImpaction or excessive secretion of cerumen yForeign bodies xinsects, beans, pebbles, small toys

94 Obstructions of the Ear zSigns & Symptoms yTinnitus or buzzing yPain in the ear ySlight hearing loss yTugging at ear

95 Obstructions of the Ear zTreatment yRemoval of cerumen by irrigation yForeign objects are removed with forceps xMay require surgery yCarbamide peroxide to soften cerumen

96 Otosclerosis zEtiology/Pathophysiology yChronic progressive deafness yFormation of spongy bone, esp around the oval window yCause unknown yFamilial yWomen are affected twice as often as men

97 Otosclerosis zSigns & Symptoms ySlowly progressive conductive hearing loss yTinnitus yDizziness to vertigo

98 Otosclerosis zTreatment yStapedectomy yAir conduction hearing aid xif stapedectomy is not indicated

99 Menieres Disease zEtiology/Pathophysiology yChronic disease of the inner ear yRecurrent episodes of vertigo, progressive unilateral nerve deafness, and tinnitus yMost common in women; 50-60 years of age yCause unknown yIncrease in endolymph fluid xincreased production or decreased absorption

100 Menieres Disease zSigns & Symptoms yVertigo yNausea yTinnitus yHearing loss yVomiting yDiaphoresis yNystagmus

101 Menieres Disease zTreatment yNo specific treatment yDecrease fluid pressure xFluid restriction xDiuretics xLow salt diet yDramamine, Meclizine, and Benadryl ySurgery xDestruction of labyrinth xEndolymphatic shunt xCryosurgery xVestibular nerve section

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