Eye trauma treatment Topical anesthetic – Before inspection
Eye trauma DX Test Fluorescein staining – ID Foreign bodies Abrasions Can you find the abrasion?
Eye trauma DX Test Ophthalmoscopic examination
Eye trauma DX Test X-ray CT scan – Orbital fx – Foreign bodies
Eye trauma: Irrigate Small foreign bodies – Irrigate sterile saline Chemical burns – Irrigate Copious amounts of fluid
Eye trauma: Irrigate Procedure – “from the inner canthus of the eye to the outer” – Head tipped slightly to the affected side
NOTE!!! Immediately irrigate the eye is a chemical burn is suspected. Irrigation to remove the chemical is of higher priority than assessment of the eye
Eye trauma TX Remove loose foreign bodies – Use a Moist Sterile Cotton-tipped applicator
Eye trauma TX Severe or penetrating injury – Bed rest – Stabilize eye Apply eye pad Over both eyes
Eye trauma TX Post-care – Eye-drops / ointment – Eye pad/shield per order – Avoid wearing contacts until cornea has healed completely
Nursing Care Teach to prevent eye injuries! – Eye protection – Seat belts flush eye immediately if chemicals splash
Nursing care If an abrasion or penetrating or blunt injury – Loosely cover with sterile gauze – Do not remove penetrating objects – Patch both eyes
Nursing Care: After injury Reinforce follow-up apt Discuss meds & application Teach how to apply eye patch Do not rub or scratch the eye
Nursing Care: After injury Teach to avoid activities that intraocular pressure – Lifting – Straining – Bending over
Small Group Questions 1.Define the following abbreviations: OS, OD, UO, gtts 2.Describe conjunctivitis, how would you assess for it? 3.What is the common treatment for conjunctivitis? 4.You are fishing with a young child and the line breaks and the fish hook flies into their eye. What would you do? 5.After the hook is removed, what instructions should be given to the child?
Cataracts Clouding of the lens impaired vision – Common – >65 – Affects both eyes
Cataracts Age Cells become less clear Affects edges first Spreads towards center
Cataracts Affects – Near vision – Far vision Details obscured Glare – light / dark Pupils appear – cloudy gray / white
Memory alert Mydriatics (drugs that dilate pupils) must be avoided with glaucoma.
Nursing Care: health promotion Early screening – >40 q 2-4 years – > 60 q 1 – 2 years
Nursing Assessment Risk factors Ask about vision Family Hx Inspect eye
Nursing Assessment Assess vision Assess pupils
NRS DX: Risk for injury Assess ability to provide self care Alert others not to move items in room
Application of Eye drops Use aseptic technique Have clients sit upright or lie supine with the head tilted slightly up Rest hand on the client’s forehead, hold the dropper 1 to 2 cm above his conjunctival sac and instill the medication into the center of the sac. Then instruct the client to close his eye gently. Apply gentle pressure with your finger and a clean tissue on the nasolacrimal duct for 30 to 60 seconds
Small Group Questions 1.Differentiate between cataracts and glaucoma 2.What is the common treatment for cataracts? 3.What would you teach a patient who had/ was having cataracts surgery? 4.What is the common treatment for glaucoma? 5.What is the prognosis for glaucoma? 6.Describe how to put in eye drops
Otitis Media Inflammation of the middle ear – Ear drum Protects middle ear from environment – Eustachian tube Connects with nasopharynx
Otitis Media Risk factors – URI – Allergies – Eustachian tube dysfunction
Serous Otitis media Eustachian tube is obstructed Air gradually absorbed Negative pressure Serous fluid drawn in
Serous Otitis media S&S – hearing – Snapping /popping sensation – Bulging or sunken eardrum – Change in atmospheric pressure PAIN!
Acute Otitis media URI Eustachian tube swelling Impairs drainage Bacteria grows in fluid Inflammatory process Pus increases pressure Ear drum ruptures
Acute Otitis media S&S – Pain – Fever – Dizziness or Vertigo – Eardrum Red Inflamed Dull Bulging
Otitis Media: Dx History Physical exam – Otoscope
Nursing Care: Ear surgery HOB – Elevate – Unaffected side Stand on unaffected side to communicate Remind to avoid – Coughing – Sneezing – Blowing nose
Nursing Care: Ear surgery Instruction for home care – Avoid showers until MD OKs – Keep ear plug clean and change prn – Do not remove inner ear dressing until MD OKs – No swim, drive or travel by air until MD-OK – Antiemetic per MD order – Antihistamine per MD order
Assessment: Otitis Media History – Onset / duration – S&S – Hx URI – Move auricle / pinna – Inspect throat & ear – Temperature – Assess hearing – Palpate mastoid process
NRS DX: Pain Mild analgesics – Q4hour PRN Heat to affected side of face & head Instruct to report abrupt pain relief
NRS DX: Knowledge Deficit Take All antibiotics Discuss S/E of antibiotics – Diarrhea – Vaginitis – Thrush – Eat 8 oz yogurt q day
NRS DX: Knowledge Deficit Instruct pt w/ tubes – No Swimming Diving Submerging head while bathing Air travel Enc – Rest – fluid intake – Nutritious diet
Small Group Questions 1.What are the S&S of otitis media 2.What is the pathophysiology of otitis media 3.What medications are prescribed to a client with otitis media? 4.What client teaching would you give in regards to the above medications? 5.A 2 year old is having tubes placed in their ear bilaterally. The mother is confused about the procedure and what to expect. What would you teach her?