28Eye trauma treatment Topical anesthetic Before inspection RelievePainPhotophobia
29Eye trauma DX Test Fluorescein staining Can you find the abrasion? ID Foreign bodiesAbrasionsCan you find the abrasion?
30Eye trauma DX Test Ophthalmoscopic examination Detect bleedingTrauma to the interior chamber
31Eye trauma DX Test X-ray CT scan Orbital fx Foreign bodies Computed tomography (CT or CAT) scan: The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into images of the part of your body being studied.CT scans are sometimes used to see if a melanoma has spread outside of the eye into nearby structures. It may also be used to look for spread of the cancer to distant organs such as the liver.Before the scan, you may be asked to drink a contrast solution and/or get an intravenous (IV) injection of a contrast dye that helps better outline abnormal areas in the body. You may need an IV line through which the contrast dye is injected. The injection can cause some flushing (redness and warm feeling). Some people are allergic and get hives or, rarely, more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor is you have ever had a reaction to any contrast material used for x-rays.You need to lie still on a table while the scan is being done. During the test, the table moves in and out of the scanner, a ring-shaped machine that completely surrounds the table. You might feel a bit confined by the ring, but you have to lie [still] while the pictures are being taken.Coronal CT scan of the orbit which shows a blowout fracture in the region of infraorbital nerve.
32Eye trauma: Irrigate Small foreign bodies Chemical burns Irrigate sterile salineChemical burnsCopious amounts of fluid
33Eye trauma: Irrigate Procedure “from the inner canthus of the eye to the outer”Head tipped slightly to the affected sideProcedure“Fluid is directed from the inner canthus of the eye to the outer”Inside outsideHead tipped slightly to the affected sidePrevents contamination of the other eye
34NOTE!!!Immediately irrigate the eye is a chemical burn is suspected. Irrigation to remove the chemical is of higher priority than assessment of the eye
35Eye trauma TX Remove loose foreign bodies Use a Moist Sterile Cotton-tipped applicator
36Eye trauma TX Severe or penetrating injury Bed rest Stabilize eye Apply eye padOver both eyesRationalReduces eye movementHelps preserve vision
37Eye trauma TX Post-care Eye-drops / ointment Eye pad/shield per order Avoid wearing contacts until cornea has healed completelyPost-careEye-drops / ointmentEye pad/shield per orderRationalReduce painDecrease photophobiaPromote healingAvoid wearing contacts until cornea has healed completely
38Nursing Care Teach to prevent eye injuries! Eye protectionSeat beltsflush eye immediately if chemicals splash
39Nursing care If an abrasion or penetrating or blunt injury Loosely cover with sterile gauzeDo not remove penetrating objectsPatch both eyes
40Nursing Care: After injury Reinforce follow-up aptDiscuss meds & applicationTeach how to apply eye patchDo not rub or scratch the eye
41Nursing Care: After injury Teach to avoid activities that h intraocular pressureLiftingStrainingBending over
42Small Group QuestionsDefine the following abbreviations: OS, OD, UO, gttsDescribe conjunctivitis, how would you assess for it?What is the common treatment for conjunctivitis?You are fishing with a young child and the line breaks and the fish hook flies into their eye. What would you do?After the hook is removed, what instructions should be given to the child?
43Cataracts Clouding of the lens impaired vision Common >65 Affects both eyes
44Cataracts Age Cells become less clear Affects edges first Spreads towards center
45Cataracts Affects Details obscured Glare Pupils appear Near vision Far visionDetails obscuredGlarelight / darkPupils appearcloudy gray / white
65NRS DX: Risk for injury Assess ability to provide self care Alert others not to move items in room
66Application of Eye drops Use aseptic techniqueHave clients sit upright or lie supine with the head tilted slightly upRest 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 secondsUse surgical aseptic technique when instilling medications in eyes.Have clients sit upright or lie supine with the head tilted slightly and looking up at the ceiling.With the radial aspect of your dominant hand resting 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 to prevent systemic absorption of the medicationNursing Procedures: Assess the patient and the cart for any allergiesCheck the written orders on MARObtains the necessary equipmentsFollow the five rights of drug administrationDetermine the identification armbandWash hand and don non-sterile glovesExplain the procedure to the patient and ask if he or she wants to instill his or her own eye dropsGently wash the eye if there is crust or drainage along the margins of inner canthus. (always wipe from the innter canthus to the outer and use warm soaks to soften material if necessary)Position patient in a supine position with the head slightly hyperextentedRemove cap from eye bottle and place cap on its sidePut a tissue below the lower lidSqueeze the amount of medication as prescribed into the eyedropperWith dominant hand, hold eyedropper ½ to ¾ inch above the eyeball, the rest hand is on patient forehead to stabilizePlace nondominant hand on cheekbone and expose lower conjunctival sac by pulling on cheek while applying slight pressure to the inner chantusInstruct the patient to look up and drop the drops into center of conjunctival sacIf the patient blinks and the drops land on the outer lid or eyelash, repeat the procedureDo not instill medication drops directly into the corneaInstruct patient to close and move eyes gentlyRemove gloves and wash handsRecord the route, site, and time administered on the MARHealth care professionals need to ensure that the proper drug is being instilled and that it has not passed its expiration date. Some ophthalmic solutions may be contraindicated or can cause allergic reactions. Eyedrop containers should be clearly labeled and checked before instillation.The eyedrops should also be monitored for discoloration or sedimentation, which indicate that the ophthalmic solution is decomposing. In that case, a new dose of medicine should be obtained and the affected bottle discarded.Moreover, the ophthalmic staff member dispensing the drops should double-check the patient's identification and chart to ensure the correct dose is being instilled into the correct eye. The dispensing ophthalmic professional should never touch the tip of the eyedropper to the patient's eye. Touching will contaminate the remaining medication. In case of direct eye contact, the medication should be thrown away.Sterilization is an important part of eyedrop instillation. Before eyedrops are instilled, the ophthalmic assistant, technician, nurse, optometrist, or ophthalmologist should wash his or her hands thoroughly. The ophthalmic staff member then should gather all necessary supplies. For some eyedrops, the dispenser may want to warm the drops to body temperature by holding the bottle in his or her hand for about two minutes.Next, the dispenser should position the patient correctly. The patient should sit back in the examination chair with their head slightly hyperextended. Once the patient is correctly positioned, the dispenser should clean the eyelids from the inner canthus outward with a sterile saline solution to remove any eye secretions or previously instilled medications. The dispenser should wash their hands after these preparations are completed.Immediately before instillation, the dispenser should depress the patient's lower lid with the finger of one hand and lightly pinch the patient's lower lid to make a pouch for the medication. The upper lid should also be held open to prevent blinking during instillation. The dispenser should tell the patient to look up. Using the other hand, the dispenser should instill the drop into the everted lower lid. The drops should not be instilled on the cornea. This precaution is necessary to avoid startling the patient, or causing unnecessary pain.After the appropriate amount of medication is instilled, the ophthalmic professional should release the lid and remove any excess fluid. The patient should be told to gently close their eyes so as to not release any medication. If another medication is to be instilled, a delay of at least 30 seconds is required between instillations.PreparationPatients should have the procedure explained to them before instillation to ensure best results. If patients are treated for certain eye ailments such as conjunctivitis, they should be warned in advance not to wear contact lenses or eye makeup.Before instillation, the ophthalmic staff should double-check the dosage and type of medication. They should also wash their hands thoroughly.AftercarePatients who will be dispensing their own eyedrops after the initial treatment need careful instructions on proper instillation. Allied health professionals should guide patients step by step through the procedure to ensure maximum benefit from the medication.If patients are treated for infections or conjunctivitis, they should be advised to wash their hands regularly; avoid touching their eyes; avoid wearing eye makeup or contact lenses; and to discard any eye drops or eye makeup used before treatment for the infection began. Follow-up appointments for further treatment may also be necessary.Glaucoma patients using eyedrop medications should be monitored to determine if the drops are effective. Many times a combination of drops is necessary to treat glaucoma.ComplicationsEyedrops cause irritation in some patients that might result in eye redness or burning. Stronger medications can cause more extreme allergic symptoms, such as dizziness and disorientation. Some cycloplegic drops can cause such severe reactions as delirium, a rapid pulse, and difficulty swallowing. Patients should be monitored after instillation, and health care professionals should record any side effects.ResultsProperly instilled eyedrops should effectively treat a number of eye disorders. Dilatory drops facilitate eye refraction and retinal examination.Health care team rolesNursing and allied health professionals are usually responsible for eyedrop instillation. Ophthalmic assistants, technicians and nurses ensure that the proper dosage is administered to the correct patient, the medication is fresh, the medication and eyedropper are sterile and in good condition, and the patient is told step-by-step how the procedure is performed. The allied health professional may also need to repatch an affected eye, monitor patients for side effects, chart medications for each patient, and dispose of (used) equipment.
67Small Group Questions Differentiate between cataracts and glaucoma What is the common treatment for cataracts?What would you teach a patient who had/ was having cataracts surgery?What is the common treatment for glaucoma?What is the prognosis for glaucoma?Describe how to put in eye drops
68Otitis Media Inflammation of the middle ear Ear drum Eustachian tube Protects middle ear from environmentEustachian tubeConnects with nasopharynx
81Nursing Care: Ear surgery Post-opAssessBleedingNauseaAdmin antiemeticsVertigo / dizzinessHearing
82Nursing Care: Ear surgery HOBElevateUnaffected sideStand on unaffected side to communicateRemind to avoidCoughingSneezingBlowing nose
83Nursing Care: Ear surgery Instruction for home careAvoid showers until MD OKsKeep ear plug clean and change prnDo not remove inner ear dressing until MD OKsNo swim, drive or travel by air until MD-OKAntiemetic per MD orderAntihistamine per MD order
84Nursing Care: Ear surgery Notify MD ifFeverBleedingh drainageh dizzinessi hearing
85Assessment: Otitis Media HistoryOnset / durationS&SHx URIMove auricle / pinnaInspect throat & earTemperatureAssess hearingPalpate mastoid processauricle, also called Pinna, in human anatomy, the visible portion of the external ear, and the point of difference between the human ear and that of other mammals. The auricle in humans is almost rudimentary and generally immobile and lies close to the side of the head. It is composed of a thin plate of yellow fibrocartilage covered by a tight-fitting skin. The external ear cartilage is molded into shape and has well-defined hollows, furrows, and ridges that form an irregular shallow funne
86NRS DX: Pain Mild analgesics Heat to affected side of face & head Q4hour PRNHeat to affected side of face & headInstruct to report abrupt pain relief
87NRS DX: Knowledge Deficit Take All antibioticsDiscuss S/E of antibioticsDiarrheaVaginitisThrushEat 8 oz yogurt q day
88NRS DX: Knowledge Deficit Instruct pt w/ tubesNoSwimmingDivingSubmerging head while bathingAir travelEncResth fluid intakeNutritious diet
89Small Group Questions What are the S&S of otitis media What is the pathophysiology of otitis mediaWhat medications are prescribed to a client with otitis media?What client teaching would you give in regards to the above medications?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?