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Sensory System Chapter 40. Eye abbreviations: Left eye – OS Right eye – OD Both eyes – OU Drop/s – gtt/ gtts.

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Presentation on theme: "Sensory System Chapter 40. Eye abbreviations: Left eye – OS Right eye – OD Both eyes – OU Drop/s – gtt/ gtts."— Presentation transcript:

1 Sensory System Chapter 40

2 Eye abbreviations: Left eye – OS Right eye – OD Both eyes – OU Drop/s – gtt/ gtts

3 Conjunctivitis Inflammation of the conjunctiva AKA – “pink eye”

4 Conjunctivitis Caused by – Bacteria – Viral Spread by – Direct contact

5 Conjunctivitis S&S (mild) – Redness – Itching pruritus – Tearing – Discharge

6 Conjunctivitis Dx – History – Visual examination – “conjunctival scraping” Culture

7 Conjunctivitis Rx – Antibiotics Topical

8 Nursing assessment Symptoms Effects on vision Associate symptoms Date of last eye exam Corrective lenses???

9 Nursing Assessment Past medical history Test vision – Snellen eye chart – Rosenbaum chart

10 Snellen Eye chartRosenbaum chart Pic from book

11 Nursing Assessment Inspect eye Check pupil – PERRLA

12 PERRLA P upils E qual R ound R eactive to L ight A ccommodation

13 Priority Nursing Diagnosis: Risk for disturbed sensory perception (visual) Instruct to wash hands Instruct to avoid touching or rubbing eyes Emphasize proper contact care

14 NRS DX: Acute pain Administer analgesics routinely Patch both eyes PRN Teach to apply warm compresses for 15 minutes, 3-4 x day

15 NRS DX: Acute pain Wear dark glasses Avoid excessive reading

16 NRS DX: Knowledge deficit Teach – Hand washing – Correct eye care – Do not share Makeup Towels Contact lenses – Do not use old makeup – Cleaning techniques for contacts

17 Eye trauma Common types of eye injury – Foreign body – Abrasion – Laceration – Burn

18 Corneal Abrasion AKA – Scratched cornea

19 Corneal Abrasion S&S – Pain! – Photophobia – Tearing

20 Corneal Abrasion Prognosis – Usually heal without scarring

21 Burns Types of burns – Chemical burns – Thermal burns – UV burns

22 Burns S&S – Pain – Affects vision – Swollen eyelids – Conjunctiva red & edematous Slough – Cornea cloudy or hazy

23 Perforated eye Examples of causes – Metal flakes – Glass shards – Weapons

24 Perforated eye S&S – Pain – Partial or complete loss of vision – Bleeding – Loss of eye contents

25 Blunt eye trauma Common cause – Sports injuries

26 Blunt eye trauma Minor – Ecchymosis (lid) AKA: – Black eye – Subconjunctival hemorrhage

27 Eye trauma Assessment Eye exam – Vision – Movement Unless penetrating objects – Inspect Foreign objects Lacerations

28 Eye trauma treatment Topical anesthetic – Before inspection

29 Eye trauma DX Test Fluorescein staining – ID Foreign bodies Abrasions Can you find the abrasion?

30 Eye trauma DX Test Ophthalmoscopic examination

31 Eye trauma DX Test X-ray CT scan – Orbital fx – Foreign bodies

32 Eye trauma: Irrigate Small foreign bodies – Irrigate sterile saline Chemical burns – Irrigate Copious amounts of fluid

33 Eye trauma: Irrigate Procedure – “from the inner canthus of the eye to the outer” – Head tipped slightly to the affected side

34 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

35 Eye trauma TX Remove loose foreign bodies – Use a Moist Sterile Cotton-tipped applicator

36 Eye trauma TX Severe or penetrating injury – Bed rest – Stabilize eye Apply eye pad Over both eyes

37 Eye trauma TX Post-care – Eye-drops / ointment – Eye pad/shield per order – Avoid wearing contacts until cornea has healed completely

38 Nursing Care Teach to prevent eye injuries! – Eye protection – Seat belts flush eye immediately if chemicals splash

39 Nursing care If an abrasion or penetrating or blunt injury  – Loosely cover with sterile gauze – Do not remove penetrating objects – Patch both eyes

40 Nursing Care: After injury Reinforce follow-up apt Discuss meds & application Teach how to apply eye patch Do not rub or scratch the eye

41 Nursing Care: After injury Teach to avoid activities that  intraocular pressure – Lifting – Straining – Bending over

42 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?

43 Cataracts Clouding of the lens  impaired vision – Common – >65 – Affects both eyes

44 Cataracts Age  Cells become less clear Affects edges first  Spreads towards center

45 Cataracts Affects – Near vision – Far vision Details obscured Glare – light / dark Pupils appear – cloudy gray / white

46 Cataracts Risk factors – Age Senile cataracts – Sunlight – Cigarette smoke – Heavy alcohol consumption – Eye trauma – Diabetes mellitus

47 Cataracts: Dx History Eye examination

48 Cataracts: Tx Surgical removal Clouded lens removed Intraocular lens is implanted

49 Nursing Care: Eye surgery Pre-op – Assess understand of procedure – Assess vision of unaffected eye – Reinforce post-op teaching – Remove all eye make-up – Admin. Pre-op meds per order

50 Nursing Care: Eye surgery Post-op – Assess V/S LOC Comfort Status of eye dressing – Maintain eye patch / shield per order – Position Semi-Fowlers Fowlers

51 Nursing Care: Eye surgery Approach client on unaffected side Intervene PRN to prevent – Vomiting – Straining – Coughing – Sneezing Immediately report sudden / sharp pain to MD

52 Nursing Care: Eye surgery S&S to report to MD – Redness or cloudiness – Drainage –  vision – Floaters – Flashes – Halos

53 Nursing Care: Eye surgery Personal items & call light within reach Admin eye-drops and meds per order Arrange or referals

54 Nursing Care: Eye surgery Teach – How to instill eye-drops – How to apply eye patch – Avoid rubbing – Wear sun glasses – Make & keep apt.

55 Glaucoma Increased intraocular pressure  – Gradual vision loss Vision loss is permanent

56 Chronic Glaucoma: S&S Painless Difficulty adapting light to dark Blurred vision Halos Difficulty focusing on near objects

57 Acute glaucoma: S&S Severe eye PAIN N&V Halos Red eye, cornea clouded Pupil – Dilated – Fixed

58 Clinical Alert! Acute glaucoma is a medical emergency. Without prompt treatment the affected eye will become blind. Immediately report manifestations of acute glaucoma to the charge nurse or MD

59 Glaucoma: Dx Tonometry – Measures intraocular pressure Visual field testing – Checks peripheral vision

60 Glaucoma: Rx Meds to  intraocular pressure

61 Memory alert Mydriatics (drugs that dilate pupils) must be avoided with glaucoma.

62 Nursing Care: health promotion Early screening – >40 q 2-4 years – > 60 q 1 – 2 years

63 Nursing Assessment Risk factors Ask about vision Family Hx Inspect eye

64 Nursing Assessment Assess vision Assess pupils

65 NRS DX: Risk for injury Assess ability to provide self care Alert others not to move items in room

66 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

67 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

68 Otitis Media Inflammation of the middle ear – Ear drum Protects middle ear from environment – Eustachian tube Connects with nasopharynx

69 Otitis Media Risk factors – URI – Allergies – Eustachian tube dysfunction

70 Serous Otitis media Eustachian tube is obstructed  Air gradually absorbed  Negative pressure  Serous fluid drawn in

71 Serous Otitis media S&S –  hearing – Snapping /popping sensation – Bulging or sunken eardrum – Change in atmospheric pressure  PAIN!

72 Acute Otitis media URI  Eustachian tube swelling  Impairs drainage  Bacteria grows in fluid  Inflammatory process  Pus increases pressure  Ear drum ruptures

73 Acute Otitis media S&S – Pain – Fever – Dizziness or Vertigo – Eardrum Red Inflamed Dull Bulging

74 Otitis Media: Dx History Physical exam – Otoscope

75 Otitis Media: Rx Decongestants Antibiotics Mild Analgesics – Acetaminophen

76 Complementary therapies Pain relief from Otitis Media – Drop of lavender oil – Warm cloth

77 Otitis Media: Surgery Tympanocentesis – Needle through eardrum  – Extract fluid & pus

78 Otitis Media: Surgery Myringotomy – Surgical opening of the middle ear

79 Otitis Media: Surgery Ventilation (tympanostomy) tubes – Ventilation and drainage of middle ear during healing

80 Nursing Care: Ear surgery Pre-op – Assess hearing – Discuss post-op hearing strategies – Explain post-op restrictions Blowing nose Coughing Sneezing

81 Nursing Care: Ear surgery Post-op – Assess Bleeding Nausea – Admin antiemetics Vertigo / dizziness Hearing

82 Nursing Care: Ear surgery HOB – Elevate – Unaffected side Stand on unaffected side to communicate Remind to avoid – Coughing – Sneezing – Blowing nose

83 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

84 Nursing Care: Ear surgery Notify MD if – Fever – Bleeding –  drainage –  dizziness –  hearing

85 Assessment: Otitis Media History – Onset / duration – S&S – Hx URI – Move auricle / pinna – Inspect throat & ear – Temperature – Assess hearing – Palpate mastoid process

86 NRS DX: Pain Mild analgesics – Q4hour PRN Heat to affected side of face & head Instruct to report abrupt pain relief

87 NRS DX: Knowledge Deficit Take All antibiotics Discuss S/E of antibiotics – Diarrhea – Vaginitis – Thrush – Eat 8 oz yogurt q day

88 NRS DX: Knowledge Deficit Instruct pt w/ tubes – No Swimming Diving Submerging head while bathing Air travel Enc – Rest –  fluid intake – Nutritious diet

89 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?

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