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Nursing of Adults with Medical & Surgical Conditons

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Presentation on theme: "Nursing of Adults with Medical & Surgical Conditons"— Presentation transcript:

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

2 Layers of the Eyeball Outer Layer Sclera
Tough, white fibrous, protective layer Anterior portion is the cornea transparent “Eye’s Window” lies over the colored part (iris) of the eye Remainder is white, and is commonly known as the “white of the eye”.

3 Layers of the Eyeball Middle Layer Choroid coat
Contains the blood vessels that supply the eye Anterior 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 Inner Layer Retina “The camera of the eye”
receives image formed by the lens Only in the posterior portion of the eye consists of specialized nerve tissue for the reception of light Structure upon which light rays come to focus Contains tiny receptors rods - night vision cones - day vision Optic Nerve conducts impulses from the receptors to the brain

5 Humors of the Eyeball Aqueous Humor Vitreous Humor
Watery, transparent liquid that circulates through the anterior cavity of the eye. Maintains intraocular pressure Vitreous Humor Clear, jelly-like fluid in the posterior cavity Fills the vitreous body to give shape to the eye

6 Eye Muscles Extrinsic Eye Muscles
Attach to the outside of the eyeball and to the bones of the orbit Voluntary muscles Move the eyeball in any desired direction Four are straight muscles superior rectus, inferior rectus, medial rectus, lateral rectus Two are oblique muscles superior oblique, inferior oblique

7 Eye Muscles Intrinsic Eye Muscles Located inside the eyeball
Two involuntary muscles Iris donut shaped sphincter muscle regulates the size of the pupil; amount of light entering eye Ciliary 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
Eyebrows and Eyelashes Protect against foreign objects entering the eye Eyelids Located in front of the eyeball Blink as a result of sensory stimuli Consist of voluntary muscle and skin Conjunctiva mucous membrane lining eyelids transparent and is continuous over the surface of the eye Palpebral Fissure Opening between the eyelids Inner and Outer Canthus angles at the ends of the eyelids

9 Accessory Structures of the Eye
Lacrimal Glands and Ducts Secrete tears keep anterior surface moist and free from irritating particles Size of small almonds Located in the upper, outer portion of each orbit Nasolacrimal 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 External Ear Pinna (auricle) External Auditory Canal
The outer, extended portion Composed of cartilage and covered with skin External Auditory Canal About 1 inch in length Contains cerumenous glands Tympanic Membrane (eardrum) Stretches across the end of the auditory canal Separates the external ear from the middle ear

11 Parts of the Ear Middle Ear
Small air cavity located in the temporal bone Contains three ossicles Malleus (hammer) attached to tympanic membrane Incus (anvil) attached to the head of the malleus Stapes (stirrup) fits in the oval window Allows transmission of sound by the vibrations of the ossicles Eustachian Tube Connects the middle ear with the nasopharynx Allows equalization of air pressure on both sides of the eardrum

12 Parts of the Ear Internal Ear
Contains essential organs for hearing and equilibrium Sends equilibrium and hearing sensations to the auditory nerve Membranous Labyrinth Lies within the bony labyrinth Filled with fluid (endolymph) Contains receptors for equilibrium sense of position sense of head movement hearing

13 Parts of the Ear Bony Labyrinth Cochlea Semi-circular Canals Vestibule
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 Semi-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 Vestibule Between the cochlea and the semi-circular canals Maintain a sense of “up and down”.

14 Conduction Air Conduction Bone Conduction Fluid Conduction
Occurs in the external ear Sound waves come through the external auditory meatus and set the tympanic membrane in vibration Bone Conduction Occurs in the middle ear The chain of ossicles transmits the vibration of the tympanic membrane to the inner ear Fluid Conduction Occurs in the inner ear Vibration of the ossicles sets the fluid system into motion Movement of fluid in the cochlea stimulates the Organ of Corti; to the auditory nerve; to the brain

15 Process of Hearing

16 Special Senses Smell Olfactory sense Organ of Smell
Nose Receptors for the olfactory nerve lie in the mucosa of the upper part of the nasal cavity Adaptation to odors is very rapid receptors become fatigued

17 Special Senses Taste Gustatory Sense Organ of taste
Tongue Receptors are the taste buds located in the papillae of the tongue Four fundamental taste sensations Salty - tip of the tongue Sweet - tip of the tongue Sour - sides of the tongue Bitter - back of the tongue

18 Taste Receptors

19 Special Senses Touch Pain Tactile receptors
Located throughout the integumentary system Respond to touch, pressure, and vibration Pain Pain receptors Located in the skin and viscera Gives warning of potentially harmful environmental changes

20 Touch and Pain Receptors

21 Disorders of the Eye

22 Diagnostic Tests Snellen’s Test Purpose Procedure
Assessment of visual aculity Used as screening test Procedure Pt stands 20 ft from chart Covers one eye Reads above or below the 20/20 line


24 Snellen’s Test

25 Color Vision Purpose Procedure Assess ability to see color
Prerequisite for driver’s license Procedure Color dots are reflected on a background of mixed colors. Pt identifies color patterns on the test field

26 Color Vision

27 Refraction Purpose Procedure
Measure visual acuity to determine refractory errors such as: myopia, hyperopia, presbyopia, and astigmatism Procedure Ophthalmologist asks pt to indicate clear/blurred vision with each lens change in the retinoscope.

28 Ophtalmoscopy Purpose Procedure
Evaluation of underlying structures of the eye Routine screening Procedure Mydriatic drops are applied Dilates pupils Room is darkened Pt is asked to focus on stationary object Examiner uses ophthalmoscope to view internal eye structure

29 Ophthalmoscopy

30 Tonometry Purpose Procedure Measurement of intraocular pressure
Determine tumors and glaucoma Procedure Examiner places tonometer on cornea Pressure readings are obtained Normal intraocular pressure ranges from 10 to 22 mm Hg

31 Tonometer                                                                                                                      

32 Amster Grid Test Purpose Procedure
Diagnose and monitor macular problems Procedure Patient fixates on center dot and records any abnormalities of the grid lines, such as wavy, missing, or distorted areas.

33 Amster Grid                                        

34 Schimirmer Tear Test Purpose Procedure
Measures tear volume produced throughout fixed time period Procedure One end of lacrimal filter paper is placed in lower cul-de-sac Area of tear saturation is measured after 5 minutes

35 Blindness and Near Blindness
Etiology/Pathophysiology Loss of visual acuity Congenital or acquired Legal blindness 20/200 with corrective eyewear (normal 20/20) visual field less than 20 degrees (normal 180)

36 Blindness and Near Blindness
Signs & Symptoms Diplopia double vision Pain Floaters and light flashes Pruritus Burning of the eyes Loss of peripheral vision Halos Orbital pressure Bulging of the eyes

37 Blindness and Near Blindness
Treatment Corrective eyewear Canes Seeing eye dogs Magnifying systems Surgical procedures

38 Refractory Errors Astigmatism Strabismus Myopia Hyperopia

39 Refractory Errors Etiology/Pathophysiology Astigmatism
-unequal curve in the shape of the cornea or lens

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

41 Refractory Errors Myopia Nearsightedness Eyeball is too long

42 Refractory Errors Hyperopia Farsightedness Eyeball is too short

43 Refractory Errors Signs & Symptoms Treatment
Diminished or blurred vision Treatment Corrective lenses Surgical correction

44 Conjunctivitis Etiology/Pathophysiology
Inflammation of the conjunctiva Bacterial or viral infection Allergy Environmental factors Commonly called “pink eye”

45 Conjunctivitis Signs & Symptoms Erythema of the conjunctiva
Edema of the eyelid Crusting discharge Pruritus Burning Excessive tearing

46 Conjunctivitis Treatment Warm compresses
Eye irrigations with normal saline Antibiotic drops or ointment Keep free of exudate

47 Keratitis Etiology/Pathophysiology Inflammation of the cornea
Injury, irritants, allergies, viral infection, or diseases Pneumoccoucs, staphylococcus, streptococcus and Pseudomonas are most common types of bacterial causes. Herpes simplex is most common viral cause.

48 Keratitis Signs & Symptoms Severe eye pain Photophobia Tearing Edema
Visual disturbances

49 Keratitis Treatment Topical antibiotic therapy Systemic antibiotics
Analgesics Pressure dressings relax eye muscle and decrease discomfort Warm or cold compresses Epithelial debridement Keratoplasty corneal transplant

50 Cataracts Etiology/Pathophysiology
Noninfectious opacity or clouding of the lens Congenital Acquired Senile associated with older adults most common

51 Cateracts

52 Cataracts Signs & Symptoms Blurred vision Diplopia Photosensitivity
double vision Photosensitivity Decreased night vision Opacity in the center portion of lens

53 Cataracts Treatment Surgical removal Lens implant or glasses

54 Post-Op Avoid direct sunlight Bedrest with BRP’s Analgesics
No bending down or straining Avoid coughing, sneezing, and blowing nose

55 Diabetic Retinopathy Etiology/Pathophysiology
Disorder of retinal blood vessels Capillary microaneurysms, hemorrhage, exudates and formation of new vessels and connective tissue Usually occurs approximately 10 years after onset of DM

56 Diabetic Retinopathy Signs & Symptoms Microaneurysms
identified by ophthalmoscopy Progressive loss of vision “floaters”

57 Diabetic Retinopathy Treatment Photocoagulation Vitrectomy
destroys new blood vessels seals leaking vessels helps prevent retinal edema Vitrectomy used if photocoagulation is not possible Removal of vitreous and replaces it with saline

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

59 Macular Degeneration Signs & Symptoms
Gradual and variable bilateral loss of vision Color perception may also be affected

60 Macular Degeneration Treatment Usually no treatment
May use photocoagulation if new vessels have not involved the macular retina

61 Retinal Detachment Etiology/Pathophysiology
Separation of the retina from the choroid in the posterior area of the eye Usually results from a hole in the retina that allows vitreous humor to leak between the choroid and the retina Trauma Aging Inflammation

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

63 Retinal Detachment Treatment Photocoagulation Cryosurgery Diathermy
burn localized tears or breaks Cryosurgery freeze the borders of a retinal hole Diathermy burns retina break using ultrasonic probe Scleral buckling pulls the choroid and sclera back together using an encircling band around the outside of the eyeball

64 Glaucoma Etiology/Pathophysiology
An abnormal condition of elevated pressure within an eye Obstruction of outflow of aqueous humor Causes damage to optic nerve Two types Open-angle slowly progressive; results from degeneration Closed-angle occurs if there is an abrupt angle change of the iris

65 Glaucoma Signs & Symtoms Open-angle Closed-angle
No s/s during early stages Tunnel vision Eye pain Difficulty adjusting to darkness Halos around lights Inability to detect colors Closed-angle Severe pain Decreased vision Nausea and vomiting Erythema of the sclera Enlarged and fixed pupil

66 Glaucoma Treatment Open-angle glaucoma Beta-blockers Miotics
Betoptic reduces intraocular pressure Miotics Piolcarpine causes the pupil to constrict; drawing the iris away from the cornea; allowing drainage of aqueous humor Carbonic anhydrase inhibitors Diamox decreases production of aqueous humor

67 Glaucoma Closed-angle Osmotic diuretics Iridectomy
Mannitol, carbonic anhydrase inhibitors, and miotics Iridectomy removal of part of the iris restores drainage of the aqueous humor

68 Corneal Injuries Etiology/Pathophysiology
Result from injuries to corneal layers of the eye Foreign bodies are the most common cause dust particles, propellants, and eyelashes Burns chemical irritants Abrasions and lacerations usually superficial caused by fingernails or clothing Penetrating wounds may cause blindness

69 Corneal Injuries Signs & Symptoms pain with movement of eye
excessive tearing erythema of conjunctiva pruritis

70 Corneal Injuries Treatment Flush with normal saline or water
Antibiotic drops or ointment Penetrating wounds do not remove object if present cover both eyes may need to use a cup to cover object seek medical attention

71 Disorders of the Ear

72 Diagnostic Tests Otoscopy Visualize external canal and eardrum

73 Tuning Fork Tests Weber’s Test Assesses auditory acuity
Uses tuning forks Distinguishes conductive from sensorineural loss Tuning fork is placed on the center of the patient’s forehead

74 Rinne Test Distinguishes conductive from senorineural hearing loss
Uses tuning forks Tuning fork is placed close to the external auditory meatus

75 Audiometric Testing Assesses frequencies and tones

76 Vestibular Testing Romberg Test Past-point Test
Measures ability to perform specific tasks with eyes open and then closed Assesses balance Past-point Test Ability to place a finger accurately on a selected point on the body Assesses coordination

77 Hearing Loss (Deafness)
Etiology/Pathophysiology Decreased auditory acuity Partial Complete Most common disability in the U.S. Affects development of speech and conceptual ability

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

79 Hearing Loss (Deafness)
Congenital Present from birth or early infancy Anoxia or trauma during delivery Rh incompatibility Mother’s exposure to syphilis or rubella, or exposure to ototoxic drugs Functional No known cause for loss Central Brain’s auditory pathways are damaged CVA

80 Hearing Loss (Deafness)
Signs & Symptoms Requests for repeating information Nonresponse Delayed speech development

81 Hearing Loss (Deafness)
Treatment According to cause Hearing aids Surgical procedures Cochlear implant



84 External Otitis Etiology/Pathophysiology
Inflammation or infection of the external canal “Swimmer’s Ear” Allergy, bacteria, fungi, viruses, and trauma

85 External Otitis Signs & Symptoms
Pain with movement of auricle or chewing Erythema, scaling, pruritus, edema, watery discharge and crusting of the external ear

86 External Otitis Treatment Oral analgesics Corticosteroids
Antibiotic or antifungal ear drops Systemic antibiotics

87 Otitis Media Etiology/Pathophysiology
Inflammation or infection of the middle ear Occurs most often in children (6-36 months) shorter and straighter eustachian tubes Bacterial, viral, allergies

88 Otitis Media Signs & Symptoms Fullness in the ear
Severe, deep, throbbing pain may disappear if tympanic membrane ruptures Hearing loss Tinnitus Fever

89 Otitis Media Treatment Antibiotics Analgesics Local heat
organism specific Analgesics Local heat Nasal decongestants Aspiration of fluid from behind eardrum Myringotomy surgical incision of the tympanic membrane may also place tubes

90 Labyrinthitis Etiology/Pathophysiology
Inflammation of the labyrinthine canals of the inner ear Most common cause of vertigo Viral infection from URI Drugs and food Tobacco and alcohol

91 Labyrinthitis Signs & Symptoms Severe and sudden vertigo
Nausea and vomiting Nystagmus involuntary movement of eyes Photophobia Headache Ataxic gait

92 Labyrinthitis Treatment Antibiotics Dramamine or Meclizine for vertigo
IV fluids if N/V

93 Obstructions of the Ear
Etiology/Pathophysiology Impaction or excessive secretion of cerumen Foreign bodies insects, beans, pebbles, small toys

94 Obstructions of the Ear
Signs & Symptoms Tinnitus or buzzing Pain in the ear Slight hearing loss Tugging at ear

95 Obstructions of the Ear
Treatment Removal of cerumen by irrigation Foreign objects are removed with forceps May require surgery Carbamide peroxide to soften cerumen

96 Otosclerosis Etiology/Pathophysiology Chronic progressive deafness
Formation of spongy bone, esp around the oval window Cause unknown Familial Women are affected twice as often as men

97 Otosclerosis Signs & Symptoms
Slowly progressive conductive hearing loss Tinnitus Dizziness to vertigo

98 Otosclerosis Treatment Stapedectomy Air conduction hearing aid
if stapedectomy is not indicated

99 Meniere’s Disease Etiology/Pathophysiology
Chronic disease of the inner ear Recurrent episodes of vertigo, progressive unilateral nerve deafness, and tinnitus Most common in women; years of age Cause unknown Increase in endolymph fluid increased production or decreased absorption

100 Meniere’s Disease Signs & Symptoms Vertigo Nausea Tinnitus
Hearing loss Vomiting Diaphoresis Nystagmus

101 Meniere’s Disease Treatment No specific treatment
Decrease fluid pressure Fluid restriction Diuretics Low salt diet Dramamine, Meclizine, and Benadryl Surgery Destruction of labyrinth Endolymphatic shunt Cryosurgery Vestibular nerve section

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