Nursing Care of Clients with
Eye and Ear Disorders
Chapter 40
Physical Assessment of Eye and
Vision
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Snellen chart or E chart for testing visional
acuity
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Cardinal fields
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20 feet
test for extraocular eye movements
Cover-uncover test
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test for stabisms
Physical Assessment of Ear and
Hearing
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Hearing
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Weber test
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Rinne test
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Whisper test
Eye Disorders
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Age Related Vision Changes
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flatting of the cornea
pupillary constriction
decrease in lens elasticity
loss of sensory cells
Physical changes
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inversion, eversion of lid, decreased tear
secretion, “hollowed-eyed”
Conjunctivitis-red, pain, itchy,
sticky drainage
Eye Disorders
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Inflammatory Disorders
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conjunctivitis
inflammation of the conjunctiva
 bacterial or viral
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Treatment
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topical anti-infectives
anti-inflammatories
Eye Disorders
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Corneal Infections/Inflammations
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corneal scarring and ulcerations are a major
cause of world-wide blindness
Treatment
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Corneal Transplant
The Client with Eye Trauma
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Corneal Abrasion
Burns
Penetrating Trauma
Blunt Trauma
Treatment
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topical anesthesia
facial X-rays or C-T Scans
The Client with Eye Trauma
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Foreign body removal
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Eye irrigation
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sterile saline irrigation
chemical burn
Surgery
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penetrating wound
The Client with Cataracts
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Cataract
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a clouding of the lens of the eye
interferes with light transmission and the
ability to perceive images clearly
Significant cause of visional problems in the
elderly (50-70%)
Senile Cataracts

normal aging process
The Client with Cataracts
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Treatment
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Surgical removal of cataract and lens
Implantation of intraocular lens
Post-operative Nursing Care
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assessment
eye patch
semi-folwer’s
Post-operative Nursing Care
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Avoid coughing, sneezing straining
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these increase intraocular pressure
Assess for post-op pain
Assess for surgical complications
Approach from unaffected side
Teach Home Care
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meds., symptoms to report, photophobia
Glaucoma
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Characterized by increased intraocular
pressure and gradual loss of vision
“Silent” thief of vision
Narrowing of visual fields
2 Types
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Open Angle and Closed Angle
Glaucoma - inner eye pressure
Glaucoma
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Open Angle
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common (90%)
>35yrs, genetic link, African-American
Pathophysiology
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impaired aqueous outflow
increased intraocular pressure
usually bilateral
Glaucoma
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Clinical Manifestations
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none
frequent lens changes in glasses
impaired night vision
halos
reduction of vision field, become narrow
increased intraocular pressure (tonometry)
Glaucoma
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Treatment
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miotics - pilocarpine
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Laser Surgery (trabeculoplasty)

cause scar tissue to create tension to stretch
opening to drain aqueous fluid
Glaucoma Stage 4
Diabetic Retinopathy
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

Leading cause of new
blindness between ages of
20-74
84% of diabetics will
develop some form
 depends of length of
time you have diabetes
Vascular disorder that
affects the retina
 capillaries become
sclerotic
Diabetic Retinopathy
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Management
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Yearly ophthalmologic exams
Laser photocoagulation
Focus is educational
vision changes -blurred
 black spots (Floaters)
 flashing lights
 sudden loss of vision
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Diabetic Retinopathy - vision
Ear Disorders
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External Otitis
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swimmers ear
pseudomonas, bacteria, fungus or trauma
Treatment
cleansing
 antibiotics - local and systemic
 education
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Ear Disorders
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Otitis Media
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inflammation of middle ear
common in infants and young children
Red bulging tympanic membrane
Treatment
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antibiotics
myringotomy
Ear Infection check up
Inner Ear Disorders
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Meniere’s Disease
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chronic
recurrent attack of vertigo with tinnitus
progressive hearing loss
Treatment

antivert
The Client with Hearing Loss
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Affects 24% of older adults
Affects 39% of those over age 75
2 Types
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Conductive
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disruption transmission of sound
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obstructions - cerum, scarring, tumors
Sensorineural
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inner ear, auditory nerve or pathways
The Client with Hearing Loss
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Treatment
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Amplification
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
hearing aids
Surgery
reconstruct the middle ear - tympanoplasty
 cochlear implant
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Nursing Care
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Sensory/Perceptual Alteration: Auditory,
Impaired communication, Social isolation
What are your interventions?
What kind of pt. teaching will
you provide?
What’s your post-op nursing care?
What is happening here?
What about this vision