Caring fo the adult unit2 test review chapter 51,52

• Continuous irrigation with saline until neutral pH
• acid will take a while, Alkaline may take tens of hours.

a condition in which intraocular pressure isincreased beyond normal and impairs blood flow to the optic nerve andretina, resulting in vision impairment

• i.      Primary open angle
• ii.      Low tension                                                         
• iii.      Primary angle closure
• iv.      Secondary glaucoma’s -Steroid induced -Traumatic-Pigmentary Dispersion Syndrom - Pseudoexfoliation syndrome- Neovascular

• Snellen chart has rows of progressively smaller letters
• the findings are reported as the last line the person could read with no more than two errors
• a 20/30 means that a person could read at 20 feet what a person with normal vision could read at 30 feet

• An ophthalmoscope is an instrument used to exam the retina and vitreous.
• Ophthalmoscopy requires dilating the pupils with drops to give the doctor the best view inside they eye.
• It examines the lens, vitreous humor retina, and optic disc.

a scratched cornea

• miotic agents: constrict the pupils
• mydratic agnets: dialate the pupils
• cycloplegic agents: prevent accomodation
• anesthetic agents
• antibiotic agents
• anti-inflammatory agents

• check level of consciousness and vital signs during recovery from anesthesia
• inspect for drainage
• ask about patient comfort
• before discharge, assess patients understanding and ability to administer the meds

• An inflammation of the hair follicles along the eyelid margin.
• It can be caused by bacteria, most often by staphylococci.   Seborrheic blepharitis is often found with seborrhea of the scalp and eyebrows.
• Symptoms include itching, burning, andphotophobia.  Scales or crusts may beseen on the lid margins.  The patient maycomplain that the eyelids are sealed shut by died crusts on awakening
• Untreated blepharitis could lead to inflammationof the cornea or hordeolum
• The physician may prescribe an antibioticointment for the condition, be certain that the medication applied to the eyesis an ophthalmic preparation.  The eyelids also can be gently cleansed withbaby shampoo solution

• Also know as a stye
• It’s a common acutestaphylococcal infection of the eyelid margin that originates in the lashfollicle.  The affected area of the lidis read, swollen, and tender
• Treatment is the application of warm, moistcompresses several times a day.  If aperson repeated infections, then these may be related to staphylococcalinfections at some other location of the body. The physician attempts to locate any other infections and may orderHyrdeolum treated with ophthalmic antibiotic agents

• Keratoplast (Corneal transplants)
• For all eye surgeries inspect the dressing fordrainage and ask if the patient is having any pain or nausea.  After the dressing is removed, inspect theeye for corneal opacity.  In addition,evaluate the patient's visual acuity.  It’scommon for vision to be blurry the first few weeks followed by gradualimprovement.  Complete healing may takeas long as 6 months
• Specific care after keratoplasty Caution thepatient to avoid any activities that increase pressure in the eye, includingrubbing they eye, bending forward, lifting, straining and stool, andcoughing.  Report any promptly treatnausea because vomiting raises intraocular pressure. Administer stool softenersas ordered to prevent constipation.  Thepatient probably will be instructed to wear the shield for several weeks whilesleeping to prevent accidental trauma

• It begins when a tear in the retina allows fluidto collect between the sensory and pigmented layers. The fluid causes the two layers toseparate.  Separation deprives thesensory layers of nutrients and O2 that normally are supplied by the bloodvessels in the choroid.  This leads todamage to the nerve tissue in the sensory layer and resultant partial or completeloss of vision. Retinal tears may occur spontaneously or as a result ofdrama.  They are more common in olderpeople and in people with myopia
• Signs and symptoms of retinal detachment dependon the location and extent of the detachment. Patients may report seeingflashes of light or floaters. Vision may be cloudy.  If the area of detachment is large, thenvision may be lost completely.  Somepatients say it seems as if a curtain has come down or acres the line ofvision.  This is very frightening to thepatient
• Medical and surgical treatment… specialprocedures are required to repair retinal detachments.  Most holes or tears must be sealedpromptly.  Laser photocoagulation is onemethod commonly used to do this.  As thearea heals, scar tissue forms that seals the tear.  Cryotherapy also causes scar tissue to form,but it uses a cold probe applied to the eyeball behind the tear.  The cold radiates through the layers oftissue, freezing the torn tissue. Another procedure that may be used isretinopexy, in which gas is injected into the eye to apply pressure to the tear

• myopia (near-sightedness): the lens is situated too far from the retina
• hyperopia (far-sightedness): the lens is situated too close to the retina. person sees clearly at a distance but does not close up
• astigmatism: irregularities existing in the cornea

• presbycusis: old people hearing or hearing loss associated with age
• conductive: results from interferance with sound waves from the external ear to the inner ear (i.e. too much ear wax), factors that may cause this include obstruction of the external canal or eustachion tube and otosclorosis (contition in which the stabes does not vibrate)
• sensory neural hearing loss: sometimes called nerve deafness - may be congenital but it also can be caused by noise, trauma, aging, meniere disease, ototoxicity, diabetes, and cyphilis
• mixed hearing loss: a combination of the two
• central hearing loss: due to a problem in the CNS patient can not perceive or interpret sounds that are heard

• the sensation that ones body or room is spinning
• often triggered by sudden movements
• Post op. : advise patients to move slowly and carefully. instruct patients to call for help when getting up the first times

• be sure the patient knows you are present. try to move into their line of view before touching them. 
• know the patients usual means of communication
• speak slowly and distinctly
• don't turn face away from patient while speaking
• do not eat, smoke or chew gum if patient reads lips
• make sure the light source is shining to the face not the back of the head
• lower the tone of your voice
• speak towards the good ear if they have one
• amplify your voice, use a rolled sheet of paper or a stethoscope
• short sentences or phrases
• body language
• use a magic slate if available, i.e. dry erase board

• tuning fork tests
• Rinne test: tuning fork is placed on patient's mastoid bone. if the vibration is conducted through the bone, the patient hears a humming sound.  when the sound is no longer heard, move the fork so the tines are near but not touching the ear canal.  if the patient says they can hear the sound, it is recorded ac > bc or bc > ac (bc=bone conduction ac=air conduction
• weber test: tuning fork is placed on the midline of the skull and then you ask patient which ear it is loudest in.  with normal hearing, it should be equal.

• the combination of dry serumen and coarse hairs sometimes leads to obstruction of the ear canal
• the ear drum thickens, the boney joints in the middle ear degenerate somewhat, surprisingly, these changes are thought to not change the hearing significantly
• changes in the inner ear that do affect hearing- atrophy of the cochlea, cochlea nerve cells, and the organ of corti. again, hearing loss in old people is known as presbycusis

• auricle, external ear, external auditory canal, timpanic membrane or ear drum
• sounds entering the auditory canal cause the ear drum to vibrate
• the three bones, maleolus, incus and stapes, transmit the vibrations to the oval window
• the labrynth, vestibule, semi-circular canal and cochlea are in the inner ear
• the cochlea contains the organ of corti, which transmits stimuli from the oval window to the auditory nerve

• observe how patient responds to a normal voice.  note the presence of a visible hearing aid
• external ear: the ears should be positioned symmetrically. the auricles should be examined for shape, lesions and nodules, and palpated for tenderness as well as the mastoid process
• external auditory canal: use a pen light to inspect for any obstructions or drainage. the cerumen should be golden-brown in color and should not block the opening of the canal

• audiometry: assessment of the ability to hear simple sound waves
• caloric test: diagnose disorders in the vestibular system or its CNS connections
• electronystagmography: uses to detect lesions in the vestibule.
• hearing acuity test: gives precise measurements of hearing acuity

• ask about previous or acute or chronic hearing problems
• note whether female patients have had or been immunized for rubella
• immunization history to determine whether any drugs have been taken that are ototoxic

• Postoperitae:
• In postoperative period, pain, nausea, dizziness, and fever are common
• Inspect the wound dressing for drainage
• Document drainage color, odor and amount
• Interventions:
• Acute pain 
• Risk for injury                                          
• Risk for infection                                                        
• Disturbed sensory perception

 Dizziness and vertigo are common after surgery on the ear. Dizziness is a feeling of unsteadiness, whereas vertigo is the sensation that one’s body of the room is spinning.

• a hereditary condition in which an abnormalgrowth causes the foot plate of the stapes to become fixed
• Primary symptoms are slowly progressive hearing loss in the absence of infection.  
• The Rinne test reveals bone conduction to be greater than air conduction
•   Most common treatment is a surgical procedure call stapedectormy

• Labyrinthitis is inflam:mation of the labyrinth. It may be acute or chronic.
• Supportive Labyrinthitis: usually follows an acute upper respiratoryinfection, acute Otitis media, pneumonia, or influenza. It also can be anadverse effect of drugs
• S/S  Vertigo, nausea, vomiting, headache, anorexia, Nystagmus, and Sensorineural hearing loss on the affected side

• Chloramphenicol: Broad spectrum   antibiotic used to treat infections of lining of external auditory canal
• Topical Corticosteroids:Treat inflammation, pruritus, and allergic response. Usually combined with antibacterial or antifungal drug
• Antibacterial and softening agents:  Soften earwax.   Treat aphthous ulcers.
• Drying Agents: Prevent or   treat nausea, vomiting, motion sickness
• Antiemetics:  Prevent or   treat nausea, vomiting, motion sickness

• a.       Menieres disease is a disorder of the labyrinth of the ear related to an accumulation of the fluid in the inner ear
• .b.      Onset between 30-60 years old.
• c.       Cause unknown but some things have been found to trigger attacks including: Alcohol, nicotine, stress and certain stimuli including bright lights and sudden movements
• S/S: Acute attacks: hearing loss and vertigo accompanied by pallor, sweating, nausea, vomiting, tinnitus; unilaterally. It is heard as a low buzzing sound that sometimes becomes a roar. Some loss of low-frequency sound may remain.
• TMNT:                                                              i.      drugs such as atropine, epinephrine, benzodiazepine agents such as diazepam (valium), antihistamine agents, antiemetic agents, anticholinergic agents, vasodilator agents, and diuretic agents.                                
• Low sodium diets seem to increase the length of time between attacks by reducing edema in the inner ear. 
• Surgical treatment:  Surgical procedures work by draining excess fluid from the inner ear or by cutting the part of the acoustic nerve that controls balance.
• 1.      Complications of surgery: infection, hearing loss, loss of cerebrospinal fluid and damage to the seventh cranial nerve (facial nerve).

• Otologist:                                                              i.      Trained to diagnose types of hearing lossb.     
• Audiologist:                                                              i.      Carries out tests to determine whether a hearing aid will help and identifies the best kind of hearing aid.c.      
• Otolaryngologist 
•    A physician who specializes in diseases of the ears and throat.

• a.       Select the correct solution as ordered by the physician
• b.      Warm the solution to body temp (95-105 )
• c.       Have patient sir up and hold an emesis basin under the eard.      Drape the shoulder under the basin
• e.       Straighten the external canal of an adult by pulling the auricle up and back. For a child, pull the auricle down and backf.       Select an irrigating syringe or bulb syringe with a tip that is smaller than the canal.
• g.      Direct the solution toward the top of the canal in a steady stream, not toward the eardrum. The procedure can be repeated several times if needed.
• h.      Sometimes eardrops are ordered to soften the impacted cerumen before irrigating
• i.        Describe any substances rinsed out of the ear, if the impacted cerumen or foreign body does not wash out, and then inform the physician.
• j.        If the tympanic membrane is ruptured, then the canal should not be irrigated because fluid could be forced into the middle ear.