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Overview of Anatomy and PhysiologyAnatomy of the eyeAccessory structures of the eyeEyebrowsEyelashesEyelidsLacrimal apparatusFigure 53-1Overview of Anatomy and PhysiologyAnatomy of the eye (continued)Structures of the eyeballScleraCorneaChoroidCiliary bodyIrisPupilRetinaOverview of Anatomy and PhysiologyAnatomy of the eye (continued)Chambers of the eyeAnterior chamberAqueous humorPosterior chamberVitreous humorFigure 53-2Overview of Anatomy and PhysiologyAnatomy of the earExternal earAuricleExternal auditory canalTympanic membraneMiddle earEustachian tubeMalleusIncusStapesFigure 53-3Overview of Anatomy and PhysiologyAnatomy of the ear (continued)Inner earLabyrinthBony labyrinth—filled with perilymphSemicircular canalsVestibuleCochlea—organ of CortiMembranous labyrinth—filled with endolymphFigure 53-4Overview of Anatomy and PhysiologyOther special sensesTaste and smellTaste buds: salty, sweet, sour, bitterOlfactory receptors: sense of smellTouchTactile receptorsPosition/movementProprioceptorsLaboratory and Diagnostic ExaminationsDiagnostic eye testsSnellen testColor visionRefractionOphthalmoscopyTonometryAmster grid testSchirmer’s tear testDisorders of the EyeBlindness and near-blindnessEtiology/pathophysiologyLoss of visual acuityCongenital or acquiredLegal blindness20/200 with corrective eyewear (normal 20/20)Visual field less than 20 degrees (normal 180)Disorders of the EyeBlindness and near-blindness (continued)Clinical manifestations/assessmentDiplopiaPainFloaters and light flashesPruritus; burning of the eyesLoss of peripheral visionHalosOrbital pressureBulging of the eyesDisorders of the EyeBlindness and near-blindness (continued)Medical management/nursing interventionsCorrective eyewearCanesSeeing-eye dogsMagnifying systemsSurgical proceduresDisorders of the EyeRefractory errorsEtiology/pathophysiologyAstigmatism—unequal curve in the shape of the cornea or lensStrabismus—inability of the eyes to focus in one direction; cross-eyedMyopia—nearsightedness; eyeball is too longHyperopia—farsightedness; eyeball is too shortDisorders of the EyeRefractory errors (continued)Clinical manifestations/assessmentDiminished or blurred visionMedical management/nursing interventionsCorrective lensesSurgical correctionRadial keratotomy (RK)Photorefractive keratectomy (PRK)Laser-assisted in-situ keratomileusis (LASIK)Disorders of the EyeConjunctivitisEtiology/pathophysiologyInflammation of the conjunctivaBacterial or viral infectionAllergyEnvironmental factorsCommonly called pink eyeDisorders of the EyeConjunctivitis (continued)Clinical manifestations/assessmentErythema of the conjunctivaEdema of the eyelid; crusting dischargePruritus; burning; excessive tearingMedical management/nursing interventionsWarm compressesEye irrigations with normal salineAntibiotic drops or ointmentKeep free from exudateDisorders of the EyeKeratitisEtiology/pathophysiologyInflammation of the corneaInjury, irritants, allergies, viral infection, or diseasesPneumococcus, Staphylococcus, Streptococcus, and Pseudomonas are most common types of bacterial causesHerpes simplex is most common viral causeDisorders of the EyeKeratitis (continued)Clinical manifestations/assessmentSevere eye painPhotophobiaTearingEdemaVisual disturbancesDisorders of the EyeKeratitis (continued)Medical management/nursing interventionsPharmacological managementTopical and systemic antibioticsAnalgesicsPressure dressingsWarm or cold compressesEpithelial debridementKeratoplastyDisorders of the EyeDry eye disorders (keratoconjunctivitis sicca)Etiology/pathophysiologyLacrimal gland dysfunction from an autoimmune mechanismClinical manifestations/assessmentComplaints of sandy or gritty sensation in the eyeMedical management/nursing interventionsArtificial tear replacementPunctal plugs or repair if injuredDisorders of the EyeEctropion and entropionEtiology and pathophysiologyNoninfectious disorders of the eye lid causing abnormal eyelid marginsClinical manifestationsAbnormal direction of the eyelidCorneal drynessMedical management/nursing interventionsTopical medications to reduce conjunctival and corneal dryingSurgeryDisorders of the EyeCataractsEtiology/pathophysiologyNoninfectious opacity or clouding of the lensCongenital; acquired; senileClinical manifestations/assessmentBlurred visionDiplopiaPhotosensitivityDecreased night visionOpacity in the center portion of lensDisorders of the EyeCataracts (continued)Medical management/nursing interventionsSurgical removal Lens implant or glassesPostoperativeAvoid direct sunlightBed rest with bathroom privileges (BRPs)AnalgesicsNo bending down or strainingAvoid coughing, sneezing, and blowing noseDisorders of the EyeDiabetic retinopathyEtiology/pathophysiologyCapillary microaneurysms, hemorrhage, exudates, and formation of new vessels and connective tissue in the retinaClinical manifestations/assessmentMicroaneurysmsProgressive loss of vision; “floaters”Medical management/nursing interventionsPhotocoagulationVitrectomyDisorders of the EyeMacular degenerationEtiology/pathophysiologySlow, progressive loss of central and near vision due to aging retinaClinical manifestations/assessmentGradual and variable bilateral loss of visionColor perception may also be affectedMedical management/nursing interventionsUsually no treatmentMay use photocoagulationDisorders of the EyeRetinal detachmentEtiology/pathophysiologySeparation of the retina from the choroid in the posterior area of the eyeClinical manifestations/assessmentFlashes of light; floating spotsLoss of a specific field of visionMedical management/nursing interventionsPhotocoagulation; cryosurgery; diathermyScleral bucklingFigure 53-8Disorders of the EyeGlaucomaEtiology/pathophysiologyAn abnormal condition of elevated pressure within an eye; obstruction of outflow of aqueous humorOpen-angleClosed-angleFigure 53-9Disorders of the EyeGlaucoma (continued)Clinical manifestations/assessmentOpen-angleNo signs or symptoms during early stagesTunnel visionEye painDifficulty adjusting to darknessHalos around lightsInability to detect colorsDisorders of the EyeGlaucoma (continued)Clinical manifestations/assessmentClosed-angleSevere painDecreased visionNausea and vomitingErythema of the scleraEnlarged and fixed pupilHalos around lightsDisorders of the EyeGlaucoma (continued)Medical management/nursing interventionsOpen-angle glaucomaBeta blockersMioticsCarbonic anhydrase inhibitorsClosed-angleOsmotic diureticsIridectomyDisorders of the EyeCorneal injuriesEtiology/pathophysiologyResult from injuries to corneal layers of the eyeClinical manifestations/assessmentPain with movement of eyeExcessive tearing; pruritusErythema of conjunctivaDisorders of the EyeCorneal injuries (continued)Medical management/nursing interventionsFlush with normal saline or waterAntibiotic drops or ointmentPenetrating woundsDo not remove object if presentSurgeries of the EyeEnucleationSurgical removal of the eyeballKeratoplasty (corneal transplant)Excision of the corneal tissue, followed by implantation of a cornea from a donorPhotocoagulationA laser is directed into a small spot on the retinaVitrectomyRemoval of excess vitreous fluid caused by hemorrhage and replacement with normal salineLaboratory and Diagnostic ExaminationsDiagnostic ear testsOtoscopyTuning fork testsWeber’s testRinne testAutometric testingVestibular testingRomberg testPast-point testingFigure 53-13Figure 53-14Loss of Hearing (Deafness)Hearing impairmentEtiology/pathophysiologyDecreased auditory acuity; partial or completeAffects development of speechTypesConductive SensorineuralMixedCongenital FunctionalCentralLoss of Hearing (Deafness)Hearing impairment (continued)Clinical manifestations/assessmentRequests for repeating informationNonresponseDelayed speech developmentMedical management/nursing interventionsAccording to causeHearing aidsSurgical proceduresCochlear implantInflammatory and Infectious Disorders of the EarExternal otitisEtiology/pathophysiologyInflammation or infection of the external canalClinical manifestations/assessmentPain with movement of auricle or chewingErythema, scaling, pruritus, edema, watery discharge, and crusting of the external earMedical management/nursing interventionsOral analgesics; corticosteroidsAntibiotic or antifungal ear drops; oral antibioticsInflammatory and Infectious Disorders of the EarOtitis mediaEtiology/pathophysiologyInflammation or infection of the middle earClinical manifestations/assessmentFullness in the earSevere, deep, throbbing painHearing lossTinnitusFeverInflammatory and Infectious Disorders of the EarOtitis media (continued)Medical management/nursing interventionsPharmacological managementAntibioticsAnalgesicsNasal decongestantsLocal heatAspiration of fluid from behind eardrumMyringotomyInflammatory and Infectious Disorders of the EarLabyrinthitisEtiology/pathophysiologyInflammation of the labyrinthine canals of the inner earMost common cause of vertigoViral infection from URIDrugs and foodTobacco and alcoholInflammatory and Infectious Disorders of the EarLabyrinthitis (continued)Clinical manifestations/assessmentSevere and sudden vertigo; ataxic gaitNausea and vomitingNystagmus; photophobiaHeadacheMedical management/nursing interventionsAntibioticsDramamine or meclizine for vertigoIV fluids if nausea and vomiting presentInflammatory and Infectious Disorders of the EarObstructions of the earEtiology/pathophysiologyImpaction of cerumen in canal; foreign bodiesClinical manifestations/assessmentTinnitus and pain in the earSlight hearing loss; tugging at earMedical management/nursing interventionsRemoval of cerumen by irrigationForeign objects are removed with forcepsCarbamide peroxide to soften cerumenNoninfectious Disorders of the EarOtosclerosisEtiology/pathophysiologyChronic, progressive deafness due to formation of spongy bone, especially around the oval windowClinical manifestations/assessmentSlowly progressive conductive hearing lossTinnitus; dizziness to vertigoMedical management/nursing interventionsStapedectomyAir conduction hearing aidNoninfectious Disorders of the EarMénière’s diseaseEtiology/pathophysiologyChronic disease of the inner earIncrease in endolymph fluidClinical manifestations/assessmentVertigoNausea and vomitingHearing loss; tinnitusDiaphoresisNystagmusNoninfectious Disorders of the EarMénière’s disease (continued)Medical management/nursing interventionsNo specific treatmentDecrease fluid pressureFluid restriction; diuretics; low-salt dietDramamine, meclizine, and BenadrylSurgeryDestruction of labyrinthEndolymphatic shuntCryosurgeryVestibular nerve sectionSurgeries of the EarStapedectomyRemoval of the stapes of the middle earTympanoplastyOperative procedures on the eardrum or ossicles of the middle ear to restore hearingMyringotomySurgical incision of the eardrumCochlear implantSurgical implantation of a hearing device for the profoundly deaf Nursing ProcessNursing diagnosesHealth maintenance, ineffectiveAnxietySelf-care deficitFearImpaired environmental interpretation syndromeImpaired home maintenanceImpaired social interactionRisk for injuryRisk for lonelinessSensory perception, disturbed: auditory or visual ................
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