Adult 1 Exam 5 Neuro, Eyes & Ears

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Adult 1 Exam 5 Neuro, Eyes & Ears
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Adult 1 Exam 5 Neuro, Eyes & Ears
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  1. 12 Cranial Nerves
    • I - Olfactory (smell)
    • II - Optic (sight, visual acuity & fields)
    • III - Oculomotor (movement of eye muscles; pupil constrict)
    • IV - Trochlear ( downward inward eye movement)
    • V- Trigeminal (Sensory of cornea, eyelids, foreheadMotor: jaw opening & chewing)
    • VI - Abducens (lateral eye movement)
    • VII - Facial (facial expression & taste anterior tongue)
    • VIII - Acoustic (hearing & equilibrium)
    • IX - Glossophayngeal (swallowing, gag & taste post. tongue)
    • X - Vagus (heart, lungs, digestion & guttural sounds)
    • XI – Spinal Accessory -( turn head, shrug shoulders)
    • XII - Hypoglossal (tongue movement for speech & swallow)
  2. Autonomic Nervous System
    • Sympathetic
    • -EPI & NOR
    • increased heart rate
    • dilated pupil
    • increased sweat
    • decreased saliva & peristalsis (GI)
    • bladder relaxed
    • bronchodilate

    • Parasympathetic
    • -ACh
    • decreased heart rate
    • Constriction of pupil
    • normal sweat
    • increased saliva & peristalsis (GI)
    • bladder contracted
    • bronchoconstrict
  3. Neuro - Effects of Aging
    • Loss of neurons - don't regenerate
    • Enlargement of ventricles - brain
    • Decreased blood flow & CSF flow
    • Decreased brain weight
    • Myelin sheath degeneration -decreased nerve conduction
    • Changes in BP lying to standing(Orthostatic Hypotension)- decreased thirst, use of diuretics or cardiac meds
    • Sluggish reflexes & loss of balance
    • Loss of body temp control (in extremes)-Hypothalamus, metabolism , fat = loss of metabolism
    • Smaller pupils results in vision problems
  4. Neuro Diagnostic Tests
    X-rays - look for fractures (basilar skull orspinal), calcification, bone loss

    Blood Chemistries & ABG’s - to check electrolytes as well as acid-base balance

    Angiography - radio opaque medium used to visualize vessels on x-ray, esp. spasm or stenosis of arteries; dye reaction - iodine or seafood

    CT scan - computer assisted thin cross section x-rays show tumors, hemorrhage,aneurysm, ischemia, edema & tissue necrosis

    MRI – uses magnetic energy to visualize internal structures; detects shifting brain tissue due to hemorrhage

    PET Scan (Positron Emission Tomography) -uses radioactive compounds to measure cell damage or death in the brain; can ID stroke size

    SPECT Scan (Single-Photon Emission Computed Tomography) – like PET yet ID seizure activity

    EEG (Electroencephalogram) – records electrical activity of the brain esp. seizures

    EMG (Electromyogram) - tests nerve stimulation to muscles (nerve conduction)

    Lumbar Puncture - withdraw CSF for analysis; contraindicated ICP as herniates brainstem; flat x 4-24 hrs.

    Evoked Potentials - sensory pathway nerves are examined by generating &tracking a stimulus; also have visual and auditory evoked potentials

    Carotid Duplex Studies - sound waves determine blood flow in carotid

    Transcranial Ultrasound Doppler study(TCD) - sound waves used to determine blood flow in intracranial vessels
  5. CVA
    =(Cerebral Vascular Accident)AKA: “Stroke” or “Brain Attack”

    • Interruption of blood flow leading to inadequate O2 supply to brain by clot, bleed,or tumor
    • Brain uses 20% of the body’s oxygen & 20% of glucose so needs constant blood flow
    • Autoregulation unless SBP < 50 or >160; vasodilation due to:
    • -Hypercapnia (CO2)
    • -Acidosis (H+ ions)
    • -Hypoxia (O2)

    “Penumbra”- core of dead cells surrounded by minimally perfused cells - will not regenerate
  6. CVA Risk Factors
    • Age >65 yrs. But 25% < 65 yrs.
    • Gender: males > females
    • Race esp. African American & Hispanic
    • Hypertension
    • Family history or history of TIA/stroke
    • Alcohol consumption, IV drug abuse
    • Smoking
    • Obesity/high fat diet (hyperlipidemia)
    • DM Type II
    • Cardiac disease (atherosclerosis, atrial fib.)
    • Sickle cell (increased blood viscosity)
    • Stroke belt (SE includes FL, 10%)- possibly diet and heat related
    • A-fib increases risk of stroke (Mr. GD)
  7. Types of CVA’s (Ischemic)
    • Thrombotic
    • Formation of clot in vessel
    • More common where plaque is
    • TIAs common; sudden onset & disappear
    • (TIA = Transient Ishemic Attack)
    • Esp. elderly during or just after sleep
    • Men > more than women

    • Embolic
    • -sudden onset - immediate neuro defect -does not go away
    • Clot formed elsewhere and occludes vessel
    • Atrial Fib, DVT, Endocarditis etc.
    • Usually no TIAs
    • Esp. young who are awake & active
    • Men > more than women
  8. Types of CVA’s (Hemorrhagic)
    • Hemorrhagic/Intracerebral
    • Rupture of vessels due to HT, aneurysm, AV (arteriovenous) malformation, trauma or tumor erodes vessel
    • Sudden onset esp. with activity
    • More women > than men
    • Headache is a symptom due to blood irritating meninges & brain tissue

    • Sudden Onset - Two Types:
    • Intracerebral
    • Subarachnoid
  9. TIA =(Transient Ischemic Attack)
    • Brief period of localized cerebral ischemia with reversible neurologic defects < 24 hrs.
    • Transient Symptoms:
    • Sudden onset & disappearance
    • Contralateral numbness or weakness of hand, forearm, or corner of eye
    • Visual disturbances/blurring, diplopia,amaurosis fugax (fleeting blindness described as a shade coming down) Speech difficulty/aphasia
  10. TIA vs. Stroke in Evolution vs.Completed Stroke
    • TIA -first 24 hours - if does not resolve then becomes stroke in evolution
    • Stroke in evolution begins with TIA & worsens over 1-2 days esp. thrombotic - until all bad things stop happening
    • Completed stroke usually in 3 days due to necrosis (penumbra)- healthy tissue that surrunds an ischemic event - goal of tx is to save penumbra by increasing O2 transport and delivery to the area
    • Cardiogenic embolic stroke due to atrial fibrillation - embolism becomes lodged in narrow cerebral vessels
    • Recurrent stroke -
  11. CVA Signs & Symptoms:
    • Sudden onset, focal & 1-sided
    • Weakness or numbness of face, arm or leg (contralateral); except vertebral artery unilateral
    • Loss of vision of 1 eye or peripheral/sidevision (homonymous hemianopia)
    • Speech difficulties
    • Balance problems, unable to walk
    • Sudden, severe, unexplained headache
    • Dysphagia
  12. Endarterectomy
    • Lack of blood to brain from occlusion in carotid artery Surgical removal of plaque can restore circulation to brain
    • Extracranial-intracranial bypass if plaque not directly accessible
    • Carotid angioplasty &stent

    • Nursing Interventions
    • Position on unoperated side with HOB ­ 30degrees
    • Support head when changing positions
    • Look for:
    • Hemorrhage
    • Resp distress (bleeding near trachea)
    • Cranial nerve impairment
    • Hyper or hypotension(from carotid nerve stim.during surgery)
  13. CVA Treatments
    • Nutrition:
    • Check for gag reflex
    • Sit in high fowlers with head slightly flexed to prevent aspiration; food on unaffected side behind teeth & tilt head back slightly - Safety
    • Thicken food/fluids if needed
    • PEG tube if needed
    • Speech Therapy evaluation
    • Physical Therapy to prevent contractures
    • Occupational Therapy to relearn ADL
    • Discharge planning to Intermediate or Rehab setting
  14. Intra-Cranial Aneurysm
    • Outpouching & weakness in cerebral artery;may rupture with hemorrhagic stroke
    • 85% anterior at carotid & vertebro-basilar arteries in circle of Willis

    • Risk Factors:
    • Congenital
    • Hypertension (cocaine)
    • Head injury/trauma
    • Atherosclerosis
    • Age 30-60 years
    • Female > male

    S/S: Usually asymptomatic til rupture(leaking symptoms of HA, N&V, neck pain,dilated pupils & eye pain/visual deficits)

    • Complications:
    • Rebleed esp. 1st day & days 7-10 clot breaks down
    • Vasospasm 3-10 days post-bleed
    • Hydrocephalus as protein from blood lysis obstructs CSF (arachnoid villi)

    • Types:
    • Berry - congenital middle/media; no warning
    • Saccular – outpouching due to trauma/force
    • Fusiform – entire circumference of vessel swells due to arteriosclerosis
  15. Aneurysm Treatments:
    • Amicar – fibrinolysis inhibitor causes clotting1-2 wks. ( 1st wk. IV then 2nd wk. PO)
    • Calcium Channel Blocker – decrease vasospasm x 3 wks.
    • Anticonvulsants – Dilantin (filter)
    • Stool softeners – prevent straining
    • Analgesics – for headaches
    • Surgical clipping (craniotomy)
    • -Endovascular Gudlielmi coil with electric current causing coagulation
    • -Balloon remodeling & stents
    • -Parent vessel occlusion
  16. Unconsciousness
    = abnormal state when client is not aware of self or environment

    Due to: Injury to cerebral hemispheresor metabolic disorders

    • Arousal (wakefulness)
    • Ability to awaken or elicit a response; Reticular Activating System (RAS)

    • Consciousness
    • Ability to reason, think, feel, respond to astimulus; Cerebral hemispheres
  17. Glasgow Coma Scale
    • (measurement of patient’s level of consciousness)3 to 15 points with 15 being awake & alert; <7 coma
    • assess 3 areas and add scores together

    • Eyes open
    • When approaching bedside(4)
    • To verbal command (3)
    • To pain (2)
    • No response (1)

    • Best Verbal Response
    • Orient X 3 (person place &time) (5)
    • Can converse but confused or disoriented (4)
    • Swearing, inappropriate words(3)
    • Gibberish or moaning (2)
    • Lack of sound (1)

    • Best Motor Response
    • Obeys commands (6)
    • Localizes to pain (5)
    • Flexion withdrawal (4)
    • Abnormal flexion (3)[may be also called Decorticate Posturing –indicates injury at or above brainstem]
    • Abnormal extension (with internal rotation) (2)[may be called Decerebrate Posturing]
    • Lack of response (1)
  18. Decorticate Posturing
    Decerebrate Posturing
    • Decorticate Posturing(lesion at or above the brain stem)
    • Rigidly still
    • Arms flexed
    • Fists clenched
    • Legs extended

    • Decerebrate Posturing (lesion below brain stem –intracranial catastrophe)
    • Rigid body position
    • Arms stiff, extended& pronated inward
  19. COMA STATES
    Persistent vegetative state –unawareness of self & environment; brainstem & cerebellum still function (chew,swallow, cough)

    Locked-in syndrome – alert & aware of environment but locked inside body without speech or movement; infarct of pons yet RAS still working

    • Brain death – no cerebral or brain stem function x 6-24 hrs. with normal temp. & not on depressant drugs or alcohol poisoning
    • Glasgow scale 3
    • No dolls eyes - ice cold water in ear - eyes deviate to other side
    • Pupils fixed & dilated
    • No caloric stimulation
    • No spont. respirations
    • Flat EEG
  20. Tension HA
    • Most common
    • Bilat. pain from “band around head” radiating from back to front or starting above eyes
    • Sustained muscle tension from head & neck due to stress or disorders of eyes, ears, sinuses
    • TX with ice, ASA &NSAID
  21. Migraine Headaches
    • Recurring vascular headache w or w/o aura
    • Migraine Stages:
    • Aura: 5-60 min, sensory/visual disturbances (spots,light flashes) due to vasoconstriction
    • Headache: 1-2 days, due to vasodilation & reduced serotonin levels; throbbing unilat. HA with N/V, photophobia & light sensitivity
    • Post-headache: Exhausted, sensitive to touch with deep aching pain
    • TX:
    • Quiet dark place
    • Avoid tyramine foods (aged cheese, nuts, chocolate, ETOH/red wine)
    • Stress management/biofeedback
  22. Cluster Headaches
    • Cluster of headaches for days or weeks with periods of remission for months
    • Esp. middle-aged men
    • Spring & Fall with tearing & nasal congestion (? circadian mechanism or disorder of hypothalamus)
    • Wake about 2 hours after sleep with unilat.HA near eye (same place)
    • TX:
    • Avoid ETOH & nitrates
    • 100% O2 for 15 min.
  23. Headache Medications/TX:
    Beta blockers (Inderal) prevent cerebral vasodilation & inhibit serotonin uptake

    Calcium channel blockers (Verapamil)controls cerebral vasospams

    Serotonin agonists (Imitrex) cause vasoconstriction of cerebral vessels

    Tricyclic antidepressants (Elavil) for cluster & migraine HA’s as prevent norepinephrine & serotonin uptake

    Ergotamine (Cafergot) or ergot derivatives(Sansert) vasoconstrict cerebral vessels

    • NSAID/ASA anti-inflammatory analgesics
    • Narcotic analgesics (Demerol, Codeine
  24. Seizure
    Epilepsy
    Unprovoked
    Provoked
    Epilepsy
    • Seizure = spontaneous, abnormal synchronous discharges of collections of neurons in cerebral cortex
    • Increases metabolic demands for ATP x 250%
    • 60% increase in oxygen consumption
    • 2.5 x increase in cerebral blood flow or cellular exhaustion

    Epilepsy = disorder of recurrent seizures

    • Unprovoked/Primary/Idiopathic unknown cause
    • Provoked/secondary due to fever, trauma,metabolic, endocrine, infection or tumor
  25. Partial Seizures
    Simple Partial Seizure
    Partial (focal, localized to part of brain)

    • Simple Partial Seizure (Pt. is conscious)
    • -Motor-Muscle contractions of 1 body part (local or sequential/travels = Jacksonian march or seizure) -Autonomic phenomena (disrupted)
    • Tachycardia
    • Hypo or hypertension
    • Sensory
    • Hallucinations
    • Feeling of Deja vu

    • Complex Partial Seizure (Pt. is NOT conscious; amnesia)
    • Motor (repetitive, nonpurposeful activity/”automatisms”)
    • Lip smacking
    • Picking at clothing
    • Aimless walking
    • Sensory
    • Feeling of Deja vu
    • Aura (smell, hallucination)
    • Esp. temporal lobe
  26. Generalized Seizures
    (involve both hemispheres so impaired consciousness)

    • Absence/Petit Mal Seizure
    • Sudden, brief cessation of motor activity with blank stare/unresponsiveness
    • Esp. children
    • Sometimes automatisms like eyelid flutter, lip smaking
    • Last 5-30 sec. & may have hundreds in a day

    • Tonic-Clonic Seizure/Grand Mal Seizure
    • Aura (smell, bright light, vague feeling)
    • Sudden LOC
    • Tonic muscle contractions with rigid arms, legs & jaw,urine/bowel incontinence, cyanosis with fixed dilated pupils lasting 15 - 60 sec.
    • Clonic phase of alternating contractions & relaxation of muscles with hyperventilation & eyes rolled back plus frothing at mouth lasting 60-90 sec.

    • Post-ictal period/phase where breathes & regains consciousness but still confused , fatigue, muscle aches(sleeps for several hours, amnesia)
    • Esp. adults
  27. Seizure Treatments
    • Anticonvulsant drugs – lowest dose
    • Increase seizure threshold
    • Limit spread of abnormal activity
    • Dilantin w NS, Cerebyx, Tegretol, Gabitril with food, Neurontin 2 hrs. after antacids(drugs with many interactions)
    • Dilantin SE/ADR - hyperplasia of gums - mouth/ dental care needed

    • Surgery esp. temporal lobe (excise tissue)
    • Vagal nerve stimulation for partial seizures

    • Nursing Interventions
    • Airway maintenance
    • Protect
    • Loosen clothing
    • Seizure precautions ( Padded side rails)
    • Education esp. medications
  28. Alzheimer’s Disease
    Progressive, irreversible deterioration of general intellectual function (cognitive,emotional, & social behavior); hereditary component

    • Stages –
    • I (2-4 yrs.) memory lapses, subtle personalty changes, & problems calculating; family covers up
    • II (2-12yrs.) obvious memory deficits &confusion; easily agitated; paces; unable to write; uses wrong words; safety concerns;sundowning with more agitation &disoriented in evening
    • III (7yrs. from dx) disoriented x3, rigid limbs, bowel & bladder incontinence, unable to communicate; death due to aspiration pneumonia
  29. Alzheimer Nursing Dx & Interventions
    • Impaired Memory
    • Anxiety
    • Hopelessness

    • Monitor disease progression/stages
    • Family education/anticipatory guidance
    • Discuss client needs
    • Face, talk directly using simple sentences/explanations in calm voice
    • Decrease stimuli
    • Re-orient frequently yet don’t argue
    • Ensure adequate rest
    • Allow client to make decisions if possible
    • Document changes
    • Refer to appropriate agencies
  30. ALS (Amyotrophic Lateral Sclerosis; Lou Gehrig’s Disease)
    Progressive neuro disorder of muscle wasting yet cognition intact (trapped in body)

    • S/S: muscle weakness/atrophy
    • Flaccid & spastic paralysis
    • Intact mental status
    • Dysphagia/swallow & dysarthria/speech

    • DX: EMG/electromyogram (fasciculations) or muscle biopsy; increased CPK & decreased pulm.function tests
    • Death in 2-6 yr. usually due to resp. failure

    • TX: no cure
    • Riluzole extends time til ventilatory support
    • Communication method (eye muscles intact)
    • Family social support
  31. Trigeminal Neuralgia
    =(Tic Douloureax)

    • Chronic disorder of CN #V (5) causing sudden, brief severe facial pain
    • Trigger zones (chewing, temp., wind)

    • TX:
    • Tegretol (tricyclic anti-convulsant)
    • Other meds (Dilantin, Neurontin orLioresal)
    • Surgery to sever CN (rhizotomy)
    • -Closed/percutaneous (glycerol,radiofrequency heat, ballooncompression)
    • -Open (Jannetta procedure pads vessel & nerve)
  32. BELLS PALSY =
    Unilat. facial paralysis of CN VII (7)

    • S/S: acute pain with paralysis of ½ face
    • Upper eyelid paralysis & loss of corneal reflex
    • Asymmetric face
    • Increased tearing
    • Impaired taste
    • ? Herpes simplex

    • TX:
    • Corticosteroids
    • Acyclovir
    • Warm moist heat
    • Artificial tears
    • Soft diet
  33. Tetanus/Lockjaw(Clostridium tetani)
    Neurotoxin that interferes with muscle contraction

    • Signs & Symptoms:
    • Rigid, spastic muscles of jaw, neck, back &esophagus
    • Opisthotonus (arched back)
    • Risus sardonicus (rigid, fixed smile)
    • Increased saliva, perspiration & drooling
    • Intact mental status !

    • Treatment:
    • Prevention: wash wounds & immunize
    • Penicillin or Flagyl
    • Ventilation with Pavulon & Valium
    • Quiet dark environment
  34. Botulism/food poisoning(Clostridium botulinum)
    GI absorption of neurotoxin blocks release of acetylcholine with resp. & skeletal muscle paralysis

    • S/S:
    • N & V, diarrhea
    • Diplopia (double vision), ptosis, fixed dilated pupils
    • Slurred speech (dystonia of larynx)
    • Resp. & skeletal muscle paralysis
    • Intact mental status !

    • TX: IV neuro antitoxin (Trivalent)
    • Enemas, laxatives, GI lavage
    • TPN & lipids for nutrition
    • Ventilatory support
    • Prevent by discarding bulging cans of food
  35. Neuro. Nursing Diagnoses
    • Altered tissue perfusion: Cerebral RT CVA
    • Risk of ineffective airway clearance RT decreased gag reflex
    • Impaired mobility RT CVA, ALS
    • Impaired communication RT aphasia
    • Self care deficit RT ADL
    • Impaired memory RT Alzheimer’s
    • Impaired swallowing RT dysphagia
    • Self esteem deficit RT CVA, ALS, Huntington’s
    • Risk of ineffective mgmt. of treatment regimen RT seizure medications
    • Risk of impaired skin integrity RT immobility
    • Sensory/ perceptual alterations R/T cerebral injury
    • Acute Pain R/T headaches, Trigeminal Neuralgia
    • Anxiety R/T change in health/genetic testing
    • Body image disturbance RT Huntington’s disease
    • Risk for imbalanced nutrition, less than required RT inability to swallow or fear of chewing
    • Caregiver role strain RT Alzheimer’s
    • Risk for aspiration RT Huntington’s Disease
    • Chronic confusion RT Alzheimer’s
    • Powerlessness RT ALS, Tetanus
    • Risk for injury/falls RT seizures
    • Risk for injury/bleeding RT use of anticoagulants
  36. t-PA
    • tissue plasminogen activator
    • -converts plasminogen to plasmin - fibrinolysis of the clot

    DO NOT GIVE IN HEMORAGIC STROKE

    • -must be give within 3 hours of onset
    • -CT scan used to confirm not a hemoragic stroke
    • -dont have any anti-coagulants if hemoragic stroke - bleed out faster
  37. Bowel & Bladder training
    • Void on schedule (q2h) rather than in respone to urge
    • Teach kegal exercises

    • Encourage fluids and fiber
    • physical activity at tolerated
    • Us toilet at same time each day based on pattern of bowel elimination
    • stool softener if necessary
  38. Neglect syndrome
    sensory-perceptual deficit where the patient cannot integrate perceptions from affected side of body so ignores that part of the body - environment, perceptions, neglects personal care of effected part
  39. Cerebellar Function Assessments
    • Assess gait - normal, heel-to-toe, on toes, on heels
    • Rhomberg's test - stand with feet together & close eyes
    • *should be minimal swaying

    • Coordination
    • -pat knees - alternate from and back of hands
    • -touch thumb to fingers
    • -touch nose finger & nose again

    Ataxia - lack of coordination and a clumsiness of movements, with staggering, wide-based unbalanced gait (seen with stroke and cerebellar tumors)

    Parkinsonian gait - stoops over while walking and shuffles feet - arms are held close to sides

    Spastic hemiparesis - stroke - one leg stiffly dragging while the other leg circles out and forward - one arm flexed and held close to side

    Steppage gait - disease of lower motor neurons - drags of lifts the foot high then slaps foot onto floor - cannot walk on heels
  40. Aphasia
    Expressive
    Receptive
    Global

    Intervetnions
    inability to use or understand language

    Expressive aphasia - can understand what is being said but can only speak in short phrases (Broca's aphasia)

    Receptive aphasia - one cannot understand spoken or written word - speech may be fluent but with inappropriate content (Wernicke's aphasia)

    Mixed or global aphasia- disfunction in both understanding and expression

    • Intervetions:
    • Treat client as adult
    • Dont assume client who cant respond verbally cant hear
    • Dont raise voice when addressing patient
    • face client and speak slowly
    • when you dont understant their speech - be honest and say so
    • try alternatvie methods of communication - writing tablets. flash cards, computerized taking boards
  41. Types of paralysis
    Hemiplasia - paralysis on left or right side of body

    Hemiparesis - weakness on L or R side of body

    Quadriplegia - complete or partial parlysis of upper limbs and complete parylisis of lower linbs

    Paraplegia - parlysis of lower half of body
  42. CONJUNCTIVITIS
    • Acute = inflammation of lining of eyelid (“pink eye”); highly contagious
    • Due to: bacteria, viruses, or fungi, UV light, allergens or chemical irritants

    S/S: redness, itching, gritty sensation,photophobia, tearing & discharge

    • Chronic (Chlamydia trachomatis)
    • Contagious – personal contact
    • Scarring leading to blindness

    • Treatments
    • Clean eye with baby shampoo
    • Warm NS compresses to remove crust
    • Apply heat if sty or chalazion
    • Don’t share towels, makeup, or rub eye
    • Remove contact lenses & clean
    • Antibiotic/antiviral medications
    • Anti-histamines
    • Corticosteroids
    • Analgesics
  43. CATARACTS:
    Opacity/clouding of crystalline lens due to aging & denaturation of lens protein (bilat.)

    • S/S:
    • Cloudy, blurred vision both close & distant
    • Poor night vision due to Glare
    • Difficult adjusting to light & dark environments
    • Unable to distinguish color hues
    • Pupils appear cloudy, gray or white rather than black

    • DX: dark area instead of red light reflex
    • TX: Surgery for intraocular lens implant
  44. Nursing Care after Eye Surgery
    • Check visual acuity before & after surgery(stabilizes several wks postop)
    • No vomiting, sneezing, coughing, straining, or lifting > 5 lbs. as increases intraocular pressure
    • Semi-Fowlers lying on unaffected side to decrease intraocular pressure except retinare-attachment (retinal) surgery
    • Sunglasses for photophobia
    • Complications (notify MD if):
    • Pain or drainage from affected eye
    • Hemorrhage/bleeding in anterior chamber
    • Flashes of light, floaters, “curtain coming down”
    • Cloudy appearance to cornea
  45. Glaucoma
    Increased intraocular pressure damages retina & optic nerve (leading cause of blindness in U.S.)

    • Open angle/chronic simple (90%) with decreased outflow of aqueous humor and increased pressure
    • Asymptomatic except painless gradual loss of peripheral vision; bilateral; esp. Blacks

    • Closed angle/narrow (10%) with lens shifted forward pushing iris laterally; unilateral; esp. Asians & Escamos
    • Sharp eye pain with colored halo lights
    • Abrupt decrease in visual acuity
    • Fixed, nonreactive pupils

    • Preventative Measures:
    • Lower BP
    • Regular eye exams
  46. Retinal Detachment
    • RETINALDETACHMENT
    • Separation of the retina from the choroid
    • Medical emergency surgery needed
    • Signs/Symptoms:
    • •Floaters
    • •Flashes of light
    • •Blurred vision
    • •Progressive deterioration of vision
    • •Sensation of curtain or veil drawn across field of vision
    • •Loss of central vision, if macula involved
  47. TX. For Retinal Detachment
    Cryotherapy or laser coagulation to crease area of inflammation to band layers together

    Scleral buckling – fold sclera to bring choroid in contact with retin

    Vitrectomy – remove vitreous humor& replace with sterile NS

    Pneumatic retinopexy – air bubble to push retina in contact with choroid

    • Postop, position pt’s head so detached retina in closer contact to choroid
    • 90% success rate retinal reattachments
  48. AGE-RELATED MACULAR DEGENERATION (AMD)
    • Degeneration of Macula resulting in central vision loss; slow & bilateral
    • Abnormal accumulation of waste in the retinal epithelium called Drusen (flecks in eye) - not curable

    • 2 Types:Atrophic – dry type (slow progressive);
    • TX. with antioxidant vitamins & visual aids - vits C, E, A, zinc, and copper slow progression

    • Exudative – wet type (more aggressive);
    • TX. with laser photocoagulation - fragile blood vessels destroyed to prevent bleeding

    photodynamic therapy with verteporfin - light shined into eye to avtivate drug (destroys new blood vessels) -(avoid sunlight x 5 d)

    • Tx - large-print books
    • magnifiers
    • lighting
  49. Signs & Symptoms AMD
    • Loss of central vision
    • Blurred vision
    • Visual distortion/wavy lines
    • Risk Factors –􀂄 Age > 65
    • Smoking 2X
    • Race: Caucasian
    • Lack of antioxidants
  50. Hearing Loss:
    • Conductive loss involves middle & external ear due to mechanical cause
    • Cerumen impaction
    • Unable to hear “muffled” tones, all freq.
    • Rinne test bone>air conduction
    • Weber test lateralizes sound to deaf ear
    • Hearing aid helpful

    • Sensorineural loss due to structural changes to inner ear or auditory nerve
    • Presbycusis/hearing loss high pitched tones
    • Difficulty filtering out background noise
    • Rinne test air>bone conduction but < 2:1
    • Weber test lateralizes sound to unaffected ear
    • Hearing aid doesn’t help as increase background

    • Prevention:
    • -environmental noise control < 85 decibels
    • -care and cleaning of ear canals
    • -dont place objects in ears
    • -use plugs during swimming or diving
    • -avoid exposure to loud noise
    • -monitor or SE of ototoxic medicaitons
    • -hearing evaluation
  51. AGING EYE:
    Presbyopia
    • Graying of eyebrows & lashes with coarser hair
    • Decrease elasticity of eyelid muscles with crow’s feet & pseudoptosis
    • -Ectropion = lower lid droops away from globe
    • -Entropion = lower lid turns inward
    • Decrease corneal sensitivity/reflex
    • Decrease pupil size & reactivity so less light
    • Decrease tearing so dry eyes
    • Presbyopia = loss of lens elasticity & near vision
    • Decrease color perception esp. blue, violet &green
    • Decrease depth perception leading to falls
    • Senile enophthalmos/recessed eyeballs

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