-
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)
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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
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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
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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
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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
-
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)
-
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
-
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
-
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
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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 -
-
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
-
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)
-
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
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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
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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
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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
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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)
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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
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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
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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
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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
-
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.
-
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
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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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
-
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
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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
-
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
-
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
-
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
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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
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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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
Signs & Symptoms AMD
- Loss of central vision
- Blurred vision
- Visual distortion/wavy lines
- Risk Factors –? Age > 65
- Smoking 2X
- Race: Caucasian
- Lack of antioxidants
-
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
-
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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