eyes & ears ppt
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Eyes & Ears Powerpoint presentationTRANSCRIPT
NEUROSENSORYNEUROSENSORYNEUROSENSORYNEUROSENSORY
SYSTEMSYSTEMSYSTEMSYSTEM
ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEYESEYES
ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEYESEYES
EXTERNAL STRUCTURESEXTERNAL STRUCTURES
• EYELIDSEYELIDS• CONJUNCTIVACONJUNCTIVA
– PALBEBRALPALBEBRAL– BULBARBULBAR
• LACRIMAL APPARATUSLACRIMAL APPARATUS– LACRIMAL GLAND, DUCTS & PASSAGESLACRIMAL GLAND, DUCTS & PASSAGES
• 6 EXTRAOCULAR MUSCLES6 EXTRAOCULAR MUSCLES• Levator palpebrae muscleLevator palpebrae muscle
EXTERNAL STRUCTURESEXTERNAL STRUCTURES
• EYELIDSEYELIDS• CONJUNCTIVACONJUNCTIVA
– PALBEBRALPALBEBRAL– BULBARBULBAR
• LACRIMAL APPARATUSLACRIMAL APPARATUS– LACRIMAL GLAND, DUCTS & PASSAGESLACRIMAL GLAND, DUCTS & PASSAGES
• 6 EXTRAOCULAR MUSCLES6 EXTRAOCULAR MUSCLES• Levator palpebrae muscleLevator palpebrae muscle
ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEYESEYES
• ORBITORBIT
• EYEBALL : 3 LAYERS: EYEBALL : 3 LAYERS: • OUTEROUTER
– SCLERASCLERA– CORNEACORNEA
• MIDDLE MIDDLE – CHOROIDCHOROID– CILIARY BODY CILIARY BODY – IRISIRIS
•INNERINNER–RODSRODS
–SENSITIVE TO LIGHTSENSITIVE TO LIGHT–PERIPHERAL VISIONPERIPHERAL VISION
–CONESCONES–FINE FINE DESCRIMINATIONDESCRIMINATION–COLOR VSIONCOLOR VSION
EYESEYES
ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEYESEYES
• LENS – FOCUS IMAGELENS – FOCUS IMAGE
• FLUIDS OF THE EYE:FLUIDS OF THE EYE:– AQUEOUS HUMORAQUEOUS HUMOR
• ANTERIOR & POSTERIOR CHAMBERSANTERIOR & POSTERIOR CHAMBERS• ANTERIOR EYE CAVITYANTERIOR EYE CAVITY• NUTRIENTS TO LENS & CORNEANUTRIENTS TO LENS & CORNEA• INTRAOCULAR PRESSURE MAINTENANCEINTRAOCULAR PRESSURE MAINTENANCE
– 20-25 mmHg20-25 mmHg
– VITREOUS HUMORVITREOUS HUMOR• POSTERIOR EYE CAVITYPOSTERIOR EYE CAVITY• TRANSPARENCY & FORM OF THE EYETRANSPARENCY & FORM OF THE EYE
EYESEYES
VISUAL PATHWAYSVISUAL PATHWAYSRETINARETINA
OPTIC NERVEOPTIC NERVE
OPTIC CHIASMOPTIC CHIASM
OPTIC TRACTOPTIC TRACT
OCCIPITAL LOBEOCCIPITAL LOBE
Physical Examination-EYEPhysical Examination-EYE
• VISUAL ACUITY : VISUAL ACUITY : SNELLEN’S CHARTSNELLEN’S CHART
• VISUAL FIELDS: VISUAL FIELDS: PERIMETRYPERIMETRY
• EXTERNAL STRUCTURESEXTERNAL STRUCTURES– POSITION & ALIGNMENT OF EYESPOSITION & ALIGNMENT OF EYES– PUPILS (PERRLA)PUPILS (PERRLA)
• EXTRAOCULAR MOVEMENTSEXTRAOCULAR MOVEMENTS– PARALYSISPARALYSIS– NYSTAGMUSNYSTAGMUS
• CORNEAL REFLEXCORNEAL REFLEX
Don’t look at me…
DIAGNOSTIC TESTSDIAGNOSTIC TESTS
• SNELLENSNELLEN• OPHTHALMOSCOPEOPHTHALMOSCOPE• BIOMICROSCOPE / SLITLAMPBIOMICROSCOPE / SLITLAMP
– EXAMINE THE ANTERIOR SEGMENT OF THE EYEEXAMINE THE ANTERIOR SEGMENT OF THE EYE
• TONOMETERTONOMETER– 14-20 mmHg14-20 mmHg
• BJERRUM’S TANGENT SCREENBJERRUM’S TANGENT SCREEN– CENTRAL FIELD OF VISIONCENTRAL FIELD OF VISION
• ISHIHARA COLOR PLATE TEST ISHIHARA COLOR PLATE TEST – IDENTIFY 3 PRIMARY COLORSIDENTIFY 3 PRIMARY COLORS
• GONIOSCOPYGONIOSCOPY– ANGLE OF ANTERIOR CHAMBERANGLE OF ANTERIOR CHAMBER
PLANNING FOR HEALTH PLANNING FOR HEALTH PROMOTIONPROMOTION
CARE OF THE EYESCARE OF THE EYES
• EYEDROPS, DISCOURAGEDEYEDROPS, DISCOURAGED• PRINTED MATTER: 14 INCHES AWAYPRINTED MATTER: 14 INCHES AWAY• TV: 10-12 FT AWAYTV: 10-12 FT AWAY• READ WITH ILLUMINATION: 100-150 WATTSREAD WITH ILLUMINATION: 100-150 WATTS• LIGHT FROM BEHINDLIGHT FROM BEHIND• TEACH ABOUT DANGER SIGNALS OF TEACH ABOUT DANGER SIGNALS OF
VISUAL DISORDERVISUAL DISORDER
•PERSISTENT REDNESSPERSISTENT REDNESS•CONTINUED DISCOMFORT & PAIN ESP CONTINUED DISCOMFORT & PAIN ESP
FOLLOWING INJURYFOLLOWING INJURY•CHILDREN: CROSSING OF EYESCHILDREN: CROSSING OF EYES•BLURRED VISION/ SPOTS BEFORE THE EYESBLURRED VISION/ SPOTS BEFORE THE EYES•GROWTH ON THE EYE/ OPACITIESGROWTH ON THE EYE/ OPACITIES•CONTINUAL DISCHARGE, CRUSTING ORCONTINUAL DISCHARGE, CRUSTING OR
TEARINGTEARING•PUPIL IRREGULARITIESPUPIL IRREGULARITIES
PLANNING FOR HEALTH PLANNING FOR HEALTH MAINTENANCE & RESTORATIONMAINTENANCE & RESTORATION• INSTILLATION OF EYEDROPSINSTILLATION OF EYEDROPS
– LOWER CUL-DE-SACLOWER CUL-DE-SAC– JUST CLOSE EYES, NOT SQUEEZEJUST CLOSE EYES, NOT SQUEEZE
• INSTILLATION OF EYE OINTMENTINSTILLATION OF EYE OINTMENT– FROM INNER CANTHUS, OUTWARDFROM INNER CANTHUS, OUTWARD
• HOT/ COLD COMPRESSHOT/ COLD COMPRESS• EYE IRRIGATIONSEYE IRRIGATIONS
– REMOVE CHEMICALS OR SECRETIONSREMOVE CHEMICALS OR SECRETIONS
• MASSAGE THE EYEBALLMASSAGE THE EYEBALL– IN GLAUCOMA ESP AFTER OPERATIONSIN GLAUCOMA ESP AFTER OPERATIONS
• CARE OF CONTACT LENSCARE OF CONTACT LENS– NOT TO WEAR WITH SWIMMINGNOT TO WEAR WITH SWIMMING
DISORDERS - EYEDISORDERS - EYE
• INJURIES & INJURIES & TRAUMATRAUMA
• INFECTIONSINFECTIONS
• CATARACTCATARACT
• GLAUCOMAGLAUCOMA
• DETACHMENT OF DETACHMENT OF THE RETINATHE RETINA
• REFRACTIVE REFRACTIVE ERRORSERRORS
INJURIES & TRAUMAINJURIES & TRAUMA
EMERGENCY:EMERGENCY:• TREAT THE PATIENT, LEAVE THE EYE ALONE, TREAT THE PATIENT, LEAVE THE EYE ALONE,
EXCEPT IN CHEMICAL INJURY EXCEPT IN CHEMICAL INJURY - FLUSH EYES STAT- FLUSH EYES STAT
• FOREIGN BODIES: FLUSH WITH WATER FOR 15 FOREIGN BODIES: FLUSH WITH WATER FOR 15 MIN WHILE GOING TO THE DOCTOR; DON’T MIN WHILE GOING TO THE DOCTOR; DON’T TOUCH CORNEATOUCH CORNEA
• MAY USE CARBONATED DRINKS IF WATER IS MAY USE CARBONATED DRINKS IF WATER IS NOT AVAILABLENOT AVAILABLE
INFECTIONSINFECTIONS
• HORDEOLUM/ STY -Zeis glandHORDEOLUM/ STY -Zeis gland in the follicle in the follicle
• CHALAZION –meibomian glandsCHALAZION –meibomian glands• CONJUNCTIVITIS – pink eyeCONJUNCTIVITIS – pink eye
– bacterial infection, allergy, traumabacterial infection, allergy, trauma
• UVEITIS - irisUVEITIS - iris• KERATITIS - corneaKERATITIS - cornea• PTERYGIUM – triangular foldPTERYGIUM – triangular fold
– From white of the eye to the corneaFrom white of the eye to the cornea
CATARACTCATARACT• Opacity of the lens & its capsule which interferes Opacity of the lens & its capsule which interferes
with transparencywith transparency
S/SX:S/SX:• Dimness in visual acuityDimness in visual acuity• Rapid & marked cxs of refraction errorRapid & marked cxs of refraction error
CLASSIFICATION:CLASSIFICATION:• Primary/ senilePrimary/ senile• Secondary/ traumaticSecondary/ traumatic
• CongenitalCongenital
TREATMENT:TREATMENT:•Intracapsular extraction – Intracapsular extraction – lens & capsulelens & capsule•Extracapsular extraction – Extracapsular extraction – lens onlylens only•Cryoextraction – Cryoextraction – probe cooled below 0 probe cooled below 0 ooCC•Phacoemulsification – Phacoemulsification – probe vibratesprobe vibrates•Enzymatic zonulysis – Enzymatic zonulysis – alphachemotrypsin: alphachemotrypsin: fibrinolytic & proteolytic, to anterior chamberfibrinolytic & proteolytic, to anterior chamberIntraocular lens – Intraocular lens – synthetic; distant visionsynthetic; distant vision
for aphasic patientfor aphasic patient
EYE SURGERYEYE SURGERY
NURSING CARE PRE-OPNURSING CARE PRE-OP
• Orient to new environmentOrient to new environment• Teach deep breathing & how to Teach deep breathing & how to
close eyes without squeezingclose eyes without squeezing• Eye antibiotics preopEye antibiotics preop• Mydiatrics if orderedMydiatrics if ordered
EYE SURGERYEYE SURGERY
NURSING CARE POST-OPNURSING CARE POST-OP
• Reorient patient to his Reorient patient to his surroundingssurroundings
• Prevent increase in IOP & stress on Prevent increase in IOP & stress on the suture linethe suture line
ACTIVITIES THAT INCREASE IOP:ACTIVITIES THAT INCREASE IOP:
•CoughingCoughing•Brushing Brushing •Shaving Shaving •Vomiting Vomiting •Bending Bending •Stooping Stooping
•Promote comfort of the patient: Promote comfort of the patient: mild analgesic to control painmild analgesic to control pain
EYE SURGERYEYE SURGERY
NURSING CARE POST-OPNURSING CARE POST-OP
• Observe & treat complicationsObserve & treat complicationsCOMPLICATIONS:COMPLICATIONS:•NAUSEA & VOMITINGNAUSEA & VOMITING
•AntiemeticsAntiemetics•Cold compressCold compress
•HEMORRHAGEHEMORRHAGE•Sudden pain of the eyeSudden pain of the eye
•PROLAPSE OF THE IRISPROLAPSE OF THE IRIS•Most common postop complicationMost common postop complication•Can precipitate glaucomaCan precipitate glaucoma
• Promote the rehab of the patientPromote the rehab of the patient•Encourage the patient to become Encourage the patient to become
independent- walk with him when he first independent- walk with him when he first become ambulatorybecome ambulatory•Health teachingsHealth teachings
EYE SURGERYEYE SURGERY
HEALTH TEACHINGS:HEALTH TEACHINGS:
• 1-4 wks : dark glasses; temporary corrective 1-4 wks : dark glasses; temporary corrective lenseslenses
• 6-8 wks: permanent lenses6-8 wks: permanent lenses• It will take time to learn distances & climb It will take time to learn distances & climb
stairsstairs• Color slightly changedColor slightly changed• Use one eye at a time unless with contact lensUse one eye at a time unless with contact lens• Decreased peripheral visionDecreased peripheral vision
GLAUCOMAGLAUCOMA• INCREASED IOPINCREASED IOP• PROGRESSIVE LOSS OF PERIPHERAL VISIONPROGRESSIVE LOSS OF PERIPHERAL VISION
CAUSE: CAUSE: OBSTRUCTION TO CIRCULATION OF AQUEOUS OBSTRUCTION TO CIRCULATION OF AQUEOUS HUMORHUMOR
TYPES:TYPES:1.1. CHRONIC/ SIMPLE/ OPEN-ANGLECHRONIC/ SIMPLE/ OPEN-ANGLE2.2. ACUTE ANGLE CLOSUREACUTE ANGLE CLOSURE3.3. CongenitalCongenital4.4. Secondary – trauma, uveitis, postopSecondary – trauma, uveitis, postop5.5. Absolute – uncontrolled- enucleationAbsolute – uncontrolled- enucleation
EYESEYES
CORNEACORNEA
IRISIRIS
CILIARY BODYCILIARY BODYANTERIORANTERIORCHAMBERCHAMBER
LENSLENS
CANAL OF SCHLEMMCANAL OF SCHLEMM
ZONULESZONULES
OPEN-ANGLE GLAUCOMAOPEN-ANGLE GLAUCOMA
EYESEYES
CORNEACORNEA
IRISIRIS
CILIARY BODYCILIARY BODYANTERIORANTERIORCHAMBERCHAMBER
LENSLENS
CANAL OF SCHLEMMCANAL OF SCHLEMM
ZONULESZONULES
ACUTE-ANGLE CLOSURE GLAUCOMAACUTE-ANGLE CLOSURE GLAUCOMA
OPEN ANGLE GLAUCOMAOPEN ANGLE GLAUCOMA
S/SX:S/SX:
• Loss of peripheral vision (tunnel)Loss of peripheral vision (tunnel)• Difficulty in adjusting to darknessDifficulty in adjusting to darkness• Failure to detect changes in colorFailure to detect changes in color• Headache, pain behind the eyeballHeadache, pain behind the eyeball• HalosHalos• Nausea & vomitingNausea & vomiting
OPEN ANGLE GLAUCOMAOPEN ANGLE GLAUCOMA
MANAGEMENT:MANAGEMENT:
Conservative :Conservative :• Miotics : pupillary constrictionMiotics : pupillary constriction
draw iris smooth muscle away draw iris smooth muscle away from the canalfrom the canal
Given early amGiven early am• Acetazolamide : decrease aqueous Acetazolamide : decrease aqueous
productionproduction• Fluid restrictionFluid restriction
Aggressive: Aggressive:
Principle: improve drainage of aqueousPrinciple: improve drainage of aqueous
•Iridocleisis-Iridocleisis-anterior chamber & subconjunctival spaceanterior chamber & subconjunctival space
•Corneoscleral trephening – Corneoscleral trephening – junction of cornea & sclerajunction of cornea & sclera
•Trabeculotomy Trabeculotomy •Laser therapy to meshworkLaser therapy to meshwork
Acute Angle GlaucomaAcute Angle Glaucoma
CAUSE:CAUSE:• Pupillary dilation by mydiatricsPupillary dilation by mydiatrics• Abnormal anterior displacement of irisAbnormal anterior displacement of iris
S/SX:S/SX:• Severe eye painSevere eye pain• Nausea & vomitingNausea & vomiting• Blurred visionBlurred vision• Colored halos around lightsColored halos around lights• Dilated pupilsDilated pupils• Increased IOPIncreased IOP
MANAGEMENT:MANAGEMENT:
•MioticsMiotics•DiamoxDiamox•Osmotic agents – glycerolOsmotic agents – glycerol•Surgery - iridectomySurgery - iridectomy
GLAUCOMAGLAUCOMA
NURSING CARE – SURGERYNURSING CARE – SURGERY
PRE-OPPRE-OP• Explain that vision lost cannot be restored, Explain that vision lost cannot be restored,
but further loss can be preventedbut further loss can be preventedPOST-OPPOST-OP• Flat 24H- prevent iris prolapseFlat 24H- prevent iris prolapse• Narotics or sedativesNarotics or sedatives• Liquid diet until 1Liquid diet until 1stst dressing dressing• Turn to unoperative siteTurn to unoperative site
LONG TERM CARE:LONG TERM CARE:
•No restriction on the use of the eyesNo restriction on the use of the eyes•No fluid restriction; exercise permittedNo fluid restriction; exercise permitted•Medical follow up needed for lifeMedical follow up needed for life
RETINARETINA CHOROIDCHOROID
SCLERASCLERA
OPTIC NERVEOPTIC NERVE
RETINAL DETACHMENTRETINAL DETACHMENT
RETINAL DETACHMENTRETINAL DETACHMENT
• Fluid accumulationFluid accumulation• TumorTumor
CAUSE:CAUSE:• Myopic Myopic
degenerationdegeneration• TraumaTrauma• Aphakia Aphakia
S/SX:S/SX:• Floating spots or Floating spots or
opacities before the opacities before the eyeeye
• Casts shadows on Casts shadows on the retinathe retina
• BrightFlashes of BrightFlashes of lightlight
• Progressive Progressive constriction of constriction of vision in 1 eyevision in 1 eye
MANAGEMENT:MANAGEMENT:
Conservative :Conservative :•Quiet in bed with eyes coveredQuiet in bed with eyes covered•Head: positioned so that retinal holes lowerHead: positioned so that retinal holes lower•Photocoagulation – Photocoagulation – small burn to retinasmall burn to retina•Cryotherapy – Cryotherapy – cold probe to freeze retinacold probe to freeze retina
Surgical: Surgical: •Scleral buckling- Scleral buckling- sealing break & reattachingsealing break & reattaching
retinaretina
RETINAL DETACHMENTRETINAL DETACHMENT
POST-OP NURSING CARE:POST-OP NURSING CARE:• Cover eyesCover eyes• Area of detachment, dependentArea of detachment, dependent• MydiatricsMydiatrics• Discharge instructions:Discharge instructions:
– No strenuous exercises & acivity x No strenuous exercises & acivity x 6mos6mos
– Contact sports restrictedContact sports restricted– No sudden jarring head motionNo sudden jarring head motion– No restriction with use of eyesNo restriction with use of eyes
REFRACTIVE ERRORSREFRACTIVE ERRORS
REFRACTION – bending of light raysREFRACTION – bending of light raysACCOMMODATION – ability to adjust from near to ACCOMMODATION – ability to adjust from near to
far visionfar visionADAPTATION – ability to see light from darknessADAPTATION – ability to see light from darkness
COMMON ERRORS:COMMON ERRORS:• MyopiaMyopia• HyperopiaHyperopia• PresbyopiaPresbyopia
•AstigmatismAstigmatism•Blindness Blindness
myopiamyopia
NEAR-SIGHTEDNEAR-SIGHTED
• Long A-P dimension of the eyeballLong A-P dimension of the eyeball• Light rays focus infront of the Light rays focus infront of the
retinaretina• Good vision for near distancesGood vision for near distances• Concave lensesConcave lenses
hyperopiahyperopia
FAR-SIGHTEDFAR-SIGHTED
• Eyeball A-P dimension too shortEyeball A-P dimension too short• Light rays focus behind the retinaLight rays focus behind the retina• Good vision for far distancesGood vision for far distances• Convex lensesConvex lenses
presbyopiapresbyopia
FARSIGHTEDNESS OF OLD AGEFARSIGHTEDNESS OF OLD AGE
• Gradual loss of accommodationGradual loss of accommodation• Loss of lens elasticityLoss of lens elasticity• Inability to rad without holding the Inability to rad without holding the
material more than 13 ft from the material more than 13 ft from the eyeeye
• Bifocal lensesBifocal lenses
ASTIGMATISMASTIGMATISM
• Asymmetry or irregular curvature Asymmetry or irregular curvature of the corneaof the cornea
• Cylindrical lensesCylindrical lenses
BLINDNESSBLINDNESS
• Vision: 20/200Vision: 20/200
• Severus, 42y.o, is receiving Severus, 42y.o, is receiving cryotherapy for repair of a cryotherapy for repair of a detached retina. When taking detached retina. When taking history from him, which symptom history from him, which symptom would the nurse expect him to would the nurse expect him to have?have?
a.a. DiplopiaDiplopiab.b. Severe eye painSevere eye painc.c. Sudden blindnessSudden blindnessd.d. Bright flashes of lightBright flashes of light
ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEARSEARS
EXTERNAL EAREXTERNAL EAR• AURICLEAURICLE• PINNAPINNA• TYMPANIC MEMBRANETYMPANIC MEMBRANE
MIDDLE EARMIDDLE EAR• OSSICLES: MALLEOUS, INCUS, STAPESOSSICLES: MALLEOUS, INCUS, STAPES• EUSTACHIAN TUBEEUSTACHIAN TUBE
EAREAR
ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEARSEARS
INNER EARINNER EAR• ORGAN OF CORTI ORGAN OF CORTI
– HEARINGHEARING
• VESTIBULAR APPARATUSVESTIBULAR APPARATUS– BALANCEBALANCE– 3 SEMICIRCULAR CANALS3 SEMICIRCULAR CANALS– UTRICLEUTRICLE
EAREAR
ANATOMY & PHYSIOLOGYANATOMY & PHYSIOLOGYEARSEARS
SOUND WAVES TO TYMPANIC MEMBRANESOUND WAVES TO TYMPANIC MEMBRANE
OSSICLES IN MOTIONOSSICLES IN MOTION
VIBRATION FROM STAPES TO OVAL WINDOWVIBRATION FROM STAPES TO OVAL WINDOW
COCHLEA : ORGAN OF CORTICOCHLEA : ORGAN OF CORTI
CRANIAL NERVE 8 TO TEMPORAL LOBECRANIAL NERVE 8 TO TEMPORAL LOBE
HEARINGHEARING
AUDITORY ASSESSMENTAUDITORY ASSESSMENT
EXTERNAL EAR EXAMINATIONEXTERNAL EAR EXAMINATION
• Inspection & palpation of auricleInspection & palpation of auricle• Visualization: straighten the auditory canal: Visualization: straighten the auditory canal:
– PULL AURICLE UP, & BACKPULL AURICLE UP, & BACK
• NORMAL EARDRUM: NORMAL EARDRUM: – slightly conicalslightly conical– ShinyShiny– pearly gray in colorpearly gray in color
AUDITORY ASSESSMENTAUDITORY ASSESSMENT
HEARING TEST:HEARING TEST:
Tests for acuteness of hearing or Tests for acuteness of hearing or degree of deafness:degree of deafness:
• Whisper or spoken voice testWhisper or spoken voice test• Audiometer :Audiometer :
– Pure tone – mx loudness in decibelPure tone – mx loudness in decibel– Speech – ability to understand & descriminateSpeech – ability to understand & descriminate
• Watch tick testWatch tick test• Tuning fork testTuning fork test
AUDITORY ASSESSMENTAUDITORY ASSESSMENT
HEARING TEST:HEARING TEST:
Test to localize cause of deafness:Test to localize cause of deafness:
• Schwabach’sSchwabach’s• Rinne’sRinne’s• Weber’sWeber’s
SCHWABACH’SSCHWABACH’S
•Bone conduction vs normal hearingBone conduction vs normal hearing•Tuning fork @ px’s mastoid until the patientTuning fork @ px’s mastoid until the patient
hears no sound.hears no sound.•TF transferred to examiner’s earTF transferred to examiner’s ear•N = no sound heardN = no sound heard•ABN = ABN = sensorineural hearing losssensorineural hearing loss
RINNE’S TESTRINNE’S TEST
•Sound heard better: air vs boneSound heard better: air vs bone
•N = positive; air conduction is betterN = positive; air conduction is better•ABN: negative: bone conduction betterABN: negative: bone conduction better
conductive hearing lossconductive hearing loss
WEBER’SWEBER’S
•TF top midline of the headTF top midline of the head•Sound heard: normal ear vs affected earSound heard: normal ear vs affected ear•Better in affected ear: Better in affected ear: conductiveconductive•Better in normal ear : Better in normal ear : sensorineuralsensorineural
AUDITORY ASSESSMENTAUDITORY ASSESSMENT
TEST FOR VESTIBULAR FUNCTONTEST FOR VESTIBULAR FUNCTON
• CALORIC TESTCALORIC TEST– Check direction of nystagmusCheck direction of nystagmus– COWS ( cold-opposite; warm-same side of COWS ( cold-opposite; warm-same side of
stimulated ear)stimulated ear)
• ROTATION (BARANY) TESTROTATION (BARANY) TEST– Rotating chairRotating chair– Nystagmus is opposite to the direction of Nystagmus is opposite to the direction of
rotationrotation
HEALTH PROMOTIONHEALTH PROMOTION
EAR PROTECTIONEAR PROTECTION
• Noise over 70 decibels is Noise over 70 decibels is potentially damaging to hearingpotentially damaging to hearing
• Most common & impt type of Most common & impt type of occupational hearing is caused by occupational hearing is caused by LOUD NOISELOUD NOISE
GENERAL EAR CAREGENERAL EAR CARE
• Ear is self-cleaningEar is self-cleaning• Cerumen-lubricant; traps dirtCerumen-lubricant; traps dirt• Keep eyes, mouth & both nostrils Keep eyes, mouth & both nostrils
while blowing the nosewhile blowing the nose• Cleanse the external ear reached Cleanse the external ear reached
by vision by vision
NURSING INTERVENTIONSNURSING INTERVENTIONS
EAR DROPSEAR DROPS• WarmWarm• After adm’n, head should remain tiltedAfter adm’n, head should remain tilted
SOFTENING & REMOVING IMPACTED SOFTENING & REMOVING IMPACTED CERUMENCERUMEN
• Few drops of hydrogen peroxide/ warm Few drops of hydrogen peroxide/ warm glycerineglycerine
• Irrigate the earIrrigate the ear
NURSING INTERVENTIONSNURSING INTERVENTIONS
EAR IRRIGATIONEAR IRRIGATION
• To clean the external canalTo clean the external canal• Remove impated cerumenRemove impated cerumen• Caloric testCaloric test• Apply antiseptic solutionsApply antiseptic solutions• Remove foreign bodiesRemove foreign bodies
COMMON EAR PROBLEMSCOMMON EAR PROBLEMS
1.1. OTOSCLEROSISOTOSCLEROSIS
2.2. MENIERE’S DSEMENIERE’S DSE
3.3. HEARING IMPAIRMENTHEARING IMPAIRMENT
OTOSCLEROSISOTOSCLEROSIS
• Normal bone is replaced by spongy Normal bone is replaced by spongy bonebone
• Ankylosis of the footplate of the Ankylosis of the footplate of the stapesstapes
• Impaired vibration systemImpaired vibration system
OTOSCLEROSISOTOSCLEROSIS
ASSESSMENTASSESSMENT
• Gradual hearing loss Gradual hearing loss • Difficulty hearing a whisperDifficulty hearing a whisper• Own voice is loudOwn voice is loud• Paracusis : hear better in loud Paracusis : hear better in loud
environmentenvironment• Rinne’s test: bone conduction betterRinne’s test: bone conduction better
OTOSCLEROSISOTOSCLEROSIS
PLANNING & IMPLEMENTATIONPLANNING & IMPLEMENTATION
• Hearing aidHearing aid• Surgery – primary form of txSurgery – primary form of tx
– StapedectomyStapedectomy– Stapes mobilization operationStapes mobilization operation– Fenestration operation : new window Fenestration operation : new window
is createdis created
EAR SURGERYEAR SURGERY
PRE-OP CARE;PRE-OP CARE;
• Hair shampooHair shampoo• Inform client:Inform client:
– Head still during surgeryHead still during surgery– Post op: get out of bed with assistancePost op: get out of bed with assistance
avoid nose blowing until 1 weekavoid nose blowing until 1 week
EAR SURGERYEAR SURGERY
POST OP POST OP
• Promote comfort & safetyPromote comfort & safety• Promote psychological well-beingPromote psychological well-being• Prevent complicationsPrevent complications
COMFORT & SAFETYCOMFORT & SAFETY
•24h bed rest24h bed rest•No TVNo TV•Pain relieverPain reliever•Gradual ambulation with assistanceGradual ambulation with assistance
PSYCHOLOGICAL WELL-BEINGPSYCHOLOGICAL WELL-BEING
•Reassurance about decreased hearing from Reassurance about decreased hearing from swelling & dressingswelling & dressing
•Slushing within the ear- report to physicianSlushing within the ear- report to physician
COMPLICATIONS;COMPLICATIONS;
•Facial nerve involvementFacial nerve involvement•Facial paralysis, facial weaknessFacial paralysis, facial weakness•Inability to show teeth, wrinkle forehead,Inability to show teeth, wrinkle forehead,
raise eyebrows or close eyesraise eyebrows or close eyes•Meningitis – bacterialMeningitis – bacterial
•Report signs & symptomsReport signs & symptoms•Bleeding Bleeding
EAR SURGERYEAR SURGERY
DISCHARGE PLANNINGDISCHARGE PLANNING
• Discharged with dressingDischarged with dressing• Sudden head movement, avoidedSudden head movement, avoided• No elevatorsNo elevators• No hair washing at least 2 weeksNo hair washing at least 2 weeks• Avoid people with URTIAvoid people with URTI
MENIERE’S DSEMENIERE’S DSE
• Chronic Chronic • Increase in endolymphatic pressureIncrease in endolymphatic pressure
ASSESSMENT:ASSESSMENT:• TinnitusTinnitus• Unilateral hearing lossUnilateral hearing loss• Vertigo Vertigo
MENIERE’S DSEMENIERE’S DSE
PLANNING & IMPLEMENTATIONPLANNING & IMPLEMENTATION
• CONSERVATIVE: palliativeCONSERVATIVE: palliative– Bed restBed rest– MedsMeds
• Sedative :PhenobarbitalSedative :Phenobarbital• Antihistamine Antihistamine • AntiemeticsAntiemetics
– Low salt dietLow salt diet
MENIERE’S DSEMENIERE’S DSE
PLANNING & IMPLEMENTATIONPLANNING & IMPLEMENTATION
• SURGERY- delayed until client’s SURGERY- delayed until client’s hearing below the serviceable levelhearing below the serviceable level– Destruction of the labyrinthDestruction of the labyrinth– Decompression of endolymphatic sacDecompression of endolymphatic sac– Sectioning of the vestibular nerveSectioning of the vestibular nerve– Cryosurgery of the labyrinthCryosurgery of the labyrinth
HEARING IMPAIRMENTHEARING IMPAIRMENT
TYPES OF HEARING LOSSTYPES OF HEARING LOSS
• CONDUCTIVE CONDUCTIVE – Damage to the conducting systemDamage to the conducting system– Hearing aid is usefulHearing aid is useful
• SENSORINEURALSENSORINEURAL– Damage to the:Damage to the:1.1. Organ of CortiOrgan of Corti2.2. Cochlear nerveCochlear nerve3.3. Acoustic branch of the auditory nerveAcoustic branch of the auditory nerve
COMMUNICATING WITH COMMUNICATING WITH HEARING-IMPAIRED CLIENTSHEARING-IMPAIRED CLIENTS
• Avoid use of gestures without speechAvoid use of gestures without speech• Do not shoutDo not shout• Speak distinctly & as close to the clientSpeak distinctly & as close to the client• Use short phrasesUse short phrases• Do not communicate with someone else Do not communicate with someone else
in front of a hearing-impaired clientin front of a hearing-impaired client• Hearing impairment goes with visual Hearing impairment goes with visual
problems in elderlyproblems in elderly
SOUND AMPLIFICATIONSOUND AMPLIFICATION
TYPES OF HEARING AIDS;TYPES OF HEARING AIDS;
• Post-auricularPost-auricular• Body-typeBody-type• In-the ear modelIn-the ear model
Select hearing aid that has cotrollable Select hearing aid that has cotrollable volume & is properly fittedvolume & is properly fitted
• Albus, 62 yo, has a Albus, 62 yo, has a stapedectomy. Which of the stapedectomy. Which of the following is the most important following is the most important for the nurse to include in the for the nurse to include in the post-op care plan?post-op care plan?
a.a. Checking the gag reflexChecking the gag reflex
b.b. Encouraging independenceEncouraging independence
c.c. Instruct not to blow noseInstruct not to blow nose
d.d. Position on the operative sidePosition on the operative side
““that’s that’s allallfolks”folks”
““that’s that’s allallfolks”folks”