Care of the Clients With Alteration in Sensation

8/6/2019 Care of the Clients With Alteration in Sensation

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CARE OF THE CLIENTS WITHALTERATION IN SENSATION

PREPARED BY:JOMAR P. RONQUILLO, RN, MANc


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THE EYES: THE WINDOWS TO THE

SOUL


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NORMAL ANATOMY AND PHYSILOGY

OF THE EYES The Eyehas three layers:

Sclera

Choroid Retina


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THE SCLERA


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THE SCLERA


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THE CHOROID


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THE CHOROID

Associatedstructures:

Ciliary body

Iris


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CHOROID:

Ciliary Body


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CHOROID:

Ciliary Body


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CHOROID:

Ciliary Body


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CHOROID:

Iris


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CHOROID:

Iris


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THE RETINA


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THE RETINA


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THE RETINA

Associatedstructures:

Macula Lutea

Rodsand cones


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NORMAL ANATOMY AND

PHYSIOLOGY OF THE EYES Cavitiesoftheeye:

AnteriorCavity

Anterior chamber Aqueoushumor

posterior chamber

PosteriorCavity

Vitreoushumor


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OF THE EYES


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OF THE EYES


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OF THE EYES


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OF THE EYES THE LENS


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OF THE EYES THE EXTRINSIC EYE MUSCLES


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OF THE EYES THE INTRINSIC EYE MUSCLES


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OF THE EYES THE PALPEBRAE


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OF THE EYES THE LACRIMAL SYSTEM


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COMMON DISORDERS OF THE EYE


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GLAUCOMA

A groupofoculardisorders characterized by

optic nervedamage..

Thereisanincreasedintraocularpressure. Riskfactors:

Age

Family hx ofglaucoma

DM

CVD


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GLAUCOMA

Thereisimbalance betweenaqueoushumor

productionanddrainage


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GLAUCOMA

2 MAJOR TYPES:

Acute (Closed-Angle) Glaucoma

Chr0nic (Open-Angle) Glaucoma


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CLOSED-ANGLE GLAUCOMA


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CLOSED-ANGLE GLAUCOMA


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OPEN-ANGLE GLAUCOMA


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GLAUCOMA

Vision lossin Glaucomais IRREVERSIBLE.

Blockage to the circulationoftheaqueous

humormay besecondary to: Infection

Injury

Hereditary predisposition

Narrowing ofthe canal ofSchlemm


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GLAUCOMA


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GLAUCOMA

ASSESSMENT:


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CHRONIC GLAUCOMA

ASSESSMENT:

Patient bumpsintootherpersonsorfail to

seepassing vehicles Peripheral vision lossprogressing to legal

blindness

Persistent dull eyepainin themorning

Difficulty adjusting todim lights


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CHRONIC GLAUCOMA

ASSESSMENT:

Frequent changing ofglasses

Tearing

Blurredappearanceofiris

Haloaround lights


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ACUTE GLAUCOMA

ASSESSMENT:


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ACUTE GLAUCOMA

ASSESSMENT:


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ACUTE GLAUCOMA

ASSESSMENT:


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ACUTE GLAUCOMA

ASSESSMENT:


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ACUTE GLAUCOMA

ASSESSMENT:


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ACUTE GLAUCOMA

ASSESSMENT:

Inflamedeye


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ACUTE GLAUCOMA

ASSESSMENT:


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ACUTE GLAUCOMA

ASSESSMENT:

Visual impairment


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CHRONIC GLAUCOMA

COLLABORATIVE MANAGEMENT:

Miotics

Acetazolamide Fluidrestriction

Avoidstressandfatigue

Surgery


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CHRONIC GLAUCOMA


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CHRONIC GLAUCOMA


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CHRONIC GLAUCOMA


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CHRONIC GLAUCOMA


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ACUTE GLAUCOMA

COLLABORATIVE MANAGEMENT: Bedrest, elevateHOB

MonitorV/S

Miotic eyedrops Acetazolamide

Glycerol

Emotional support

Assist thepatient Avoid ABCs!

Antiemetics

Prepareforsurgery


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GLAUCOMA

DRUGS:

Cholinergics

Pilocarpine, Carbachol


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GLAUCOMA

Adrenergic Agonists

Dipivefrin, epinephrine

Beta-blockers Betaxolol, Timolol

Alpha-Adrenergic Agonists

Apraclonidine

Brimonidine

Carbonic-Anhydrase Inhibitors

Acetazolamide, Methazolamide, Dorzolamide


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GLAUCOMA

Prostaglandin Analogues

Latanoprost


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CATARACTS


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CATARACTS


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CATARACTS

Is the clouding oropacity ofthe lens thatleads to blurring ofvisionandeventual lossofsight.

Caused by degenerative changes

Most oftenoccursin theaged

Classifications:

Senile Traumatic

Congenital

Secondary


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CATARACTS

ASSESSMENT AND DIAGNOSTICFINDINGS:

Dimmer perceptionofthesurroundings

Light scattering Colorshifting


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CATARACTS


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CATARACTS


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CATARACTS

MEDICAL MANAGEMENT:

Is thereamedication that can cure cataracts?

Assistivedevices: Glasses

Contact lenses

Mydriatics


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CATARACTS

SURGICAL MANAGEMENT:


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CATARACTS


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CATARACTS


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CATARACTS

LENS REPLACEMENT:

Aphakia

3 Lensreplacement options:

Aphakik eyeglasses

Contact lenses

IOL implants Posteriorandanterior chamber IOL


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CATARACTS


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CATARACTS


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CATARACTS

PostoperativeCare:

Protect theeye

Eyepatch

Eye glasses

Metal shield

Teach thepatient signsofcomplications

Activity Daily changeofdressings

Safety!


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GENERAL PREOPERATIVE CARE

OF PATIENTS UNDERGOING

SURGERY


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PREOPERATIVE DRUGS

Isopto Atropine, Atropisol

Cyclomidril (Cyclopentolate, Phenylephrine)

Cyclogyl (Cyclopentolate HCL) Scopolamine

Mydriacyl (Cycloplegia)

Use with caution!


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POSTOPERATIVE CARE

What is theproperpositioning aftersurgery?

Is burning sensationnormal aftersurgery?

How is theoperatedeyeprotectedaftersurgery?

Are thereany activities contraindicated?

What are the warning signsofcomplications

to beawareof?

What medicationsareusually prescribed?


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REFRACTIVE ERRORS


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REFRACTIVE ERRORS

Inrefractiveerrors, visionisimpaired because

ofashortenedorelongatedeyeball

Can beeasily corrected Visual perceptionas todepthoftheeyeball:

Emmetropia

Myopia

Hyperopia

Astigmatism


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REFRACTIVE ERRORS


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REFRACTIVE ERRORS


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LOW VISION AND BLINDNESS

Low vision isa general termdescribing visual

impairment that requirespatient touse

devicesorstrategiesinaddition to corrective

glasses toperformvisual tasks.


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Low vision isdefined by a BCVA of20/70 to

20/200

Blindness isdefinedasa best BCVA of20/400tono light perception

Legalblindness isa conditionofimpaired

visionin whichanindividual hasa BCVA that

doesnot exceed20/200


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MEDICAL MANAGEMENT:

Useofoptical andnon-optical aids

MARCimplantation


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RETINAL DISORDERS


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RETINAL DETACHMENT

Retinal detachment refers to theseparation

ofthe RPE from thesensory layer.

Types: Rhegmatogenous

Traction

Combination

Exudative


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RETINAL DETACHMENT

CLINICAL MANIFESTATIONS:

Visual disturbances that arepainless

ASSESSMENT AND DIAGNOSTICFINDINGS: Dilatedfundus examinationusing anindirect

ophthalmoscopeanda Goldmann three-mirrorexamination


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RETINAL DETACHMENT


Scleral buckling

Injectionofgasorsiliconeoil

Laser therapy


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RETINAL DETACHMENT

NURSING MANAGEMENT:

Properpositioning aftersurgery

Bedrest andeyeprotection


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COMMONLY USED OCULAR

MEDICATIONS


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MEDICATIONS Topical anesthetics

Mydriatics and cycloplegics


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MEDICATIONS Topical anesthetics:

Proparacraine hcl (Ophthaine 0.5%)

Tetracaine hcl (Pontocaine 0.5%)


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MEDICATIONS Mydriatics and cycloplegics:

Phenylephrine

Atropine

Scopolamine Homatropine

Cyclopentolate

Tropicamide

OBSERVE PROPER ADMINISTRATION OFTOPICAL EYE MEDICATIONS


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DISORDERS OF THE EARS


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TYMPANIC MEMBRANE

PERFORATION Usually caused by infectionor trauma

Injury toinnerearstructuresmay alsoresult

Healsspontaneously


Tympanoplasty


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ACUTE OTITIS MEDIA

Anacuteinfectionfthemiddleear, usually

lasting than 6 weeks

Microorganismsenter themiddleearafter

eustachian tubedysfunction

Purulent exudate ispresent


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ACUTE OTITIS MEDIA

Usually unilateral

Pain

Eardrainage

Fever

Hearing loss

Erythematous tympanic membrane


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ACUTE OTITIS MEDIA

MEDICAL MANAGEMENT:

Antibiotic therapy

SURGICAL MANAGEMENT: Myringotomy


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CHRONIC OTITIS MEDIA

Is theresult ofrecurrent episodesofacute

otitis media causing irreverible pathology and

persistent perforationofthe tympanic

membrane


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May beminimal

Hearing loss

Otorrhea

Perforated tympanic membrane

Cholesteatoma


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MEDICAL MANAGEMENT:

Suctioning ofsecretions

Instillationofantibiotic drops


Tympanoplasty

Ossiculoplasty

Mastoidectomy


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MNIRES DISEASE

Anabnormal innerearfluid balance


Hearing loss

Tinnitus

Fullnessin theear

Vertigo with N/V


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MNIRES DISEASE

MEDICAL MANAGEMENT:

Diet andmedication therapy

Pharmacologic therapy:

Meclizine (Antivert)

Diazepam (Valium)

Promethazine (Phenergan)

Diuretics

MNIRES DISEASE


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MNIRES DISEASE


Endolymphatic sac decompression

Middleandinnerearinfusions

Vestibularnervesection

Documents

Care of the Clients With Alteration in Sensation