CARE OF THE CLIENTS

WITH
EYE AND EAR
DISORDER
Review of Systems
EYES
Eyes
Supplies about 70% of all sensory
information of the brain.
Composed of:
External structures:
Eyelid
conjunctiva (a thin, transparent mucous
membrane that lines the lid)
lacrimal apparatus (which lubricates and
protects the cornea and conjunctiva by
producing absorbing tears)
extraocular muscles (which hold the eyes to
parallel to create binocular vision)
Eyeball

Internal structures.
Iris - gives color to the eye and
divides the space between the cornea
and lens into anterior and posterior
chambers.
Cornea - works with the sclera to give
the eye its shape
Pupil - the circular aperture in the iris
that changes size as the iris adapts to
amount of light entering the eye
Lens a biconvex, avascular,
colorless and transparent structure
Vitreous bodya clear, transparent,
avascular, gelatinous fluid that fills
the space in the posterior portion of
the eye
Retinaa thin semitransparent
layer of nerve tissue that lines
the eye wall
Retinal cones color
discoloration
Retinal rods peripheral vision
Optic nerve - transmit visual
impulses from the retina to the
brain
Disorders of Conjunctiva/Cornea
Conjunctivitis
Caused by viral, bacterial infections
Assessment: redness, swelling, lacrimation, pain,
itching, discharge from eyes
Corneal Ulceration
May result to corneal perforation, blindness
Causes: trauma, exposure, allergy, Vit def, infection
Corneal Transplantation
Donor of cornea from cadavers
Cornea removed from body 2-4 hrs of death, 12
hrs if body is refrigerated, 48 hrs if cornea
is kept on sterile container

Retinal Disorders
Retinal Detachment
Separation of two layers of the retina
Causes
Trauma
Sudden, severe exertion in debilitated clients
Tumor
Exudates
Aphakia (absence of lens)
Assessment
floaters, flashes of lights
constriction of vision in one area
Vitreous cloudy in fundoscopy
Collaborative Management
Keep client quiet in bed with eyes covered
Head positioned so that retinal hole is in the lowest part of the eye
Early surgery; scleral buckling
Preop care: mydriatics as ordered
Postop care
Position depends on extent and location of retinal detachment
Area affected should be in superior portion
Ambulation and activity to be prescribed by the surgeon
Pressure patch over the eye
Rest the eye and head immediate post op
Avoid increase in ICP
Hemorrhage is a common complication of the surgery
Sedentary activities in 3 wks, strenous activity in 2 months
Glaucoma
Types:
Acute (Narrow Angle Glaucoma/Close Angle)
Chronic (Wide Angle Glaucoma/Open Angle)

Causes:
Infection
Injury
Hereditary
Narrowing of Canal of Schlemm

Assessment
Chronic Glaucoma
Impaired peripheral vision (Tunnel Vision)
Insidous onset no discomfort
Frequent bumps
Initially affects one eye
Dull eye pain in AM, persistent
Poor discrimination of color, blurred vision
Rainbows or halos in VF
Headache, pain behind eyeballs, nausea & vomiting
Assessment
Acute Glaucoma
Rapid onset of severe eye pain
Blurred vision, rainbows or halos around lights
Headache, nausea & vomiting
Inflamed eyes, fixed dilated pupils
Visual impairment
Collaborative Management
Promote bedrest
Administered miotics as ordered
Administer acetazolamide, glycerol as ordered
Avoid mydriatics ( Atropine)
Assess visual impairment & IOP (>20 mmHg)
Administer antiemetics and analgesics as ordered
Provide emotional support
Prepare for surgery as ordered
Cataract
Clouding/blurring of lens leading to eventual loss of sight
Causes: old age, congenital, trauma
Classification:
Senile: associated with aging
Traumatic: associated with injury
Congenital: occurs at birth
Secondary: associated with a systemic disease
Collaborative Management
SURGERY
ECCE: Extracapsular Cataract Extraction
ICCE: Intracapsular Cataract Extraction
Cryoextraction
Iridectomy

Preop Care
General Care for Eye Surgeries
If both eyes are to be covered postop, client needs to be
oriented to the staff and the physical environment
prior to procedure
Child client should be practiced to have eyes covered to
decrease anxiety and restlessness postop
If both eyes will be covered or vision is severely
impaired, place call light within reach of client
Preparation of the eyes prior to surgery may involve
instillation of eye medications.

Postop Care
Eye/s is/are covered with eyepads and eyeshields
OOB 1 day after surgery
Daily change of dressing is done, removed on the 7-10
th
day
Eyeshields at night for 1 month post op
Administer eyedrops as ordered
Temporary glasses may be prescribed for 1-4
th
week,
permanent glasses in 6-12
th
week when healing is
complete
Intraocular lens implant may be installed at time of
surgery (better binocular vision)
Review of Systems
EARS

Diagnostic Tests for Auditory Acuity
Tuning Fork Test
Rhinnes
Weber
Whisper Voice Test
Audiometry
Pure Tone
Speech
Tympanogram/Impedance Audiometry
Oculovestibular Test/Caloric Ice Water Test
Symptoms of Ear Diseases
Deafness: conductive, sensorineural, mixed
Pain (otalgia)
Discharge
Vertigo
Tinnitus
Assessment of Client with Hearing Loss
Irritable, hostile, hypersensitive in interpersonal relations
Has difficulty in following directions
Complains about people mumbling
Turns up volume of TV
Ask for frequent repetition
Answers questions inappropriately
Leans forward to hear better
Has abnormal articulation
Has unusually soft or loud voice
Experience social isolation
Guidelines in Communicating
Talk directly to the person facing him/her
Speak clearly using normal tone of voice
Do not whisper to someone when in front of hearing impaired
Use gestures with speech
Do not avoid conversation with a person who has hearing loss
Do not show annoyance by careless facial expression
Move closer to the person toward the better ear
Do not smile, chew gum or cover mouth when talking
Encourage use of hearing aid when available
Menieres Disease(Endolymphatic Hydrops)
Characterize by accumulation of endolymph in the
inner ear
It is chronic, with remissions and exacerbations
Causes
Virus
Emotional Stress
Idiopathic
Assessment
Vertigo
Tinnitus
Hearing loss
Collaborative Management

Bed rest
Low Na diet
Limit fluids
Avoid reading in times of vertigo
Avoid alcohol, caffeine, tobacco
Stress therapy
Tranquilizers, vagal blockers, antihistamines,, vasodilators,
diuretics
Different Types of Ear Surgeries
Myringoplasty: closure of perforated TM
Tympanoplasty: closure of TM if middle ear is involved
Myringotomy: simple incision in the TM
Ossiculoplasty: ossicular reconstruction
Stapedectomy: removal of stapes and replacement of
prosthesis
Stapedotomy: laser creating hole in footplate of stapes and
prosthesis replacement
Labyrinthectomy: removal of the membranous labyrinth
Post op Care in Ear Surgery
Lie on unoperated side
Blow nose gently one side at a time
Sneeze or cough with mouth open for 1 week post op
Avoid physical activity for one week, exercise or sports for 3 weeks
Keep dry for 6 weeks post op
Do not shampoo hair for 1 week
Protect ear with 2 pieces of cotton, outer piece saturated with
petrolatum
Avoid plane travel for 1 week, equalize pressure
Report any unusual drainage other than slight bleeding
Avoid straining of eyes for 1 week
Seek assistance when ambulating for the 1
st
time