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Strabismus

Assessment
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Visible deviation of the eye
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Diplopia
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Tilt head or squint eye

Diagnose
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Eyes do not function as unit
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Imbalance of extraocular muscles

Plan/implement
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Nonsurgical treatment begins no later than age 6
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Occlusion of unaffected eye
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Corrective lenses designed to strengthen weaker eye
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Surgery on rectus of eye
Detached retina

Assessment
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Flashes of light
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Blurry sooty vision, floaters
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Sensation of particles moving in line of vision
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Confusion, apprehension

Diagnose
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Trauma
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Aging
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Diabetes
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tumor

Plan/implement
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Bed rest- do not bend over, avoid excessive movement
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Patch affected or both eyes to decrease movement
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Positioning

Detachment should be in dependent position


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Surgery to attach retina to choriod; gas or air bubble used to apply pressure to
retina
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No hair washing for 1 wk
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Sedatives and tranquilizers
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Avoid strenuous activity for 3 months
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Surgery

Preop

Assess visual acuity

Prepare preorbital area

Orient to surroundings

Postop

Complications

Hemorrhage, sharp pain, infxn

Avoid sneezing, coughing, straining, bending

Meds

Eye shield

Cataracts

Assessment
o
Objects appear distorted/blurred, decreased color perception
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Glare/double vision

Diagnose
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Partial or total opacity
o
Cause

Congenital

Trauma

Aging

DM, intraocular surgery

Steroid therapy

Radioactivity

Plan/implement
o
Surgical management

Extracapsular extraction- cut through anterior capsule

Intracapsular extraction- removal of entire lens and capsule

Greater risk of retinal detachment

Lens implant

Complications

Hemorrhage indicated by sharp pain

Inc. ICP

Infxn- yellow/green drainage

pupils remain dilated without lens (aphakic), constricted with lens


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Avoid straining, bending
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Instill eye drops to affected eye
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Sleep on unaffected side
Glaucoma

Assessment
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Cloudy blurry vision, or vision loss
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Artificial lights have halos or rainbows around them
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Decreased peripheral vision
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Pain, headache
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Nausea, vomiting

Diagnosis
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Abnormal increase in intraocular pressure leading to visual disability and
blindness; obstruction of aqueous humor
o
Types

Closed-angle- sudden onset, emergency

Open-angle (primary)- blockage of aqueous humor flow


o
Causes

Angle-closure

Emotional disturbance

Allergies

Closed-angle

Trauma, tumor, hemorrhage, iritis, aging

Plan/implement
o
Medications

Prostaglandin agonist, adrenergic agonist, beta-adrenergic blockers,


cholinergic agonist, carbonic anhydrase inhibitors
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Laser surgery
o
Avoid tight clothing
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Avoid mydriatics (atropine)
o
Danger signs

Brow arching

Blurry vision

Diminshed peripheral vision

Eye pain/ headache

Hearing loss

Conductive loss
o
Assessment

Pain, fever, headache

Discharge

Altered growth and development

Personality change

Irritability, depression, suspiciousness, withdrawal


o
Analysis

Disorder of auditory canal, eardrums, or osicles

Caused by infxn, inflammation, foreign body, trauma, ear wax

Complications- meningitis resulting from initial infection

Diagnostics

Audiogram- quantitative (degree of loss)

Tuning fork- qualitative (type of loss)


o
Plan/implement

Heat

Antibiotics

Hearing aids

Ear irrigations

Contraindicated if there is evidence of swelling or tenderness

Ear drops

Surgery

Preop

Baseline hearing

Assessment of symptoms

Wash hair

Postop

Perceptive (sensorinueral)

Reinforce dressing, dont change


Avoid pressure
Complications
Facial nerve damage
Infxn
Vertigo, tinnitus