Professional Documents
Culture Documents
PATIENTS WITH
AUSIO VISUAL
DISTURBANCES
External Structures of the Eye
VISION
EYELIDS (PALPEBRAL) & EYELASHES
• Protect the eye from foreign particles
CONJUNCTIVA
PALPEBRAL CONJUNCTIVA
• Pink; lines inner surface of eyelids
BULBAR CONJUNCTIVA
• White with small blood vessels, covers
anterior sclera
A. CHOROID
- a dark brown membrane located between the
sclera & the retina
- it lines most of the sclera & is attached to the
retina but can easily detach from the sclera
- contains blood vessels that nourishes the retina
- located posteriorly
VISION
B. MIDDLE LAYER
B. CILIARY BODY
- connects the choroid with the iris
- secretes aqueous humor that helps
give the eye its shape
C. IRIS
- the colored portion of the eye
- located in front of the lens
- it has a central opening called the pupil
VISION
INTERNAL STRUCTURES OF THE EYE
C. INNER LAYER (RETINA)
- a thin, delicate structure in which the fibers of the optic nerve
are distributed
- bordered externally by the choroid & sclera and internally by the
vitreous
- contains blood vessels & photoreceptors (cones & rods)
- light sensitive layer
CONTAINS THE FOLLOWING STRUCTURES
1. CONES
- Specialized for fine discrimination, central vision & color
vision
- Functions at bright levels of illumination
2. RODS
- More sensitive to light than cones
- Aid in peripheral vision
- Functions at reduced levels of illumination
VISION
INTERNAL STRUCTURES OF THE EYE
2. FLUIDS OF THE EYE
A. AQUEOUS HUMOR
- Clear, watery fluid that fills the anterior &
posterior chambers of the eye
- produced by the ciliary processes, & the fluid
drains in the Canal of Sclemm
- The anterior chamber lies between the cornea &
iris
- the posterior chamber lies between the iris & lens
- serves as refracting medium & provides nutrients
to lens & cornea
- contributes to maintenance of IOP
VISION
INTERNAL STRUCTURES OF THE EYE
2. FLUIDS OF THE EYE
B. VITREOUS HUMOR
- Clear, gelatinous/jell-like material that fill the posterior cavity of
the eye
- Maintains the form & shape of the eye
- Provides additional physical support to the eye
- It is produced by the vitreous body
3. VITREOUS BODY
- contains a gelatinous substance that occupies the
vitreous chamber which is the space between the lens & retina
- transmits light & gives shape to the posterior eye
VISION
INTERNAL STRUCTURES OF THE EYE
4. OPTIC DISK
- a creamy pink to white depressed area in the retina
- the optic nerve enters & exits the eyeball in this area
- Referred to as the “BLIND SPOT”
5. MACULA LUTEA
- Small, oval, yellowish pink area located lateral
& temporal to the optic disk
- the central depressed part of the macula is the “FOVEA
CENTRALIS” which is an area where acute vision occurs
VISION
INTERNAL STRUCTURES OF THE EYE
6. CANAL OF SCHLEMM
- a passageway that extends completely around the eye
- permits fluid to drain out of the eye into the systemic circulation
so that a constant IOP is maintained
7. LENS
- A transparent circular structure behind the iris & in front of the
vitreous body
- Bends rays of light so that the light falls on the retina
8. PUPILS
- Control the amount of light that enters the eye & reaches the
retina
- Darkness produces dilation while light produces constriction
VISION
INTERNAL STRUCTURES OF THE EYE
9. EYE MUSCLES
- Muscles do not work independently but work in
conjunction with the muscle that produces the
opposite movement
A. RECTUS MUSCLES
- Exert their pull when the eye turns temporally
B. OBLIQUE MUSCLES
- Exert their pull when the eye turns nasally
VISION
INTERNAL STRUCTURES OF THE EYE
10. NERVES
A. CRANIAL NERVE II
- Optic nerve (nerve of sight)
C. CRANIAL NERVE IV
- Trochlear
D. CRANIAL NERVE VI
- Abducens
VISION
INTERNAL STRUCTURES OF THE EYE
11. BLOOD VESSELS
A. OPTHALMIC ARTERY
- Major artery supplying the structures in the eye
B. OPTHALMIC VEINS
- Venous drainage occurs through vision
ABBREVIATION
– L Eye OS
– R Eye OD
– Both Eyes OU
– REM
– Rapid eye movement
– EOM
– Extra ocular muscles
– PERRLA
ASSESSMENT OF VISION
VISUAL ACUITY TEST
- measures the client’s distance & near vision
1. SNELLEN CHART
- simple tool to record visual acuity
Normal: 20/20
• Numerator
→Distance from chart
• Denominator
→ Distance at which a
normal eye
can read
2. CONFRONTATIONAL TEST
- Performed to examine visual fields or peripheral vision
3. EOM FUNCTION
- tests muscle function of the eyes
- tests 6 cardinal positions of gaze
1. Client’s right (lateral position)
2. Upward & right (temporal position)
3. Down & right
4. Client’s left (lateral position)
5. Upward & left (temporal position)
6. Down & left
-
ASSESSMENT OF VISION
COLOR VISION TEST
- Tests for color vision which involve picking nos. or letters out of a
complex & colorful picture
• Color vision
• Colored numbers
within a circle of
colored dots
• Nursing care:
– Read the numbers
– Each eye tested
• PUPILS
• - Normal:
Normal round & of equal size
• - Increasing light causes pupillary constriction
• Decreasing light causes pupillary dilation
• - the client is asked to look straight ahead while the examiner
quickly
• brings a beam of light ( penlight) in from the side & directs it
onto the side
• - Constriction of the eye is a direct response to the light
shining into the eye;
• constriction of the opposite eye is known as CONSENSUAL
RESPONSE
DIAGNOSTIC TESTS FOR THE EYE
FLUORESCEIN ANGIOGRAPHY
- detailed imaging & recording of ocular circulation by
a series of photographs after administration of the dye
COMPUTED TOMOGRAPHY
- a beam of x-ray scans the skull & orbits of the eye
- a cross-sectional image is formed by the use of a computer
- contrast material is not usually administered
SLIT LAMP
- allows examination of the anterior ocular structures under
microscopic magnification
- the client leans on a chin rest to stabilize the head while a
narrow beam of light is aimed so that it illuminates only
a narrow segment of the eye.
DIAGNOSTIC TESTS FOR THE EYE
CORNEAL STAINING
- installation of a topical dye into the conjunctival sac to outline
the irregularities of the corneal surface that are not easily visible
- the eye is viewed through a blue filter, and a bright green color
indicates areas of non-intact corneal epithelium
TONOMETRY
- the test is primarily used to assess for an increase in
IOP and potential glaucoma
TONOMETER APPARATUSES
OPHTHALMOSCOPY
• An ophthalmoscope is an
instrument used to
examine the retina and
vitreous. Ophthalmoscopy
requires dilating the pupils
with drops to give the
doctor the best view inside
the eye.
• Internal and external eye
structures
REVIEW FOR 10 MINUTES AND WE
WILL HAVEA QUIZ!!!
DISORDERS
OF THE EYE
Risk factors of eye
disorders
AGING PROCESS
CONGENITAL
DIABETES
MELLITUS
HEREDITARY
MEDICATIONS
TRAUMA
LEGALLY BLIND
- a person is legally blind if the best visual acuity with corrective
lenses in the better eye is 20/200 or less or a visual field of 20
degrees or less in the better eye
NURSING CARE
• When speaking to a client who has limited sight or blind, the nurse
uses a normal tone of voice
• Alert the client when approaching
• Orient the client to the environment
• Use a focal point & provide further orientation to the environment
from the focal point
• Allow the client to touch objects in the room
• Use the clock placement of foods on the meal tray to orient the
client
• Promote independence as much as possible
LEGALLY BLIND
NURSING CARE
• Provide radios, TVs, & clocks that give the time orally or provide a
Braille watch.
• When ambulating, allow the client to grasp the nurse’s arm at the
elbow
- the nurse keeps his or her arm close to the body so that the client
can detect the direction of movement
• Instruct the client to remain one step behind the nurse when
ambulating
• Instruct the client in the use of the cane used for the blind client,
which is differentiated from other canes by its straight shape & white
color with red tip
• Instruct the client that the cane is held in the dominant hand several
inches off the floor
• Instruct the client that the cane sweeps the ground where the client’s
foot will be placed next to determine the presence of obstacles
CATARACTS
- an opacity of the lens that distorts the image projected onto the
retina & that can progress to blindness
- Intervention is indicated when visual acuity has been reduced to
a level that the client finds to be unacceptable or adversely
affecting lifestyle
CAUSES
Aging process (Senile cataracts)
Inherited (Congenital cataracts)
Injury (Traumatic cataracts)
Can occur as a result of another eye disease (Secondary cataracts)
CATARACTS
ASSESSMENT
Opaque or cloudy white pupil
Gradual loss of vision
Blurred vision
Decreased color perception
Vision that is better in dim light with pupil dilation
Photophobia
Absence of red reflex
CATARACTS
MEDICAL MANAGEMENT
- surgical removal of the lens, one eye at a time
- a lens implantation may be performed at the time of
surgical procedure
• EXTRACAPSULAR EXTRACTION
- the lens is lifted out without removing the lens capsule
- may be performed with Phacoemulsion
PHACOEMULSION
- the lens is broken up by ultrasonic vibrations & extracted
• INTRACAPSULAR EXTRACTION
- the lens is removed within its capsule through a small
incision
• PARTIAL IRIDECTOMY
- may be performed with lens extraction to prevent acute
secondary glaucoma
CATARACTS
PRE-OP NURSING CARE
• Instruct measures to prevent or decrease IOP
• Administer pre-op eye medications including mydriatics &
cycloplegics as prescribed
TYPES
PARTIAL RETINAL DETACHMENT
- becomes complete if left untreated
ASSESSMENT
Amblyopia if not treated early
Permanent loss of vision if not treated early
Loss of binocular vision
Impairment of depth perception
Frequent headaches
Squints or tilts head to see
STRABISMUS
NURSING CARE
• Corrective lenses as indicated
• Instruct the parents regarding patching (occlusion therapy) of the “good” eye
- to strengthen the weak eye
• Prepare for botulinum toxin (Botox) injection into the eye muscle
- produces temporary paralysis
- allows muscles opposite the paralyzed muscle to strengthen the eye
• Inform the parents that the injection of botulinum toxin wears off in about 2
months & if successful, correction will occur
• Prepare for surgery to realign the weak muscles as Rx if nonsurgical
interventions are unsuccessful
• Instruct the need for follow-up visits
CONJUNCTIVITIS
- also known as “PINK EYE”
- inflammation of the conjunctiva
- usually caused by allergy, infection, or trauma
TYPES
BACTERIAL OR VIRAL CONJUNCTIVITIS
- extremely contagious
CHLAMYDIAL CONJUNCTIVITIS
- is rare in older children & if diagnosed in a child who is not sexually
active, the child should be assessed for possible sexual abuse
ASSESSMENT
Itching, burning or scratchy eyelids
Redness
Edema
Discharge
CONJUNCTIVITIS
NURSING CARE
• Instruct in infection control measures such as good handwashing & not
sharing towels & washcloths
• Administer antibiotic or antiviral eye drops or ointment as Rx if infection is
present
• Administer antihistamines as Rx if an allergy is present
• Instruct the parents that the child should be kept home from school or day
care until antibiotic eye drops have been administered for 24 hrs
• Instruct in the use of cool compresses to lessen irritation & in wearing dark
glasses for photophobia
• Instruct the child to avoid rubbing the eye to prevent injury
• D/C use of contact lenses & to obtain new lenses to eliminate the chance of
re-infection
• Instruct the adolescent that eye make-up should be discarded & replaced
HYPHEM
A
- the presence of blood in the anterior chamber
- occurs as a result of injury
- condition usually resolves in 5-7 days
NURSING CARE
• Encourage rest in semi-Fowler’s position
• Avoid sudden eye movements for 3-5 days to decrease bleeding
• Administer cycloplegic eye drops as prescribed
- to place the eye at rest
• Instruct in the use of eye shields or eye patches as prescribed
• Instruct the client to restrict reading & watching TV
CONTUSIONS
CONTUSIONS
- bleeding into the soft tissue as a result of an injury
- causes a black eye & the discoloration disappears in
approximately 10 days
- pain, photophobia, edema & diplopia may occur
NURSING CARE
• Place ice on the eye immediately
• Instruct the client to receive an eye examination
FOREIGN
BODIES
- an object such as dust that enters the eye
NURSING CARE
• Have the client look upward, expose the lower lid, wet a cotton-
tipped applicator with sterile NSS & gently twist the swab over
the particle & remove it
• If the particle cannot be seen, have the client look downward,
place a cotton applicator horizontally on the outer surface of
the upper eye lid, grasp the lashes, & pull the upper lid outward
& over the cotton applicator, if the particle is seen, gently twist
over it to remove
PENETRATING OBJECTS
- an injury that occurs to the eye in which an object
penetrates the eye
NURSING CARE
• Never remove the object because it may be holding ocular
structures in place, the object must be removed by MD
• Cover the object with a cup
• Don’t allow the client to bend
• Don’t place pressure on the eye
• Client is to be seen by MD stat
CHEMICAL BURNS
- an eye injury in which a caustic substance enters the eye
NURSING CARE
• Treatment should begin stat
• Flush the eyes at the site of injury with water for at least 15-20 mins
• At the site of injury, obtain a small sample of the chemical involved
• At the ER, the eyes is irrigated with NSS or an opthalmic irrigation
solution
• The solution is directed across the cornea & toward the lateral
canthus
• Prepare for visual acuity assessment
• Apply an antibiotic ointment as prescribed
• Cover the eye with a patch as prescribed
ENUCLEATION
- removal of the entire eyeball
EXENTERATION
- removal of the eyeball & surrounding tissues
• Performed for the removal of ocular tumors
• After the eye is removed, a ball implant is inserted to provide a firm
base for socket prosthesis & to facilitate the best cosmetic result
• A prosthesis is fitted approximately 1 month after surgery
PRE-OP NURSING CARE
• Provide emotional support to the client
• Encourage the client to verbalize feelings related to loss
EXTERNAL EAR
- Embedded in the temporal bone bilaterally at the level of
the eyes
- Extends from the auricle through the external canal to the
tympanic membrane or eardrum
- Includes the mastoid process, a bony ridge located over the
temporal bone
HEARING
EXTERNAL EAR
A. AURICLE (PINNA)
- Outer projection of ear composed of cartilage & covered
by skin
- collects sound waves
B. EXTERNAL AUDITORY CANAL
- Lined with skin
- Glands secrete cerumen (wax)
- provides protection
- transmits sound waves to tympanic membrane
C. TYMPANIC MEMBRANE (EARDRUM)
- Located at the end of the external canal
- Vibrates in response to sound & transmit vibrations to
middle ear
HEARING
MIDDLE EAR
- Consists of the medial side of the tympanic membrane
- The tympanic membrane is a thick transparent sheet of
tissue that provides a barrier between the external ear &
the middle ear
- The middle ear is protected from the inner ear by the round
& the oval window membranes
- The eustachian tube opens into the middle ear & allows for
equalization of pressure on both sides of the tympanic
membrane
HEARING
MIDDLE EAR
A. OSSICLES
- Contains 3 small bones: Malleus (Hammer) attached to
tympanic membrane
Incus (Anvil)
Stapes (Stirrup)
- Ossicles are set in motion by sound waves from
to the footplate of the stapes in the oval window
OVAL WINDOW:
WINDOW an opening bet. the middle & inner ear
B. EUSTACHIAN TUBE
- Connects nasopharynx & middle ear
- Equalizes pressure on both sides of eardrum
HEARING
INNER EAR
- Contains the semi-circular canals, the cochlea & the distal
end of the 8th cranial nerve
- Maintains sense of balance & equilibrium
A. SEMI-CIRCULAR CANALS
- Contains fluid & hair cells connected to sensory nerve
fibers of the vestibular portion of 8th cranial nerve
B. COCHLEA
- Spiral-shaped organ of hearing
- Connects organ of Corti, receptor and organ for hearing
- Transmits sound waves from the oval window & initiates
nerve impulses carried by cranial nerve VIII (acoustic
branch) to the brain ( temporal lobe of cerebrum)
HEARING
INNER EAR
C. 8th CRANIAL NERVE
1. COCHLEAR BRANCH
- transmits neuro-impulses from the cochlea to the brain
where it is interpreted as sound
2. VESTIBULAR BRANCH
- maintains balance & equilibrium
HEARING & EQUILIBRIUM
• The external ear conducts sound waves to the middle
ear
• The middle ear also called the tympanic cavity conducts
sound waves to the inner ear
• The middle ear is filled with air which is kept at atmospheric
pressure by the opening of the eustachian tube
• The inner ear contains sensory receptors for sound & for
equilibrium
• The receptors in the inner ear transmit sound waves &
changes in body position to the nerve impulses
ASSESSMENT OF THE EAR
OTOSCOPIC EXAM
GUIDELINES
- the speculum is never blindly introduced into the external canal
because of the risk of perforating the tympanic membrane
- tilt the head slightly away & hold the otoscope upside down as if
it were a large pen
- this permits the examiner’s hand to lie against the head for
support
- pull the pinna up & back to straighten the external canal in an
adult
- visualize the external canal while slowly inserting the speculum
ASSESSMENT OF THE EAR
OTOSCOPIC EXAM
NORMAL FINDINGS OF THE EXTERNAL CANAL
Pink & intact without lesions
Has various amounts of cerumen & fine little hairs
WATCH TEST
• A ticking watch is used to test the high-frequency sounds
• The examiner holds a ticking watch about 5 inches from each
ear & asks the client if the ticking is heard
ASSESSMENT OF THE EAR
TUNING FORK TESTS
A. WEBER TUNING FORK TEST
• Normal result: hearing the sound equally in both ears
FINDINGS
• If the client hears the sound louder in 1 ear,
- (+) LATERALIZATION is present
- applied to the side where the sound is heard the loudest
INTERPRETATION
• The finding may indicate the client has CONDUCTIVE
HEARING LOSS in the ear to which the ear is lateralized
• The finding may indicate that there is a SENSORINEURAL
HEARING LOSS in the opposite ear
ASSESSMENT OF THE EAR
TUNING FORK TESTS
B. RINNE TUNING FORK TEST
• Compares the client’s hearing by air conduction & bone conduction
• AIR CONDUCTION is 2-3X longer than BONE CONDUCTION
FINDINGS
• The client with vestibular function problem lacks a normal sense
of position sense and is unable to return to the extended fingers
to the point of reference, the fingers instead either goes to the
right or left of the reference point
VESTIBULAR ASSESSMENT OF
THE EAR
GAZE NYSTAGMUS EVALUATION
• Examine the client’s eyes as they look straight ahead, 30
degrees to each side, upward & downward
FINDINGS
• Any spontaneous nystagmus is a (+) result
- ABNORMAL FINDING
- a constant involuntary cyclic movement of the eyeball in any
direction represents a problem with the vestibular system
VESTIBULAR ASSESSMENT
OF THE EAR
HAPLIKE MANEUVER
• Assesses for positional vertigo or induced dizziness
• The client assumes a supine position
• The head is rotated to one side for 1 minute
FINDINGS
• (+) test result is presence of nystagmus after 5-10 sec
- ABNORMAL FINDING
- a constant involuntary cyclic movement of the eyeball in any
direction represents a problem with the vestibular system
DIAGNOSTIC TESTS FOR THE
EAR
TOMOGRAPHY
- may be performed with or without contract medium
- assesses the mastoid, middle ear & inner ear structures
- multiple x-rays of the head are done
NURSING CARE
• All jewelry are removed
• Lead eye shields are used to cover the cornea to diminish the radiation dose
to the eyes
• The client must remain still in a supine position
• No follow-up care is required
DIAGNOSTIC TESTS FOR THE
EAR
AUDIOMETRY
- measures hearing acuity
- uses 2 types: PURE TONE AUDIOMETRY & SPEECH AUDIOMETRY
- after testing, audiogram patterns are depicted on a graph to determine
the type & level of hearing loss
PURE TONE AUDIOMETRY
- used to identify problems with hearing, speech, music & other sounds in
the environment
SPEECH AUDIOMETRY
- the client’s ability to hear spoken words is measured
NURSING CARE
• Inform the client regarding the procedure
• Instruct the client to identify the sounds as they are heard
DIAGNOSTIC TESTS FOR THE
EAR
ELECTRONYSTAGMOGRAPHY
- a vestibular test that evaluates spontaneous &
induced eye movements known as nystagmus
- used to distinguish between normal nystagmus &
either medication-induced nystagmus or nystagmus
caused by a lesion in the central or peripheral
vestibular pathway
- records changing electrical fields with movement of
the eye, as monitored by electrodes placed on the
skin around the eye
DIAGNOSTIC TESTS FOR THE
EAR
NURSING CARE
• NPO for 3 hrs before testing
• Unnecessary medications are omitted for 24 hours
• Instruct client that this is a long & tiring procedure
• Client should bring prescription eyeglasses to the exam
• The client is instructed to gaze at lights, focus on a moving pattern, focus on
a moving point, & sit with the eyes closed
• While sitting in a chair, the client may be rotated to provide info about
vestibular function
• Client’s ears are irrigated with cool & warm water which cause N & V
• After the procedure, the client begins taking clear fluids slowly & cautiously
because N & V may occur
• Assistance may be necessary following the procedure
DIAGNOSTIC TESTS FOR THE
EAR
CALORIC TEST (BI-THERMAL TEST)
- performed to evaluate the client experiencing dizziness
- Nystagmus, nausea, vomiting or ataxia
- may indicate a pathological condition of the labyrinth system,
whereas a decreased response may indicate that the vestibular
system is affected
NURSING CARE
• Warm water causes a greater response than cold water
• Warm water caloric testing (irrigation) precedes cool water caloric testing
(irrigation)
• The character & duration of the eye movements are measured
• The client must assume a supine position with eyes closed & head elevated
to 30 degrees
• After the procedure, the client begins taking clear fluids slowly & cautiously
because N & V may occur
• Assistance with ambulation may also be necessary following the procedure
DISORDERS
OF THE EAR
Risk factors of ear
disorders
AGING PROCESS
INFECTION
MEDICATIONS
OTOTOXICITY
TRAUMA
TUMORS
CONDUCTIVE
HEARING LOSS
- occurs when sound waves are blocked to the inner ear fibers
because of external ear or middle ear disorders
- disorders can often be corrected with no damage to hearing, or
minimal permanent hearing loss
CAUSES
Any inflammatory process or obstruction of the external or middle
ear
Tumors
Otosclerosis
A build-up of scar tissue on the ossicles from previous middle ear
surgery
SENSORINEURAL HEARING
LOSS
- a pathological process of the inner ear or of sensory fibers that
lead to the cerebral cortex
- is often permanent, & measures must be taken to reduce further
damage or to attempt to amplify sound as a means of improving
hearing to some degree
CAUSES
Damage to the inner ear structures
Damage to the cranial nerve VIII
Prolonged exposure to loud noise
Medications, trauma, infections, surgery
Inherited disorders
Metabolic & circulatory disorders
Meniere’s syndrome
Diabetes mellitus
Myxedema
MIXED HEARING LOSS
- also known as conductive-sensorineural hearing loss
- client has both sensorineural & conductive hearing loss
ASSESSMENT
Hearing loss is gradual & bilateral
Client states that he/she has no problem with hearing but can’t
understand what the words are
Client thinks that the speaker is mumbling
EXTERNAL OTITIS
- infective inflammatory or allergic responses involving the
structure of the external auditory canal or the auricles
- an irritating or infective agent comes into contact with
epithelial layer of the external ear
- this leads to either an allergic response or S/S of infection
- the skin becomes red, swollen, & tender to touch on
movement
- the excessive swelling of the canal lead to conductive
hearing loss
- due to obstruction
- more common in children & termed as “SWIMMER’S EAR”
- occurs more often in hot, humid environments
- prevention includes the elimination of irritating or infecting agents
EXTERNAL OTITIS
ASSESSMENT
Pain
Itching
Plugged feeling in the ear
Redness & edema
Exudate
Hearing loss
EXTERNAL OTITIS
NURSING CARE
• Apply heat locally for 20 minutes 3x a day
• Encourage rest to assist in reducing pain
• Administer analgesics such as aspirin or acetaminophen (Tylenol) for
the pain as prescribed
• Instruct the client that the ears should be kept clean & dry
• Instruct the client to use earplugs for swimming
• Instruct the client that cotton-tipped applicators should not be used to
dry ear because their use can lead to trauma to the canal
• Instruct the client that irritating agents such as hair products or
headphones should be discontinued
OTITIS MEDIA
- infection of the middle ear occurring as a result of a blocked
eustachian tube, which prevents normal drainage
- a common complication of an acute respiratory infection
- infants & children are more prone
- their eustachian tubes are shorter, wider & straighter
ASSESSMENT
Fever
Irritability, restlessness & loss of appetite
Rolling of head from side to side
Pulling on or rubbing the ear
Earache or pain
Signs of hearing loss
Purulent ear drainage
Red, opaque, bulging or retracting tympanic membrane
OTITIS MEDIA
NURSING CARE
• Encourage oral fluids
• Teach the parents to feed infants in an upright position
• Instruct the child to avoid chewing during the acute period
- chewing increases the pain
• Provide local heat & have the child lie with affected ear down
• Instruct the parents in the appropriate procedure to clean drainage from the
ear with sterile cotton swabs
• Instruct in the administer of analgesics or antipyretics such as
Acetaminophen (Tylenol) to decrease fever & pain
• Instruct the parents in the administration of prescribed antibiotics,
emphasizing that the 10-14 day period is necessary to eradicate positive
organisms
• Instruct the parents that screening for hearing loss may be necessary
• If ear drops are prescribed, instruct the parents that the auditory canal is
straightened by pulling the pinna down & back in children younger than
3 yrs. & by pulling the pinna up & back for a child older than 3 yrs.
MYRINGOTOM
Y
- insertion of tympanoplasty tubes in the middle ear to
equalize pressure & keep the ears dry
TYMPANOPLASTY
- a reconstruction of the middle ear may be attempted to improve
conductive hearing loss
chronic OTITIS
MEDIA
PRE-OP NURSING CARE
• Administer antibiotic eye drops as Rx
• Clear the ear of debris as Rx & irrigate ear with a solution of
equal parts of vinegar & sterile water as Rx
- to restore normal pH of the ear
• Instruct to avoid persons with URTI
• Instruct client to obtain adequate rest, eat a balanced diet &
drink adequate fluids
• Instruct in DBE & coughing but forceful coughing avoided.
- increases pressure in the middle ear esp. post-op
chronic OTITIS MEDIA
ASSESSMENT
Swelling behind the ear & pain with minimal movement of the head
Cellulitis on the skin or external scalp over the mastoid process
A reddened, dull, thick, immobile tympanic membrane with or without
perforation
Tender & enlarged post-auricular lymph nodes
Low-grade fever
Anorexia
MASTOIDITIS
PRE-OP NURSING CARE
• Prepare the client for surgical removal of the infected
material
• Monitor for complications
• SIMLPLE OR MODIFIED RADICAL MASTOIDECTOMY
WITH TYMPANOPLASTY is the common treatment
• Once tissue that is infected is removed, tympanoplasty is
performed to reconstruct the ossicles & the tympanic
membranes, in an attempt to restore normal hearing
MASTOIDITIS
COMPLICATIONS
Damage to the abducens & facial cranial nerves
Damage exhibited by inability to look laterally (cranial nerve
VI) & a drooping of the mouth on the affected side (cranial
nerve VII)
Meningitis
Chronic purulent otitis media
Wound infections
Vertigo, if the infection spreads into the labyrinth
MASTOIDITIS
POST-OP NURSING CARE
• Monitor for dizziness
• Monitor for signs of meningitis as evidenced by a stiff neck &
vomiting
• Prepare for wound dressing change 24 hrs post-op
• Monitor the surgical incision for edema, drainage, & redness
• Position the client flat with the operative side up
• Restrict the client to bed with bedside commode privileges
for 24 hrs as Rx
• Assist the client with getting out of bed
- to prevent falling or injuries from dizziness
• With reconstruction of the ossicles via a graft, precautions
are taken to prevent dislodging of the graft
OTOSCLEROSIS
- disease of the labyrinthine capsule of the middle ear that results in a
bony overgrowth of the tissue surrounding the ossicles
- causes the dev’t of irregular areas of new bone formation & causes
fixation of the bones
- stapes fixation leads to CONDUCTIVE HEARING LOSS
- if the disease involves the inner ear, SENSORINEURAL HEARING
LOSS is present
- it is not uncommon to have bilateral involvement, although hearing loss
may be worse in one ear
- cause is unknown, although has familial tendency
- nonsurgical intervention promotes the improvement of hearing through
amplification
- surgical intervention involves removal of the bony growth that is
causing the hearing loss
- a PARTIAL STAPEDECTOMY or COMPLETE STAPEDECTOMY
WITH PROSTHESIS (FENESTRATION) may be surgically performed
OTOSCLEROSIS
ASSESSMENT
Slowly progressing conductive hearing loss
Bilateral hearing loss
A ringing or roaring type of constant tinnitus
Loud sounds heard in the ear when chewing
Pinkish discoloration (SCHWARTZE’S SIGN) of the tympanic
membrane
- indicates vascular changes in the ear
(-) Rinne test
Weber test shows lateralization of the sound to the ear with
the most conductive hearing loss
FENESTRATION
- removal of the stapes with a small hole drilled in
the footplate & a prosthesis is connected
between the incus & footplate
- sounds cause the prosthesis to vibrate in the
same manner as the stapes
COMPLICATIONS
Complete hearing loss
Prolonged vertigo
Infection
Facial nerve damage
FENESTRATION
PRE-OP NURSING CARE
• Instruct the client in measures to prevent middle ear or
external ear infections
• Instruct the client to avoid excessive nose blowing
• Instruct not to clean the ear canal with cotton-tipped
applicators
• Instruct the client to remove the hearing aid 2 weeks before
surgery to ensure the integration of local tissue
FENESTRATION
POST-OP NURSING CARE
• Inform the client that hearing is initially worse after the surgical procedure & no
noticeable improvement in hearing may occur for as long as 6 weeks
- due to swelling
• Inform the client that the Gelfoam ear packing interferes with hearing but is
used to decrease bleeding
• Assist with ambulating during the first 1-2 days after surgery
• Provide side rails when the client is in bed
• Administer antibiotics & antivertiginous & pain meds as Rx
• Assess for facial nerve damage, weakness, changes in taste sensation,
vertigo, nausea & vomiting
• Instruct to move head slowly when changing positions
- to prevent vertigo
• Instruct to avoid showering & getting the head & wound wet
• Instruct to refrain from using small objects to clean the external ear canal
• Instruct to avoid rapid, extreme changes in pressure caused by quick head
movements, sneezing,nose blowing, straining & changes in altitude
• Instruct to avoid changes in the middle ear pressure
- it could dislodge the graft prosthesis
LABYRINTHITIS
- infection of the labyrinth that occurs as a
complication of acute or chronic otitis media
ASSESSMENT
Hearing loss that may be permanent on the
affected side
Tinnitus
Spontaneous nystagmus to the affected side
Vertigo
Nausea & vomiting
LABYRINTHITIS
PRE-OP NURSING CARE
• Monitor for signs of meningitis, the most common
complication
- evidenced by headache, stiff neck lethargy
• Administer systemic antibiotics as Rx
• Advise client to rest in bed in a darkened room
• Administer antiemetics & antivertiginous medications as Rx
• Instruct the client that the vertigo subsides as inflammation
resolves
• Instruct the client that balance problems that persist may
require gait training through physical therapy
MENIERE’S SYNDROME
- a syndrome also called ENDOLYMPHATIC
HYDROPS
- refers to dilation of the endolympathic system by either
overproduction or decreased reabsorption of endolymphatic
fluid
- characterized by tinnitus, unilateral sensorineural hearing loss,
& vertigo
- symptoms occur in attacks & last for several days, & the client
becomes totally incapacitated
- initial hearing loss is reversible, but as the frequency of attacks
continues, hearing loss becomes permanent
- repeated damage to the cochlea caused by increased fluid
pressure leads to the permanent hearing loss
MENIERE’S SYNDROME
CAUSES
Any factor that increases endolymphatic secretion in
the labyrinth
Viral & bacterial infections
Allergic reactions
Biochemical disturbances
Vascular disturbances producing changes in the
microcirculation in the labyrinth
MENIERE’S SYNDROME
ASSESSMENT
Feelings of fullness in the ear
Tinnitus, as a continuous low-pitched roar or humming sound
- is present most of the time but worsens just before &
during severe attacks
Hearing loss is worse during an attack
Vertigo
- periods of whirling which might cause the client to fall to the
ground
- sometimes so intense that even when lying down, the client
holds the bed or ground in an attempt to prevent the whirling
Nausea & vomiting
Nystagmus
Severe headaches
MENIERE’S SYNDROME
NON-SURGICAL MANAGEMENT
• Preventing injury during vertigo attacks
• Providing bed rest in a quiet environment
• Provide assistance with walking
• Instruct the client to move the head slowly
- to prevent worsening of vertigo
• Initiate Na & fluid restrictions as Rx
• Instruct to avoid smoking
• Administer Nicotinic acid (Niacin) as Rx
- promote vasodilating effect
• Administer antihistamines as Rx
- reduce the production of histamine & reduces inflammation
• Administer antiemetics as Rx
• Administer tranquilizers & sedatives as Rx
- to calm client & allow rest, control the vertigo, N&V
MENIERE’S SYNDROME
SURGICAL MANAGEMENT
- performed when medical therapy is ineffective & the
functional level of the client has decreased significantly
• ENDOLYMPHATIC DRAINAGE
& INSERTION OF THE SHUNT
- may be performed early in the course of the disease to assist
with the drainage of excess fluids
ASSESSMENT
Symptoms usually begin with tinnitus & progress to gradual
sensorineural hearing loss
As tumors enlarges, damage to adjacent cranial nerves occurs
TRAUMA
- the tympanic membrane has a limited stretching ability & gives
way under high pressure
- foreign objects placed in the external canal may exert pressure
on the tympanic membrane & cause perforation
- if the object continues thorough the canal, the bony structures
of stapes, incus & malleus may be damaged
- a blunt injury to the basal skull & ear can damage the middle
ear structures through fractures extending to the middle ear
- excessive blowing & rapid changes of pressure that occur with
non-pressurized air flights can increase pressure in the middle
ear
- depending on the damage to the ossicles, hearing loss may or
may not return
TRAUMA
NURSING CARE
• Tympanic perforations usually heal within 24 hours
• Surgical reconstruction of the ossicles & tympanic
membrane through tympanoplasty or myringotomy
may be performed to improve hearing
CERUMEN &
FOREIGN BODIES
CERUMEN/EAR WAX
- the most common cause of impacted canals
FOREIGN BODIES
- can include vegetables, beads, pencil erasers & insects
ASSESSMENT
Sensation of fullness in the ear with or without hearing loss
Pain, itching or bleeding
CERUMEN
NURSING CARE
• Removal of the wax by irrigation is a slow process
• Irrigation is C/I in clients with a hx of tympanic membrane
perforation
• To soften cerumen, add 3 gtts of glycerin to the ear @ hs
& 3 gtts of hydrogen peroxide BID
• After several days the ear is irrigated
• 50-70 ml of solution is the maximal amount a client can
tolerate during an irrigation sitting
FOREIGN
BODIES
NURSING CARE
• If the foreign matter is vegetable, irrigation is used with care
- the material expends with hydration
• Insects are killed before removal unless they can be coaxed
out by flashlight or a humming noise
• Mineral oil or alcohol is instilled to suffocate the insect which
is then removed with ear forceps
• Use small ear forceps to remove the object & avoid pushing
the object farther into the canal & damaging the tympanic
membrane
OPTHALMIC
AND
OTIC
MEDICATIONS
INSTALLATION OF EYE DROPS
EYE DROPS
• Wash hands
• Put on gloves
• Check the name, strength, & expiration date of the medication
• Instruct the client to tilt the head backward, open the eyes & look up
• Pull the lower lid down against the cheekbone
• Hold the bottle, gently rest the wrist of the hand on the client’s cheek
• Squeeze the bottle gently to allow the drop to fall into the conjunctival
sac
• Instruct the client to close the eyes gently & not to squeeze the eyes shut
• Wait 3-5 minutes before instilling another drop, if more than 1 is Rx
- to promote maximal absorption of the medication
• Don’t allow the medication bottle, dropper, or applicator to come in
contact with the eyeball
Installation of eye
medications
EYE OINTMENTS
• Hold the ointment tube near, but not touching, the eye or
eyelashes
• Squeeze a thin ribbon of ointment along the lining of the lower
conjunctival sac from the inner to the outer canthus
• Instruct the client to close the eyes gently
• Instruct the client that vision may be blurred by the ointment
MYDRIATICS,
MYDRIATICS, Cycloplegic
Cycloplegic &
&
anticholinergic
anticholinergic medications
medications
MYDRIATICS
- dilate the pupils (mydriasis)
CYCLOPLEGIA
- relax the ciliary muscles
ANTICHOLINERGICS
- block responses of the sphincter muscle in the ciliary body,
producing mydriasis
MYDRIATICS,
MYDRIATICS, Cycloplegic
Cycloplegic &
&
anticholinergic
anticholinergic medications
medications
- used pre-op or for eye examinations to produce mydriasis
- C/I in clients with glaucoma because of the risk of increased
IOP
- Mydriatics are C/I in cardiac dysrhythmias & cerebral
atherosclerosis & should be used with caution in the elderly
and in clients with prostatic hypertrophy, diabetes mellitus or
parkinsonism
MYDRIATICS
MYDRIATICS && Cycloplegic
Cycloplegic eye
eye
medications
medications
EXAMPLES
• Atropine sulfate (Isopto-Atropine, Ocu-Tropine, Atropair, Atropisol)
• Scopolamine hydrobromide (Isopto-Hyoscine)
• Cyclopentolate hydrochloride (Cyclogyl, AK-Pentolate, Pentolair)
• Homotropine hydrobromide (Isopto Homatrine, AK-Homatropine,
Spectro-Homatrine)
• Tropicamide (Mydriacyl, I-Picamide, Tropicacyl)
• Phenylephrine hydrochloride (AK-Dilate, Dilatair, Mydfrin, Ocu-Phrin)
MYDRIATICS,
MYDRIATICS, Cycloplegic
Cycloplegic &
&
anticholinergic
anticholinergic medications
medications
SIDE EFFECTS
Tachycardia
Photophobia
Conjunctivitis
Dermatitis
ATROPINE
ATROPINE
TOXICITY
TOXICITY
Dry mouth
Blurred vision
Photophobia
Tachycardia
Fever
Urinary retention
Constipation
Headache, brow pain
Confusion
Hallucinations, delirium
Coma
Worsening of narrow-angled glaucoma
SYSTEMIC
SYSTEMIC REACTIONS
REACTIONS
OF
OF ANTICHOLINERGICS
ANTICHOLINERGICS
Dry mouth & skin
Fever
Thirst
Confusion
Hyperactivity
ALPHA-ADRENERGIC BLOCKER
- example Dapiprazole hydrochoride (Rev-Eyes)
- used to counteract mydriasis
MYDRIATICS,
MYDRIATICS, Cycloplegic
Cycloplegic &
&
anticholinergic
anticholinergic medications
medications
NURSING CARE
• Monitor for allergic reactions
• Assess for risk of injury
• Assess for constipation & urinary retention
• Instruct the client that a burning sensation may occur on installation
• Instruct the client not to drive or operate machine for 24 hrs after
installation of the medication unless otherwise directed by the
physician
• Instruct the client to wear sunglasses until the effects of the
medication wear off
• Instruct to notify MD if blurring of vision, loss of sight, difficulty in
breathing, sweating or flushing occurs
• Instruct the client to report eye pain to the physician
ANTI-INFECTIVE
ANTI-INFECTIVE
EYE
EYE
MEDICATIONS
MEDICATIONS
- Kill or inhibit the growth of bacteria, fungi, & viruses
SIDE EFFECTS
Superinfection
Global irritation
NURSING CARE
• Assess for risk of injury
• Instruct the client in how to apply the eye medication
• Instruct the client to continue treatment as Rx
• Instruct the client to wash hands thoroughly & frequently
• Advise the client that if improvement does not occur, notify the MD
ANTI-INFECTIVE
ANTI-INFECTIVEEYE
EYE
MEDICATIONS
MEDICATIONS
ANTIBACTERIAL
• Chloramphenicol (Chloromycetin, Chloroptic)
• Ciprofloxacin hydrochloride (Cipro)
• Erythromycin (Ilotycin)
• Gentamicin sulfate (Garamycin, Genoptic)
• Norfloxacin (Chibroxin)
• Tobramycin (Nebcin, Tobrex)
• Silver nitrate 1%
ANTIFUNGAL
• Natamycin (Natacyn Opthalmic)
ANTIVIRAL
• Idoxuridine (Herplex-Liquifilm)
• Trifluridine (Viroptic)
• Vidarabine (Vira-A Opthalmic)
ANTI-INFLAMMATORY
ANTI-INFLAMMATORYEYE
EYE
MEDICATIONS
MEDICATIONS
- Control inflammation, thereby reducing vision loss & scarring
- Used for uveitis, allergic conditions, & inflammation of the conjunctiva,
cornea, & lids
SIDE EFFECTS
Cataracts
Increased IOP
Impaired healing
Masking S/S of infection
NURSING CARE
• Assess for risk of injury
• Instruct the client in how to apply the eye medication
• Instruct the client to continue treatment as Rx
• Instruct the client to wash hands thoroughly & frequently
• Advise the client that if improvement does not occur, notify the MD
• Note that dexamethasone (Maxidex) should not be used for eye abrasions
& wounds
ANTI-INFLAMMATORY
ANTI-INFLAMMATORY
EYE
EYE MEDICATIONS
MEDICATIONS
EXAMPLES
• Dexamethasone (Maxidex)
• Diclofenac (Voltaren)
• Flurbiprofen Na (Ocufen)
• Suprofen (Profenal)
• Ketorolac tromethamine (Acular)
• Prednisone acetate (Predforte, Econopred)
• Prednisolone Na phosphate (AK-Pred, Inflamase)
• Rimaxolone (Vexol)
TOPICAL
TOPICAL ANESTHETICS
ANESTHETICS
FOR
FOR THE
THE EYE
EYE
- Produce corneal anesthesia
- Used for anesthesia for eye examinations, for surgery, or to remove
foreign bodies from the eye
SIDE EFFECTS
Temporary stinging or burning of the eye
Temporary loss of corneal reflex
NURSING CARE
• Assess for risk of injury
• Note that the medications should not be given to the client for home use &
are not to be self-administered by the client
• Note that the blink reflex is temporarily lost & that the corneal epithelium
needs to be protected
• Provide an eye patch to protect the eye from injury until the corneal reflex
returns
TOPICAL
TOPICAL ANESTHETICS
ANESTHETICS
FOR
FOR THE
THE EYE
EYE
EXAMPLES
• Proparacaine HCl (Ophthaine, Opthenic)
• Tetracaine HCl (Pontocaine)
EYE
EYE LUBRICANTS
LUBRICANTS
- Replace tears or add moisture to the eyes
- Moisten contact lenses or an artificial eye
- Protect the eyes during surgery or diagnostic procedures
- Used for keratitis, during anesthesia or in a disorder that results in
unconsciousness or decreased blinking
SIDE EFFECTS
Burning in installation
Discomfort or pain in installation
NURSING CARE
• Inform the client that burning may occur on installation
• Be alert to allergic responses to the preservatives in the lubricants
EYE
EYE
LUBRICANTS
LUBRICANTS
EXAMPLES
• Hydroxypropyl methylcellulose (Lacril, Isopto Plain)
• Petroleum-based ointment (Artificial Tears, Liquifilm Tears)
MIOTICS
MIOTICS
- reduce IOP by constricting the pupil & contracting the ciliary muscle,
thereby increasing the blood flow to the retina & decreasing retinal
damage & loss of vision
- open the anterior chamber angle & increase the outflow of aqueous
humor
- used for chronic open-angle glaucoma or acute & chronic closed-angle
glaucoma
- used to achieve miosis during eye surgery
- C/I in clients with retinal detachment, adhesions between the iris &
lens, or inflammatory diseases
- used with caution in clients with asthma, hypertension, corneal
abrasion,hyperthyroidism, coronary vascular disease, urinary tract
obstruction, GI obstruction, ulcer disease, parkinsonism, or
bradycardia
MIOTICS
MIOTICS
MIOTIC CHOLINERGIC MEDS
- reduce IOP by mimicking the action of acetylcholine
MIOTIC ACETYLCHOLINE
INHIBITORS MEDS
- reduce IOP by inhibiting the action of cholinesterase
MIOTICS
MIOTICS
SIDE EFFECTS SYSTEMIC EFFECTS
Myopia Flushing
Diaphoresis
GI upset & diarrhea
Headache
Frequent urination
Eye pain Increased salivation
Decreased vision in poor light Muscle weakness
Local irritation Respiratory difficulty
TOXICITY
Vertigo & syncope
Bradycardia
Hypotension
Cardiac dysrhythmias
Tremors
Seizures
MIOTICS
MIOTICS
EXAMPLES
• Acethylcholine Cl (Miochol)
• Carbachol (Miostat)
• Pilocarpine HCl (Isopto Carpine, Pilocar)
• Pilocarpine nitrate (Pilofrin, Liquifilm, Pilagan)
• Echothiophate iodide (Phospholine iodide)
• Demecarium bromide (Humorsol)
• Isoflurophate (Floropryl)
MIOTICS
MIOTICS
NURSING CARE
• Assess V/S & risk of injury
• Assess the client for the degree of diminished vision
• Monitor S/E & toxic effects
• Monitor for postural hypotension & instruct the client to change positions
slowly
• Assess breath sounds for rales & rhonchi
- cholinergic meds cause bronchospasms & increased bronchial secretions
• Maintain oral hygiene
- due to increased salivation
• Have Atropine sulfate available as antidote for Pilocarpine
• Instruct the client regarding the correct administration of eye meds
• Instruct the client not to stop the meds suddenly
• Instruct to avoid activities such as driving while vision is impaired
• Instruct clients with glaucoma to read labels on OTC meds & to avoid
Atropine-like meds
- Atropine increase IOP
OCUSERT
OCUSERT
-
SYSTEM
SYSTEM
It’s a thin eye wafer (disk) impregnated with time-release Pilocarpine
- Devised to overcome the frequent application of Pilocarpine
- Placed in the upper or lower cul-de-sac of the eye
- Pilocarpine is released over 1 wk & disk is replaced every 7 days
- Drawbacks of its use include sudden leakage of Pilocarpine, migration
of the system over the cornea, & unnoticed loss of the system
NURSING CARE
• Assess the client’s ability to insert the medication disk
• Store the medication in the refrigerator
• Instruct the client to discard damage or contaminated disks
• Inform the client that temporary stinging is expected but to notify MD if
blurred vision or brow pain occurs
• Instruct the client to check for the presence of the disk in the conjunctival
sac daily qHS & upon arising
• Since vision may change in the first few hours after the eye system is
inserted, instruct the client to replace the disk at bedtime
BETA-ADRENERGIC
BLOCKING EYE
MEDICATIONS
- Reduce IOP by decreasing sympathetic impulses & decreasing
aqueous humor production without affecting accommodation or
pupil size
- Used to treat chronic open-angle glaucoma
- C/I in the client with asthma
- systemic absorption can cause increased airway resistance
- Used with caution in the client receiving oral beta-blockers
SIDE EFFECTS
Ocular irritation
Visual disturbances
Bradycardia
Hypotension
Bronchospasm
BETA-ADRENERGIC
BETA-ADRENERGIC
BLOCKING
BLOCKINGEYE
EYE
MEDICATIONS
MEDICATIONS
EXAMPLES
• Betaxolol HCl (Betoptic)
• Carteolol HCl (Ocupress)
• Levobunolol HCl (Betagan)
• Metipranolol (Optipranolol)
• Timolol maleate (Timoptic)
BETA-ADRENERGIC
BETA-ADRENERGIC
BLOCKING
BLOCKINGEYE
EYE
MEDICATIONS
MEDICATIONS
NURSING CARE
• Monitor V/S before administering medication esp. BP & PR
• If the pulse is below 60 or if systolic BP is below 90 mm Hg, withhold the
medication & contact MD
• Monitor for shortness of breath and I&O
• Assess for risk of injury
• Instruct the client to notify MD if shortness of breath occurs
• Instruct not to D/C medication abruptly
• Instruct to change positions slowly to avoid orthostatic hypotension
• Instruct to avoid hazardous activities
• Instruct to avoid OTC meds without the MD’s approval
ADRENERGIC
ADRENERGIC EYE
EYE
MEDICATIONS
MEDICATIONS
- Decrease the production of aqueous humor & lead to a decrease in
IOP
- Used to treat glaucoma
ADRENERGIC MEDICATIONS
• Apraclonidine HCl (Iopidine)
• Brimonidine tartrate (Alphagen)
• Dipivefrin HCl (Propine)
• Epinephrine borate (Epinal, Eppy)
• Epinephrine HCl (Epifrin, Glaucon)
CARBONIC
CARBONIC ANHYDRASE
ANHYDRASE
MEDICATIONS
MEDICATIONS
- Interfere with the production of carbonic acid which leads to
decreased aqueous humor formation & decreased IOP
- Used for long-term treatment of open-angle glaucoma
- C/I in the client allergic to sulfonamides
SIDE EFFECTS
Appetite loss
GI upset
Paresthesias in the fingers, toes & face
Polyuria
Hypokalemia
Renal calculi
Photosensitivity
Lethargy & drowsiness
Depression
CARBONIC
CARBONIC ANHYDRASE
ANHYDRASE
MEDICATIONS
MEDICATIONS
NURSING CARE
• Monitor V/S
• Assess visual acuity
• Assess for risk of injury
• Monitor I&O
• Monitor weight
• Maintain oral hygiene
• Monitor for side effects such as lethargy, anorexia, drowsiness, polyuria,
nausea, & vomiting
• Monitor electrolytes for hypokalemia
• Increase fluid intake unless C/I
• Advise the client to avoid prolonged exposure to sunlight
• Encourage the client to use artificial tears for dry eyes
• Instruct not to D/C the medication abruptly
• Instruct to avoid hazardous activities while vision is impaired
OSMOTIC
OSMOTIC MEDICATIONS
MEDICATIONS
- Lower IOP
- Used in emergency treatment of acute closed-angle glaucoma
- Used pre-op & post-op to decrease vitreous humor volume
SIDE EFFECTS
Heache
Nausea, vomiting, diarrhea
Disorientation
Electrolyte imbalance
NURSING CARE
• Assess V/S, visual acuity & risk for injury
• Monitor weight and I&O
• Monitor electrolytes
• Increase fluid intake unless C/I
• Monitor for changes in level of orientation
OSMOTIC
OSMOTIC EYE
EYE
MEDICATIONS
MEDICATIONS
EXAMPLES
• Glycerin (Glyrol, Osmoglyn)
• Mannitol (Osmitrol)
• Urea (Ureaphil)
Otic
Otic MEDICATION
MEDICATION
ADMINISTRATION
ADMINISTRATION
CHILD
• Pull the pinna down & back for infants & children younger than 3
years of age
• Pull the pinna up & back for children for children more than 3 years
Otic
Otic MEDICATION
MEDICATION
ADMINISTRATION
ADMINISTRATION
SIDE EFFECTS
Overgrowth of non-susceptible organisms
NURSING CARE
• Assess V/S
• Assess for allergies & pain
• Monitor for nephrotoxicity
• Instruct the client to report dizziness, fatigue, fever, or sore throat
- indicative of superimposed infection
• Instruct to complete the entire course of medication
• Instruct to keep the ear canals dry
ANTI-INFECTIVE
ANTI-INFECTIVE
MEDICATIONS
MEDICATIONS
EXAMPLES
• Amoxicillin (Amoxil)
• Ampicillin trihydrate (Polycillin)
• Cefaclor (Ceclor)
• Clindamycin HCl (Cleocin)
• Trimethoprim (TMP) & Sulfamethaxazole (SMZ)
- Bactrim, Cotrim, Septra
• Erythromycin (Ilotycin, E-Mycin)
• Penicillin V potassium (Pen V)
• Loracarbef (Lorabid)
• Clarithromycin (Biaxin)
• Polymyxin B sulfate (Aerosporin)
• Tetracycline HCl (Achromycin)
• Acetic acid and Aluminum acetate (Otic Domeboro)
ANTI-HISTAMINES
ANTI-HISTAMINES &
&
DECONGESTANTS
DECONGESTANTS
- Produce vasoconstriction
- Stimulate the receptors of the respiratory mucosa
- Reduce respiratory tissue hyperemia & edema to open obstructed
eustachian tubes
- Used for acute otitis media
SIDE EFFECTS
Drowsiness
Blurred vision
Dry mucous membranes
NURSING CARE
• Inform the client that drowsiness, blurred vision, & dry mouth may occur
• Instruct the client to increase fluid intake unless C/I & to suck on hard
candy to alleviate dry mouth
• Instruct the client to avoid hazardous activities if drowsiness occurs
ANTI-HISTAMINES
ANTI-HISTAMINES &
&
DECONGESTANTS
DECONGESTANTS
EXAMPLES
• Tripolidine & pseudoephedrine (Actifed)
• Naphazoline HCl (Allerest, Albalon)
• Chlorpheniramine (Chlor-Trimeton, Teldrin)
• Brompheniramine (Bromphen, Dimetane)
• Terfenadine (Seldane)
• Clemastine (Tavist)
• Cetirizine (Zyrtec)
• Astemizole (Hismanal)
LOCAL
LOCAL
ANESTHETICS
ANESTHETICS
- Block nerve conduction at or near the application site to control pain
- Used for pain associated with ear infections
SIDE EFFECTS
Allergic reaction
Irritation
NURSING CARE
• Monitor for effectiveness if used for pain relief
• Assess for irritation or allergic reaction
CERUMINOLYTIC
CERUMINOLYTIC
MEDICATIONS
MEDICATIONS
- Emulsify & loosen cerumen deposits
- Used to loosen & remove impacted ear wax from the ear canal
SIDE EFFECTS
Irritation
Redness or swelling of the ear canal
NURSING CARE
• Instruct the client not to use drops more often than prescribed
• Moisten a cotton plug with medication before insertion
• Keep the container tightly closed & away from moisture
• Avoid touching the ear with the dropper
• 30 minutes after installation, gently irrigate the ear as Rx with warm
water using a rubber bulb ear syringe
• Irrigation may be done with hydrogen peroxide sol’n as Rx
- to flush cerumen deposits out of the ear canal
• For chromic cerumen impaction, 1-2 gtts of mineral oil will soften the wax
• Instruct the client to notify MD if redness, pain or swelling persists
CERUMINOLYTIC
CERUMINOLYTIC
MEDICATIONS
MEDICATIONS
EXAMPLES
• Carbamide peroxide (Debrox)
• Boric acid (Ear-Dry)
• Trolamine polypeptide oleate-condensate
- Cerumenex