Nursing of Adults with Medical & Surgical Conditons

1. Nursing of AdultswithMedical & Surgical Conditons Eyes, Ears, and Special Senses

2. Layers of the Eyeball • Outer Layer • Sclera • Tough, white fibrous, protective layer • Anterior portion is the cornea • transparent • “Eye’s Window” • lies over the colored part (iris) of the eye • Remainder is white, and is commonly known as the “white of the eye”.

3. Layers of the Eyeball • Middle Layer • Choroid coat • Contains the blood vessels that supply the eye • Anterior portion has three separate structures • Iris • the colored part of the eye • shaped like a donut • attaches to the ciliary body • opening in the middle is called the pupil • Ciliary Body • muscular ring that alters the shape of the iris • Suspensory Ligament • structure that holds the lens in place

4. Layers of the Eyeball • Inner Layer • Retina • “The camera of the eye” • receives image formed by the lens • Only in the posterior portion of the eye • consists of specialized nerve tissue for the reception of light • Structure upon which light rays come to focus • Contains tiny receptors • rods - night vision • cones - day vision • Optic Nerve • conducts impulses from the receptors to the brain

5. Humors of the Eyeball • Aqueous Humor • Watery, transparent liquid that circulates through the anterior cavity of the eye. • Maintains intraocular pressure • Vitreous Humor • Clear, jelly-like fluid in the posterior cavity • Fills the vitreous body to give shape to the eye

6. Eye Muscles • Extrinsic Eye Muscles • Attach to the outside of the eyeball and to the bones of the orbit • Voluntary muscles • Move the eyeball in any desired direction • Four are straight muscles • superior rectus, inferior rectus, medial rectus, lateral rectus • Two are oblique muscles • superior oblique, inferior oblique

7. Eye Muscles • Intrinsic Eye Muscles • Located inside the eyeball • Two involuntary muscles • Iris • donut shaped sphincter muscle • regulates the size of the pupil; amount of light entering eye • Ciliary Body • flattened ring the size of the iris • alters the shape of the iris • changes the focus of the lens; adjusts the eye for distant and close-up vision

8. Accessory Structures of the Eye • Eyebrows and Eyelashes • Protect against foreign objects entering the eye • Eyelids • Located in front of the eyeball • Blink as a result of sensory stimuli • Consist of voluntary muscle and skin • Conjunctiva • mucous membrane lining eyelids • transparent and is continuous over the surface of the eye • Palpebral Fissure • Opening between the eyelids • Inner and Outer Canthus • angles at the ends of the eyelids

9. Accessory Structures of the Eye • Lacrimal Glands and Ducts • Secrete tears • keep anterior surface moist and free from irritating particles • Size of small almonds • Located in the upper, outer portion of each orbit • Nasolacrimal Ducts • small tubes extending from the lacrimal sacs into the nose to drain tears from the eye to the nose

10. Parts of the Ear • External Ear • Pinna (auricle) • The outer, extended portion • Composed of cartilage and covered with skin • External Auditory Canal • About 1 inch in length • Contains cerumenous glands • Tympanic Membrane (eardrum) • Stretches across the end of the auditory canal • Separates the external ear from the middle ear

11. Parts of the Ear • Middle Ear • Small air cavity located in the temporal bone • Contains three ossicles • Malleus (hammer) • attached to tympanic membrane • Incus (anvil) • attached to the head of the malleus • Stapes (stirrup) • fits in the oval window • Allows transmission of sound by the vibrations of the ossicles • Eustachian Tube • Connects the middle ear with the nasopharynx • Allows equalization of air pressure on both sides of the eardrum

12. Parts of the Ear • Internal Ear • Contains essential organs for hearing and equilibrium • Sends equilibrium and hearing sensations to the auditory nerve • Membranous Labyrinth • Lies within the bony labyrinth • Filled with fluid (endolymph) • Contains receptors for • equilibrium • sense of position • sense of head movement • hearing

13. Parts of the Ear • Bony Labyrinth • Cochlea • resembles the shape of a snail • filled with fluid (perilymph) • contains receptors for hearing • Organ of Corti • hearing sense organ • sends sensations to the cochlear nerve • Semi-circular Canals • Three canals placed at right angles to each other • Filled with fluid (endolymph) • Contain receptors for equilibrium • Movement of fluid stimulates the receptors; send the message to the brain • Vestibule • Between the cochlea and the semi-circular canals • Maintain a sense of “up and down”.

14. Conduction • Air Conduction • Occurs in the external ear • Sound waves come through the external auditory meatus and set the tympanic membrane in vibration • Bone Conduction • Occurs in the middle ear • The chain of ossicles transmits the vibration of the tympanic membrane to the inner ear • Fluid Conduction • Occurs in the inner ear • Vibration of the ossicles sets the fluid system into motion • Movement of fluid in the cochlea stimulates the Organ of Corti; to the auditory nerve; to the brain

15. Process of Hearing

16. Special Senses • Smell • Olfactory sense • Organ of Smell • Nose • Receptors for the olfactory nerve lie in the mucosa of the upper part of the nasal cavity • Adaptation to odors is very rapid • receptors become fatigued

17. Special Senses • Taste • Gustatory Sense • Organ of taste • Tongue • Receptors are the taste buds located in the papillae of the tongue • Four fundamental taste sensations • Salty - tip of the tongue • Sweet - tip of the tongue • Sour - sides of the tongue • Bitter - back of the tongue

18. Taste Receptors

19. Special Senses • Touch • Tactile receptors • Located throughout the integumentary system • Respond to touch, pressure, and vibration • Pain • Pain receptors • Located in the skin and viscera • Gives warning of potentially harmful environmental changes

20. Touch and Pain Receptors

21. Disorders of theEye

22. Diagnostic Tests • Snellen’s Test • Purpose • Assessment of visual aculity • Used as screening test • Procedure • Pt stands 20 ft from chart • Covers one eye • Reads above or below the 20/20 line

24. Snellen’s Test

25. Color Vision • Purpose • Assess ability to see color • Prerequisite for driver’s license • Procedure • Color dots are reflected on a background of mixed colors. • Pt identifies color patterns on the test field

26. Color Vision

27. Refraction • Purpose • Measure visual acuity to determine refractory errors such as: myopia, hyperopia, presbyopia, and astigmatism • Procedure • Ophthalmologist asks pt to indicate clear/blurred vision with each lens change in the retinoscope.

28. Ophtalmoscopy • Purpose • Evaluation of underlying structures of the eye • Routine screening • Procedure • Mydriatic drops are applied • Dilates pupils • Room is darkened • Pt is asked to focus on stationary object • Examiner uses ophthalmoscope to view internal eye structure

29. Ophthalmoscopy

30. Tonometry • Purpose • Measurement of intraocular pressure • Determine tumors and glaucoma • Procedure • Examiner places tonometer on cornea • Pressure readings are obtained • Normal intraocular pressure ranges from 10 to 22 mm Hg

31. Tonometer

32. Amster Grid Test • Purpose • Diagnose and monitor macular problems • Procedure • Patient fixates on center dot and records any abnormalities of the grid lines, such as wavy, missing, or distorted areas.

33. Amster Grid

34. Schimirmer Tear Test • Purpose • Measures tear volume produced throughout fixed time period • Procedure • One end of lacrimal filter paper is placed in lower cul-de-sac • Area of tear saturation is measured after 5 minutes

35. Blindness and Near Blindness • Etiology/Pathophysiology • Loss of visual acuity • Congenital or acquired • Legal blindness • 20/200 with corrective eyewear (normal 20/20) • visual field less than 20 degrees (normal 180)

36. Blindness and Near Blindness • Signs & Symptoms • Diplopia • double vision • Pain • Floaters and light flashes • Pruritus • Burning of the eyes • Loss of peripheral vision • Halos • Orbital pressure • Bulging of the eyes

37. Blindness and Near Blindness • Treatment • Corrective eyewear • Canes • Seeing eye dogs • Magnifying systems • Surgical procedures

38. Refractory Errors • Astigmatism • Strabismus • Myopia • Hyperopia

39. Refractory Errors • Etiology/Pathophysiology • Astigmatism -unequal curve in the shape of the cornea or lens

40. Refractory Errors • Strabismus -inability of the eyes to focus in one direction -cross-eyed

41. Refractory Errors • Myopia • Nearsightedness • Eyeball is too long

42. Refractory Errors • Hyperopia • Farsightedness • Eyeball is too short

43. Refractory Errors • Signs & Symptoms • Diminished or blurred vision • Treatment • Corrective lenses • Surgical correction

44. Conjunctivitis • Etiology/Pathophysiology • Inflammation of the conjunctiva • Bacterial or viral infection • Allergy • Environmental factors • Commonly called “pink eye”

45. Conjunctivitis • Signs & Symptoms • Erythema of the conjunctiva • Edema of the eyelid • Crusting discharge • Pruritus • Burning • Excessive tearing

46. Conjunctivitis • Treatment • Warm compresses • Eye irrigations with normal saline • Antibiotic drops or ointment • Keep free of exudate

47. Keratitis • Etiology/Pathophysiology • Inflammation of the cornea • Injury, irritants, allergies, viral infection, or diseases • Pneumoccoucs, staphylococcus, streptococcus and Pseudomonas are most common types of bacterial causes. • Herpes simplex is most common viral cause.

48. Keratitis • Signs & Symptoms • Severe eye pain • Photophobia • Tearing • Edema • Visual disturbances

49. Keratitis • Treatment • Topical antibiotic therapy • Systemic antibiotics • Analgesics • Pressure dressings • relax eye muscle and decrease discomfort • Warm or cold compresses • Epithelial debridement • Keratoplasty • corneal transplant

50. Cataracts • Etiology/Pathophysiology • Noninfectious opacity or clouding of the lens • Congenital • Acquired • Senile • associated with older adults • most common