Documentos de Académico
Documentos de Profesional
Documentos de Cultura
• The cornea, aqueous humor, lens, and vitreous must all remain clear for light to reach the
retina and stimulate the photoreceptor cells.
• Refraction is the ability of the eye to bend light rays so that they fall on the retina. When
light does not focus properly, it is called refractive error.
• Presbycusis can result from aging or insults from a variety of sources. Tinnitus, or ringing
in the ears, may accompany the hearing loss that results from the aging process.
• External and middle ear portions conduct and amplify sound waves from the environment.
Problems located in these areas cause conductive hearing loss with changes in sound
perception/sensitivity.
• The inner ear functions in hearing and balance. Problems located in this area or along the
nerve pathway from the brain cause sensorineural hearing loss with changes in tone
perception/sensitivity.
• Central auditory system problems cause central hearing loss with difficulty in understanding
the meaning of words.
• Visual assessment determines visual acuity, ability to judge closeness and distance,
extraocular muscle function, evaluating visual fields and pupil function, and measuring
intraocular pressure.
• Auditory assessment notes head posturing and appropriateness of responses when speaking
to the patient and balance. Problems with balance may present as nystagmus or vertigo.
• Visual and auditory external structures are assessed by inspection for symmetry and
deformity. Some eye structures must be visualized with an ophthalmoscope; an otoscope is
used for further assessment of certain ear structures.
• Visual assessment can include color vision and stereopsis with auditory assessment often
including whisper/spoken word testing, audiometry, and tuning fork tests.
REFRACTIVE ERRORS
• Refractive errors are the most common visual problems. They occur when light
rays do not converge into a single focus on the retina.
EXTRAOCULAR DISORDERS
• A hordeolum (sty) is an infection of sebaceous glands in the lid margin.
CATARACT
• A cataract is an opacity within the lens.
• Symptoms of cataracts are decreased vision, abnormal color perception, and glare.
• Removal of the cataract is the most common surgery for older adults. Most patients
undergoing cataract removal have an intraocular lens implanted during surgery.
• After cataract surgery, the eyes are temporarily covered with a patch and protective shield.
• Postoperative nursing goals include teaching about eye care, activity restrictions,
medications, follow-up visit schedule, and signs/symptoms of possible complications.
RETINOPATHY
• Retinopathy is microvascular damage to the retina that can lead to blurred and
progressive vision loss.
RETINAL DETACHMENT
• Retinal detachment is a separation of the retina and underlying epithelium with fluid
accumulation between the two layers.
• Detachment is caused by a retinal break, which is interruption in the full thickness of retinal
tissue.
• Treatment of retinal detachment is to first seal retinal breaks and then relieve inward traction
on retina.
• Several types of surgery used include laser photocoagulation and cryopexy and then scleral
buckling.
• Visual prognosis varies, depending on the extent, length, and area of detachment.
• Discharge planning and teaching are important, with the nurse beginning this process early
as the patient is not hospitalized for long.
• AMD is related to retinal aging. Family history is another strong predictor of risk.
GLAUCOMA
• Glaucoma is associated with increased intraocular pressure (IOP), optic nerve atrophy, and
peripheral visual field loss.
• Glaucoma often occurs with advanced age and is a major cause of permanent blindness.
• Etiology is due to consequences of elevated IOP. Glaucoma is largely preventable with early
detection and treatment.
• Two types of glaucoma include: primary angle-closure glaucoma (PACG) and primary open-
angle glaucoma (POAG), which is the more common.
o With POAG, few symptoms exist and it is often not noticed until peripheral vision is
severely compromised.
o Symptoms of PACG include sudden, excruciating eye pain along with nausea and
vomiting.
o Therapy is to lower IOP to prevent optic nerve damage through drugs, argon laser
trabeculoplasty, trabeculectomy, and iridotomy. The nurse should teach about
glaucoma risk and the importance of early detection and treatment.
• Symptoms include purulent exudate and inflammation that can involve the ossicles,
eustachian tube, and mastoid bone.
• It is often painless.
MÉNIÈRE’S DISEASE
• Ménière’s disease is characterized by symptoms of inner ear disease with episodic vertigo,
tinnitus, fluctuating sensorineural hearing loss, and aural fullness.
• Attacks may begin with sense of ear fullness, tinnitus, and decreased hearing acuity.
• The duration of attacks is hours to days, and attacks occur several times a year.
• Hearing loss fluctuates, and with continued attacks, recovery lessens, eventually leading to
permanent hearing loss.
• If not relieved, surgeries include endolymphatic sac decompression and vestibular nerve
resection.
• Nursing care minimizes vertigo and provides for patient safety with acute attacks.
HEARING DISORDERS
• Hearing disorders are the primary handicapping disability in the United States.
• Signs of hearing loss include asking others to speak up, answering questions inappropriately,
not responding when not looking at speaker, straining to hear, and increasing sensitivity to
slight increases in noise level.
• Often the patient is unaware of minimal hearing loss. Assistive devices and techniques
include hearing aids, speech reading, and a cochlear implant.
• Presbycusis (hearing loss associated with aging) includes loss of peripheral auditory
sensitivity, decline in word recognition ability, and associated psychologic and
communication issues.