SCHOOL OF NURSING

NCM 116: MEDICAL SURGICAL NURSING

FINALS: CARE OF CLIENT WITH EYE AND EARS DISORDER
Transcribed by: Crisanta Grace Oponda Section: BSN 301 – 2nd Semester (S.Y 2022-2023)

TOPIC FUNCTION OF TEARS:

SUB-TOPIC
SUB-SUB-TOPIC  Acts to lubricate the eye/washes away irritation materials ex. Dust
 Prevents drying of the conjunctiva
 Nourishment of cornea
CONTENTS
 OVERVIEW OF THE STRUCTURE AND FUNCTIONS OF THE EYE
 EYELIDS SCLERA
 EYEBROWS AND EYELASHES  Contains a firm fibrous membrane that maintains the spherical shape of
 CONJUNCTIVA
 LACRIMAL GLAND the eye and gives attachment to the EOM (Extraocular Movement)
 SCLERA  Contains a firm fibrous membrane that maintains the spherical shape of
 CORNEA
the eye and gives attachment to the EOM (CN 3 4 6) – 6 cardinal gaze
 MIDDLE MOST LAYER
 INNER MOST LAYER (RETINA)  Internal/Intrinsic Part of the eyeball, in the outer layer or the protective
 ERROR OF REFRACTION coat we have the sclera: White part of the eye/occupies 2/3rd of the eye
 CLAUCOMA
 CATARACT
 6 CARDINAL GAZE Tested simultaneously of the same time
 RETINAL DETACHMENT
 EAR DISORDERS
 MENEIRE’S DISEASE
CORNEA
 Outer, transparent structure covering the iris, pupil and the anterior
chamber
 Protection against invading microorganism
CARE OF CLIENT WITH EYES AND EARS DISORDER  Myopia – near sightedness
 Hyperopia – far sightedness
OVERVIEW OF THE STRUCTURE AND FUNCTION OF THE EYE
 Spherical in shape (almond like structure) about 2.5 cm in diameter MIDDLE MOST LAYER
 Supplied by CN II (optic nerve)  CHOROID
 For vision o A thin, brown tissue
 The optic nerve relays message from eyes to the brain to create visual o Highly vascularized
images, cranial nerve II, is also responsible for the light reflex and o Provides nutrients and oxygen to the retina
accommodation reflex  CILLARY BODY
o A thick tissue composed of ciliary process and muscles
EYELIDS o Continues with the choroid behind and the iris in front
 External structure of the eye o Produces aqueous humor
 Palpebral Fissure – the opening of the upper and lower Lid  A fluid that gives shape to the eye anteriorly and maintains the IOP
 Normal size of the eyelids is 10 mm vertically, and 30 mm horizontally N=12-21 mmHg
 Ciliary body produces aqueous humor > goes to the anterior and
 MEIBOMEAN GLANDS 🡪 secretes an oil to lubricate the eyelashes
posterior chamber (nourishes and gives O2 to cornea and lens) > travels
FUNCTION:
to the trabecular meshwork > drains into the canal of schlemn
 Protects the eyeball
 IRIS
 Secretion, distribution and drainage of tears
o Colored muscular ring of the eye
 Blinking/corneal reflex - protective mechanism against direc exposure to
o Consists of smooth muscle fibers
sunlight and dusts, or irritants
o Radial SMF and Circular SMF > Pupil
STY/STYE OR HORDEOLUM
o Positioned between the cornea and the Lens
 Acute localized swelling/infection of the meibomian gland of the eyelid o Regulates the amount of light entering the eye by regulating
usually caused by STAPHYLOCOCCUS AUREUS the size of the pupil
 IF HORDEOLUM, is more than 5 days, they need to consult to the doctor,  Daylight – 2-4 mm
the doctor will order penicillin or cephalosporins, however if the patient  Night time – 4-8 mm
is allergic to the medication mentioned above, the dr. will order  Normal Response = PERRLA
cephalexin  Equal in size ISOCORIA
FACTS: TEARS IS 99% BACTERICIDAL BECAUSE IT CONTAINS HYDROLYTIC ENZYME  Near vision – constricts
 Far vision – dilates
EYEBROWS AND EYELASHES
 Hair follicles INNER MOST LAYER (RETINA)
 Eyelash and eyebrows protects the eye from direct exposure to sunlight,  Pigmented
dust, irritants, foreign objects, and perspiration o No photoreceptor
o Light receptor vision
CONJUNCTIVA  Neural Layer
 It is called as the “Pink of the Eye” > consist of numerous minute o Rods – responsible for twilight or night vision
capillaries o Cones - responsible for daylight or colored vision
CONJUCTIVITIS neurosensory retina is a light-sensitive tissue lining the inner surface of the eye.
 Increase lacrimation  Optic disc
 Formation of crust drainage o the round spot on the retina formed by the passage of the
 Redness, or inflammation of the conjunctiva axons of the retinal ganglion cells, which transfer signals from
Drug of choice the photoreceptors of the eye to the optic nerve, allowing us
 Tobramycin sulfate 🡪 most common to see.
 Fluoroquinlolones  Macula lutea
o also called fovea, contains a very high concentration of cones.
These are the light-sensitive cells in the retina that give
LACRIMAL GLAND
detailed central vision. The macula is the yellow oval spot at
 Secretes and produces tears
the center of the retina (back of the eye) that contains blood
 Located at the depression of each frontal bone
vessels and nerve fibers
 TEARS Contains lysosomes that prevents microbial invasion (highly
bactericidal)
 SCHOOL OF NURSING
NCM 116: MEDICAL SURGICAL NURSING
FINALS: CARE OF CLIENT WITH EYE AND EARS DISORDER
Transcribed by: Crisanta Grace Oponda Section: BSN 301 – 2nd Semester (S.Y 2022-2023)

 Fovea centralis o Gradual in onset, bilateral

o a small depression within the neurosensory retina where o SIGNS AND SYMPTOMS
visual acuity is the highest. The fovea itself is the central o Painless
portion of the macula, which is responsible for central vision. o Loss of peripheral vison
o Optic disc cupping
ERROR OF REFRACTION
 MYOPIA
o Nearsightedness, or myopia, as it is medically termed, is a
vision condition in which people can see close objects clearly,
but objects farther away appear blurred. Myopia occurs if the
eyeball is too long or the cornea (the clear front cover of the
eye) is too curved.
 HYPEROPIA
o Hyperopia, or farsightedness, is a vision condition in which  ACUTE CLOSED-ANGLE GLAUCOMA - characterized by forward
distant objects are usually seen more clearly than close ones. displacement of the iris to the cornea
Hyperopia occurs due to the shape of the eye and its o Could lead to blindness
components; it is not just a function of the aging of the lens, o Sudden/acute onset, unilateral
which occurs with presbyopia. o Most dangerous
 ASTIGMATISM o 50-70 mmHg
o a common eye problem that can make your vision blurry or o SIGNS AND SYMPTOMS:
distorted. It happens when your cornea (the clear front layer o Severe eye pain
of your eye) or lens (an inner part of your eye that helps the o Nausea and vomiting
eye focus) has a different shape than normal. The only way to o Vision changes: blurred, seeing halos around lights
find out if you have astigmatism is to get an eye exam. o Red eyes
 PRESBYOPIA o Edema to the cornea
o a refractive error that makes it hard for middle-aged and older
adults to see things up close. It happens because the lens (an
inner part of the eye that helps the eye focus) stops focusing
light correctly on the retina (a light-sensitive layer of tissue at
the back of the eye).

DIAGNOSTIC PROCEDURE
 TONOMETRY
o Painless procedure
o Reveals increase IOP
GLAUCOMA  PERIMETRY
 a group of eye diseases that can cause vision loss and blindness by o Reveals decrease in peripheral vision
damaging a nerve in the back of your eye called the optic nerve. The  GONIOSCOPY
symptoms can start so slowly that you may not notice them. The only o Checks patient’s drainage angle
way to find out if you have glaucoma is to get a comprehensive dilated MEDICAL MANAGEMENT
eye exam.  Selective Laser Trabeculoplasty
RISK FACTORS  Trabeculectomy
 40 above  Laser Iridotomy
 Hereditary  Iridectomy
 Hypertension  Eyedrops
 Diabetes mellitus MEDICATIONS
 Related to recent eye trauma, surgery or inflammation  ALPHA AGONIST (BRIMONIDE)
 Obesity o it both reduces aqueous humor production and stimulates
TYPES OF GLAUCOMA aqueous humor outflow through the uveoscleral pathway
OPEN ANGLE GLAUCOMA CLOSE ANGLE GLAUCOMA  BETA BLOCKERS (TIMOLOL)
Drainage angle is open Drainage becomes very narrow o decreases production of aqueous humor
Trabecular meshwork is clogged Trabecular meshwork is not clogged  Systemic effects
 Not for patient with bradycardia, asthma, or COPD
 CARBONIC ANHYDRASE INHIBITORS (ACETAZOLAMIDE)
o decreases aqueous humor production
 CHOLINERGICS (PILOCARPINE) EYEDROPS
o lower intraocular pressure
 PROSTAGLANDIN ANALOGUE (BIMATORPOST)
o promotes drainage of aqueous humor
 RHO KINASE INHIBITORS (NETARSUDIL)
o promotes drainage of aqueous humor
 EPINEPHRINE EYEDROP
o decreases formation and secretion of aqueous humor
 CHRONIC OPEN ANGLE GLAUCOMA - obstruction in the flow of aqueous  BRIMONIDE
humor at the trabecular meshwork of the canal of schlemn o it works with alpha receptor by activating it.
o most common
o IOP = 30-50 mmHg
 SCHOOL OF NURSING
NCM 116: MEDICAL SURGICAL NURSING
FINALS: CARE OF CLIENT WITH EYE AND EARS DISORDER
Transcribed by: Crisanta Grace Oponda Section: BSN 301 – 2nd Semester (S.Y 2022-2023)

 ACETAZOLAMIDE RETINAL DETACHMENT

o Promotes increase outflow of aqueous humor for  an eye problem that happens when your retina (a light-sensitive layer of
drainage/diuretic that inhibits carbonic acid production - tissue in the back of your eye) is pulled away from its normal position at
Assess for a sulfonamide allergy the back of your eye.
 BIMATOPROST  Causes:
o It promotes drainage of aqueous humor but it doesn’t cause  Myopic degeneration
systemic effects  Trauma
 RHOKINASE INHIBITOR  Aphakia
o Conjunctival hyperemia  Exudates that occur in front or behind the retina
 EPINEPHRINE DROP  Sudden physical exertion
o do not give atropine sulfate eyedrops, it could lead to increase
ASSSSMENT
IOP
 Floating spots or opacities before the eyes
 Flashes of lights
CATARACT  Portion of retina hanging like gray cloud - results from light scattering
 a cloudy area in the lens of your eye (the clear part of the eye that helps
MEDICAL MANAGEMENT
to focus light). Cataracts are very common as you get older. In fact, more
 PHOTOCOAGULATION
than half of all Americans age 80 or older either have cataracts or have
o in which a laser or xenon are “spot welds” the retina to the
had surgery to get rid of cataracts
pigment epithelium.
RISK FACTORS
 ELECTRODIATHERMY
 Aging o in which a tiny hole is made in the sclera to drain subretinal
 Congenital fluid, allowing the pigment epithelium to adhere to the retina.
 Trauma to the eye  CRYOSURGERY OR RETINAL CRYOPEXY
 Diabetes o another “spot weld” technique that uses a super cooled probe
 Unprotected eye exposure to sunlight to adhere the pigment epithelium to the retina.
 Medication: corticosteroid  SCLERAL BUCKLING
 Smoking o in which the sclera is shortened to force the pigment
 Genetics epithelium closer to the retina; commonly accompanied by
SIGNS AND SYMPTOMS vitrectomy.
 Cloudy/blurry vision PHARMACOLOGY
 Sensitivity to glare and light  Cyclopentolate hydrochloride (Cyclogyl) a cycloplegic agent that causes
dilation of the pupil and rest of the muscles of accommodation
 antibiotics Gentamicin; prednisolone acetate to prevent eye infections
 Other Drugs: Antiemetics and analgesics are ordered to manage nausea,
vomiting, and pain.
POST OP CARE
 Position depends on the extent and location of retinal detachment.
 Ambulation and activity will be prescribed by the surgeon
DIAGNOSTIC TOOL  Pressure patch over the eye
 Snellen chart  Rest the eyes and head immediate post op
o to check the visual acuity  Avoid Valsalva maneuver
 Slit lamp test  Change dressing daily
o to see the structure of the eye  HEMORRHAGE - common complication after surgery
 Opthalmoscope  Avoid straneous activity for 6 weeks
o to dilate the pupil to assess the optic nerve
NURSING INTERVENTION EAR DISORDERS
 Regular eye check up
 Anti- glare glasses MENEIRE’S DISEASE
 Protect the eye from sunrays, use of sunglasses, and large brim hats  an abnormality in inner ear fluid balance caused by a malabsorption in
 Eat fruits and veggies high in vitamin C,E, Lutein, zeaxanthin 🡪 important the endolymphatic sac or a blockage in the endolymphatic duct
for eye health  Also known as ENDOLYMPHATIC HYDROPS (dilation of the endolymphatic
 Avoid smoking and alcohol consumption space)
SURGICAL MANAGEMENT  TRIAD SYMPTOMS: Vertigo, tinnitus, sensorineural hearing loss
 Phacoemulsification CAUSES:
o Extraction or emulsification of the nucleus to remove the  Unknown
cloudy lens with soundwaves, then ung old lens is replaced by  Virus
a lens called intraocular lens.  Emotional stress
o PUPIL DILATION MEDICATION
SUBSET OF MENIERRE’S DISEASE
o Mydriatics (Phenylephrine)
 Cochlear Ménière’s disease
 dilates the pupil
o Fluctuating, progressive sensorineural hearing loss associated
o Cycloplegics
with tinnitus and aural pressure in the absence of vestibular
 dilates the pupil by losing its accommodation
symptoms or findings
 Vestibular Ménière’s disease
o occurrence of episodic vertigo associated with aural pressure
but no cochlear symptoms.
INTERVENTION
 Bed rest during acute attack 🡪 to prevent risk for fall, risk for injury
because of the vertigo
 Low Sodium diet - to prevent water retention
 SCHOOL OF NURSING
NCM 116: MEDICAL SURGICAL NURSING
FINALS: CARE OF CLIENT WITH EYE AND EARS DISORDER
Transcribed by: Crisanta Grace Oponda Section: BSN 301 – 2nd Semester (S.Y 2022-2023)

 Avoid drinking large amount of fluids

 Avoid reading during vertigo
MEDICAL MANAGEMENT
 Antihistamine (Meclizine)
o shortens the attack
 Tranquilizers (Diazepam)
o to control vertigo
 Anti emetic (Phenergan)
o to control the nausea and vomiting, and the vertigo because
of their antihistamine effect
 Diuretic therapy (Hydrochlorthiazide)
o decrease pressure in the endolymphatic system
 Gentamycin
o antibiotic, AE: HEARING LOSS
SURGICAL MANAGEMENT
 Endolymphatic Sac Decompression 🡪 equalizes pressure in the
endolymphatic space
o Shunt is inserted in the endolymphatic sac through
postauricular incision.
o First line surgical approach (safe and simple)
 Vestibular Nerve Sectioning 🡪 a procedure that helps eliminate vertigo
attacks while preserving hearing
o Conserves hearing
PRE-OP CARE
 Assess for URTI
 Shampoo the hair
 Inform the patient that he/she will be under local anesthesia
POST-OP CARE
 Lie on unoperated side
 Blow nose gently on side at a time: sneeze or cough with open mouth for
1 week after surgery
o to increase pressure from blowing
o can cause healing of eardrum to move or shift
 Avoid straneous activity for 3 weeks
 Keep ear dry for 6 weeks post op
o Do not shampoo for 1 week
o Protect ear with 2 pieces of cotton
 Avoid air travel for 1 week post op
o for sensation of ear pressure, hold nose, close mouth and
swallow to equalize pressure
 Report any drainage to the physician
 Avoid reading, watching TV or fast moving object for 1 week post op