AUDIO-VISUAL DISORDERS a.

Open: no symptoms, mild aching

eye
CATARACT - opacity/loss of transparency of the lens b. Closed: rapid onset of severe eye
Predisposing Factor: advancing age pain, blurred vision, dilated pupils

Pathophysiology: Diagnosis:
1. Tonometry: (+) > 25 mmHg
Altered nutrient metabolism within the lens 2. Perimetry: (+) ↓ peripheral vision
↓ 3. Visual acuity: reduced
Protein in the lens breaks down & loses transparency
↓ Medical Management
Lens becomes cloudy. 1. Cholinergic agonist (Miotics).
↓ a. Pilocarpine HCL (pilocar)
Light rays cannot pass through the retina b. Carbachol (Miostat)
↓ 2. Beta adrenergic blockers.
Visual loss a. Timolol (Timoptic)
3. Carbonic anhydrase inhibitor.
Clinical Manifestation a. Acetazolamide (Diamox)
1. Gradual painless blurring of vision
2. Cloudy appearance of the lens Surgical Management
3. Loss of central vision 1. Trabeculoplasty
2. Peripheral Iridotomy
Diagnosis: Ophthalmoscopy/slit lamp test
(+) Milky white appearance of the lens Nursing Management (post-op)
1. Place an eye patch on the affected eye
Nursing Diagnosis: Risk for injury related to visual loss 2. Lie on the unaffected side
3. Watch out for ↑IOP: ↑HR, eye pain &
Surgical Management discomfort, N/V
1. Intracapsular Cataract Lens Extraction: total
removal Nursing Management
2. Extracapsular Cataract Lens Extraction: 1. Avoid activities that increase IOP.
partial removal 2. Avoid exposure to URTI and emotional upset.
Nursing Management (pre-op) 3. Avoid products containing atropine sulfate &
1. Instruct the client regarding the epinephrine.
postoperative measures to prevent or 4. Strict medication regimen.
decrease intraocular pressure 5. Maintenance of regular bowel habits.
2. Administer preoperative eye medications,
mydriatics (Mydriacyl)- dilates pupils and
cycloplegics (Cyclogyl)- paralyzes ciliary RETINAL DETACHMENT - separation of the retina
muscle from the choroid layer

Nursing Management (post-op) Etiology:

1. Avoid activities that increase IOP. 1. Trauma
2. Wear an eye shield (1 month). 2. Aging process
3. Avoid rapid eye and head movement.
4. No rubbing of the eyes Pathophysiology:
5. Sedentary lifestyle (2 weeks) Trauma
6. Notify the physician: ↓
a. Severe pain not relieved by pain Tear in the retina
meds. ↓
b. Loss of vision Vitreous humor seeps in between the retina &
c. N/V or excessive coughing choroid layer
d. Eye injury ↓
e. Eye discharge Separation of the retina from the choroid layer
↓
Disruption of choroidal blood supply to the retina
GLAUCOMA - increase IOP due to accumulation of ↓
aqueous humor caused by an obstruction in the Visual deficits
canal of Schlemm.
Clinical Manifestation
Types 1. Recurrent Flashes of light.
1. Open-angle (Chronic, simple, or wide-angle). 2. Floaters.
2. Closed-angle (acute or narrow-angle). 3. Falling curtain/veil-like sensation.
4. Progressive loss of visual field →(blindness)
Pathophysiology:
Diagnosis: Ophthalmoscopy: (+) reveal detached
Obstruction to the outflow of aqueous humor thru retina
the canal of Schlemm
↓ Surgical Management
↑ IOP 1. Scleral buckling
↓ 2. Laser surgery
Compression and damage of the retina & optic nerve
↓ Nursing Management (pre-op)
Irreversible blindness 1. Bilateral eye patches
2. Maintain bed rest & in the prescribed
Clinical Manifestation position.
1. Tunnel vision/gun-barrel vision. 3. Avoid jerky head movements
2. Halos around lights.
3. Decrease visual acuity Nursing Management (post-op)
4. Other symptoms 1. Provide bed rest for 1 to 2 days
2. Position: supine or on the unoperated eye
 3. Avoid rapid eye movements from side to side Nursing Management (post-op)
4. Avoid sudden and jarring head movements. 1. Position the patient on the unaffected side.
5. Avoid Increase IOP 2. Restricted head position.
6. Limit reading for 3 to 5 weeks 3. Avoid sudden pressure changes in the ear…
4. Avoid smoking & crowds/exposure to cold.

MENIERE'S DISEASE - a chronic disease that

involves the inner ear characterized by an CONJUNCTIVITIS (PINK EYE) - inflammation of
accumulation of endolymph in the inner ear the conjunctiva
AKA: Endolymphatic Hydrops
Etiology
Etiology: Unknown 1. Allergy
Emotional stress, aging, allergy 2. Microbial infection [bacteria (streptococcus
pneumoniae, haemophilus influenza,
Pathophysiology: chlamydia & staphylococcus aureus), virus
(adenovirus & herpes simplex virus), fungus]
Overproduction or decreased absorption of 3. Trauma (physical or chemical)
endolymph
↓ Clinical Manifestation
Pressure increases inside the inner ear 1. General symptoms
↓ a. Foreign body, scratchy or burning
Destruction of the cochlear hair cells (Organ of Corti) sensation
and vestibular hair cells b. Itching and photophobia
2. Redness and eye pain
3. Lid edema
Clinical Manifestation 4. Discharge or exudate (purulent,
1. Tinnitus mucopurulent, watery)
2. Hearing loss
3. Vertigo Medical Management
Medical Management 1. Administer antibiotic or viral eye drops or
1. Acetazolamide (Diamox). ointment as prescribed if the infection is
2. Antivertigo drugs. present
a. Diphenhydramine (Benadryl) 2. Antihistamine as prescribed if an allergy is
b. Meclizine (Bonamine) present
3. Antiemetics
a. Metoclopramide (Plasil) Nursing Management
1. Infection control measures such as good
Surgical Management hand-washing & not sharing towels &
1. Conservative washcloths
a. Endolymphatic sac decompression. 2. Infected employees & others must not be
2. Destructive allowed to work/attend school until
a. Vestibular nerve section. symptoms have resolved
b. Labyrinthectomy. 3. Cold compresses to lessen irritation and
soothe the pain
Nursing Diagnosis: Risk for injury 4. Wearing dark glasses for photophobia; eye
patches are contraindicated
Nursing Management 5. Instruct the child to avoid rubbing the eye to
1. Promote safety prevent injury
a. Bed rest. 6. Discontinue the use of contact lenses &
b. Assist patient out of bed obtain new lenses to eliminate the chance of
2. Provide a quiet, dim-lit environment. re-infection
3. Low sodium diet and fluid restriction 7. Discard and replace all makeup articles
4. Stop smoking.
5. No caffeine
OTITIS MEDIA - infection of the middle ear. A
common complication of acute respiratory infection;
OTOSCLEROSIS - an overgrowth of spongy bones in infants & children are more prone.
the labyrinth across the margin of the oval window &
to the footplate of the stapes Common causative agents: Streptococcus
pneumoniae, Haemophilus influenza, and Moraxella
Etiology: Unknown catarrhalis

Pathophysiology: Etiology
1. Contaminated nasopharyngeal secretion
Overgrowth of spongy bone s across the margin of reached the middle ear via the Eustachian
the oval window & footplate of the stapes tube (children)
↓ 2. Tympanic membrane perforation (adult)
Footplate of stapes become fixed (locked) in the oval
window Pathophysiology:
↓
Prevention of sound wave transmission to the inner Entry of pathogens in the middle ear via Eustachian
ear tube or via the perforated tympanic membrane
↓ ↓
Deafness Inflammation of the middle ear mucosa
↓
Clinical Manifestation Production of pus which fills up the middle ear
1. Slow gradual hearing loss ↓
2. Tinnitus Rupture of the tympanic membrane
↓
Surgical Management: Stapedectomy Ear drainage
Clinical Manifestation CHRONIC OTITIS MEDIA – chronic infection of the
1. Earache or pain middle ear preceded by neglected or recurrent AOM
2. Fever that causes irreversible tissue pathology which causes
3. Ear drainage (serous or purulent) damage to the tympanic membrane, destroys the ear
4. Hearing loss ossicles and can involve the mastoid
5. Dizziness → nausea and vomiting
6. Feeling of fullness & pressure in the ear Clinical Manifestation
7. Irritability & restlessness; rolling of the 1. Hearing loss and persistent or intermittent
head from side to side; pulling on or foul-smelling painless drainage
rubbing the ear in infants and children 2. Pain is present if acute mastoiditis occurs;
when mastoiditis is present, post-auricular
Diagnostic Evaluation: Otoscope (+) erythematous area tenderness and may be erythematous
tympanic membrane & often bulging with impaired or edematous
mobility 3. Perforation of the tympanic membrane upon
otoscopic examination
Complications 4. Cholesteatoma (tumor of the middle ear or
1. Tympanic membrane perforation mastoid, or both, that can destroy structures
2. Secondary complications: mastoiditis, of the temporal bone) associated with
meningitis, or brain abscess (rare) chronic infection.

Medical Management Medical Management: Instillation of antibiotic drops or

1. Antibiotic therapy application of antibiotic powder to treat purulent
a. Penicillin discharge
b. Amoxicillin or ampicillin
2. Analgesic or antipyretic such as Surgical Management
acetaminophen (Tylenol) to decrease fever & 1. Tympanoplasty (myringoplasty)– surgical
pain repair of the tympanic membrane to prevent
recurrent infection, reestablish middle ear
Nursing Management function, close the perforation, and improve
1. Relieve pain hearing
a. Bed rest 2. Ossiculoplasty - surgical reconstruction of
b. Local cold compress or hot the middle ear bones to restore hearing
compress 3. Mastoidectomy to remove cholesteatoma,
2. Safety measures to prevent falls gain access to disease structures, and create
a. Side rails a dry (non-infected) and healthy ear.
b. Call assistance when getting out of
bed or walking Nursing Management
c. Move slowly from one position to 1. Relieve post-operative pain
another to decrease dizziness 2. Instruct patient to observe for possible
3. Encourage oral fluids complications:
4. Teach/instruct the parents to: a. Facial asymmetry or paralysis
a. feed infants in an upright position b. Spread of infection to the brain
b. lie the child with the affected ear
down
c. clean drainage from the ear with
sterile cotton swabs using the
appropriate procedure
d. straightened the auditory canal 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. if ear drops
are prescribed
5. Patient Education: hygienic practices to
prevent reinfection.

Surgical Management
1. Myringotomy (tympanotomy) – an incision in
the tympanic membrane
2. Needle aspiration

Preoperative teaching: instruct the patient not to

sneeze, cough, blow nose, or touch the ear/dressing
until allowed

Post-op teaching:
1. Swimming, diving & submerging under water
are not allowed until the tympanic membrane
heals.
2. Avoid strenuous exercise, rapid head
movements, bouncing or bending, traveling
by air, forceful coughing, and contact with
persons with colds.
3. Avoid washing hair, showering, or getting the
head wet for a week as prescribed.
4. Instruct the client that if she/he needs to
blow the nose, blow one side at a time with
a wide mouth opens.