CARE OF CLIENTS WITH PROBLEMS IN PERCEPTION AND COORDINATION

DIAGNOSTIC TESTS

A detailed imaging and recording of the ocular circulation by a series of photographs after the administration of a dye

This test is useful for assessing problems with retinal circulation, such as those that occur in diabetic retinopathy, retinal bleeding, and macular degeneration to rule out intraocular tumors

Fluorescein Angiography

Assess the client for allergies and previous reaction to dyes

Obtain informed consent

A mydriatic medication, which causes pupil dilation, is instilled into the eye 1 hour before the test

Dye is injected into the vein of the client’s arm

Interventions

Inform the client that dye may cause the skin to appear yellow for several hours after the test and is eliminated gradually through the urine

Encourage rest after the procedure

Encourage fluid intake to assist in eliminating the dye

Urine might appear bright green

Allows examination of the anterior ocular structures under microscopic magnification

The client leans on a chin rest to stabilize the head while a narrowed beam light is aimed so that it illuminates only a narrow segment of the eye

Slit Lamp

Explain the procedure to the client

Advise the client about the brightness of the light and the need to look forward at a point over the examiner’s ear

Interventions

Is used to primarily assess for an increase of IOP and potential glaucoma

Normal IOP is 10 to 21 mmHg

Client must be instructed to avoid rubbing the eye following the examination if the eye has been anesthetized because of the potential for scratching the cornea

Tonometry

Assesses the mastoid, middle ear, and inner ear structures

Multiple radiographs of the head are obtained

Tomography

All jewelry is 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

Interventions

CATARACTS

Opacity of the lens that distorts the image projected onto the retina and that can progress to blindness

Causes include the aging process (senile cataracts), inherited (congenital cataracts), and injury (traumatic cataracts)

Interventions is indicated when visual acuity has been reduced to a level that the client finds to be unacceptable or adversely affects his or her lifestyle

Blurred vision and decreased color perception are early signs

Halos around lights

Reduced visual acuity

Presence of w white pupil

Loss of vision

Signs and Symptoms

Surgical removal of the lens, one eye at a time

Instruct the client regarding the postoperative measures to prevent or decrease intraocular pressure

Stress to the client that care after surgery requires instillation of different types of eye drops several times a day for 2 to 4 weeks

Interventions

Administer eye medications preoperatively, including mydriatics and cyclopegics as prescribed

After the surgery, elevate the head of the bed 30 to 45 degrees

Turn the client to the nonoperative side

Maintain an eye patch as prescribed; orient the client to the environment

Position the client’s personal belongings to the nonoperative side

Use side rails for safety

Assist with ambulation

Use an eye shield at bed time

GLAUCOMA

A group of ocular diseases resulting in increased IOP

Results form inadequate drainage of aqueous humor from the canal of Schlemm or overproduction of aqueous humor

The condition damages the optic nerve and can result in blindness

Gradual loss of visual fields may go unnoticed

Acute closed-angle or narrow angle glaucoma – results form obstruction to outflow of aqueous humor

Chronic closed-angle glaucoma – follows an untreated attack of acute closed-angle glaucoma

Chronic open-angle glaucoma – results from overproduction or obstruction to the outflow of aqueous humor

Types of Glaucoma

Acute glaucoma – is a rapid onset of IOP higher than 50 to 70 mmHg

Chronic glaucoma – is a slow progressive, gradual onset of IOP higher than 30 to 50 mmHg

Diminished accommodation and increased IOP

Loss of peripheral vision

Decreased visual acuity

Halos around lights

Headache or eye pain

Signs and Symptoms

Treat acute glaucoma as a medical emergency

Administer medications as prescribed to lower IOP

Prepare the client for peripheral iridectomy, which allows aqueous humor to flow from the posterior to the anterior chamber

Interventions

Administer miotics, carbonic anhydrase inhibitors, and betablockers as prescribed

Instruct the client of the need for lifelong medication use

Instruct the client to avoid anticholinergic medications

Instruct client to report eye pain and changes in vision

Prepare the client for trabeculoplasty as prescribed to facilitate aqueous humor drainage

Prepare the client for trabeculectomy as prescribed, which allows drainage of aqueous humor into the conjunctival spaces by the creation of an opening

RETINAL DETACHMENT

Detachment or separation of the retina from the epithelium

Occurs when the layers of the retina separate because of the accumulation of fluid between them, or when both retinal layers elevate away from the choroid as a result of a tumor

Partial detachment becomes complete if untreated, which can lead to blindness

Flashes of light

Floaters or black spots (signs of bleeding)

Increase in blurred vision

Sense of curtain being drawn over the eye

Loss of a portion of the visual field

Signs and Symptoms

Provide bed rest

Cover both eyes with patches as prescribed

Speak to the client before approaching

Protect the client from injury

Avoid jerky head movements

Interventions

Minimize eye stress

Prepare the client for a surgical procedure as prescribed

Scleral buckling, to hold the choroid and retina togetehr with a splint until scar tissue forms, closing the tear

OTITIS MEDIA

An inflammatory disorder usually caused by an infection of the middle ear occurring as a result of a blocked Eustachian tube, which prevents normal drainage

Common complication of an acute respiratory infection

Infants and children are more prone

Fever

Irritability and restlessness

Loss of appetite

Pulling on or rubbing the ear

Ear pain

Purulent drainage

Signs and Symptoms

Encourage fluid intake

Feed infants in upright position t prevent reflux

Lie with the affected ear down

Dry the ear by wicking

Interventions

Administer antipyretics as prescribed

Administer antibiotics as prescribed

Screen for hearing loss

Instruct the parents about the procedure for administering era medications

MENIERE’S SYNDROME

Also called as endolymphatic hydrops

Dilation of the endolymphatic system by overproduction or decreased reabsorption of endolymphatic fluid

Characterized by tinnitus, sensorineural hearing loss, and vertigo

Symptoms occur in attacks and last for several days, and the client becomes totally incapacitated during the attacks

Initial hearing loss is reversible but as the frequency of attacks continue, hearing loss becomes permanent

Damage to the cochlea cause increase fluid pressure leads to permanent hearing loss

Caused by viral and bacterial infections, allergic reactions, vascular disturbance

Feelings of fullness in the ear

Tinnitus

Hearing loss

Vertigo

Nausea and vomiting

Headaches

Signs and Symptoms

Prevent injury during vertigo attacks

Provide bed rest in a quiet environment

Provide assistance with walking

Instruct the client to move the head slowly

Initiate sodium and fluid restrictions as prescribed

Interventions

Instruct the client to stop smoking

Administer nicotinic acid (niacin) as prescribed for vasodilatory effects

Administer antihistamines as prescribed

Administer antiemetics as prscribed

Labyrinthectomy may be performed

DRUGS

Dilate the pupils (mydriasis) and relax the ciliary muscles (cyclopegia)

Used preoperatively or for eye examinations

Contraindicated with glaucoma

Tropicamide (Mydriacil, Tropicacyl, Opticyl)

Mydriatic-Cyclopegic

Reduce IOP by constricting pupils and contracting the ciliary muscle

Open the anterior chamber angle and increase the outflow of aqueous humor

Pilocarpine hydrochloride (Isopto Carpine)

Miotics

Interfere with the production of carbonic acid, which leads to decreased aqueous humor formation and decreased IOP

Long term treatment for open angle glaucoma

Acetazolamdie (Diamox)

Carbonic Anhydrase Inhibitors