Human Senses - Complete The Worksheet

SENSES VISUAL THE EYE
The eye
Complete the missing words:
1. The eyeball consists of three layers, the
a. ___________________________ - fibrous coat that supports the eye
i. ___________________________ - tough, white connective tissue, located
anteriorly and posteriorly
ii. ___________________________ - transparent tissue through which light enters
the eye, located anteriorly
b. The middle layer of the eye consist of three parts
i. ___________________________ - a dark brown membrane located between the

sclera & the retina, it lines most of the sclera & is attached to the retina but can
easily detach from the sclera and contains blood vessels that nourishes the retina
ii. ___________________________ - connects the choroid with the iris, secretes
aqueous humor that helps give the eye its shape
iii. ___________________________ - the colored portion of the eye, extension of the
ciliary body, located in front of the lens and it has a central opening called the pupil
c. The inner layer of the eye also known as the ___________________________ is a thin
dedicate structure in which the fibers of the ___________________________ are

distributed and extremely sensitive to ___________________________.
2. FLUIDS OF THE EYE

A. AQUEOUS HUMOR
- Clear, watery fluid fills anterior & posterior
chamber
- produced by the ciliary processes, & the fluid
drains in the Canal of Sclemm
- serves as refracting medium & provides
nutrients to lens & cornea
- contributes to maintenance of IOP
B. VITREOUS HUMOR
- Clear, gelatinous/jell-like material that fill the
posterior cavity of the eye
- Maintains the form & shape of the eye
- Provides additional physical support to the
Eye
3. EYE MUSCLES
A. INTRINSIC MUSCLES:
a. IRIS
b. CILIARY BODY
B. EXTRINSIC
a. FOUR STRAIGHT RECTUS MUSCLE
- superior, inferior, lateral & medial
b. TWO OBLIQUE MUSCLES
- superior & inferior
4. BLOOD VESSELS
A. OPTHALMIC ARTERY
- major artery supplying the structures in the eye
B. OPTHALMIC VEINS
- venous drainage occurs through vision
5. NERVE SUPPLY TO THE EYE
A. CRANIAL NERVE II
- Optic nerve (nerve of sight)
B. CRANIAL NERVE V
- Trigeminal (opthalmic)
C. MOTOR NERVE ( CN III, CN IV, CN VI)
- oculomotor, trochlear, abducens
SENSORY PATHWAY FOR VISION

the ROD & CONE receptors, which are sensitive to light initiate nerve impulse messages which w/c
travel over the optic nerves
OPTIC CHIASMA is the crossing point for fibers from the medial halves of the retinae
that in OPTIC CHIASMA, the optic nerve fibers from the medial halves of the retinae cross to the
opposite side of the brain while from the lateral halves or the retinae remain uncrossed
Thus fibers from the right half of each eye carry impulses to the brains right occipital lobe, and fibers
from the left half of each eye carry impulses to the left occipital lobe.
From the OPTIC CHIASMA, the optic nerves continue, as optic tracts, to the cerebrum.
Within the brain, visual impulses are interpreted as light
REFLEXES OF THE EYE

LIGHT REFLEX
- pupil becomes smaller when light is flashed in
the eye
B. ACCOMODATION REFLEX
- pupil becomes smaller when gaze is shifted
from distant to near object
PHYSIOLOGY OF BINOCULAR VISION

CONVERGENCE OF VISUAL AXES
-coordinated movement of 2 eyes toward fixation of same near point
B. REGULATION OF PUPIL SIZE
-regulating amount of light entering eyes by

changing pupil sizes
C. REFRACTION OF LIGHT RAYS
- rays are refracted or bent as they pass thru
varying densities
D. ACCOMMODATION
a. near vision- ciliary muscle contract, lens
bulges /convex
b. distant vision- ciliary muscle relaxes, lens
flattens
ASSESSMENT OF VISION
VISUAL ACUITY TEST
- measures the clients distance & near vision
SNELLEN CHART
- simple tool to record visual acuity
- the client stands 20 ft from the chart & covers 1
eye and uses the
other eye to read the line that appears more
clearly
- this procedure is repeated for the other eye
- the findings are recorded as a comparison
between what the client can read at 20 ft and
the no. of feet normally required by an individual to read the same line
EXAMPLE: 20/50
- The client is able to read at 20 ft from the chart
what a healthy eye can read at 50 ft
CONFRONTATIONAL TEST
- Performed to examine visual fields or peripheral

vision
- The examiner & the client sit facing each other
- The test assumes that the examiner has normal
peripheral vision
EXTRAOCULAR MUSCLE FUNCTION
- tests muscle function of the eyes
- tests 6 cardinal positions of gaze
1. Clients right (lateral position)
2. Upward & right (temporal position)
3. Down & right
4. Clients left (lateral position)
5. Upward & left (temporal position)
6. Down & left
- client holds head still & asked to move eyes &
follow a small object
- the examiner looks for any parallel movements
of the eye or for
NYSTAGMUS
- an involuntary rhythmic rapid twitching of
the eyeballs
ASSESSMENT OF VISION
COLOR VISION TEST
- Tests for color vision which involve picking nos. or letters out of a
complex & colorful picture
ISHIHARA CHART
- consists of nos. that are composed of colored dots located within a circle
of colored dots
- client is asked to read the nos. on the chart
- each eye is tested separately
- the test is sensitive for the diagnosis of
red/green blindness but not
effective for the detection of the discrimination
of blue
PUPILS
- Normal: round & of equal size
- Increasing light causes pupillary constriction
Decreasing light causes pupillary dilation
- the client is asked to look straight ahead while
the examiner quickly
brings a beam of light ( penlight) in from the side
& directs it onto the side
- CONSENSUAL
RESPONSE
DIAGNOSTIC TESTS FOR THE EYE

1. FLUORESCEIN ANGIOGRAPHY
- detailed imaging & recording of ocular circulation by
a series of photographs after administration of the
dye
PRE-OP NURSING CARE
Assess for allergies & previous reactions to dyes
Obtain informed consent

A mydriatic medication is instilled in the eye 1 hr. before the test
The dye is injected into the vein of the clients arm
Inform client that the dye may cause the skin to appear yellow for several hrs. after the test & this is
gradually eliminated through the urine
The client may experience N&V, sneezing, paresthesia of the tongue or pain at the injection site
If hives appear, oral or IM antihistamines such as Diphenhydramine
(Benadryl) are given as prescribed.
POST-OP NURSING CARE
Encourage rest.
Encourage oral fluids.
Remind the client that the yellow skin appearance will disappear
Instruct the client that the urine will appear bright green until the dye is excreted
Instruct the client to avoid direct sunlight for a few hrs after the test.
Instruct the client that the photophobia will continue until pupil size
returns to normal
2. COMPUTED TOMOGRAPHY
- a beam of x-ray scans the skull & orbits of the eye
- a cross-sectional image is formed by the use of a
computer
- contrast material is not usually administered
NURSING CARE
No special client preparation or follow-up care required
Instruct the client that he or she will be positioned in a confined space & need to keep the head still
during the procedure.
3. SLIT LAMP
- allows examination of the anterior ocular structures
under microscopic magnification
- the client leans on a chin rest to stabilize the head

while a narrow beam of light is aimed so that it
illuminates only a narrow
segment of the eye.
NURSING CARE
Explain the procedure to the client.
Advise the client about the brightness of the light & the need to look forward at the point over the
examiners ear
4. CORNEAL STAINING
- installation of a topical dye into the conjunctival sac
to outline the irregularities of the corneal surface
that are not easily visible
- the eye is viewed through a blue filter, and a bright
green color indicates areas of non-intact corneal
epithelium
NURSING CARE
If a client wears contact lenses, they must be removed
The client is instructed to blink after the dye has been applied to distribute the dye evenly across the
cornea
5. TONOMETRY
- the test is primarily used to assess for an increase in
IOP and potential glaucoma
- NORMAL IOP: 8-21 mm Hg
NURSING CARE
Each eye is anesthetized.

The client is asked to stare forward at a point above the examiners ear
A flattened cone is brought in contact with the cornea
The amount of pressure needed to flatten the cone is measured
The client is instructed to avoid rubbing the eye following the examination if the eye has been
anesthetized
- the potential for scratching the cornea exists
OPTHALMIC MEDICATIONS
PARASYMPATHOLYTIC DRUGS
- used pre-op or for eye examinations to produce mydriasis
- C/I in clients with glaucoma because of the risk of
increased IOP
- Mydriatics are C/I in cardiac dysrhythmias &

cerebral atherosclerosis & should be used with
caution in the elderly & in clients with prostatic hypertrophy, DM or parkinsonism
MYDRIATICS, CYCLOPLEGIC & ANTICHOLINERGIC medications

MYDRIATICS
- dilate the pupils (mydriasis)
CYCLOPLEGIA
- relax the ciliary muscles
ANTICHOLINERGICS
- block responses of the sphincter muscle in the
Ex.
Atropine sulfate (Isopto-Atropine, Ocu-Tropine, Atropair, Atropisol)
Scopolamine hydrobromide (Isopto-Hyoscine)
Cyclopentolate hydrochloride (Cyclogyl, AK-Pentolate, Pentolair)
Homotropine hydrobromide (Isopto Homatrine, AK-Homatropine,
ciliary body, producing mydriasis
Spectro-Homatrine)
Tropicamide (Mydriacyl, I-Picamide, Tropicacyl)
Phenylephrine hydrochloride (AK-Dilate, Dilatair, Mydfrin, Ocu-Phrin)
NURSING RESPONSIBILITIES
Monitor for allergic reactions
Assess for risk of injury
Assess for constipation & urinary retention
Instruct the client that a burning sensation may occur
on installation
Instruct the client not to drive or operate machine for 24 hrs after installation of the medication
unless otherwise directed by the physician
Instruct the client to wear sunglasses until the effects of the medication wear off
Instruct to notify MD if blurring of vision, loss of sight, difficulty in breathing, sweating or flushing occurs
Instruct the client to report eye pain to the physician
PARASYMPATHOMIMETIC
A. GROUP I: MIOTIC CHOLINERGIC DRUGS
acetylcholine
- act directly on the myoneural junction & produce
body
musculature ( accommodation)
B. GROUP II: CHOLINESTERASE INHIBITORS
- reduce IOP by inhibiting the action of cholinesterase
- action of this drug is difficult to reverse
MIOTICS
- reduce IOP by constricting the pupil & contracting the
ciliary muscle, thereby increasing the blood flow to
the retina & decreasing retinal damage & loss of
vision
- open the anterior chamber angle & increase the
- - reduce IOP by mimicking the action of

strong contractions of the iris ( miosis) & ciliary
outflow of aqueous humor

- used for chronic open-angle glaucoma or acute &
chronic closed-angle glaucoma
- used to achieve miosis during eye surgery
- C/I in clients with retinal detachment, adhesions
between the iris & lens, or inflammatory diseases
- used with caution in clients with asthma,

hypertension, corneal abrasion,hyperthyroidism,
coronary vascular disease, urinary tract obstruction,
GI obstruction, ulcer disease, parkinsonism, or
bradycardia
Ex.
Acethylcholine Cl (Miochol)
Carbachol (Miostat)
Pilocarpine HCl (Isopto Carpine, Pilocar)
Pilocarpine nitrate (Pilofrin, Liquifilm, Pilagan)
Echothiophate iodide (Phospholine iodide)
Demecarium bromide (Humorsol)
Isoflurophate (Floropryl)
NURSING CARE
Assess V/S & risk of injury
Assess the client for the degree of diminished vision
Monitor for postural hypotension & instruct the client to change positions slowly
Assess breath sounds for rales & rhonchi
cholinergic meds cause bronchospasms &
increased bronchial secretions
Maintain oral hygiene due to increased salivation
Have Atropine sulfate available as antidote for Pilocarpine

Instruct the client not to stop the meds suddenly
Instruct to avoid activities such as driving while vision is impaired
Instruct clients with glaucoma to read labels on OTC meds & to avoid Atropine-like meds
Atropine increase IOP
BETA-ADRENERGIC BLOCKING EYE MEDICATIONS

- IOP by decreasing sympathetic impulses & decreasing
aqueous humor production w/o affecting
accommodation or pupil size
- Used to treat chronic open-angle glaucoma
- C/I in the client with asthma
EX.
Betaxolol HCl (Betoptic)
Carteolol HCl (Ocupress)
Levobunolol HCl (Betagan)
Metipranolol (Optipranolol)
Timolol maleate (Timoptic)
NURSING CARE
Monitor V/S before administering medication esp. BP & PR
If the pulse is below 60 or if systolic BP is below 90 mm Hg, withhold the medication & contact MD
Monitor for shortness of breath and I&O
Instruct the client to notify MD if shortness of breath occurs
Instruct not to D/C medication abruptly
Instruct to change positions slowly to avoid orthostatic hypotension
Instruct to avoid hazardous activities
Instruct to avoid OTC meds without the MDs approval
ADRENERGIC EYE MEDICATIONS

- Decrease the production of aqueous humor & lead
to a decrease in IOP
- Used to treat glaucoma
ADRENERGIC MEDICATIONS
Apraclonidine HCl (Iopidine)
Brimonidine tartrate (Alphagen)
Dipivefrin HCl (Propine)
Epinephrine borate (Epinal, Eppy)
Epinephrine HCl (Epifrin, Glaucon)
CARBONIC ANHYDRASE MEDICATIONS

- Interfere with the production of carbonic acid
which leads to decreased aqueous humor
formation & decreased IOP
- Used for long-term treatment of open-angle
glaucoma
- C/I in the client allergic to sulfonamides
EX.
ACETAZOLAMIDE ( DIAMOX)
DICHLORPHENHAMIDE (DARANIDE, ORATROL)
ETHOXYZOLAMIDE (CARDRASE, ETHAMIDE)
METHAZOLAMIDE (NEPTAZANE)
NURSING CARE
Monitor V/S
Assess visual acuity

Monitor I&O
Monitor weight
Maintain oral hygiene
Monitor for lethargy, anorexia, drowsiness, polyuria, N/V
Monitor electrolytes for hypokalemia
Increase fluid intake unless C/I
Advise the client to avoid prolonged exposure to sunlight
Encourage the client to use artificial tears for dry eyes
Instruct not to D/C the medication abruptly
Instruct to avoid hazardous activities while vision impaired
OSMOTIC MEDICATIONS
- Lower IOP
- Used in emergency treatment of acute closedangle glaucoma
- Used pre-op & post-op to decrease vitreous humor

volume
EXAMPLES
Glycerin (Glyrol, Osmoglyn)
Mannitol (Osmitrol)
Urea (Ureaphil)
NURSING CARE
Assess V/S, visual acuity & risk for injury
Monitor weight and I&O
Monitor electrolytes
Increase fluid intake unless C/I
Monitor for changes in level of orientation
EYE LUBRICANTS
- Replace tears or add moisture to the eyes
- Moisten contact lenses or an artificial eye
- Protect the eyes during surgery or diagnostic
procedures
- Used for keratitis, during anesthesia or in a
disorder that results in unconsciousness or
decreased blinking
EXAMPLES
Hydroxypropyl methylcellulose (Lacril, Isopto Plain)
Petroleum-based ointment (Artificial Tears, Liquifilm Tears)
NURSING CARE
Inform the client that burning may occur on installation
Be alert to allergic responses to the preservatives in the lubricants
TOPICAL ANESTHETICS FOR THE EYE

- Produce corneal anesthesia
- Used for anesthesia for eye examinations, surgery,
or to remove foreign bodies from the eye
EXAMPLES
Proparacaine HCl (Ophthaine, Opthenic)
Tetracaine HCl (Pontocaine)
NURSING CARE
Note that the medications should not be given to the client for home use & are not to be selfadministered by the client
Note that the blink reflex is temporarily lost & that the corneal epithelium needs to be protected
Provide an eye patch to protect the eye from injury until the corneal reflex returns
ANTI-INFECTIVE EYE MEDICATIONS

ANTIBACTERIAL
Chloramphenicol (Chloromycetin, Chloroptic)
Ciprofloxacin hydrochloride (Cipro)
Erythromycin (Ilotycin)
Gentamicin sulfate (Garamycin, Genoptic)
Norfloxacin (Chibroxin)
Tobramycin (Nebcin, Tobrex)
Silver nitrate 1%
ANTIFUNGAL
Natamycin (Natacyn Opthalmic)
ANTIVIRAL
Idoxuridine (Herplex-Liquifilm)
Trifluridine (Viroptic)
Vidarabine (Vira-A Opthalmic)
NURSING CARE
Instruct the client in how to apply the eye medication
Instruct the client to continue treatment as Rx
Instruct the client to wash hands thoroughly & frequently
Advise the client that if improvement does not occur, notify the MD
ANTI-INFLAMMATORY EYE MEDICATIONS

EXAMPLES
Dexamethasone (Maxidex)
Diclofenac (Voltaren)
Flurbiprofen Na (Ocufen)
Suprofen (Profenal)
Ketorolac tromethamine (Acular)
Prednisone acetate (Predforte, Econopred)
Prednisolone Na phosphate (AK-Pred, Inflamase)
Rimaxolone (Vexol)
DISORDERS OF THE EYE
LEGALLY BLIND
- a person is legally blind if the best visual acuity with
corrective lenses in the better eye is 20/200 or less or
a visual field of 20 degrees or less in the better eye
NURSING CARE
When speaking to a client who has limited sight or blind, the nurse uses a normal tone of voice
Alert the client when approaching
Orient the client to the environment
Use a focal point & provide further orientation to the environment from the focal point
Allow the client to touch objects in the room
Use the clock placement of foods on the meal tray to orient the client
Promote independence as much as possible
Provide radios, TVs, & clocks that give the time orally or provide a Braille watch.
When ambulating, allow the client to grasp the nurses arm at the elbow
Instruct the client to remain one step behind the nurse when ambulating
Instruct the client in the use of the cane used for the blind client, which is differentiated from other
canes by its straight shape & white color with red tip
Instruct the client that the cane is held in the dominant hand several inches off the floor
Instruct the client that the cane sweeps the ground where the clients foot will be placed next to
determine the presence of obstacles
1. CATARACTS
- an opacity of the lens that distorts the image
projected onto the retina & that can progress to
blindness
- intervention is indicated when visual acuity has been
reduced to a level that the client finds to be
unacceptable or adversely affecting lifestyle
CAUSES
Aging process (Senile cataracts)
Inherited (Congenital cataracts)
Injury (Traumatic cataracts)
Can occur as a result of another eye disease (Secondary cataracts)
ASSESSMENT
Opaque or cloudy white pupil
Gradual loss of vision
Blurred vision
Decreased color perception
Vision that is better in dim light with pupil dilation
Photophobia
Absence of red reflex
MEDICAL MANAGEMENT
- surgical removal of the lens, one eye at a time
- a lens implantation may be performed at the time
of surgical procedure
EXTRACAPSULAR EXTRACTION
- the lens is lifted out w/o removing the lens capsule
- may be performed with Phacoemulsion
PHACOEMULSIFICATION
- the lens is broken up by ultrasonic vibrations &
extracted
INTRACAPSULAR EXTRACTION
- the lens is removed within its capsule through as
small incision
PRE-OP NURSING CARE
Instruct measures to prevent or decrease IOP
Administer pre-op eye medications including mydriatics & cycloplegics as prescribed
Elevate the head of the bed 30-45 degrees
Turn the client to the back or un-operative side
Maintain an eye patch & orient the client to the environment
Position the clients personal belongings on the un-operative side
Use side rails for safety
Assist with ambulation
CLIENT EDUCATION AFTER CATARACT SURGERY
Avoid eye straining
Avoid rubbing or placing pressure on the eyes
Avoid rapid movements, straining, sneezing, coughing, bending, vomiting, or lifting objects over 5 lbs
Teach measures to prevent constipation
Wipe excess drainage or tearing with a sterile wet cotton ball from the inner to the outward canthus
Use an eye shield at bedtime
If an eye implant is not performed, the eye cannot accommodate & glasses must be worn at all times
Cataract glasses act as magnifying glasses & replace central vision only
Cataract glasses magnify, & objects appear closer therefore teach client to judge distance & climb
stairs carefully
Contact lenses provide sharp visual acuity but dexterity is needed to insert them
Contact the MD for any decrease in vision, severe eye pain or increase in eye discharge
2. GLAUCOMA
- increased IOP as a result of inadequate drainage of
aqueous humor from the canal of Schlemm or over
production of aqueous humor
- the condition damages the optic nerve & can result
in blindness
TYPES
A. ACUTE = a rapid onset of IOP > 50-7- mm Hg
CLOSED-ANGLE/NARROW ANGLE GLAUCOMA
- results from obstruction to outflow to
aqueous humor
B. CHRONIC = a slow progressive, gradual onset of IOP>30-50 mmHg
CLOSED-ANGLE GLAUCOMA
- follows an untreated attack of acute close-angled
glaucoma
OPEN-ANGLE GLAUCOMA
- results from an overproduction or obstruction to
the outflow of aqueous humor
ASSESSMENT
Progressive loss of peripheral vision followed by a loss of central vision
Elevated IOP (Normal pressure is 10-21 mm Hg)
Vision worsening in the evening with difficulty
adjusting to dark rooms
Blurred vision
Halos around white lights
Frontal headaches
Photophobia
Increased lacrimation
Progressive loss of central vision
NURSING CARE FOR ACUTE GLAUCOMA
Treat as medical emergency
Administer medications as prescribed to lower IOP
Prepare the client for peripheral iridectomy
- allows aqueous humor to flow from the posterior
to anterior chamber
NURSING CARE FOR CHRONIC GLAUCOMA
Instruct the client the importance of medications

a. MIOTICS: to constrict the pupils
b. CARBONIC ANHYDRASE INHIBITORS: to decrease
the production of aqueous humor
c. BETA-BLOCKERS: to decrease the production of
aqueous humor & IOP
Instruct the client the need for life-long medication use
Instruct the client to wear a Medic-Alert bracelet
Instruct the client to avoid anti-cholinergic medications
Instruct the client to report eye pain, halos around eyes & changes of vision to the physician
Instruct the client that when maximal medical therapy has failed to halt the progression of visual field
loss & optic nerve damage,
surgery will be recommended
Prepare the client for TRABECULOPLASTY as prescribed
to facilitate aqueous humor drainage
Prepare client for TRABECULECTOMY as prescribed
- allows drainage of aqueous humor into the
conjuctival spaces by the creation of an opening
3. RETINAL DETACHMENT
- occurs when the layers of the retina separate because
of accumulation of fluid between them
- also occurs when both retinal layers elevate away
from the choroid as a result of a tumor
TYPES
PARTIAL RETINAL DETACHMENT
- becomes complete if left untreated
COMPLETE RETINAL DETACHMENT
- when detachment is complete, blindness may occur

ASSESSMENT
Flashes of light
Floaters
Increase in blurred vision
Sense of curtain being drawn
Loss of a portion of the visual field
IMMEDIATE NURSING CARE
Provide bedrest
Cover both eyes with patches to prevent further detachment
Speak to the client before approaching
Position the clients head as prescribed
Protect the client from injury
Avoid jerky head movements
Minimize eye stress
Prepare the client for surgical procedure as prescribed
MEDICAL MANAGEMENT
- draining fluid from the subretinal space so that the
retina can return to the normal position
SEALING RETINAL BREAKS BY CRYOSURGERY
- a cold probe applied to the sclera to stimulate an
inflammatory response leading to adhesions
DIATHERMY
- the use of electrode needle & heat through the
sclera to stimulate an inflammatory response
leading to adhesions
LASER THERAPY
- to stimulate an inflammatory response to seal small
retinal tears before the detachment occurs

SCLERAL BUCKLING
- to hold the choroid & retina together with a splint
until scar tissue forms closing the tear
INSERTION OF A GAS OR SILICONE OIL
- to encourage attachment because these agents
have a specific gravity less than vitreous or air & can
float against the retina
Maintain eye patches bilaterally as prescribed
Monitor hemorrhage as prescribed
Prevent N&V and monitor for restlessness which can cause hemorrhage
Monitor for sudden, sharp eye pain (notify the MD stat)
Encourage DBE but avoid coughing
Provide bed rest for 1-2 days as prescribed
If gas has been inserted, position as prescribed on the abdomen & turn the head so unaffected eye is
down
Administer eye medications as prescribed
Assist client with ADL
Avoid sudden head movements or anything that increases IOP
Instruct the client to limit reading for 3-5 weeks
Instruct client to avoid squinting, straining & constipation, lifting heavy objects &
bending from the waist
Instruct the client to wear dark glasses during the day & an eye patch at night
Encourage follow-up care because of the danger of recurrence or occurrence in the other eye
4. STRABISMUS
- called SQUINT EYE or LAZY EYE
- a condition in which the eyes are not aligned

because of lack of muscle coordination of the
extraocular muscles
- most often results from muscle imbalance or
paralysis of extraocular muscles, but may also result
from conditions such as brain tumor, myasthenia
gravis or infection
- normal in young infant but should not be present
after about age 4 months
ASSESSMENT
Amblyopia if not treated early
Permanent loss of vision if not treated early
Loss of binocular vision
Impairment of depth perception
Frequent headaches
Squints or tilts head to see
NURSING CARE
Corrective lenses as indicated
Instruct the parents regarding patching (occlusion therapy) of the good eye ( to strengthen the weak
eye)
Prepare for botulinum toxin (Botox) injection into the eye muscle
-
produces temporary paralysis
allows muscles opposite the paralyzed muscle

to strengthen the eye
Inform the parents that the injection of botulinum toxin wears off in about 2 months & if successful,
correction occurs
Prepare for surgery to realign the weak muscles as Rx if nonsurgical
Instruct the need for follow-up visits
interventions are unsuccessful
5. CONJUNCTIVITIS
- also known as PINK EYE
- inflammation of the conjunctiva
- usually caused by allergy, infection, or trauma
TYPES
BACTERIAL OR VIRAL CONJUNCTIVITIS
- extremely contagious
CHLAMYDIAL CONJUNCTIVITIS
- is rare in older children & if diagnosed in a child who
is not sexually active, the child should be assessed for
possible sexual abuse
ASSESSMENT
Itching, burning or scratchy eyelids
Redness
Edema
Discharge
NURSING CARE
Instruct in infection control measures such as good handwashing & not sharing towels & washcloths
Administer antibiotic or antiviral eye drops or ointment as Rx if infection is present
Administer antihistamines as Rx if an allergy is present
Instruct the parents that the child should be kept home from school or day care until antibiotic eye
drops have been administered for 24 hrs
Instruct in the use of cool compresses to lessen irritation & in wearing dark glasses for photophobia
Instruct the child to avoid rubbing the eye to prevent injury
D/C use of contact lenses & to obtain new lenses to eliminate the chance of re-infection
Instruct the adolescent that eye make-up should be discarded & replaced
EARS
EXTERNAL EAR
- Embedded in the temporal bone bilaterally at the
level of the eyes
- Extends from the auricle through the external canal
to the tympanic membrane or eardrum
- Includes the mastoid process, a bony ridge located
over the temporal bone
A. AURICLE (PINNA)
- Outer projection of ear composed of cartilage &
covered by skin
- collects sound waves
B. EXTERNAL AUDITORY CANAL
- Lined with skin
- Glands secrete cerumen (wax)
- provides protection
- transmits sound waves to tympanic membrane
C. TYMPANIC MEMBRANE (EARDRUM)
- Located at the end of the external canal
- Vibrates in response to sound & transmit vibrations
to middle ear
MIDDLE EAR
- Consists of the medial side of the tympanic
membrane
- The tympanic membrane is a thick transparent sheet
of tissue that provides a barrier between the
external ear & the middle ear

- The middle ear is protected from the inner ear by
the round & the oval window membranes
- The eustachian tube opens into the middle ear &
allows for equalization of pressure on both sides of
the tympanic membrane
A. OSSICLES
- Contains 3 small bones: Malleus (Hammer)
Stapes (Stirrup)
- Ossicles are set in motion by sound waves from

malleus to the footplate of the stapes in the oval
window
B. EUSTACHIAN TUBE
- Connects nasopharynx & middle ear
- Equalizes pressure on both sides of eardrum
INNER EAR
- Contains the semi-circular canals, the cochlea & the
distal end of the 8th cranial nerve
- Maintains sense of balance & equilibrium
A. SEMI-CIRCULAR CANALS
- Contains fluid & hair cells connected to sensory
nerve fibers of the vestibular portion of 8th
cranial nerve
B. COCHLEA
- Spiral-shaped organ of hearing
- Connects organ of Corti, receptor and organ for
Incus (Anvil)
hearing
- Transmits sound waves from the oval window &
initiates nerve impulses carried by cranial nerve
VIII (acoustic branch) to brain ( temporal lobe of
cerebrum)
C. 8th CRANIAL NERVE
1. COCHLEAR BRANCH
- transmits neuro-impulses from the cochlea to the
brain where it is interpreted as sound
2. VESTIBULAR BRANCH
- maintains balance & equilibrium
HEARING & EQUILIBRIUM

The external ear conducts sound waves to the middle ear
The middle ear also called the tympanic cavity conducts sound waves to the inner ear
The middle ear is filled with air which is kept at atmospheric pressure by the opening of the Eustachian
tube
The inner ear contains sensory receptors for sound & forequilibrium
The receptors in the inner ear transmit sound waves & changes in body position to the nerve impulses
ASSESSMENT OF THE EAR

OTOSCOPIC EXAM
GUIDELINES
- the speculum is never blindly introduced into the
external canal because of the risk of perforating
the tympanic membrane
- tilt the head slightly away & hold the otoscope
upside down as if it were a large pen
- this permits the examiners hand to lie against the

head for support
- pull the pinna up & back to straighten the external
canal in an adult
- visualize the external canal while slowly inserting
the speculum
NORMAL FINDINGS OF THE EXTERNAL CANAL
Pink & intact without lesions
Has various amounts of cerumen & fine little hairs
NORMAL FINDINGS OF THE TYMPANIC MEMBRANE
The tympanic membrane should be intact without perforations & free from lesions
The tympanic membrane is transparent, opaque, pearly gray & slightly concave
AUDITORY ASSESSMENT
Sound is transmitted by air conduction & bone conduction
Air is 2-3x longer than bone conduction
CATEGORIES OF HEARING LOSS

CONDUCTIVE HEARING LOSS
- due to any physical obstruction to the transmission
of sound waves
SENSORINEURAL HEARING LOSS
- due to a defect in the organ of hearing, in the 8th
cranial nerve, or in the brain itself
MIXED CONDUCTIVE, SENSORINEURAL HEARING LOSS
- results in profound hearing loss
VOICE TEST
Ask the client to block one external canal

The examiner stands 1-2 ft away & quickly whispers a statement
The client is asked to repeat the whispered statement
Each ear is tested separately
WATCH TEST
A ticking watch is used to test the high-frequency sounds
The examiner holds a ticking watch about 5 inches from each ear & asks the client if the ticking is
heard.
TUNING FORK TESTS

A. WEBER TUNING FORK TEST
CONDUCTIVE HEARING LOSS = the sound is heard in affected ear
SENSORINEURAL HEARING LOSS= sound heard in the unaffected ear
B. RINNE TUNING FORK TEST
NORMAL RESULT: (+) RINNE TEST/ AC>BC
CONDUCTIVE HEARING LOSS
If the client is unable to hear the sound through the ear in front of the pinna, (-) RINNE TEST/ AC<BC
VESTIBULAR ASSESSMENT OF THE EAR

TEST FOR FALLING
The examiner asks the client to stand with the feet together & arms hanging loosely at the sides &
eyes closed
The client normally remains erect with slight swaying
ABNORMAL RESULT: (+) ROMBERG SIGN
- presence of significant swaying
TEST FOR PAST POINTING

NORMAL TEST RESPONSE:
- The client can easily return to the point of
reference
FINDINGS
The client with vestibular function problem lacks a normal sense of position sense and is unable to
return to the extended fingers to the point of reference, the fingers instead either goes to the right or left
of the reference point
GAZE NYSTAGMUS EVALUATION
Examine the clients eyes as they look straight ahead, 30 degrees to each side, upward & downward
FINDINGS
- Any spontaneous nystagmus is a (+) result
- ABNORMAL FINDING
- a constant involuntary cyclic movement of the
eyeball in any direction represents a problem with
the vestibular system
HALLPIKE MANEUVER
Assesses for positional vertigo or induced dizziness
The client assumes a supine position
The head is rotated to one side for 1 minute
FINDINGS
(+) test result is presence of nystagmus after 5-10 sec
- ABNORMAL FINDING
- a constant involuntary cyclic movement of the
eyeball in any direction represents a problem with
the vestibular system
DIAGNOSTIC TESTS FOR THE EAR

TOMOGRAPHY
- may be performed with or without contrast
medium
- assesses the mastoid, middle ear & inner ear

structures
- multiple x-rays of the head are done
NURSING CARE
All jewelry are 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
No follow-up care is required
AUDIOMETRY
- measures hearing acuity
- uses 2 types: PURE TONE AUDIOMETRY & SPEECH
AUDIOMETRY
- after testing, audiogram patterns are depicted on a
graph to determine the type & level of hearing loss
PURE TONE AUDIOMETRY

- used to identify problems with hearing, speech,
music & other sounds in the environment
SPEECH AUDIOMETRY
- the clients ability to hear spoken words is measured
NURSING CARE
Inform the client regarding the procedure
Instruct the client to identify the sounds as they are heard
ELECTRONYSTAGMOGRAPHY
- evaluates spontaneous nystagmus
- used to distinguish between normal nystagmus &

either medication-induced nystagmus or
nystagmus caused by a lesion in the central or
peripheral vestibular pathway
- records changing electrical fields with movement
of the eye, as monitored by electrodes placed on
the skin around the eye
CALORIC TEST (BI-THERMAL TEST)

- evaluate dizziness
- Nystagmus, N/V or ataxia
- indicate a pathological condition of the labyrinth
system, whereas a decreased response may
indicate that the vestibular system is affected
NURSING CARE
Warm water causes a greater response than cold water
Warm water caloric testing (irrigation) precedes cool water caloric testing (irrigation)
The character & duration of the eye movements are measured
The client must assume a supine position with eyes closed & head elevated to 30 degrees
After the procedure, the client begins taking clear fluids slowly & cautiously because N & V may occur
Assistance with ambulation may also be necessary following the procedure
OTIC MEDICATIONS
ADMINISTERING EAR DROPS
ADULT
Pull the pinna up & back to straighten the external canal to instill ear drops
CHILD
Pull the pinna down & back for infants & children younger than 3 years of age
Pull the pinna up & back for children for children more than 3 years
IRRIGATION OF THE EAR
Irrigation of the ear needs to be prescribed by MD
Ensure that there is direct visualization of the tympanic membrane
Warm irrigating solution to 100 F
-
solutions not close to the clients body temp

will cause ear injury, nausea & vertigo
Irrigation must be done gently to avoid damage to the eardrum

When irrigating, dont direct irrigating solution directly toward the eardrum
If perforation of the eardrum is suspected, irrigation is not done
MEDICATIONS THAT AFFECT HEARING

ANTIBIOTICS
Amikacin (Amikin)
Chloramphenicol
- Chloromycetin
- Chloroptic
- Ophthoclor
Erythromycin
- E-Mycin
- ERYC
- Ery-Tab
- PCE Dispertabs
- Ilotycin
Gentamicin (Garamycin)
Streptomycin sulfate
(Streptomycin)
Tobramycin sulfate (Nebcin)
Vancomycin (Vancocin)
DIURETICS
Acetazolamide (Diamox)
Furosemide (Lasix)
Ethacrynic acid (Edecrine)
OTHERS
Cisplatin (Platinol, Platinol-AQ)
Nitrogen mustard
Quinine (Quinamn)
Quinidine
- Cardioquin
- Quinaglute
- Quindex
ANTI-INFECTIVE MEDICATIONS
EXAMPLES
Amoxicillin (Amoxil)
Ampicillin trihydrate (Polycillin)
Cefaclor (Ceclor)
Clindamycin HCl (Cleocin)
Trimethoprim (TMP) & Sulfamethaxazole (SMZ)
-
Bactrim, Cotrim, Septra
Erythromycin (Ilotycin, E-Mycin)

Penicillin V potassium (Pen V)
Loracarbef (Lorabid)
Clarithromycin (Biaxin)
Polymyxin B sulfate (Aerosporin)
Tetracycline HCl (Achromycin)
Acetic acid and Aluminum acetate (Otic Domeboro)
ANTI-HISTAMINES & DECONGESTANTS

- Produce vasoconstriction
- Stimulate the receptors of the respiratory mucosa
- Reduce respiratory tissue hyperemia & edema to
open obstructed eustachian tubes
- Used for acute otitis media
SIDE EFFECTS
Drowsiness
Blurred vision
Dry mucous membranes
NURSING CARE
Inform the client that drowsiness, blurred vision, & dry mouth may occur
Instruct the client to increase fluid intake unless C/I & to suck on hard candy to alleviate dry mouth
Instruct the client to avoid hazardous activities if drowsiness occurs
EXAMPLES
Tripolidine & pseudoephedrine (Actifed)
Naphazoline HCl (Allerest, Albalon)
Chlorpheniramine (Chlor-Trimeton, Teldrin)
Brompheniramine (Bromphen, Dimetane)
Terfenadine (Seldane)
Clemastine (Tavist)
Cetirizine (Zyrtec)
Astemizole (Hismanal)
LOCAL ANESTHETICS
MEDICATION :
Benzocaine (Americaine Otic; Tympagesic)
SIDE EFFECTS
Allergic reaction
Irritation
NURSING CARE
Monitor for effectiveness if used for pain relief
Assess for irritation or allergic reaction
CERUMINOLYTIC MEDICATIONS
EXAMPLES
Carbamide peroxide (Debrox)
Boric acid (Ear-Dry)
NURSING CARE
Instruct the client not to use drops more often than prescribed
Moisten a cotton plug with medication before insertion
Keep the container tightly closed & away from moisture
Avoid touching the ear with the dropper
30 minutes after installation, gently irrigate the ear as Rx with warm water using a rubber bulb ear
syringe
Irrigation may be done with hydrogen peroxide soln as Rx
For chronic cerumen impaction, 1-2 gtts of mineral oil will soften the wax
Instruct the client to notify MD if redness, pain or swelling persists
DISORDERS OF THE EAR
1. CONDUCTIVE HEARING LOSS

- occurs when sound waves are blocked to the inner ear
fibers because of external ear or middle ear disorders
- disorders can often be corrected with no damage to
hearing, or minimal permanent hearing loss
CAUSES
Any inflammatory process or obstruction of the external or middle ear
Tumors
Otosclerosis
A build-up of scar tissue on the ossicles from previous middle ear surgery
2. SENSORINEURAL HEARING LOSS

- a pathological process of the inner ear or of sensory
fibers that lead to the cerebral cortex
CAUSES
Damage to the inner ear structures
Damage to the cranial nerve VIII
Prolonged exposure to loud noise
Medications, trauma, infections, surgery
Inherited disorders
Metabolic & circulatory disorders
Menieres syndrome
Diabetes mellitus
Myxedema
3. MIXED HEARING LOSS

- also known as conductive-sensorineural hearing loss
- client has both sensorineural & conductive hearing

loss
SIGNS OF HEARING LOSS : GENERAL

Frequently asking people to repeat statements
Straining to hear
Turning head or leaning forward to favor one ear
Shouting in conversations
Ringing in the ears
Failing to respond when not looking in the direction of the sound
Answering questions incorrectly
Raising the volume of the television or radio
Avoiding large groups
Better understanding of speech when in small groups
Withdrawing from social interactions
FACILITATING COMMUNICATION
Use of written words
Provision of light in the room
Getting the attention of the client before you begin to speak
Facing the client when speaking
Talking in a room without distracting noises
Moving close to the client & speaking slowly &
clearly
Keeping hands & other objects away from the mouth when talking to the client
Talking in lower tones, because shouting is not helpful
Rephrasing sentences & repeating information
Validating
Reading lips
Using sign language
Using telephone amplifiers
Facing lights that are activated by ringing of the telephone or doorbell
Specially trained dogs that help the client to be aware of sound & to alert the client of potential
dangers
COCHLEAR IMPLANTATION
- used for sensorineural hearing loss
- a small computer converts sound waves into
electrical impulses
- electrodes are placed by the internal ear with a
computer device attached to the external ear
- electronic impulses directly stimulate nerve fibers
HEARING AIDS
- used for the client with conductive hearing loss
- can help the client with sensorineural loss,
although it is not as effective
- a difficulty that exists in its use is the amplification
of background noise as well as voices
CLIENT EDUCATION: HEARING AID
Encourage to begin using the hearing aid slowly to develop an adjustment to the service
Adjust the volume to a minimal hearing level to prevent feedback squeaking
Teach the client to concentrate on the sounds that are to be heard & to filter out background noise
Instruct the client to clean ear mold with mild soap & water
Avoid excessive wetting of the hearing aid, and try to keep the hearing aid dry
Clean the ear cannula of the hearing aid with a toothpick or pipe cleaner
Turn off the hearing aid & remove the battery when not in use
Keep extra batteries on hand
Keep the hearing aid in a safe place

Prevent hair sprays, oils, or other hair & face products from coming into contact with the receiver of the
hearing aid
4. PRESBYCUSIS
- associated with aging
- leads to degeneration or atrophy of the ganglionic
cells in the cochlea & a loss of elasticity of the
basilar membranes
- leads to compromise of the vascular supply to the
inner ear with changes in several areas of the ear
structure
ASSESSMENT
Hearing loss is gradual & bilateral
Client states that he/she has no problem with hearing but cant understand what the words are
Client thinks that the speaker is mumbling
5. EXTERNAL OTITIS
- infective inflammatory or allergic responses
involving the structure of the external auditory
canal or the auricles
- an irritating or infective agent comes into contact
with epithelial layer of the external ear
- this leads to either an allergic response or S/S of
infection
- the skin becomes red, swollen, & tender to touch
on movement
- the excessive swelling of the canal lead to
conductive
hearing loss due to obstruction
- more common in children & termed as SWIMMERS
EAR
- occurs more often in hot, humid environments
ASSESSMENT
Pain
Itching
Plugged feeling in the ear
Redness & edema
Exudate
Hearing loss
NURSING CARE
Apply heat locally for 20 minutes 3x a day
Encourage rest to assist in reducing pain
Administer analgesics such as aspirin or acetaminophen (Tylenol) for the pain as prescribed
Instruct the client that the ears should be kept clean & dry
Instruct the client to use earplugs for swimming
Instruct the client that cotton-tipped applicators should not be used to dry ear because their use can
lead to trauma to the canal
Instruct the client that irritating agents such as hair products or headphones should be discontinued
6. OTITIS MEDIA
- infection of the middle ear occurring as a result of a
blocked eustachian tube, which prevents drainage
- a common complication of an acute respiratory
infection
ASSESSMENT
Fever
Irritability, restlessness & loss of appetite
Rolling of head from side to side
Pulling on or rubbing the ear
Earache or pain
Signs of hearing loss
Purulent ear drainage
Red, opaque, bulging or retracting tympanic membrane
NURSING CARE
Encourage oral fluids
Teach the parents to feed infants in an upright position
Instruct the child to avoid chewing during the acute period
-
chewing increases the pain
Provide local heat & have the child lie with affected ear down
Instruct the parents in the appropriate procedure to clean drainage from the ear with sterile cotton
swabs
Instruct in the administer of analgesics or antipyretics such as Acetaminophen (Tylenol) to decrease
fever & pain
Instruct the parents in the administration of prescribed antibiotics, emphasizing that the 10-14 day
period is necessary to eradicate positive organisms
Instruct the parents that screening for hearing loss may be necessary
MYRINGOTOMY
- temporary incision of tympanic membrane to
decompress the membrane and promote drainage
of effusion
- insertion of tympanoplasty tubes in the middle ear
to equalize pressure & keep the ears dry
Keep the ears dry
Earplugs should be worn during bathing, shampooing & swimming
Diving & submerging under water are C/I
Client education post myringotomy
Avoid strenuous exercise
Avoid rapid head movements, bouncing or bending
Avoid straining on bowel movement
Avoid drinking through a straw
Avoid traveling by air
Avoid forceful coughing
Avoid contact with persons with colds
Avoid washing hair, showering or getting the head wet for a week as Rx
Instruct the client that if she/he needs to blow the nose, blow one side at a time with wide mouth open
Instruct the client to keep ears dry by keeping a ball of cotton coated with petroleum jelly in the ear &
to change cotton ball daily
Instruct the client to report excessive ear drainage to the physician
7. CHRONIC OTITIS MEDIA

- a chronic infective, inflammatory, or allergic
response involving the structure of the middle ear
- surgical treatment is necessary to restore hearing
- the type of surgery can vary & include a simple
reconstruction of the tympanic membrane, a
myringotomy, or replacement of the ossicles

within the middle ear
TYMPANOPLASTY
- a reconstruction of the middle ear may be
attempted to improve conductive hearing loss
PRE-OP NURSING CARE
Administer antibiotic ear drops as Rx
Clear the ear of debris as Rx & irrigate ear with a solution of equal parts of vinegar & sterile H2Oas Rx
Instruct to avoid persons with URTI
Instruct client to obtain adequate rest, eat a balanced diet & drink adequate fluids
Instruct in DBE & coughing but forceful coughing avoided.
- increases pressure in the middle ear esp. post-op
Inform client that initial hearing after surgery is diminished & hearing will improve after the ear canal
packing is removed
Keep dressing clean & dry
Keep client flat with operative ear up for at least 12 hours
Administer antibiotics as Rx
Instruct the client that he/she may return to work in approximately 3 weeks post-op
8. OTOSCLEROSIS
- disease of the labyrinthine capsule of the middle
ear that results in a bony overgrowth of the tissue
surrounding the ossicles
- causes the devt of irregular areas of new bone
formation & causes fixation of the bones
- stapes fixation leads to CONDUCTIVE HEARING
LOSS
- if it involves inner ear, SENSORINEURAL HEARING

LOSS
ASSESSMENT
Slowly progressing conductive hearing loss
Bilateral hearing loss
A ringing or roaring type of constant tinnitus
Loud sounds heard in the ear when chewing
Pinkish discoloration (SCHWARTZS SIGN) of the tympanic membrane
- indicates vascular changes in the ear
(-) Rinne test
Weber test shows lateralization of the sound to the ear with the most conductive hearing loss
- it is not uncommon to have bilateral

involvement, although hearing loss may be
worse in one ear
- nonsurgical intervention promotes the
improvement of hearing through amplification
- surgical intervention involves removal of the
bony growth that is causing the hearing loss
- a PARTIAL STAPEDECTOMY or COMPLETE
STAPEDECTOMY WITH PROSTHESIS
(FENESTRATION) may be surgically performed
FENESTRATION
- removal of the stapes with a small hole drilled in
the footplate & a prosthesis is connected
between the incus & footplate
- sounds cause the prosthesis to vibrate in the
same manner as the stapes

COMPLICATIONS:
Complete hearing loss
Prolonged vertigo
Infection
Facial nerve damage
PRE-OP NURSING CARE
Instruct the client in measures to prevent middle ear or external ear infections
Instruct the client to avoid excessive nose blowing
Instruct not to clean the ear canal with cotton-tipped applicators
Instruct the client to remove the hearing aid 2 weeks before surgery to ensure the integration of local
tissue
Inform the client that hearing is initially worse after the surgical procedure & no noticeable
improvement in hearing may occur for as long as 6 weeks
Inform the client that the Gelfoam ear packing interferes with hearing but is used to decrease bleeding
Assist with ambulating during the first 1-2 days after surgery
Provide side rails when the client is in bed
Administer antibiotics & antivertiginous & pain meds as Rx
Assess for facial nerve damage, weakness, changes in taste sensation, vertigo, nausea & vomiting
Instruct to move head slowly when changing positions
Instruct to avoid showering & getting the head & wound wet
Instruct to refrain from using small objects to clean the external ear canal
Instruct to avoid rapid, extreme changes in pressure caused by quick head movements,
sneezing,nose blowing, straining & changes in altitude
Instruct to avoid changes in the middle ear pressure
- it could dislodge the graft prosthesis
MENIERES SYNDROME
- a syndrome also called ENDOLYMPHATIC HYDROPS

(- refers to dilation of the endolympathic system by
either overproduction or decreased reabsorption of
endolymphatic fluid)
- characterized by tinnitus, unilateral sensorineural
hearing loss, & vertigo
- symptoms occur in attacks & last for several days,
& the client becomes totally incapacitated
- initial hearing loss is reversible, but as the
frequency of attacks continues, hearing loss
becomes permanent
- repeated damage to the cochlea caused by
increased fluid pressure leads to the permanent
hearing loss
CAUSES
Any factor that increases endolymphatic secretion in the labyrinth
Viral & bacterial infections
Allergic reactions
Biochemical disturbances
Vascular disturbances producing changes in the microcirculation in the labyrinth
ASSESSMENT
Feelings of fullness in the ear
Tinnitus, as a continuous low-pitched roar or humming sound - is present most of the time but
worsens just before &
during severe attacks
Hearing loss is worse during an attack
Vertigo
- periods of whirling which might cause the client
to fall to the ground
- sometimes so intense that even when lying down,

the client holds the bed or ground in an attempt
to prevent the whirling
Nausea & vomiting
Nystagmus
Severe headaches
NON-SURGICAL MANAGEMENT
Preventing injury during vertigo attacks
Providing bed rest in a quiet environment
Provide assistance with walking
Instruct the client to move the head slowly
- to prevent worsening of vertigo
Initiate Na & fluid restrictions as Rx
Instruct to avoid smoking
Administer Nicotinic acid (Niacin) as Rx
- promote vasodilating effect
Administer antihistamines as Rx
- reduce the production of histamine &
inflammation
Administer antiemetics as Rx
Administer tranquilizers & sedatives as Rx
- to calm client & allow rest, control the vertigo,
N&V
SURGICAL MANAGEMENT
- performed when medical therapy is ineffective &
the functional level of the client has decreased
significantly
ENDOLYMPHATIC DRAINAGE & INSERTION OF THE SHUNT

- may be performed early in the course of the disease
to assist with the drainage of excess fluids
RESECTION OF THE VESTIBULAR NERVE
LABYRINTHECTOMY
- removal of the labyrinth may be performed
Assess packing & dressing on the ear
Speak to the client on the side of the unaffected ear
Perform neurological assessments
Maintain side rails
Assist with ambulating
Encourage the use of bedside commode
Administer antivertiginous& antiemetic medications as Rx
CERUMEN & FOREIGN BODIES

CERUMEN/EAR WAX
- the most common cause of impacted canals
FOREIGN BODIES
- can include vegetables, beads, pencil erasers &
insects
ASSESSMENT
Sensation of fullness in the ear with or without hearing loss
Pain, itching or bleeding
CERUMEN
NURSING CARE
Removal of the wax by irrigation is a slow process
Irrigation is C/I in clients with a hx of tympanic membrane perforation
To soften cerumen, add 3 gtts of glycerin to the ear @ hs & 3 gtts of hydrogen peroxide BID
After several days the ear is irrigated
-50-70 ml of solution is the maximal amount a client can tolerate during an irrigation sitting
FOREIGN BODIES
NURSING CARE
If the foreign matter is vegetable, irrigation is used with care
Insects are killed before removal unless they can be coaxed
out by flashlight or a humming noise
Mineral oil or alcohol is instilled to suffocate the insect which is then removed with ear forceps
Use small ear forceps to remove the object & avoid pushing the object farther into the canal &
damaging the tympanic membrane
EAR CARE
EAR PROTECTION
Protecting and Caring For Your Ears
The ears are delicate and irreplaceable instruments.
Once hearing is damaged, it often can't be restored.
So give your ears and your hearing the same level of care and attention as you do other vital parts
of your body.
General Nursing Care Tips
Have your ears and hearing checked periodically
Know the warning signs of hearing loss
See a medical professional right away if you:
injure your ears,
experience ear pain, or
notice changes in your ears or sense of hearing
Warning Signs of Hearing Loss
Difficulty hearing conversations, especially in the presence of background noise

Frequently asking others to repeat what theyve said
Misunderstanding what people say
Difficulty hearing on the telephone
Requiring the TV or radio volume to be louder than others in the room prefer
Feeling that people are mumbling when they are talking
Difficulty hearing certain environmental sounds, such as birds chirping
Agreeing or nodding your head during conversations when youre not sure whats been said
Removing yourself from conversations because its too difficult to hear
Reading lips so you can try to follow what people are saying
Straining to hear or keep up with conversations
Tinnitus
Preventing Hearing Loss

Avoid loud or prolonged exposure to noise.
When you can't avoid noise, wear ear protection.
If your ears produce excessive earwax, have your ears cleaned periodically by a health care
professional. (Do not use cotton swabs, as you will lodge more earwax even deeper into the ear canal
than the small amount of wax you will remove.)
Avoid ototoxic drugs. If taking one already, talk with your doctor and see if there's a less-ototoxic
alternative.
Stay healthy and be mindful of risk factors, such as hypertension.
Noise
Avoid exposure to loud noise.
best action: get rid of the noise or leave the noisy area.
Follow this simple rule of thumb: if you need to shout to be heard over noise, it's potentially damaging
When you cant avoid noise, always wear ear protection (earplugs or earmuffs)
Be aware that repeated or prolonged exposure to lower noise levels may cause hearing damage
Protect the ears of children who are too young to know the dangers that noise can pose
Cleaning of Ears
Clean ears with extra care.
Wipe the outer ear with a washcloth or tissue.
Never put anything into your ear thats smaller than an adult finger covered with a washcloth.
Using cotton swabs or other small object may damage the sensitive structures of your inner ear
Earwax is usually removed by the ears own cleaning mechanism.
If there is build-up of excess earwax, have it removed by a physician or medical professional.
Illness and Medications

Reduce the risk of ear infections by treating upper respiratory tract infections promptly
Some illnesses and medical conditions can affect hearing.
If experiencing sudden hearing loss or persistent noise in your ears or head (tinnitus), have it seen by a
health care provider/physician right away
Illness and Medications

Be aware that certain medications are ototoxic and may damage your hearing.
Take medications only as directed, and refer to you health care provider/physician immediately if you
experience unusual symptoms
Stop smoking.
Some studies have found that adults who smoke are more likely to develop hearing loss than
nonsmokers.
Smoking can also aggravate existing conditions, such as tinnitus
Blowing of the nose
A study conducted by a team of researchers from the University of Virginia and the University of Aarhus
in Denmark, revealed that blowing your nose may actually cause mucus to be propelled back into the
sinus cavities.
Also, blowing the nose creates a huge amount of pressure in the nose -- over seven times more
pressure than is produced by sneezing or coughing.
Proper blowing of the nose
Blow your nose gently.
Blowing too hard creates even more pressure that can force infectious mucus into your ears and
sinuses.
Avoid the "both-nostrils-open" blow. Instead ...
Press a finger over one nostril.
Gently blow the nose into a paper tissue thru the one open nostril.
Switch your finger to close the opposite nostril, and repeat.
Drink plenty of fluids.
Makes it easier for mucus to be removed by blowing gently.
Blowing your nose after taking a steamy shower can also help.

Use paper tissues rather than cloth handkerchiefs.
A used handkerchief is a breeding ground for germs -- and when you reuse it you're spreading those
germs around your face and hands.
Only use a paper tissue once, then throw it away.
Minimizes the risk of putting germs back onto your face and hands.
Wash your hands when you're finished,
Microbes from your nose and tissue will be transferred to your fingers while you blow.
Prevents spread of germs to other people or back to yourself.
Ear Examination
Includes an assessment of:
Hearing, and
appearance of the ear

Ear Examination
Ear Examination
History
Look for classic symptoms of ear disease: deafness, tinnitus, discharge (otorrhia), pain (otalgia), and
vertigo
Previous ear surgery, or head injury
Family history of deafness
Systemic disease (for example stroke, multiple sclerosis, cardiovascular disease)
Ototoxic drugs (antibiotics: gentamicin), diuretics, cytotoxics)
Exposure to noise (pneumatic drill or shooting, for example)
History of atopy and allergy in children
Ear Examination
Inspecting the External Ear
Inspect the external ear before examination with an otoscope/auriscope.
Swab any discharge, and remove any wax.

Inspecting the External Ear
Look for obvious signs of abnormality:
Size and shape of pinna
Extra cartilage tags/pre-auricular sinuses or pits
Signs of trauma to pinna
Suspicious skin lesions on the pinna including neoplasia
Skin conditions of the pinna and external canal
Infection/inflammation of external ear canal with discharge
Signs/scars of previous surgery
PALPATION OF THE EXTERNAL EAR

Gently pull on the pinna to test for pain (If painful this may suggest external ear disease).
Palpate for any lymph nodes (e.g. The parotid or postauricular nodes ~ this may also be suggestive of
external ear disease)
INSPECTION OF THE EXTERNAL AUDITORY MEATUS
Examine the good ear first. With prior warning to the patient, gently pull the pinna upwards and
outwards (Directly down and back in children).
Inspecting the Ear Canal and Ear Drum
Slowly insert the otoscope/auriscope, looking at the skin of the canal while entering.
Check skin for normality or signs of inflammation.
Inspecting the Ear Canal and Ear Drum
Look for wax or other obstructions (e.g. foreign bodies tips of cotton buds!)
Ear wax
Inspecting the Tympanic Membrane
Move the otoscope in order to see several different views of the drum.
Normal tympanic membrane should appear pearly grey, concave, & roughly circular (~1cm in
diameter).
1=Attic (pars flaccida)
2= Lateral process of malleus
3=Handle of malleus
4=End of the malleus
5=Light reflex
Look for signs of inflammation
Acute otitis media
Look for signs of perforation.

Perforation of ear drum
Ear Examination
Slowly retract the otoscope/auriscope from the ear.
Change the speculum on the otoscope/auriscope and examine the other ear.
Finally document what was seen in both ears, the condition of the tympanic membrane and the
external auditory meatus
Basic hearing tests
Detailed hearing tests are usually performed in audiology clinics.
A patient with normal hearing should hear equally as well in both ears.
Tuning fork tests: Weber test and Rinne test
Free field voice testing (whisper from 40 cm)
Weber test
The vibrating fork is placed anywhere on the midline of the patient's skull. The patient has to say where
they hear the vibration. Interpretation of results is as follows:
Normal hearing: vibration will be heard on the midline or equally in both ears
Perceptive loss: sound is heard better by the intact ear
Conductive loss: sound is heard better by the affected ear
Weber Test
Weber Test
Rinne Test
Should be performed on each ear in turn.
The base of the fork is placed against the patient's mastoid process on one side.
When the patient can no longer hear the vibration, the tuning fork is placed next to their ear on the
same side.
Rinne Test
Interpretation of results is as follows:
If the sound is now heard, the Rinne test is positive, meaning that air conduction is better than bone
conduction and there is:
- no hearing loss
- perceptive hearing loss.
Conductive hearing loss may be diagnosed if the test is negative (i.e. bone conduction is better than air
conduction)
Rinne Test
Rinne Test
The whispered voice test
Has the advantage of not needing any equipment.
Patients are told that they will be asked to repeat three numbers.
The examiner stands out of view of the patient (to prevent lip reading) while covering one of the
patient's ears and rubbing the external auditory meatus with a gentle circular motion.
This serves to mask sound input from the non-test ear.
The examiner then fully exhales (which reduces voice volume) and standing 0.75 m (arm's length) from
the ear being tested whispers 3 numbers.
It is very important to pay attention to the loudness of the whispering.
Failure to repeat 50% or more of the numbers on two trials is considered a fail and suggests a 30 dB+
hearing loss.
Whispered voice test
Stand 1-2 feet behind client so they can not read your lips.
2) Instruct client to place one finger on tragus of left ear to obscure sound.
3) Whisper word with 2 distinct syllables towards client's right ear.
4) Ask client to repeat word back.
5) Repeat test for left ear.
6) Client should correctly repeat 2 syllable word.
The eye is like a camera.
The external object is seen like the camera takes the picture of any object.
The Eye
Light enters the eye thru a small hole called the pupil and is focused on the retina, which is like a
camera film.
Iris (colored ring of the eye) controls the amount of light entering the eye; closes when light is bright
and opens when light is dim.
Sclera: the tough white sheet that covers the outside of the eye
The Eye
Eye also has a focusing lens, which focuses images from different distances on the retina.
The Eye
Ciliary muscles in ciliary body control the focusing of lens automatically.
Image formed on the retina is transmitted to brain by optic nerve.
The image is finally perceived by brain.
Three Layers
of the Eyeball
Sclera: outer fibrous layer, helps keep the shape of the eye
Choroid: middle blood rich layer supplying nutrition to the eye structures
Retina: inner colored (pigmented) nerve layer of the eye.
Eye Care Practitioners
Eye Care Practitioners
Ophthalmologist
a medical doctor who specializes in eye care.
Optometrist
optometric doctor trained to provide refractive correction and diagnose/treat common issues.
Ophthalmic medical practitioner
Similar to an optometrist (in the UK).
Oculist
Older term for either an ophthalmologist or optometrist.
Ocularist
specializes in the fabrication and fitting of ocular prostheses for people who have lost eyes due to
trauma or illness.
Optician
also called Optical Dispenser
specializes in the fabrication and fitting of
spectacles. Prescription for the spectacles must
be supplied by an ophthalmologist or
optometrist.
Orthoptist
specializes in ocular motility, which is the movement of the eye controlled by the extraocular muscles.
Vision therapist
work with patients that require therapy, such as low vision patients.
Ophthalmic medical personnel
popularly called "OMP"
is a collective term for allied health personnel in ophthalmology.
often used to refer to non-specialized personnel (unlike ocularists or opticians).
Danger signs of Visual Disorders for referral

loss or distortion of central vision, or marked difference of acuity between eyes
sudden loss of peripheral vision
flashes of light or floaters (ischemia), sudden cobweb or stringy floaters (detachment)
curtain across eyes (ischemia)
halos about lights (glaucoma)
intermittent dimming of vision

strabismus
cornea > 11 mm in newborn (congenital glaucoma)
red eye with Red Eye Danger Signs
Red Eye Danger Signs

blurred vision (keratitis, glaucoma, Iritis)
ciliary flush - perilimbal conjunctival injection (Iritis)
corneal opacification or epithelial disruption (bacterial keratitis)
abnormal pupil: nonreactive, small/irregular. (glaucoma, iridocyclitis, Iritis)
proptosis
Iritis
Proptosis
Also called Exophthalmos
forward displacement of the eye in the orbit.
caused by swelling of the soft tissues or bones of the orbit.
Causes:
inflammation, infection and tumor, hyperthyroidism
CONTINUED :Red Eye Danger Signs
increased intraocular pressure
colored halos (acute angle-closure glaucoma)
pain (glaucoma, Iritis, bacterial keratitis)
Aus sign: sharp pain in covered (red) eye when uncovered eye is illuminated (Iritis)
photophobia (iridocyclitis, Iritis)
Keratitis
Glaucoma
Eye Health Promotion
Nutrition
Ensure proper intake of nutrients necessary for optimum vision health in the daily diet
Ensure intake of different vitamins, minerals, and herbal supplements

shown by research as essential for good vision health and the prevention of potentially blinding vision
conditions
Vitamin A
absolutely essential for eye and vision health.
required by the retina for its proper functions
recommended for those with poor night vision
Helps eyes adjust to light changes
Moistens the eyes, which can enhance visual acuity
has been shown to prevent the forming of cataracts
helps prevent blindness from macular degeneration
Sources: sweet potatoes, carrots, mangoes, spinach, and cantaloupe, yellow squash.
Vitamin C
- An antioxidant
Linked to the prevention of cataracts
One study has shown that taking 300 to 600 mg supplemental vitamin C reduced cataract risk by 70
percent, delay of macular degeneration, and eye pressure reduction in glaucoma patients.
Sources: orange juice, citrus fruits and broccoli, cauliflower, cabbage, and strawberries.
Vitamin E
Use as an antioxidant
Helps protect against cataracts and age-related macular degeneration.
A clinical study has showed that taking vitamin E can cut the risk of developing cataracts in half.
Another study also showed that the combination of vitamins C and E had a protective effect against UV
rays.
Sources: wheat germ, dark green leafy vegetables (such as spinach), sweet potatoes, avocado,
asparagus
Zinc
Our eyes actually contain the greatest concentration of zinc in our body.
an essential element required for the conversion of beta-carotene into vitamin A.
Sources: Oysters, red meat and poultry
Chromium
plays a large role in muscle contraction including eye muscles
low levels of chromium are a major risk factor for increased intraocular pressure
Sources: beef, liver, eggs, chicken, oysters, wheat germ, green peppers, broccoli, apples, bananas,
and spinach.
Glutathione
An amino acid that protects the tissues surrounding the lens of the eyes
Helps prevent cataracts, glaucoma, retinal disease, and diabetic blindness.
Sources: garlic, eggs, asparagus, and onions, watermelon, asparagus, and grapefruits.
Lutein and zeaxanthin

Accumulate within the retina and imbue a yellow pigment that helps protect the eye
Protects photoreceptors of the retina from light damage
Act like sunglass filters to protect the eye
Lower the risk of cataracts and macular degeneration
Are also antioxidants
Sources: dark, leafy greens , corn, oranges, papaya and squash.
Ginkgo Biloba
Increases blood flow to the retina.

Can slow retinal deterioration which results in an increase of visual acuity.
Prevention of Eye Injury

Protect your eyes from the sun.
Ultraviolet radiation can harm your eyes.
Use a wide-brim hat and UV-absorbing eyewear to protect your eyes from harmful effects of the sun.
Eyewear should provide 99 to 100 percent of UV-A and UV-B protection.
Regular eyeglasses do not provide enough safety protection.
Protect your eyes with proper safety glasses.
Injuries can be prevented if proper eye protection is used at home, in the workplace and playing sports.
Use appropriate lighting.
Proper lighting can help improve safety at home and prevent eye injuries.

Keep your children safe.
Pay special attention to where sharp items are placed.
Items such as cosmetics, kitchen utensils and desk supplies can cause eye damage.
Avoid flying or projectile toys and any with sharp points and dangerous edges.
Visit eye doctor
(ophthalmologist) regularly.
Recommended regular eye exam at least every 2 years.
Early detection of problems is key to treatment and prevention.
Specific Prevention of Eye Injury

At home or outside:
Wash your hands after using household chemicals.
Wear chemical safety goggles when using hazardous solvents and detergents, and do not mix cleaning
agents around or near a child.
At home or outside:
Turn spray nozzles away from your face and the faces of others.
Read and follow directions when opening bottle-tops (such as wine, carbonated beverages).
Read and follow directions when playing games and operating equipment.

At home or outside:
Provide lights and handrails to improve safety on stairs.
Keep paints, pesticides and fertilizers properly stored in a secure area.
Be sure to wear recommended protective goggles, helmets, and safety gear during the appropriate
activities.
Use guards on all power equipment.
Protect eyes from the sun with either by a wind-brimmed hat or by wearing ultraviolet (UV)-protective
sunglasses
Never look directly at the sun (especially during an eclipse).

At play:
Recommended protective eyewear should be worn during the appropriate sports and recreational
activities.
A helmet with a polycarbonate face mask or wire shield should be worn during the appropriate sports.
Fireworks should be handled with care and only be used by adults.
Appropriate protective eyewear should be worn during sporting and recreational activities.
Protective eyewear should be worn when using lawnmowers, as debris may be projected into the air.
At school, it is important to wear protective eye wear when performing science or lab experiments.
Prevention of Eye Strain

Most common symptoms of eye strain, which may be attributed to prolonged computer screen or tv
viewing.
Symptoms may include:
red, watery, irritated eyes
tired, aching, or heavy eyelids
problems with focusing
muscle spasms of the eye or eye lid
headache
backache
Symptoms of eye strain are often relieved by:
resting the eyes
changing the work environment
wearing the proper glasses.
Using proper lighting when using a computer
Prevention of Eye Strain when Using a Computer
Position the video display terminal (VDT) slightly further away than where you normally hold reading
material.
Position the top of the VDT screen at or slightly below eye level.
Place all reference material as close to the screen as possible to minimize head and eye movements
and focusing changes.
Minimize lighting reflections and glare.
Keep the VDT screen clean and dust-free.
Schedule periodic rest breaks to avoid eye fatigue.
Keep the eyes lubricated (by blinking) to prevent them from drying out.
Keep the VDT screen in proper focus.
Consult ophthalmologist
some individuals who normally do not need glasses may need corrective lenses for computer work.

Human Senses - Complete The Worksheet

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SENSES VISUAL THE EYE

i. ___________________________ - a dark brown membrane located between the

dedicate structure in which the fibers of the ___________________________ are

2. FLUIDS OF THE EYE

SENSES VISUAL THE EYE

5. NERVE SUPPLY TO THE EYE

SENSES VISUAL THE EYE

SENSORY PATHWAY FOR VISION

REFLEXES OF THE EYE

PHYSIOLOGY OF BINOCULAR VISION

SENSES VISUAL THE EYE

-regulating amount of light entering eyes by

SENSES VISUAL THE EYE

- Performed to examine visual fields or peripheral

SENSES VISUAL THE EYE

DIAGNOSTIC TESTS FOR THE EYE

SENSES VISUAL THE EYE

Obtain informed consent

SENSES VISUAL THE EYE

- the client leans on a chin rest to stabilize the head

SENSES VISUAL THE EYE

Each eye is anesthetized.

- C/I in clients with glaucoma because of the risk of

- Mydriatics are C/I in cardiac dysrhythmias &

MYDRIATICS, CYCLOPLEGIC & ANTICHOLINERGIC medications

ciliary body, producing mydriasis

SENSES VISUAL THE EYE

- - reduce IOP by mimicking the action of

SENSES VISUAL THE EYE

outflow of aqueous humor

- used with caution in clients with asthma,

SENSES VISUAL THE EYE

Have Atropine sulfate available as antidote for Pilocarpine

BETA-ADRENERGIC BLOCKING EYE MEDICATIONS

SENSES VISUAL THE EYE

Instruct to avoid OTC meds without the MDs approval

ADRENERGIC EYE MEDICATIONS

CARBONIC ANHYDRASE MEDICATIONS

SENSES VISUAL THE EYE

Assess for risk of injury

- Used pre-op & post-op to decrease vitreous humor

SENSES VISUAL THE EYE

Monitor for changes in level of orientation

TOPICAL ANESTHETICS FOR THE EYE

SENSES VISUAL THE EYE

ANTI-INFECTIVE EYE MEDICATIONS

ANTI-INFLAMMATORY EYE MEDICATIONS

SENSES VISUAL THE EYE

DISORDERS OF THE EYE

SENSES VISUAL THE EYE

SENSES VISUAL THE EYE

SENSES VISUAL THE EYE

SENSES VISUAL THE EYE

SENSES VISUAL THE EYE

Instruct the client the importance of medications

SENSES VISUAL THE EYE

- when detachment is complete, blindness may occur

SENSES VISUAL THE EYE

retinal tears before the detachment occurs

SENSES VISUAL THE EYE

- a condition in which the eyes are not aligned

produces temporary paralysis