Adult Health – Visual Auditory

gas, which holds the retina in a specific position to allow healing ADULT HEALTH – VISUAL/AUDITORY RETINAL DETACHMENT • • • • Retinal detachment is separation of the sensory retina from the underlying pigment epithelium. Clients experiencing retinal detachment may report a gradual, curtainlike loss of the visual field. Traumatic retinal detachment may also result in abrupt vision loss. Retinal detachment requires emergency surgery to attempt to restore vision. Surgical repair involves rebinding the choroid and retina. After repair, interventions focus on promoting retinal reattachment. Postoperative teaching should include: • o Avoiding activities that increase intraocular pressure (eg, rubbing the eye, straining) o Reporting sudden pain, flashes of light, vision loss, or bleeding, which may indicate detachment or infection, to the health care provider o Avoiding focused activities (eg, reading, writing, sewing), which can cause rapid eye movements and increase the risk for detachment o Wearing an eye patch or shield as directed to prevent rubbing/scratching of the eye and minimize eye movement o Ensuring appropriate positioning as instructed by the surgeon because clients may receive intravitreal oil or • • • Signs of retinal detachment include floaters, sudden flashes of light, and loss of vision. If signs of detachment occur, the surgeon should be notified immediately. Chronic hyperglycemia can cause microvascular damage in the retina, leading to diabetic retinopathy, the most common cause of new blindness in adults. A retinal detachment requiring emergency management. A partial retinal detachment may be painless and cause symptoms such as a curtain blocking part of the visual field, floaters or lines, and sudden flashes of light. An unrepaired complete retinal detachment can cause blindness. Retinal detachment is separation of the sensory retina from the underlying pigment epithelium with fluid accumulation. It can be a result of spontaneous atrophic retinal breaks or acute trauma. Common symptoms include a painless loss of vision "like a curtain" coming across the field of vision, light flashes, or a gnat/hairnet appearance in the vision field. This report needs emergent evaluation. Untreated symptomatic retinal detachment usually leads to blindness in that eye. In addition, this is the only presentation that is acute: the rule for prioritization is acute before chronic. Blunt-force trauma to the head is associated with potentially severe complications (eg, brain damage and herniation, retinal detachment, seizures). Prompt recognition of potential complications is essential to prevent irreversible changes to the client's neurological status and level of function. Retinal detachment is a separation of the retina from the posterior wall of the eye that may occur following head trauma. This is an ocular emergency as permanent blindness may result without intervention. Signs of retinal detachment include perception of lightning flashes or floaters and a curtain-like or gnats/hairnet/cobweb effect throughout the visual field MACULAR DEGENERATION • • • • Age-related macular degeneration is a degenerative eye disease that brings about the gradual loss of central vision, leaving peripheral vision intact. Macular degeneration is a progressive, incurable disease of the eye in which the central portion of the retina, the macula, begins to deteriorate. This deterioration causes distortion (blurred or wavy visual disturbances) or loss of the central field of vision, whereas the peripheral vision remains intact Macular degeneration has two different etiologies. "Dry" macular degeneration involves ischemia and atrophy of the macula that results from blockage of the retinal microvasculature. "Wet" macular degeneration involves the abnormal growth of new blood vessels in the macula that bleed and leak fluid, eventually destroying the macula. Progression of macular degeneration may be slowed with smoking cessation, intake of specific supplements (eg, carotenoids, vitamins C and E), laser therapy, and injection of antineoplastic medications. Risk factors for macular degeneration include advanced age, family history, hypertension, smoking, and long-term poor intake of carotenoid-containing fruits and vegetables. • Meniere disease (endolymphatic hydrops) results from excess fluid accumulation in the inner ear. • Clients have episodic attacks of vertigo, tinnitus, hearing loss, and feelings of fullness or pressure in the ear. The disorder typically affects only one ear and can lead to permanent hearing loss. • Attacks of Meniere disease can result in a total loss of proprioception, and clients often report feeling "pulled to the ground" (drop attacks), making client safety a priority. • Vertigo can be severe and is associated with nausea, vomiting, and feelings of anxiety. • Self-care for Meniere disease may include: o Consuming a low-sodium diet to decrease the potential for fluid excess within the inner ear. Intake of potassium and other electrolytes does not need to be restricted o Limiting or avoiding aggravating substances (eg, nicotine, caffeine, alcohol) and stimuli (eg, flickering lights, watching television) o Adhering to prescribed therapies for relief of symptoms (eg, antiemetics, antihistamines, sedatives, and mild diuretics) o Avoiding sudden changes in the position of the head (eg, bending over) during vertigo spells o Participating in vestibular rehabilitation therapy o Implementing safety measures during attacks (eg, assistance with walking, bed rest) • MENIERE’S DISEASE During an attack, the client is treated with vestibular suppressants, including sedatives (eg, benzodiazepines such as diazepam), antihistamines (eg, diphenhydramine, meclizine), • • • • • • • • anticholinergics (eg, scopolamine), and antiemetics. The nurse's priority is to plan for client safety with fall precautions given the severe vertigo and use of sedating medications. Fall precautions include adjusting the bed to a low position with side rails up and instructing the client to call for help before getting up. Vertigo may be minimized by staying in a quiet, dark room and avoiding sudden head movements. The client should reduce stimulation by not watching television or looking at flickering lights. The client's diet should be salt restricted to prevent fluid buildup in the ear. An emesis basin should be provided at the bedside, but fall precautions are the priority. A quiet environment can help minimize vertigo. However, it is a lower priority than the fall precautions. Most clients with Meniere disease require parenteral fluids given the nausea and vomiting. However, these are not the highest priority. • • • • • lens producing glare and halos, which are worse at night; and decreased color perception. Following cataract surgery, the client will be instructed that for several days (or until approved by the surgeon), activities that may increase intraocular pressure should be avoided to decrease the risk of damage to sutures or surgical site. These include bending (eg, vacuuming floors, playing golf), lifting more than 5 lb, sneezing, coughing, rubbing or placing pressure on the eye, or straining during a bowel movement. The nurse should encourage this client to increase fluids and fiber in the diet as well as consider an over-the-counter stool softener or laxative. It may take 1-2 weeks before visual acuity is improved. It is common for the client to experience itching ("sand" in the eye), photophobia, and mild pain for several days following surgery. Purulent drainage, increased redness, and severe pain should be reported. Sleeping on 2 pillows will elevate the head of the bed and decrease intraocular pressure. CATARACT SURGERY ACUTE ANGLE CLOSURE GLAUCOMA • A cataract is cloudiness (ie, opacity) of the lens that may occur at birth or more commonly in older adults. The signs/symptoms of a cataract include painless, gradual loss of visual acuity with blurry vision; scattered light on the • Primary open-angle glaucoma (POAG) is an eye condition characterized by an increase in intraocular pressure and gradual loss of peripheral vision (ie, tunnel vision). The signs/symptoms of POAG • • develop slowly and include painless impairment of peripheral vision with normal central vision, difficulty with vision in dim lighting, increased sensitivity to glare, and halos observed around bright lights. POAG can lead to blindness if left untreated. Acute angle-closure glaucoma is a form of glaucoma that requires immediate medical intervention. Glaucoma disorders are characterized by increased intraocular pressure (IOP) due to decreased outflow of the aqueous humor, resulting in compression of the optic nerve that can lead to permanent blindness. In acute angle-closure glaucoma, IOP increases rapidly and drastically, which can lead to the following manifestations: o o o o o • • Sudden onset of severe eye pain Reduced central vision Blurred vision Ocular redness Report of seeing halos around lights Gradual loss of peripheral vision and difficulty adjusting to different lighting are manifestations of chronic open-angle glaucoma. Although further evaluation and treatment are necessary, this condition develops slowly and is not considered an emergency situation. Opaque lenses are characteristic of cataracts, which are not a medical emergency. • • • EYE INJURY CASE: During a camping trip, a camp counselor falls and gets a small splinter of wood embedded in the right eye. What action should the volunteer camp nurse take first? PATCH BOTH EYES WITH EYE SHIELDS • The camp nurse protects the injured eye using an eye shield (eg, small Styrofoam or paper cup), ensuring the shield does not touch the foreign body. The eyes work in synchrony with each other; therefore, the non-injured eye is patched to prevent further eye movement. The nurse also facilitates transport to the nearest emergency care center for assessment and treatment by an ophthalmologist. • Flushing the eye with cool water is contraindicated as it may cause further damage by moving the splinter and/or introducing potential wound pathogens. • Instilling optic antibiotic ointment would interfere with ophthalmologic medical examination. Optic antibiotic ointment may OCULAR CHEMICAL BURNS • • Ocular chemical burns require emergency care to prevent permanent vision loss. Alkali burns (eg, ammonia, cement, lye-containing drain cleanser) are particularly dangerous as they will quickly penetrate deep into the eye, causing severe, irreversible damage. For all types of ocular chemical burns, copious eye irrigation with sterile saline or water should begin immediately to flush the chemical irritant out of the eye Before transport to an emergency care facility, tap water can be used for eye irrigation. If transported by ambulance, emergency care personnel continue irrigation during transport with IV tubing or a Morgan lens. Irrigation is continued until the pH of the eye returns to normal (pH 6.57.5), which typically requires 30-60 minutes depending on the type of chemical. Depending on the severity of the burn, anesthetic eye drops may be instilled prior to irrigation because ocular burns are very painful, but systemic analgesia is not a priority. Care of ocular burns may include covering the eye with an eye patch and use of eye drops to prevent eye muscle spasms; however, eye irrigation should be performed first. The Snellen eye chart is commonly used to assess visual acuity. However, eye irrigation is essential and should not be delayed. be prescribed by the health care provider to reduce the risk of infection once the object is removed from the eye. • The nurse should not attempt to remove a foreign body embedded in the eye. An ophthalmologist, a health care provider who specializes in the surgical and nonsurgical evaluation and treatment of eye conditions, should remove the embedded object as soon as possible.