Keloid. SYSTEM ANATOMY & PHYSIOLOGY OF EYES EXTERNAL STRUCTURES EYELIDS CONJUNCTIVA PALBEBRAL BULBAR...
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Transcript of Keloid. SYSTEM ANATOMY & PHYSIOLOGY OF EYES EXTERNAL STRUCTURES EYELIDS CONJUNCTIVA PALBEBRAL BULBAR...
Keloid
SYSTEMSYSTEM
ANATOMY & PHYSIOLOGY OF EYESANATOMY & PHYSIOLOGY OF EYESEXTERNAL STRUCTURES
EYELIDS
CONJUNCTIVAPALBEBRALBULBAR
LACRIMAL APPARATUSLACRIMAL GLAND, DUCTS & PASSAGES
6 EXTRAOCULAR MUSCLES
Levator palpebrae muscle
EXTERNAL STRUCTURES
EYELIDS
CONJUNCTIVAPALBEBRALBULBAR
LACRIMAL APPARATUSLACRIMAL GLAND, DUCTS & PASSAGES
6 EXTRAOCULAR MUSCLES
Levator palpebrae muscle
ANATOMY & PHYSIOLOGYEYESORBIT
EYEBALL : 3 LAYERS: OUTER
SCLERACORNEA
MIDDLE CHOROIDCILIARY BODY IRIS
•INNER–RODS
–SENSITIVE TO LIGHT–PERIPHERAL VISION
–CONES–FINE DESCRIMINATION–COLOR VSION
EYESEYES
ANATOMY & PHYSIOLOGYEYESLENS – FOCUS IMAGE
FLUIDS OF THE EYE:AQUEOUS HUMOR
ANTERIOR & POSTERIOR CHAMBERS ANTERIOR EYE CAVITY NUTRIENTS TO LENS & CORNEA INTRAOCULAR PRESSURE MAINTENANCE
20-25 mmHgVITREOUS HUMOR
POSTERIOR EYE CAVITY TRANSPARENCY & FORM OF THE EYE
EYESEYES
VISUAL PATHWAYSRETINARETINA
OPTIC NERVEOPTIC NERVE
OPTIC CHIASMOPTIC CHIASM
OPTIC TRACTOPTIC TRACT
OCCIPITAL LOBEOCCIPITAL LOBE
Physical Examination-EYEVISUAL ACUITY : SNELLEN’S CHARTVISUAL FIELDS: PERIMETRYEXTERNAL STRUCTURES
POSITION & ALIGNMENT OF EYESPUPILS (PERRLA)
EXTRAOCULAR MOVEMENTSPARALYSISNYSTAGMUS
CORNEAL REFLEX
DIAGNOSTIC TESTSSNELLENOPHTHALMOSCOPEBIOMICROSCOPE / SLITLAMP
EXAMINE THE ANTERIOR SEGMENT OF THE EYETONOMETER
14-20 mmHgBJERRUM’S TANGENT SCREEN
CENTRAL FIELD OF VISIONISHIHARA COLOR PLATE TEST
IDENTIFY 3 PRIMARY COLORSGONIOSCOPY
ANGLE OF ANTERIOR CHAMBER
PLANNING FOR HEALTH PROMOTIONCARE OF THE EYES
EYEDROPS, DISCOURAGEDPRINTED MATTER: 14 INCHES AWAYTV: 10-12 FT AWAYREAD WITH ILLUMINATION: 100-150
WATTSLIGHT FROM BEHINDTEACH ABOUT DANGER SIGNALS OF
VISUAL DISORDER
•PERSISTENT REDNESSPERSISTENT REDNESS•CONTINUED DISCOMFORT & PAIN ESP CONTINUED DISCOMFORT & PAIN ESP
FOLLOWING INJURYFOLLOWING INJURY•CHILDREN: CROSSING OF EYESCHILDREN: CROSSING OF EYES•BLURRED VISION/ SPOTS BEFORE THE EYESBLURRED VISION/ SPOTS BEFORE THE EYES•GROWTH ON THE EYE/ OPACITIESGROWTH ON THE EYE/ OPACITIES•CONTINUAL DISCHARGE, CRUSTING ORCONTINUAL DISCHARGE, CRUSTING OR
TEARINGTEARING•PUPIL IRREGULARITIESPUPIL IRREGULARITIES
DISORDERS - EYEINJURIES &
TRAUMA
INFECTIONS
CATARACT
GLAUCOMA
DETACHMENT OF THE RETINA
REFRACTIVE ERRORS
INJURIES & TRAUMAEMERGENCY:TREAT THE PATIENT, LEAVE THE EYE
ALONE, EXCEPT IN CHEMICAL INJURY - FLUSH EYES STAT
FOREIGN BODIES: FLUSH WITH WATER FOR 15 MIN WHILE GOING TO THE DOCTOR; DON’T TOUCH CORNEA
INFECTIONSHORDEOLUM/ STY -Zeis gland in the
follicle
CHALAZION –meibomian glandsCONJUNCTIVITIS – pink eye
bacterial infection, allergy, trauma
UVEITIS - irisKERATITIS - corneaPTERYGIUM – triangular fold
From white of the eye to the cornea
Conjunctivitis
Sty
Chalazion
Pterygium
CATARACTOpacity of the lens & its capsule which interferes
with transparency
S/SX:Dimness in visual acuityRapid & marked refraction error
CLASSIFICATION:Primary/ senileSecondary/ traumaticCongenital
Cataract
TreatmentReplacement of the intra ocular lens
Commonly done by phakoemulsification technique
EYE SURGERYNURSING CARE PRE-OP
Orient to new environment
Teach deep breathing & how to close eyes without squeezing
Eye antibiotics preop
Mydiatrics if ordered
EYE SURGERYNURSING CARE POST-OP
Reorient patient to his surroundings
Prevent increase in IOP & stress on the suture line
Contd….ACTIVITIES THAT INCREASE IOP:ACTIVITIES THAT INCREASE IOP:
• CoughingCoughing• Vomiting Vomiting • Bending Bending • Stooping Stooping
• Promote comfort of the patient: mild Promote comfort of the patient: mild analgesic to control painanalgesic to control pain
EYE SURGERYNURSING CARE POST-OP
Observe & treat complicationsCOMPLICATIONS:COMPLICATIONS:•NAUSEA & VOMITINGNAUSEA & VOMITING
•AntiemeticsAntiemetics•Cold compressCold compress
•HEMORRHAGEHEMORRHAGE•Sudden pain of the eyeSudden pain of the eye
•PROLAPSE OF THE IRISPROLAPSE OF THE IRIS•Most common postop complicationMost common postop complication•Can precipitate glaucomaCan precipitate glaucoma
• Promote the rehab of the patientPromote the rehab of the patient•Encourage the patient to become Encourage the patient to become
independent- walk with him when he first independent- walk with him when he first become ambulatorybecome ambulatory•Health teachingsHealth teachings
EYE SURGERY HEALTH TEACHINGS:
1-4 wks : dark glasses; temporary corrective lenses
6-8 wks: permanent lensesIt will take time to learn distances & climb
stairsColor slightly changedUse one eye at a time unless with contact lensDecreased peripheral vision
GLAUCOMA INCREASED IOP PROGRESSIVE LOSS OF PERIPHERAL VISION
CAUSE: OBSTRUCTION TO CIRCULATION OF AQUEOUS HUMOR
TYPES:1. CHRONIC/ SIMPLE/ OPEN-ANGLE2. ACUTE ANGLE CLOSURE3. Congenital4. Secondary – trauma, uveitis, postop5. Absolute – uncontrolled- enucleation
EYESEYES
CORNEACORNEA
IRISIRIS
CILIARY BODYCILIARY BODYANTERIORANTERIORCHAMBERCHAMBER
LENSLENS
CANAL OF SCHLEMMCANAL OF SCHLEMM
ZONULESZONULES
OPEN-ANGLE GLAUCOMAOPEN-ANGLE GLAUCOMA
EYESEYES
CORNEACORNEA
IRISIRIS
CILIARY BODYCILIARY BODYANTERIORANTERIORCHAMBERCHAMBER
LENSLENS
CANAL OF SCHLEMMCANAL OF SCHLEMM
ZONULESZONULES
ACUTE-ANGLE CLOSURE GLAUCOMAACUTE-ANGLE CLOSURE GLAUCOMA
OPEN ANGLE GLAUCOMAS/SX:
Loss of peripheral vision (tunnel)Difficulty in adjusting to darknessFailure to detect changes in colorHeadache, pain behind the eyeballHalosNausea & vomiting
OPEN ANGLE GLAUCOMAMANAGEMENT:
Conservative :Miotics : pupillary constriction
draw iris smooth muscle away from the canal
Acetazolamide : decrease aqueous production
Fluid restriction
Definitive managementPrinciple: improve drainage of aqueous
• Iridocleisis-anterior chamber & subconjunctival space
• Corneoscleral trephening – junction of cornea & sclera
• Trabeculotomy
• Laser therapy to meshwork
Acute Angle GlaucomaCAUSE:Pupillary dilation by mydiatricsAbnormal anterior displacement of iris
S/SX:Severe eye painNausea & vomitingBlurred visionColored halos around lightsDilated pupilsIncreased IOP
MANAGEMENT:
• Miotics• Azetazolamide• Osmotic agents – glycerol• Surgery - iridectomy
GLAUCOMANURSING CARE – SURGERY
PRE-OPExplain that vision lost cannot be restored,
but further loss can be prevented
POST-OPFlat 24H- prevent iris prolapseNarotics or sedativesLiquid diet until 1st dressingTurn to unoperative site
LONG TERM CARE:
• No restriction on the use of the eyes• No fluid restriction; exercise permitted• Medical follow up needed for life
RETINARETINA CHOROIDCHOROID
SCLERASCLERA
OPTIC NERVEOPTIC NERVE
RETINAL DETACHMENTRETINAL DETACHMENT
RETINAL DETACHMENTFluid accumulationTumor
CAUSE:Myopic
degenerationTraumaAphakia
S/SX: Floating spots or
opacities before the eye
Casts shadows on the retina
BrightFlashes of light
Progressive constriction of vision in 1 eye
Management
Conservative :• Quiet in bed with eyes covered• Head: positioned so that retinal holes lower• Photocoagulation – small burn to retina
• Cryotherapy – cold probe to freeze retina
Surgical: • Scleral buckling- Scleral buckling- sealing break & reattachingsealing break & reattaching
RETINAL DETACHMENTPOST-OP NURSING CARE:Cover eyesArea of detachment, dependentMydiatricsDischarge instructions:
No strenuous exercises & acivity x 6mosContact sports restrictedNo sudden jarring head motionNo restriction with use of eyes
REFRACTIVE ERRORSREFRACTION – bending of light raysACCOMMODATION – ability to adjust from near to
far visionADAPTATION – ability to see light from darkness
COMMON ERRORS:MyopiaHyperopiaPresbyopia
•Astigmatism•Blindness
myopiaNEAR-SIGHTED
Long A-P dimension of the eyeballLight rays focus infront of the retinaGood vision for near distancesConcave lenses
Myopia
hyperopiaFAR-SIGHTED
Eyeball A-P dimension too shortLight rays focus behind the retinaGood vision for far distancesConvex lenses
Hyperopia
presbyopiaFARSIGHTEDNESS OF OLD AGE
Gradual loss of accommodationLoss of lens elasticityInability to read without holding the material
more than 13 ft from the eyeBifocal lenses
ASTIGMATISM
Asymmetry or irregular curvature of the cornea
Cylindrical lenses
BLINDNESS
Vision: 20/200
ANATOMY & PHYSIOLOGYEARSEXTERNAL EARAURICLEPINNATYMPANIC MEMBRANE
MIDDLE EAROSSICLES: MALLEOUS, INCUS, STAPESEUSTACHIAN TUBE
EAREAR
ANATOMY & PHYSIOLOGYEARSINNER EARORGAN OF CORTI
HEARING
VESTIBULAR APPARATUSBALANCE3 SEMICIRCULAR CANALSUTRICLE
EAREAR
ANATOMY & PHYSIOLOGYEARS
SOUND WAVES TO TYMPANIC MEMBRANESOUND WAVES TO TYMPANIC MEMBRANE
OSSICLES IN MOTIONOSSICLES IN MOTION
VIBRATION FROM STAPES TO OVAL WINDOWVIBRATION FROM STAPES TO OVAL WINDOW
COCHLEA : ORGAN OF CORTICOCHLEA : ORGAN OF CORTI
CRANIAL NERVE 8 TO TEMPORAL LOBECRANIAL NERVE 8 TO TEMPORAL LOBE
HEARINGHEARING
AUDITORY ASSESSMENTEXTERNAL EAR EXAMINATION
Inspection & palpation of auricleVisualization: straighten the auditory canal:
PULL AURICLE UP, & BACK
NORMAL EARDRUM: slightly conicalShinypearly gray in color
AUDITORY ASSESSMENTHEARING TEST:
Tests for acuteness of hearing or degree of deafness:
Whisper or spoken voice testAudiometer :
Pure tone – mx loudness in decibelSpeech – ability to understand & descriminate
Watch tick testTuning fork test
AUDITORY ASSESSMENTHEARING TEST:
Test to localize cause of deafness:
Rinne’s
Weber’s
Auditory assessmentWEBER’S
• Tuning fork top midline of the head• Sound heard: normal ear vs affected ear• Better in affected ear: conductive• Better in normal ear : sensorineural
AUDITORY ASSESSMENTTEST FOR VESTIBULAR FUNCTON
CALORIC TESTCheck direction of nystagmusCOWS ( cold-opposite; warm-same side of
stimulated ear)ROTATION (BARANY) TEST
Rotating chairNystagmus is opposite to the direction of
rotation
HEALTH PROMOTIONEAR PROTECTION
Noise over 70 decibels is potentially damaging to hearing
Most common & impt type of occupational hearing is caused by LOUD NOISE
GENERAL EAR CAREEar is self-cleaning
Cerumen-lubricant; traps dirt
Cleanse the external ear reached by vision
NURSING INTERVENTIONSEAR DROPSWarmAfter adm’n, head should remain tiltedSOFTENING & REMOVING IMPACTED
CERUMENFew drops of hydrogen peroxide/ warm
glycerineIrrigate the ear
NURSING INTERVENTIONSEAR IRRIGATION
To clean the external canalRemove impated cerumenCaloric testApply antiseptic solutionsRemove foreign bodies
COMMON EAR PROBLEMS
1. OTOSCLEROSIS
2. MENIERE’S DISEASE
3. HEARING IMPAIRMENT
OTOSCLEROSISNormal bone is replaced by spongy bone
Ankylosis of the footplate of the stapes
Impaired vibration system
OTOSCLEROSISASSESSMENT
Gradual hearing loss Difficulty hearing a whisperOwn voice is loudParacusis : hear better in loud
environmentRinne’s test: bone conduction better
OTOSCLEROSISPLANNING & IMPLEMENTATION
Hearing aidSurgery – primary form of tx
StapedectomyStapes mobilization operationFenestration operation : new window is
created
EAR SURGERYPRE-OP CARE;
Hair shampooInform client:
Head still during surgeryPost op: get out of bed with assistance
avoid nose blowing until 1 week
EAR SURGERYPOST OP
Promote comfort & safety
Promote psychological well-being
Prevent complications
Complications
• Facial nerve involvement• Facial paralysis, facial weakness• Inability to show teeth, wrinkle forehead, raise eyebrows or close eyes
• Meningitis – bacterial• Report signs & symptoms
• Bleeding
MENIERE’S DSEChronic Increase in endolymphatic pressure
ASSESSMENT:TinnitusUnilateral hearing lossVertigo
MENIERE’S DSEPLANNING & IMPLEMENTATION
CONSERVATIVE: palliativeBed restMeds
Sedative :Phenobarbital Antihistamine Antiemetics
Low salt diet
MENIERE’S DSEPLANNING & IMPLEMENTATION
SURGERY- delayed until client’s hearing below the serviceable levelDestruction of the labyrinthDecompression of endolymphatic sacSectioning of the vestibular nerveCryosurgery of the labyrinth
HEARING IMPAIRMENTTYPES OF HEARING LOSS
CONDUCTIVE Damage to the conducting system Hearing aid is useful
SENSORINEURAL Damage to the:1. Organ of Corti2. Cochlear nerve3. Acoustic branch of the auditory nerve
COMMUNICATING WITH HEARING-IMPAIRED CLIENTSAvoid use of gestures without speechDo not shoutSpeak distinctly & as close to the clientUse short phrasesDo not communicate with someone else in
front of a hearing-impaired clientHearing impairment goes with visual
problems in elderly
SOUND AMPLIFICATIONTYPES OF HEARING AIDS;
Post-auricularBody-typeIn-the ear model
Select hearing aid that has cotrollable volume & is properly fitted