Internal Structures

Outer Layer Sclera Cornea Middle Layer Choroid Ciliary Body Iris Pupil

Inner Layer Retina Lens Vitreous humor Optic disk Macula Lutea Aqueous humor Canal of Schlemm

MEASUREMENT OF VISION
Visual Acuity Snellens Chart Confrontational test
Extraocular Muscle Function Six cardinal position of gaze

Color Vision Ishihara Chart/Plates

DIAGNOSTIC TESTS
Slit lamp Tonometry Opthalmoscopic Examination

CATARACTS
Causes: Aging Process Inherited Injury Endocrine disorders Signs & Symptoms Gradual or abrupt? Painful or painless? opaque or cloudy white pupil decreasing visual acuity progressive nearsightedness

 Diagnostic Study
Slit lamp examination Opthalmoscopic examination

Surgical Management
Intracapsular Cataract Extraction (ICCE) Extracapsular Cataract Extraction (ECCE)

Pharmacologic Management
Mydriatrics Epinephrine, adrenaline, phenylephrine HCl (NeoSynephrine, Ocu-phrin) Cycloplegics Atropine SO4 (Atropisol), scopolamine hydrobromide (Isopto-Hyoscine), cyclopentolate (Cyclogyl) Acetazolamide, Mannitol Antibiotics Mild Analgesics

RETINAL DETACHEMENT
Causes Trauma Retinal degeneration Tumor in the eye Hemorrhage Cataract surgery Myopia

 Signs & Symptoms Painful or Painless?

Diagnostic study Opthalmoscopic examination

 Implementation Provide bed rest Cover eyes Speak before approaching Position head as prescribed Protect from injury

 Surgical Procedures Scleral Buckling

Post-op nursing management

eyepatch Monitor for complication

Wear dark glasses during the day

GLAUCOMA

Types:
Chronic Open-Angle Glaucoma Primary / simple / chronic ^ 30 50 mmHg Signs & symptoms: No early s/s Insidious visual impairment Diminished accommodation & loss of peripheral vision Halos around lights

 Acute Closed-Angle / Narrow Angle Glaucoma

50-70 mmHg Signs & symptoms: Transitory attacks of diminished visual acuity Halos around lights Excruciating pain ________, ________, _________ Blurred, cloudy vision

Management:
Topical Miotics pilocarpine (Pilocar), Carbachol

Topical Beta-blockers betaxolol (Betoptic), metipranol (Optipranolol), timolol (Timoptic)

 Oral Carbonic Anhydrase Inhibitors reduces production of AH acetazolamide (Diamox), may cause malaise, anorexia & fatigue but do not d/c drug.
Osmotic diuretic / Hyperosmotic agents mannitol (Glycerol), Glycerine (Glyrol, Osmoglyn)

Diagnostic Studies:
Otoscopic Examination
Weber test Rinne test

 Rombergs test

Caloric test

MENIERES DISEASE (Endolymphatic Hydrops)

Causes: Unknown May be related to the degeneration of cochlear hair cells. Hypernatremia Emotional disorders

 Signs & Symptoms

3 Cardinal signs: ____________, ____________, __________ nausea/vomiting, nystagmus, severe headache Warning sign of an attack: _____________________________

 Management:
Furstenburg Diet Vasodilators, Antihistamines, Mild sedatives Diuretics During attack: assume comfortable position

OTOTOXIC SUBSTANCES Diuretics: ____________ Chemotherapeutic agents: Cisplatin(Platinol), nitrogen mustard Anti-inflammatory agents: __________ Antibiotics: _________ Chemicals: alcohol, arsenic, nicotine

Anatomy & Physiology

External Structures: Auricle / Pinna External Auditory Canal Tympanic membrane (Eardrum) Middle Ear Ossicles Mallus (Hammer) Incus (Anvil) Stapes (Stirrups)

Eustachian Tube

Inner Ear Vestibule Semicircular canals Utricle & Saccule Cochlea Organ of Corti Fluids Perilymph Endolymph

OTOSCLEROSIS
Risk Factors: Familial tendency Women Caucasian Signs & Symptoms: gradual, progressive hearing loss constant tinnitus

Rinne test / Weber test

Management:
Stapedectomy
watch for signs of infxn Antibiotics for prophylaxis Bed rest Do not blow nose for at least 2 weeks

The nurse is evaluating a child for haring loss. In reviewing the childs history, which finding would not be associated with a hearing loss? a. Prenatal problem of rubella b. Repeated, chronic ear infection c. Taking penicillin and cephalosporin medication d. Exposure to high-intensity sound waves.

A 3-year old child had a myringotomy about a week ago. The mother call the nurse and report that one of the tubes fell out. After the nurse makes an appointment for the child to be seen by the physician, what would be important for her to tell her mother? Observe for any purulent drainage from the ear. Rinse the tube in soapy H2O and keep it. Do not allow any H2O to get into the childs ear. Do not allow the child to play outside.

INTEGUMENTARY SYSTEM

DECUBITUS ULCER
RISK FACTORS: 1. Immobility 2. Aging 3. Moisture 4. Inadequate hydration 5. Pyrexia 6. Dryness 7. Incontinence 8. Cognitive impairments 9. Equipment 10. Shearing force or friction

STAGES
STAGE I STAGE II
STAGE III STAGE IV

MANAGEMENT
1. 2. 3. 4. 5. 6. 7. Positioning & Supportive device Diet Adequate hydration Massage bony prominences Apply Dressings Antibiotic therapy Debridement

STAGES
STAGE I STAGE II
STAGE III STAGE IV

 ETIOLOGY
Thermal Chemical Electrical Radiation

PATHOPHYSIOLOGY
TYPES: Superficial Burn (1st degree) Layer: Pain: Characteristics: Healing:

Partial-thickness Burns (2nd degree)

Layers: Pain: red to pale ivory moist skin w/ blisters Healing:

Full Thickness Burns (3rd degree)

Layers: Pain: Skin: white, cherry red, black; - blisters; dry, hard, leathery appearance.

Cardiovascular Response Renal & GIT Respiratory Immune System

Nursing Management:

Provide Emergency Care

Eliminate source of burn Cool the burn for several mins. remove restrictive objects. cover wound

apply ABC of trauma Assess for & treat smoke inhalation injury Assess for & treat carbon monoxide poisoning prevent shock monitor acid-base balance & electrolyte NPO

Wound Care

Wound Cleansing&Hydrotherapy
Burn Wound Coverings Biologic Dressings: Amnion Allograft Xenograft Biosynthetic Dressing Biobrane Autograft

Care of Graft Site:

immobilize graft site keep site free from pressure remove exudates monitor foul-smelling drainage use support garments & splints silver sulfadiazine (Silvadene) mafenide acetate 10% cream silver nitrate

Topical Antimicrobials

Metabolic Support

Estimate Burn Size: Rule of Nines Lund & Browder

Promote optimum recovery Wound management Physical Therapy Pain Management Morphine SO4 Meperidine (Demerol)

Which intervention is inappropriate for a client with severe burns?

a. b. c. d. Administration of IM pain medications Oxygen therapy Aggressive fluid resuscitation Remove restrictive clothing

A client arrives at the burn center after sustaining a serious burn injury. The burned area is white and leathery with no blisters. What is the best classification? a. First degree burn injury b. Superficial partial thickness burn injury c. Deep partial thickness burn injury d. Third degree burn injury

A client has just arrived at the emergency department after sustaining a major burn injury. Which of the following metabolic alterations is expected during the first 8 hours post-burn.
a. b. c. d. Hyponatremia and hypokalemia Hyponatremia and hyperkalemia Hypernatremia and hypokalemia Hypernatremia and hyperkalemia

Providing adequate nutrition is essential for a burn client. Which of the following statements best describes the nutritional needs of a burn client? a. A child needs 100 cal/kg during hospitalization b. The hypermetabolic stage after a burn injury leads to poor healing c. Caloric needs can be lowered by controlling environmental temperature d. Maintaining a hypermetabolic rate will lower the childs risk for infection

A client suffered a thermal burn injury caused by inhalation of steam. The clients mouth is edematous, and the nurse notes blisters in the clients mouth. Based on this data, the nurse monitors the client most closely for: a. Difficulty swallowing b. pain c. Fluid loss d. Wheezing