Silvestri: Saunders Comprehensive Review for the NCLEX-PN Examination, 4th Edition

Chapter 54: The Eye and the Ear Teaching Tools 1. Have the students read the chapter. 2. Have students answer practice questions at end of Chapter 54. Have a class discussion, selecting students to discuss their answers, explaining rationales for both correct and incorrect answers. 3. Glaucoma versus Cataracts Have students match which data collection findings are found with each of the eye disorders. Some answers may be appropriate for both disorders. Eye Disorder ____ 1. Glaucoma ____ 2. Cataracts Data Collection Finding a. Gradual loss of vision b. Progressive loss of peripheral vision c. Decreased color perception d. Absence of red reflex e. Halos around white lights f. Photophobia g. Elevated intraocular pressure h. Opaque or cloudy white pupil i. Difficulty adjusting to dark rooms and night j. Eye pain k. Vision that is better in dim light with pupil dilation

Answers: 1. 2.

b, e, f, g, i, j a, c, d, f, h, k

4. Client Teaching Regarding Postoperative Cataract Care Have students develop a postoperative teaching plan for the client who has just undergone corrective surgery for a cataract. Follow with class discussion. Answer: Client Teaching after Cataract Corrective Surgery (until follow-up with physician and as prescribed) Avoid any eye-straining activities, such as reading or sewing. Avoid rubbing or placing pressure on the eyes. Avoid rapid movements, straining, sneezing, coughing, bending, vomiting, or lifting

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objects heavier than 5 lb May require the physician writing prescriptions for or recommending stool softeners, antihistamines, antiemetics, and cough suppressants. Follow instructions for eye drops and medications as prescribed. Similar to preoperative regimen, lasting up to 1 to 2 weeks postsurgery. If the client cannot read or doesnt understand, clarify with the nurse or pharmacist. Wipe excess drainage or tearing from the eye with a sterile wet cotton ball from inner to outer canthus. Use eye shield as prescribed, usually for 1 to 2 days. If a lens implant was not performed, wear glasses at all times. Eye will not accommodate. Discuss with the physician the need to change prescription of glasses. Have eyeglasses made to adjust to change in vision postsurgery. Contact the physician for any decrease in vision, severe eye pain, or increase in eye discharge. 5. Menieres Disease Divide class into groups, having them all develop a teaching session on Menieres disease. Select one group at a time to present description, causes, data collection findings, nonsurgical interventions, surgical interventions, and postoperative interventions. Answers: Menieres Disease Description Also called endolymphatic hydrops. Refers to dilation of endolymphatic system caused by overproduction or decreased reabsorption of endolymphatic fluid. Symptoms occur in attacks, lasting for several days. Client becomes totally incapacitated during attacks. Initial hearing loss is reversible, but becomes permanent as attacks continue. Repeated damage to cochlea caused by increased fluid pressure leads to permanent hearing loss. More common in women. Causes Any factor that increases endolymphatic secretions in the labyrinth. Viral and bacterial infections. Allergic reactions. Biochemical disturbances. Vascular disturbances producing changes in microcirculation of labyrinth. Data collection Feeling of fullness in ear Tinnitus or continuous low-pitched roar or humming sound, present most of the time Hearing loss that worsens with attacks Vertigo, which can become severe

Elsevier items and derived items 2010 by Saunders, an imprint of Elsevier Inc.

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Nausea and vomiting Nystagmus Severe headaches Nonsurgical interventions Prevent injury during vertigo episodes. Bedrest in a quiet environment. Provide assistance with walking when appropriate. Instruct the client to move head slowly. Initiate sodium and fluid restrictions as prescribed Instruct the client who smokes to stop smoking. Vasoconstriction properties of nicotine can worsen condition. Administer nicotinic acid (niacin) as prescribed. Vasodilatory effect Administer antihistamines as prescribed. Reduces production of histamine, thus decreasing inflammation. Administer antiemetics as prescribed. Administer tranquilizers or sedatives as prescribed. Surgical interventions Performed when medical therapy is not effective. Endolymphatic drainage or insertion of shunt may be performed. Resection of vestibular nerve or total removal of labyrinth may be performed. Postoperative interventions Assess packing and dressing on ear. Speak to the client on the side of the unaffected ear. Perform neurological data collections every 2 to 4 hours. Maintain side rails at all times. Assist with ambulation as prescribed. Bedrest with bedside commode. Administer antivertiginous and antiemetic medications as prescribed.

Elsevier items and derived items 2010 by Saunders, an imprint of Elsevier Inc.