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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
a!ueous humor that helps give the eye its shape
iii. ___________________________ - the colored portion of the eye, e"tension 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 e"tremely sensitive to ___________________________.
#. $%&'() *$ T+
. /&*&) +&0*
- Clear, watery fluid fills anterior posterior
chamber
- produced by the ciliary processes, the fluid
drains in the Canal of )clemm
- serves as refracting medium provides
nutrients to lens cornea
- contributes to maintenance of '*2
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SENSES – VISUAL – THE EYE
3. 4'T*&) +&0*
- Clear, gelatinous56ell-like material that fill the
posterior cavity of the eye
- 0aintains the form shape of the eye
- 2rovides additional physical support to the
ye
7. 0&)C%)
. '8T'8)'C 0&)C%):
a. '')
b. C'%' 3*(
3. 9T'8)'C
a. $*& )T'+T CT&) 0&)C%
- superior, inferior, lateral medial
b. T;* *3%'/& 0&)C%)
- superior inferior
nerve of sight?
3. C8'% 84 4
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SENSES – VISUAL – THE EYE
- Trigeminal >opthalmic?
C. 0*T* 84 > C8 ''', C8 '4, C8 4'?
- oculomotor, trochlear, abducens
)8)* 2T+; $* 4')'*8
the *( C*8 receptors, which are sensitive to light initiate nerve impulse messages which w5c
travel over the optic nerves
*2T'C C+')0 is the crossing point for fibers from the medial halves of the retinae
that in *2T'C C+')0, 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 brain@s right occipital lobe, and fibers
from the left half of each eye carry impulses to the left occipital lobe.
$rom the *2T'C C+')0, the optic nerves continue, as optic tracts, to the cerebrum.
;ithin the brain, visual impulses are interpreted as light
$%9) *$ T+
%'+T $%9
- pupil becomes smaller when light is flashed in
the eye
3. CC*0*(T'*8 $%9
- pupil becomes smaller when gaAe is shifted
from distant to near ob6ect
2+)'*%* *$ 3'8*C&% 4')'*8
C*848C *$ 4')&% 9)
-coordinated movement of # eyes toward fi"ation of same near point
3. &%T'*8 *$ 2&2'% )'B
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SENSES – VISUAL – THE EYE
-regulating amount of light entering eyes by
changing pupil siAes
C. $CT'*8 *$ %'+T )
- rays are refracted or bent as they pass thru
varying densities
(. CC*00*(T'*8
a. near vision- ciliary muscle contract, lens
bulges 5conve"
b. distant vision- ciliary muscle rela"es, lens
flattens
))))08T *$ 4')'*8
4')&% C&'T T)T
- measures the client@s distance near vision
)8%%8 C+T
- simple tool to record visual acuity
- the client stands # 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 # ft and
the no. of feet normally re!uired by an individual to read the same line
902%: #5=
- The client is able to read at # ft from the chart
what a healthy eye can read at = ft
C*8$*8TT'*8% T)T
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SENSES – VISUAL – THE EYE
- 2erformed to e"amine visual fields or peripheral
vision
- The e"aminer the client sit facing each other
- The test assumes that the e"aminer has normal
peripheral vision
9T*C&% 0&)C% $&8CT'*8
- tests muscle function of the eyes
- tests D cardinal positions of gaAe
1. Client@s right >lateral position?
#. &pward right >temporal position?
7. (own right
lateral position?
=. &pward left >temporal position?
D. (own left
- client holds head still asked to move eyes
follow a small ob6ect
- the e"aminer looks for any parallel movements
of the eye or for
8)T0&)
- an involuntary rhythmic rapid twitching of
the eyeballs
))))08T *$ 4')'*8
C*%* 4')'*8 T)T
- Tests for color vision which involve picking nos. or letters out of a
comple" colorful picture
')+'+ C+T
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SENSES – VISUAL – THE EYE
- 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
red5green blindness but not
effective for the detection of the discrimination
of blue
2&2'%)
- 8ormal: round of e!ual siAe
- 'ncreasing light causes pupillary constriction
(ecreasing light causes pupillary dilation
- the client is asked to look straight ahead while
the e"aminer !uickly
brings a beam of light > penlight? in from the side
directs it onto the side
- C*8)8)&% )2*8)
('8*)T'C T)T) $* T+
1. $%&*)C'8 8'*2+
- detailed imaging recording of ocular circulation by
a series of photographs after administration of the
dye
2-*2 8&)'8 C
ssess for allergies previous reactions to dyes
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SENSES – VISUAL – THE EYE
*btain informed consent
mydriatic medication is instilled in the eye 1 hr. before the test
The dye is in6ected into the vein of the client@s arm
'nform 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 e"perience 84, sneeAing, paresthesia of the tongue or pain at the in6ection site
'f hives appear, oral or '0 antihistamines such as (iphenhydramine
>3enadryl? are given as prescribed.
2*)T-*2 8&)'8 C
ncourage rest.
ncourage oral fluids.
emind the client that the yellow skin appearance will disappear
'nstruct the client that the urine will appear bright green until the dye is e"creted
'nstruct the client to avoid direct sunlight for a few hrs after the test.
'nstruct the client that the photophobia will continue until pupil siAe returns to normal
#. C*02&T( T*0*2+
- a beam of "-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
8&)'8 C
8o special client preparation or follow-up care re!uired
'nstruct the client that he or she will be positioned in a confined space need to keep the head still
during the procedure.
7. )%'T %02
- allows e"amination of the anterior ocular structures
under microscopic magnification
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SENSES – VISUAL – THE EYE
- the client leans on a chin rest to stabiliAe the head
while a narrow beam of light is aimed so that it
illuminates only a narrow
segment of the eye.
8&)'8 C
"plain the procedure to the client.
dvise the client about the brightness of the light the need to look forward at the point over the
e"aminer@s ear
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SENSES – VISUAL – THE EYE
ach eye is anesthetiAed.
The client is asked to stare forward at a point above the e"aminer@s ear
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 e"amination if the eye has been
anesthetiAed
- the potential for scratching the cornea e"ists
*2T+%0'C 0('CT'*8)
2)02T+*%T'C (&)
- used pre-op or for eye e"aminations to produce mydriasis
- C5' in clients with glaucoma because of the risk of increased '*2
- 0ydriatics are C5' in cardiac dysrhythmias cerebral atherosclerosis should be used with
caution in the elderly in clients with prostatic hypertrophy, (0 or parkinsonism
0('T'C), CC%*2%'C 8T'C+*%'8'C medications
0('T'C)
- dilate the pupils >mydriasis?
CC%*2%'
- rela" the ciliary muscles
8T'C+*%'8'C)
- block responses of the sphincter muscle in the ciliary body, producing mydriasis
".
tropine sulfate >'sopto-tropine, *cu-Tropine, tropair, tropisol?
)copolamine hydrobromide >'sopto-+yoscine?
Cyclopentolate hydrochloride >Cyclogyl, F-2entolate, 2entolair?
+omotropine hydrobromide >'sopto +omatrine, F-+omatropine,
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SENSES – VISUAL – THE EYE
)pectro-+omatrine?
Tropicamide >0ydriacyl, '-2icamide, Tropicacyl?
2henylephrine hydrochloride >F-(ilate, (ilatair, 0ydfrin, *cu-2hrin?
8&)'8 )2*8)'3'%'T')
0onitor for allergic reactions
ssess for risk of in6ury
ssess for constipation urinary retention
'nstruct the client that a burning sensation may occur on installation
'nstruct the client not to drive or operate machine for #< hrs after installation of the medication
unless otherwise directed by the physician
'nstruct the client to wear sunglasses until the effects of the medication wear off
'nstruct to notify 0( if blurring of vision, loss of sight, difficulty in breathing, sweating or flushing occurs
'nstruct the client to report eye pain to the physician
2)02T+*0'0T'C
. *&2 ': 0'*T'C C+*%'8'C (&) - - reduce '*2 by mimicking the action of
acetylcholine
- act directly on the myoneural 6unction produce strong contractions of the iris > miosis? ciliary
body musculature > accommodation?
3. *&2 '': C+*%'8)T) '8+'3'T*)
- reduce '*2 by inhibiting the action of cholinesterase
- action of this drug is difficult to reverse
0'*T'C)
- reduce '*2 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
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SENSES – VISUAL – THE EYE
outflow of a!ueous humor
- used for chronic open-angle glaucoma or acute
chronic closed-angle glaucoma
- used to achieve miosis during eye surgery
- C5' 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,
' obstruction, ulcer disease, parkinsonism, or
bradycardia
".
cethylcholine Cl >0iochol?
Carbachol >0iostat?
2ilocarpine +Cl >'sopto Carpine, 2ilocar?
2ilocarpine nitrate >2ilofrin, %i!uifilm, 2ilagan?
chothiophate iodide >2hospholine iodide?
(emecarium bromide >+umorsol?
'soflurophate >$loropryl?
8&)'8 C
ssess 45) risk of in6ury
ssess the client for the degree of diminished vision
0onitor for postural hypotension instruct the client to change positions slowly
ssess breath sounds for rales rhonchi
cholinergic meds cause bronchospasms
increased bronchial secretions
0aintain oral hygiene due to increased salivation
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SENSES – VISUAL – THE EYE
+ave tropine sulfate available as antidote for 2ilocarpine
'nstruct the client not to stop the meds suddenly
'nstruct to avoid activities such as driving while vision is impaired
'nstruct clients with glaucoma to read labels on *TC meds to avoid tropine-like meds
tropine increase '*2
3T-(8'C 3%*CF'8 0('CT'*8)
- '*2 by decreasing sympathetic impulses decreasing
a!ueous humor production w5o affecting
accommodation or pupil siAe
- &sed to treat chronic open-angle glaucoma
- C5' in the client with asthma
9.
3eta"olol +Cl >3etoptic?
Carteolol +Cl >*cupress?
%evobunolol +Cl >3etagan?
0etipranolol >*ptipranolol?
Timolol maleate >Timoptic?
8&)'8 C
0onitor 45) before administering medication esp. 32 2
'f the pulse is below D or if systolic 32 is below G mm +g, withhold the medication contact 0(
0onitor for shortness of breath and '*
ssess for risk of in6ury
'nstruct the client to notify 0( if shortness of breath occurs
'nstruct not to (5C medication abruptly
'nstruct to change positions slowly to avoid orthostatic hypotension
'nstruct to avoid haAardous activities
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SENSES – VISUAL – THE EYE
'nstruct to avoid *TC meds without the 0(@s approval
(8'C 0('CT'*8)
- (ecrease the production of a!ueous humor lead
to a decrease in '*2
- &sed to treat glaucoma
(8'C 0('CT'*8)
praclonidine +Cl >'opidine?
3rimonidine tartrate >lphagen?
(ipivefrin +Cl >2ropine?
pinephrine borate >pinal, ppy?
pinephrine +Cl >pifrin, laucon?
C3*8'C 8+() 0('CT'*8)
- 'nterfere with the production of carbonic acid
which leads to decreased a!ueous humor
formation decreased '*2
- &sed for long-term treatment of open-angle
glaucoma
- C5' in the client allergic to sulfonamides
9.
CTB*%0'( > ('0*9?
('C+%*2+8+0'( >(8'(, *T*%?
T+*9B*%0'( >C(), T+0'(?
0T+B*%0'( >82TB8?
8&)'8 C
0onitor 45)
ssess visual acuity
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SENSES – VISUAL – THE EYE
ssess for risk of in6ury
0onitor '*
0onitor weight
0aintain oral hygiene
0onitor for lethargy, anore"ia, drowsiness, polyuria, 854
0onitor electrolytes for hypokalemia
'ncrease fluid intake unless C5'
dvise the client to avoid prolonged e"posure to sunlight
ncourage the client to use artificial tears for dry eyes
'nstruct not to (5C the medication abruptly
'nstruct to avoid haAardous activities while vision impaired
*)0*T'C 0('CT'*8)
- %ower '*2
- &sed in emergency treatment of acute closed-
angle glaucoma
- &sed pre-op post-op to decrease vitreous humor
volume
902%)
lycerin >lyrol, *smoglyn?
0annitol >*smitrol?
&rea >&reaphil?
8&)'8 C
ssess 45), visual acuity risk for in6ury
0onitor weight and '*
0onitor electrolytes
'ncrease fluid intake unless C5'
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SENSES – VISUAL – THE EYE
0onitor for changes in level of orientation
%&3'C8T)
- eplace tears or add moisture to the eyes
- 0oisten contact lenses or an artificial eye
- 2rotect the eyes during surgery or diagnostic
procedures
- &sed for keratitis, during anesthesia or in a
disorder that results in unconsciousness or
decreased blinking
902%)
+ydro"ypropyl methylcellulose >%acril, 'sopto 2lain?
2etroleum-based ointment >rtificial Tears, %i!uifilm Tears?
8&)'8 C
'nform the client that burning may occur on installation
3e alert to allergic responses to the preservatives in the lubricants
T*2'C% 8)T+T'C) $* T+
- 2roduce corneal anesthesia
- &sed for anesthesia for eye e"aminations, surgery,
or to remove foreign bodies from the eye
902%)
2roparacaine +Cl >*phthaine, *pthenic?
Tetracaine +Cl >2ontocaine?
8&)'8 C
ssess for risk of in6ury
8ote that the medications should not be given to the client for home use are not to be self-
administered by the client
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SENSES – VISUAL – THE EYE
8ote that the blink refle" is temporarily lost that the corneal epithelium needs to be protected
2rovide an eye patch to protect the eye from in6ury until the corneal refle" returns
8T'-'8$CT'4 0('CT'*8)
8T'3CT'%
Chloramphenicol >Chloromycetin, Chloroptic?
Ciproflo"acin hydrochloride >Cipro?
rythromycin >'lotycin?
entamicin sulfate >aramycin, enoptic?
8orflo"acin >Chibro"in?
Tobramycin >8ebcin, Tobre"?
)ilver nitrate 1H
8T'$&8%
8atamycin >8atacyn *pthalmic?
8T'4'%
'do"uridine >+erple"-%i!uifilm?
Trifluridine >4iroptic?
4idarabine >4ira- *pthalmic?
8&)'8 C
ssess for risk of in6ury
'nstruct the client in how to apply the eye medication
'nstruct the client to continue treatment as "
'nstruct the client to wash hands thoroughly fre!uently
dvise the client that if improvement does not occur, notify the 0(
8T'-'8$%00T* 0('CT'*8)
902%)
(e"amethasone >0a"ide"?
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SENSES – VISUAL – THE EYE
(iclofenac >4oltaren?
$lurbiprofen 8a >*cufen?
)uprofen >2rofenal?
Fetorolac tromethamine >cular?
2rednisone acetate >2redforte, conopred?
2rednisolone 8a phosphate >F-2red, 'nflamase?
ima"olone >4e"ol?
(')*() *$ T+
%%% 3%'8(
- a person is legally blind if the best visual acuity with
corrective lenses in the better eye is #5# or less or
a visual field of # degrees or less in the better eye
8&)'8 C
;hen speaking to a client who has limited sight or blind, the nurse uses a normal tone of voice
lert the client when approaching
*rient the client to the environment
&se a focal point provide further orientation to the environment from the focal point
llow the client to touch ob6ects in the room
&se the clock placement of foods on the meal tray to orient the client
2romote independence as much as possible
2rovide radios, T4s, clocks that give the time orally or provide a 3raille watch.
;hen ambulating, allow the client to grasp the nurse@s arm at the elbow
'nstruct the client to remain one step behind the nurse when ambulating
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SENSES – VISUAL – THE EYE
'nstruct 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
'nstruct the client that the cane is held in the dominant hand several inches off the floor
'nstruct the client that the cane sweeps the ground where the client@s foot will be placed ne"t to
determine the presence of obstacles
1. CTCT)
- an opacity of the lens that distorts the image
pro6ected 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
C&))
ging process >)enile cataracts?
'nherited >Congenital cataracts?
'n6ury >Traumatic cataracts?
Can occur as a result of another eye disease >)econdary cataracts?
))))08T
*pa!ue or cloudy white pupil
radual loss of vision
3lurred vision
(ecreased color perception
4ision that is better in dim light with pupil dilation
2hotophobia
bsence of red refle"
0('C% 0808T
- surgical removal of the lens, one eye at a time
- a lens implantation may be performed at the time
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SENSES – VISUAL – THE EYE
of surgical procedure
9TC2)&% 9TCT'*8
- the lens is lifted out w5o removing the lens capsule
- may be performed with 2hacoemulsion
2+C*0&%)'$'CT'*8
- the lens is broken up by ultrasonic vibrations
e"tracted
'8TC2)&% 9TCT'*8
- the lens is removed within its capsule through as
small incision
2-*2 8&)'8 C
'nstruct measures to prevent or decrease '*2
dminister pre-op eye medications including mydriatics cycloplegics as prescribed
2*)T-*2 8&)'8 C
levate the head of the bed 7-
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SENSES – VISUAL – THE EYE
Cataract glasses act as magnifying glasses replace central vision only
Cataract glasses magnify, ob6ects appear closer therefore teach client to 6udge distance climb
stairs carefully
Contact lenses provide sharp visual acuity but de"terity is needed to insert them
Contact the 0( for any decrease in vision, severe eye pain or increase in eye discharge
#. %&C*0
- increased '*2 as a result of inade!uate drainage of
a!ueous humor from the canal of )chlemm or over
production of a!ueous humor
- the condition damages the optic nerve can result
in blindness
T2)
. C&T I a rapid onset of '*2 J =-K- mm +g
C%*)(-8%58*; 8% %&C*0
- results from obstruction to outflow to
a!ueous humor
3. C+*8'C I a slow progressive, gradual onset of '*2J7-= mm+g
C%*)(-8% %&C*0
- follows an untreated attack of acute close-angled
glaucoma
*28-8% %&C*0
- results from an overproduction or obstruction to
the outflow of a!ueous humor
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SENSES – VISUAL – THE EYE
))))08T
2rogressive loss of peripheral vision followed by a loss of central vision
levated '*2 >8ormal pressure is 1-#1 mm +g?
4ision worsening in the evening with difficulty
ad6usting to dark rooms
3lurred vision
+alos around white lights
$rontal headaches
2hotophobia
'ncreased lacrimation
2rogressive loss of central vision
8&)'8 C $* C&T %&C*0
Treat as medical emergency
dminister medications as prescribed to lower '*2
2repare the client for peripheral iridectomy
- allows a!ueous humor to flow from the posterior
to anterior chamber
8&)'8 C $* C+*8'C %&C*0
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SENSES – VISUAL – THE EYE
'nstruct the client the importance of medications
a. 0'*T'C): to constrict the pupils
b. C3*8'C 8+() '8+'3'T*): to decrease
the production of a!ueous humor
c. 3T-3%*CF): to decrease the production of
a!ueous humor '*2
'nstruct the client the need for life-long medication use
'nstruct the client to wear a 0edic-lert bracelet
'nstruct the client to avoid anti-cholinergic medications
'nstruct the client to report eye pain, halos around eyes changes of vision to the physician
'nstruct the client that when ma"imal medical therapy has failed to halt the progression of visual field
loss optic nerve damage,
surgery will be recommended
2repare the client for T3C&%*2%)T as prescribed
to facilitate a!ueous humor drainage
2repare client for T3C&%CT*0 as prescribed
- allows drainage of a!ueous humor into the
con6uctival spaces by the creation of an opening
7. T'8% (TC+08T
- 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
T2)
2T'% T'8% (TC+08T
- becomes complete if left untreated
C*02%T T'8% (TC+08T
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SENSES – VISUAL – THE EYE
- when detachment is complete, blindness may occur
))))08T
$lashes of light
$loaters
'ncrease in blurred vision
)ense of curtain being drawn
%oss of a portion of the visual field
'00('T 8&)'8 C
2rovide bedrest
Cover both eyes with patches to prevent further detachment
)peak to the client before approaching
2osition the client@s head as prescribed
2rotect the client from in6ury
void 6erky head movements
0inimiAe eye stress
2repare the client for surgical procedure as prescribed
0('C% 0808T
- draining fluid from the subretinal space so that the
retina can return to the normal position
)%'8 T'8% 3F) 3 C*)&
- a cold probe applied to the sclera to stimulate an
inflammatory response leading to adhesions
('T+0
- the use of electrode needle heat through the
sclera to stimulate an inflammatory response
leading to adhesions
%) T+2
- to stimulate an inflammatory response to seal small
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SENSES – VISUAL – THE EYE
retinal tears before the detachment occurs
)C%% 3&CF%'8
- to hold the choroid retina together with a splint
until scar tissue forms closing the tear
'8)T'*8 *$ ) * )'%'C*8 *'%
- to encourage attachment because these agents
have a specific gravity less than vitreous or air can
float against the retina
2*)T-*2 8&)'8 C
0aintain eye patches bilaterally as prescribed
0onitor hemorrhage as prescribed
2revent 84 and monitor for restlessness which can cause hemorrhage
0onitor for sudden, sharp eye pain >notify the 0( stat?
ncourage (3 but avoid coughing
2rovide bed rest for 1-# days as prescribed
'f gas has been inserted, position as prescribed on the abdomen turn the head so unaffected eye isdown
dminister eye medications as prescribed
ssist client with (%
void sudden head movements or anything that increases '*2
'nstruct the client to limit reading for 7-= weeks
'nstruct client to avoid s!uinting, straining constipation, lifting heavy ob6ects
bending from the waist
'nstruct the client to wear dark glasses during the day an eye patch at night
ncourage follow-up care because of the danger of recurrence or occurrence in the other eye
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SENSES – VISUAL – THE EYE
- a condition in which the eyes are not aligned
because of lack of muscle coordination of the
e"traocular muscles
- most often results from muscle imbalance or
paralysis of e"traocular 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 < months
))))08T
mblyopia if not treated early
2ermanent loss of vision if not treated early
%oss of binocular vision
'mpairment of depth perception
$re!uent headaches
)!uints or tilts head to see
8&)'8 C
Corrective lenses as indicated
'nstruct the parents regarding patching >occlusion therapy? of the LgoodM eye > to strengthen the weak
eye?
2repare for botulinum to"in >3oto"? in6ection into the eye muscle
- produces temporary paralysis
- allows muscles opposite the paralyAed muscle
to strengthen the eye
'nform the parents that the in6ection of botulinum to"in wears off in about # months if successful,
correction occurs
2repare for surgery to realign the weak muscles as " if nonsurgical interventions are unsuccessful
'nstruct the need for follow-up visits
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SENSES – VISUAL – THE EYE
=. C*8N&8CT'4'T')
- also known as L2'8F M
- inflammation of the con6unctiva
- usually caused by allergy, infection, or trauma
T2)
3CT'% * 4'% C*8N&8CT'4'T')
- e"tremely contagious
C+%0('% C*8N&8CT'4'T')
- is rare in older children if diagnosed in a child who
is not se"ually active, the child should be assessed for
possible se"ual abuse
))))08T
'tching, burning or scratchy eyelids
edness
dema
(ischarge
8&)'8 C
'nstruct in infection control measures such as good handwashing not sharing towels washcloths
dminister antibiotic or antiviral eye drops or ointment as " if infection is present
dminister antihistamines as " if an allergy is present
'nstruct the parents that the child should be kept home from school or day care until antibiotic eye
drops have been administered for #< hrs
'nstruct in the use of cool compresses to lessen irritation in wearing dark glasses for photophobia
'nstruct the child to avoid rubbing the eye to prevent in6ury
(5C use of contact lenses to obtain new lenses to eliminate the chance of re-infection
'nstruct the adolescent that eye make-up should be discarded replaced
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SENSES – VISUAL – THE EYE
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SENSES – VISUAL – THE EYE
)
9T8%
- mbedded in the temporal bone bilaterally at the
level of the eyes
- "tends from the auricle through the e"ternal canal
to the tympanic membrane or eardrum
- 'ncludes the mastoid process, a bony ridge located
over the temporal bone
. &'C% >2'88?
- *uter pro6ection of ear composed of cartilage
covered by skin
- collects sound waves
3. 9T8% &('T* C8%
- %ined with skin
- lands secrete cerumen >wa"?
- provides protection
- transmits sound waves to tympanic membrane
C. T028'C 0038 >(&0?
- %ocated at the end of the e"ternal canal
- 4ibrates in response to sound transmit vibrations
to middle ear
0'((%
- 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
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SENSES – VISUAL – THE EYE
e"ternal 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 e!ualiAation of pressure on both sides of
the tympanic membrane
. *))'C%)
- Contains 7 small bones: 0alleus >+ammer? 'ncus >nvil?
)tapes >)tirrup?
- *ssicles are set in motion by sound waves from
malleus to the footplate of the stapes in the oval
window
3. &)TC+'8 T&3
- Connects nasopharyn" middle ear
- !ualiAes pressure on both sides of eardrum
'88
- Contains the semi-circular canals, the cochlea the
distal end of the Eth cranial nerve
- 0aintains sense of balance e!uilibrium
. )0'-C'C&% C8%)
- Contains fluid hair cells connected to sensory
nerve fibers of the vestibular portion of Eth
cranial nerve
3. C*C+%
- )piral-shaped organ of hearing
- Connects organ of Corti, receptor and organ for
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SENSES – VISUAL – THE EYE
hearing
- Transmits sound waves from the oval window
initiates nerve impulses carried by cranial nerve
4''' >acoustic branch? to brain > temporal lobe of
cerebrum?
C. Eth C8'% 84
1. C*C+% 38C+
- transmits neuro-impulses from the cochlea to the
brain where it is interpreted as sound
#. 4)T'3&% 38C+
- maintains balance e!uilibrium
+'8 /&'%'3'&0
The e"ternal 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 ustachiantube
The inner ear contains sensory receptors for sound fore!uilibrium
The receptors in the inner ear transmit sound waves changes in body position to the nerve impulses
))))08T *$ T+
*T*)C*2'C 90
&'(%'8)
- the speculum is never blindly introduced into the
e"ternal 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
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SENSES – VISUAL – THE EYE
- this permits the e"aminer@s hand to lie against the
head for support
- pull the pinna up back to straighten the e"ternal
canal in an adult
- visualiAe the e"ternal canal while slowly inserting
the speculum
8*0% $'8('8) *$ T+ 9T8% C8%
2ink intact without lesions
+as various amounts of cerumen fine little hairs
8*0% $'8('8) *$ T+ T028'C 0038
The tympanic membrane should be intact without perforations free from lesions
The tympanic membrane is transparent, opa!ue, pearly gray slightly concave
&('T* ))))08T
)ound is transmitted by air conduction bone conduction
ir is #-7" longer than bone conduction
CT*') *$ +'8 %*))
C*8(&CT'4 +'8 %*))
- due to any physical obstruction to the transmission
of sound waves
)8)*'8&% +'8 %*))
- due to a defect in the organ of hearing, in the Eth
cranial nerve, or in the brain itself
0'9( C*8(&CT'4, )8)*'8&% +'8 %*))
- results in profound hearing loss
4*'C T)T
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SENSES – VISUAL – THE EYE
sk the client to block one e"ternal canal
The e"aminer stands 1-# ft away !uickly whispers a statement
The client is asked to repeat the whispered statement
ach ear is tested separately
;TC+ T)T
ticking watch is used to test the high-fre!uency sounds
The e"aminer holds a ticking watch about = inches from each ear asks the client if the ticking is
heard.
T&8'8 $*F T)T)
. ;3 T&8'8 $*F T)T
C*8(&CT'4 +'8 %*)) I the sound is heard in affected ear
)8)*'8&% +'8 %*))I sound heard in the unaffected ear
3. '88 T&8'8 $*F T)T
8*0% )&%T: >O? '88 T)T5 CJ3C
C*8(&CT'4 +'8 %*))
'f the client is unable to hear the sound through the ear in front of the pinna, >-? '88 T)T5 CP3C
4)T'3&% ))))08T *$ T+
T)T $* $%%'8
The e"aminer 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
38*0% )&%T: >O? *03 )'8
- presence of significant swaying
T)T $* 2)T 2*'8T'8
8*0% T)T )2*8):
- The client can easily return to the point of
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SENSES – VISUAL – THE EYE
reference
$'8('8)
The client with vestibular function problem lacks a normal sense of position sense and is unable to
return to the e"tended fingers to the point of reference, the fingers instead either goes to the right or left
of the reference point
B 8)T0&) 4%&T'*8
"amine the client@s eyes as they look straight ahead, 7 degrees to each side, upward downward
$'8('8)
- ny spontaneous nystagmus is a >O? result
- 38*0% $'8('8
- a constant involuntary cyclic movement of the
eyeball in any direction represents a problem with
the vestibular system
+%%2'F 08&4
ssesses for positional vertigo or induced diAAiness
The client assumes a supine position
The head is rotated to one side for 1 minute
$'8('8)
>O? test result is presence of nystagmus after =-1 sec
- 38*0% $'8('8
- a constant involuntary cyclic movement of the
eyeball in any direction represents a problem with
the vestibular system
('8*)T'C T)T) $* T+
T*0*2+
- may be performed with or without contrast
medium
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SENSES – VISUAL – THE EYE
- assesses the mastoid, middle ear inner ear
structures
- multiple "-rays of the head are done
8&)'8 C
ll 6ewelry are removed
%ead 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
8o follow-up care is re!uired
&('*0T
- measures hearing acuity
- uses # types: 2& T*8 &('*0T )2C+
&('*0T
- after testing, audiogram patterns are depicted on a
graph to determine the type level of hearing loss
2& T*8 &('*0T
- used to identify problems with hearing, speech,
music other sounds in the environment
)2C+ &('*0T
- the client@s ability to hear spoken words is measured
8&)'8 C
'nform the client regarding the procedure
'nstruct the client to identify the sounds as they are heard
%CT*8)T0*2+
- evaluates spontaneous nystagmus
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SENSES – VISUAL – THE EYE
- 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
C%*'C T)T >3'-T+0% T)T?
- evaluate diAAiness
- 8ystagmus, 854 or ata"ia
- indicate a pathological condition of the labyrinth
system, whereas a decreased response may
indicate that the vestibular system is affected
8&)'8 C
;arm water causes a greater response than cold water
;arm 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 7 degrees
fter the procedure, the client begins taking clear fluids slowly cautiously because 8 4 may occur
ssistance with ambulation may also be necessary following the procedure
*T'C 0('CT'*8)
(0'8')T'8 (*2)
(&%T
2ull the pinna up back to straighten the e"ternal canal to instill ear drops
C+'%(
2ull the pinna down back for infants children younger than 7 years of age
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SENSES – VISUAL – THE EYE
2ull the pinna up back for children for children more than 7 years
''T'*8 *$ T+
'rrigation of the ear needs to be prescribed by 0(
nsure that there is direct visualiAation of the tympanic membrane
;arm irrigating solution to 1Q $
- solutions not close to the client@s body temp
will cause ear in6ury, nausea vertigo
'rrigation must be done gently to avoid damage to the eardrum
;hen irrigating, don@t direct irrigating solution directly toward the eardrum
'f perforation of the eardrum is suspected, irrigation is not done
0('CT'*8) T+T $$CT +'8
8T'3'*T'C)
mikacin >mikin?
Chloramphenicol
- Chloromycetin
- Chloroptic
- *phthoclor
rythromycin
- -0ycin
- C
- ry-Tab
- 2C (ispertabs
- 'lotycin
entamicin >aramycin?
)treptomycin sulfate
>)treptomycin?
Tobramycin sulfate >8ebcin?
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SENSES – VISUAL – THE EYE
4ancomycin >4ancocin?
('&T'C)
cetaAolamide >(iamo"?
$urosemide >%asi"?
thacrynic acid >decrine?
*T+)
Cisplatin >2latinol, 2latinol-/?
8itrogen mustard
/uinine >/uinamn?
/uinidine
- Cardio!uin
- /uinaglute
- /uinde"
8T'-'8$CT'4 0('CT'*8)
902%)
mo"icillin >mo"il?
mpicillin trihydrate >2olycillin?
Cefaclor >Ceclor?
Clindamycin +Cl >Cleocin?
Trimethoprim >T02? )ulfametha"aAole >)0B?
- 3actrim, Cotrim, )eptra
rythromycin >'lotycin, -0ycin?
2enicillin 4 potassium >2en 4?
%oracarbef >%orabid?
Clarithromycin >3ia"in?
2olymy"in 3 sulfate >erosporin?
Tetracycline +Cl >chromycin?
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SENSES – VISUAL – THE EYE
cetic acid and luminum acetate >*tic (omeboro?
8T'-+')T0'8) (C*8)T8T)
- 2roduce vasoconstriction
- )timulate the receptors of the respiratory mucosa
- educe respiratory tissue hyperemia edema to
open obstructed eustachian tubes
- &sed for acute otitis media
)'( $$CT)
(rowsiness
3lurred vision
(ry mucous membranes
8&)'8 C
'nform the client that drowsiness, blurred vision, dry mouth may occur
'nstruct the client to increase fluid intake unless C5' to suck on hard candy to alleviate dry mouth
'nstruct the client to avoid haAardous activities if drowsiness occurs
902%)
Tripolidine pseudoephedrine >ctifed?
8aphaAoline +Cl >llerest, lbalon?
Chlorpheniramine >Chlor-Trimeton, Teldrin?
3rompheniramine >3romphen, (imetane?
Terfenadine >)eldane?
Clemastine >Tavist?
CetiriAine >Byrtec?
stemiAole >+ismanal?
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SENSES – VISUAL – THE EYE
%*C% 8)T+T'C)
0('CT'*8 :
3enAocaine >mericaine *ticR Tympagesic?
)'( $$CT)
llergic reaction
'rritation
8&)'8 C
0onitor for effectiveness if used for pain relief
ssess for irritation or allergic reaction
C&0'8*%T'C 0('CT'*8)
902%)
Carbamide pero"ide >(ebro"?
3oric acid >ar-(ry?
8&)'8 C
'nstruct the client not to use drops more often than prescribed
0oisten a cotton plug with medication before insertion
Feep the container tightly closed away from moisture
void touching the ear with the dropper
7 minutes after installation, gently irrigate the ear as " with warm water using a rubber bulb ear
syringe
'rrigation may be done with hydrogen pero"ide sol@n as "
$or chronic cerumen impaction, 1-# gtts of mineral oil will soften the wa"
'nstruct the client to notify 0( if redness, pain or swelling persists
(')*() *$ T+
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SENSES – VISUAL – THE EYE
1. C*8(&CT'4 +'8 %*))
- occurs when sound waves are blocked to the inner ear
fibers because of e"ternal ear or middle ear disorders
- disorders can often be corrected with no damage to
hearing, or minimal permanent hearing loss
C&))
ny inflammatory process or obstruction of the e"ternal or middle ear
Tumors
*tosclerosis
build-up of scar tissue on the ossicles from previous middle ear surgery
#. )8)*'8&% +'8 %*))
- a pathological process of the inner ear or of sensory
fibers that lead to the cerebral corte"
C&))
(amage to the inner ear structures
(amage to the cranial nerve 4'''
2rolonged e"posure to loud noise
0edications, trauma, infections, surgery
'nherited disorders
0etabolic circulatory disorders
0eniere@s syndrome
(iabetes mellitus
0y"edema
7. 0'9( +'8 %*))
- also known as conductive-sensorineural hearing loss
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SENSES – VISUAL – THE EYE
- client has both sensorineural conductive hearing
loss
)'8) *$ +'8 %*)) : 8%
$re!uently asking people to repeat statements
)training to hear
Turning head or leaning forward to favor one ear
)houting in conversations
inging in the ears
$ailing to respond when not looking in the direction of the sound
nswering !uestions incorrectly
aising the volume of the television or radio
voiding large groups
3etter understanding of speech when in small groups
;ithdrawing from social interactions
$C'%'TT'8 C*00&8'CT'*8
&se of written words
2rovision of light in the room
etting the attention of the client before you begin to speak
$acing the client when speaking
Talking in a room without distracting noises
0oving close to the client speaking slowly
clearly
Feeping hands other ob6ects away from the mouth when talking to the client
Talking in lower tones, because shouting is not helpful
ephrasing sentences repeating information
4alidating
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SENSES – VISUAL – THE EYE
eading lips
&sing sign language
&sing telephone amplifiers
$acing lights that are activated by ringing of the telephone or doorbell
)pecially trained dogs that help the client to be aware of sound to alert the client of potential
dangers
C*C+% '02%8TT'*8
- 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 e"ternal ear
- electronic impulses directly stimulate nerve fibers
+'8 '()
- used for the client with conductive hearing loss
- can help the client with sensorineural loss,
although it is not as effective
- a difficulty that e"ists in its use is the amplification
of background noise as well as voices
C%'8T (&CT'*8: +'8 '(
ncourage to begin using the hearing aid slowly to develop an ad6ustment to the service
d6ust the volume to a minimal hearing level to prevent feedback s!ueaking
Teach the client to concentrate on the sounds that are to be heard to filter out background noise
'nstruct the client to clean ear mold with mild soap water
void e"cessive 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
Feep e"tra batteries on hand
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SENSES – VISUAL – THE EYE
Feep the hearing aid in a safe place
2revent hair sprays, oils, or other hair face products from coming into contact with the receiver of the
hearing aid
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SENSES – VISUAL – THE EYE
infection
- the skin becomes red, swollen, tender to touch
on movement
- the e"cessive swelling of the canal lead to
conductive
hearing loss due to obstruction
- more common in children termed as L);'00@)
M
- occurs more often in hot, humid environments
))))08T
2ain
'tching
2lugged feeling in the ear
edness edema
"udate
+earing loss
8&)'8 C
pply heat locally for # minutes 7" a day
ncourage rest to assist in reducing pain
dminister analgesics such as aspirin or acetaminophen >Tylenol? for the pain as prescribed
'nstruct the client that the ears should be kept clean dry
'nstruct the client to use earplugs for swimming
'nstruct the client that cotton-tipped applicators should not be used to dry ear because their use can
lead to trauma to the canal
'nstruct the client that irritating agents such as hair products or headphones should be discontinued
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SENSES – VISUAL – THE EYE
D. *T'T') 0('
- 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
))))08T
$ever
'rritability, restlessness loss of appetite
olling of head from side to side
2ulling on or rubbing the ear
arache or pain
)igns of hearing loss
2urulent ear drainage
ed, opa!ue, bulging or retracting tympanic membrane
8&)'8 C
ncourage oral fluids
Teach the parents to feed infants in an upright position
'nstruct the child to avoid chewing during the acute period
- chewing increases the pain
2rovide local heat have the child lie with affected ear down
'nstruct the parents in the appropriate procedure to clean drainage from the ear with sterile cotton
swabs
'nstruct in the administer of analgesics or antipyretics such as cetaminophen >Tylenol? to decrease
fever pain
'nstruct the parents in the administration of prescribed antibiotics, emphasiAing that the 1-1< day
period is necessary to eradicate positive organisms
'nstruct the parents that screening for hearing loss may be necessary
0'8*T*0
- temporary incision of tympanic membrane to
decompress the membrane and promote drainage
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SENSES – VISUAL – THE EYE
of effusion
- insertion of tympanoplasty tubes in the middle ear
to e!ualiAe pressure keep the ears dry
2*)T-*2 8&)'8 C
Feep the ears dry
arplugs should be worn during bathing, shampooing swimming
(iving submerging under water are C5'
Client education post myringotomy
void strenuous e"ercise
void rapid head movements, bouncing or bending
void straining on bowel movement
void drinking through a straw
void traveling by air
void forceful coughing
void contact with persons with colds
void washing hair, showering or getting the head wet for a week as "
'nstruct the client that if she5he needs to blow the nose, blow one side at a time with wide mouth open
'nstruct the client to keep ears dry by keeping a ball of cotton coated with petroleum 6elly in the ear
to change cotton ball daily
'nstruct the client to report e"cessive ear drainage to the physician
K. C+*8'C *T'T') 0('
- 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
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SENSES – VISUAL – THE EYE
myringotomy, or replacement of the ossicles
within the middle ear
T028*2%)T
- a reconstruction of the middle ear may be
attempted to improve conductive hearing loss
2-*2 8&)'8 C
dminister antibiotic ear drops as "
Clear the ear of debris as " irrigate ear with a solution of e!ual parts of vinegar sterile +#*as "
'nstruct to avoid persons with &T'
'nstruct client to obtain ade!uate rest, eat a balanced diet drink ade!uate fluids
'nstruct in (3 coughing but forceful coughing avoided.
- increases pressure in the middle ear esp. post-op
2*)T-*2 8&)'8 C
'nform client that initial hearing after surgery is diminished hearing will improve after the ear canal
packing is removed
Feep dressing clean dry
Feep client flat with operative ear up for at least 1# hours
dminister antibiotics as "
'nstruct the client that he5she may return to work in appro"imately 7 weeks post-op
E. *T*)C%*)')
- disease of the labyrinthine capsule of the middle
ear that results in a bony overgrowth of the tissue
surrounding the ossicles
- causes the dev@t of irregular areas of new bone
formation causes fi"ation of the bones
- stapes fi"ation leads to C*8(&CT'4 +'8
%*))
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SENSES – VISUAL – THE EYE
- if it involves inner ear, )8)*'8&% +'8
%*))
))))08T
)lowly progressing conductive hearing loss
3ilateral hearing loss
ringing or roaring type of constant tinnitus
%oud sounds heard in the ear when chewing
2inkish discoloration >)C+;TB@) )'8? of the tympanic membrane
- indicates vascular changes in the ear
>-? inne test
;eber test shows lateraliAation 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 2T'% )T2(CT*0 or C*02%T
)T2(CT*0 ;'T+ 2*)T+)')
>$8)TT'*8? may be surgically performed
$8)TT'*8
- 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
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SENSES – VISUAL – THE EYE
same manner as the stapes
C*02%'CT'*8):
Complete hearing loss
2rolonged vertigo
'nfection
$acial nerve damage
2-*2 8&)'8 C
'nstruct the client in measures to prevent middle ear or e"ternal ear infections
'nstruct the client to avoid e"cessive nose blowing
'nstruct not to clean the ear canal with cotton-tipped applicators
'nstruct the client to remove the hearing aid # weeks before surgery to ensure the integration of local
tissue
2*)T-*2 8&)'8 C
'nform the client that hearing is initially worse after the surgical procedure no noticeable
improvement in hearing may occur for as long as D weeks
'nform the client that the elfoam ear packing interferes with hearing but is used to decrease bleeding
ssist with ambulating during the first 1-# days after surgery
2rovide side rails when the client is in bed
dminister antibiotics antivertiginous pain meds as "
ssess for facial nerve damage, weakness, changes in taste sensation, vertigo, nausea vomiting
'nstruct to move head slowly when changing positions
'nstruct to avoid showering getting the head wound wet
'nstruct to refrain from using small ob6ects to clean the e"ternal ear canal
'nstruct to avoid rapid, e"treme changes in pressure caused by !uick head movements,
sneeAing,nose blowing, straining changes in altitude
'nstruct to avoid changes in the middle ear pressure
- it could dislodge the graft prosthesis
08'@) )8(*0
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SENSES – VISUAL – THE EYE
- a syndrome also called 8(*%02+T'C +(*2)
>- refers to dilation of the endolympathic system by
either overproduction or decreased reabsorption of
endolymphatic fluid?
- characteriAed 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
fre!uency of attacks continues, hearing loss
becomes permanent
- repeated damage to the cochlea caused by
increased fluid pressure leads to the permanent
hearing loss
C&))
ny factor that increases endolymphatic secretion in the labyrinth
4iral bacterial infections
llergic reactions
3iochemical disturbances
4ascular disturbances producing changes in the microcirculation in the labyrinth
))))08T
$eelings of fullness in the ear
Tinnitus, as a continuous low-pitched roar or humming sound - is present most of the time but
worsens 6ust before during severe attacks
+earing loss is worse during an attack
4ertigo
- periods of whirling which might cause the client
to fall to the ground
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SENSES – VISUAL – THE EYE
- sometimes so intense that even when lying down,
the client holds the bed or ground in an attempt
to prevent the whirling
8ausea vomiting
8ystagmus
)evere headaches
8*8-)&'C% 0808T
2reventing in6ury during vertigo attacks
2roviding bed rest in a !uiet environment
2rovide assistance with walking
'nstruct the client to move the head slowly
- to prevent worsening of vertigo
'nitiate 8a fluid restrictions as "
'nstruct to avoid smoking
dminister 8icotinic acid >8iacin? as "
- promote vasodilating effect
dminister antihistamines as "
- reduce the production of histamine
inflammation
dminister antiemetics as "
dminister tran!uiliAers sedatives as "
- to calm client allow rest, control the vertigo,
84
)&'C% 0808T
- performed when medical therapy is ineffective
the functional level of the client has decreased
significantly
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SENSES – VISUAL – THE EYE
8(*%02+T'C ('8 '8)T'*8 *$ T+ )+&8T
- may be performed early in the course of the disease
to assist with the drainage of e"cess fluids
)CT'*8 *$ T+ 4)T'3&% 84
%3'8T+CT*0
- removal of the labyrinth may be performed
2*)T-*2 8&)'8 C
ssess packing dressing on the ear
)peak to the client on the side of the unaffected ear
2erform neurological assessments
0aintain side rails
ssist with ambulating
ncourage the use of bedside commode
dminister antivertiginous antiemetic medications as "
C&08 $*'8 3*(')
C&085 ;9
- the most common cause of impacted canals
$*'8 3*(')
- can include vegetables, beads, pencil erasers
insects
))))08T
)ensation of fullness in the ear with or without hearing loss
2ain, itching or bleeding
C&08
8&)'8 C
emoval of the wa" by irrigation is a slow process
'rrigation is C5' in clients with a h" of tympanic membrane perforation
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SENSES – VISUAL – THE EYE
To soften cerumen, add 7 gtts of glycerin to the ear S hs 7 gtts of hydrogen pero"ide 3'(
fter several days the ear is irrigated
-=-K ml of solution is the ma"imal amount a client can tolerate during an irrigation sitting
$*'8 3*(')
8&)'8 C
'f the foreign matter is vegetable, irrigation is used with care
'nsects are killed before removal unless they can be coa"ed out by flashlight or a humming noise
0ineral oil or alcohol is instilled to suffocate the insect which is then removed with ear forceps
&se small ear forceps to remove the ob6ect avoid pushing the ob6ect farther into the canal
damaging the tympanic membrane
C
2*TCT'*8
2rotecting and Caring $or our ars
The ears are delicate and irreplaceable instruments.
*nce hearing is damaged, it often cant be restored.
)o give your ears U and your hearing U the same level of care and attention as you do other vital parts
of your body.
eneral 8ursing Care Tips
+ave your ears and hearing checked periodically
Fnow the warning signs of hearing loss
)ee a medical professional right away if you:
in6ure your ears,
e"perience ear pain, or
notice changes in your ears or sense of hearing
;arning )igns of +earing %oss
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SENSES – VISUAL – THE EYE
(ifficulty hearing conversations, especially in the presence of background noise
$re!uently asking others to repeat what they@ve said
0isunderstanding what people say
(ifficulty hearing on the telephone
e!uiring the T4 or radio volume to be louder than others in the room prefer
$eeling that people are mumbling when they are talking
(ifficulty hearing certain environmental sounds, such as birds chirping
greeing or nodding your head during conversations when you@re not sure what@s been said
emoving yourself from conversations because it@s too difficult to hear
eading lips so you can try to follow what people are saying
)training to hear or keep up with conversations
Tinnitus
2reventing +earing %oss
void loud or prolonged e"posure to noise.
;hen you cant avoid noise, wear ear protection.
'f your ears produce e"cessive earwa", have your ears cleaned periodically by a health care
professional. >(o not use cotton swabs, as you will lodge more earwa" even deeper into the ear canal
than the small amount of wa" you will remove.?
void ototo"ic drugs. 'f taking one already, talk with your doctor and see if theres a less-ototo"ic
alternative.
)tay healthy and be mindful of risk factors, such as hypertension.
8oise
void e"posure to loud noise.
best action: get rid of the noise or leave the noisy area.
$ollow this simple rule of thumb: if you need to shout to be heard over noise, its potentially damaging
;hen you can@t avoid noise, always wear ear protection >earplugs or earmuffs?
3e aware that repeated or prolonged e"posure to lower noise levels may cause hearing damage
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SENSES – VISUAL – THE EYE
2rotect the ears of children who are too young to know the dangers that noise can pose
Cleaning of ars
Clean ears with e"tra care.
;ipe the outer ear with a washcloth or tissue.
8ever put anything into your ear that@s smaller than an adult finger covered with a washcloth.
&sing cotton swabs or other small ob6ect may damage the sensitive structures of your inner ear
arwa" is usually removed by the ear@s own cleaning mechanism.
'f there is build-up of e"cess earwa", have it removed by a physician or medical professional.
'llness and 0edications
educe the risk of ear infections by treating upper respiratory tract infections promptly
)ome illnesses and medical conditions can affect hearing.
'f e"periencing sudden hearing loss or persistent noise in your ears or head >tinnitus?, have it seen by a
health care provider5physician right away
'llness and 0edications
3e aware that certain medications are ototo"ic and may damage your hearing.
Take medications only as directed, and refer to you health care provider5physician immediately if you
e"perience unusual symptoms
)top smoking.
)ome studies have found that adults who smoke are more likely to develop hearing loss than
nonsmokers.
)moking can also aggravate e"isting conditions, such as tinnitus
3lowing of the nose
study conducted by a team of researchers from the &niversity of 4irginia and the &niversity of arhus
in (enmark, revealed that blowing your nose may actually cause mucus to be propelled back into the
sinus cavities.
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SENSES – VISUAL – THE EYE
lso, blowing the nose creates a huge amount of pressure in the nose -- over seven times more
pressure than is produced by sneeAing or coughing.
2roper blowing of the nose
3low your nose gently.
3lowing too hard creates even more pressure that can force infectious mucus into your ears and
sinuses.
void the Vboth-nostrils-openV blow. 'nstead ...
2ress a finger over one nostril.
ently blow the nose into a paper tissue thru the one open nostril.
)witch your finger to close the opposite nostril, and repeat.
2roper blowing of the nose
(rink plenty of fluids.
0akes it easier for mucus to be removed by blowing gently.
3lowing your nose after taking a steamy shower can also help.
2roper blowing of the nose
&se paper tissues rather than cloth handkerchiefs.
used handkerchief is a breeding ground for germs -- and when you reuse it youre spreading those
germs around your face and hands.
2roper blowing of the nose
*nly use a paper tissue once, then throw it away.
0inimiAes the risk of putting germs back onto your face and hands.
;ash your hands when youre finished,
0icrobes from your nose and tissue will be transferred to your fingers while you blow.
2revents spread of germs to other people or back to yourself.
ar "amination
'ncludes an assessment of:
+earing, and
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SENSES – VISUAL – THE EYE
appearance of the ear
ar "amination
ar "amination
+istory
%ook for classic symptoms of ear disease: deafness, tinnitus, discharge >otorrhia?, pain >otalgia?, and
vertigo
2revious ear surgery, or head in6ury
$amily history of deafness
)ystemic disease >for e"ample stroke, multiple sclerosis, cardiovascular disease?
*toto"ic drugs >antibiotics: gentamicin?, diuretics, cytoto"ics?
"posure to noise >pneumatic drill or shooting, for e"ample?
+istory of atopy and allergy in children
ar "amination
'nspecting the "ternal ar
'nspect the e"ternal ear before e"amination with an otoscope5auriscope.
)wab any discharge, and remove any wa".
'nspecting the "ternal ar
%ook for obvious signs of abnormality:
)iAe and shape of pinna
"tra cartilage tags5pre-auricular sinuses or pits
)igns of trauma to pinna
)uspicious skin lesions on the pinna including neoplasia
)kin conditions of the pinna and e"ternal canal
'nfection5inflammation of e"ternal ear canal with discharge
)igns5scars of previous surgery
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SENSES – VISUAL – THE EYE
2%2T'*8 *$ T+ 9T8%
ently pull on the pinna to test for pain >'f painful this may suggest e"ternal ear disease?.
2alpate for any lymph nodes >e.g. The parotid or postauricular nodes W this may also be suggestive of
e"ternal ear disease?
'8)2CT'*8 *$ T+ 9T8% &('T* 0T&)
"amine the Xgood ear@ first. ;ith prior warning to the patient, gently pull the pinna upwards and
outwards >(irectly down and back in children?.
'nspecting the ar Canal and ar (rum
)lowly insert the otoscope5auriscope, looking at the skin of the canal while entering.
Check skin for normality or signs of inflammation.
'nspecting the ar Canal and ar (rum
%ook for wa" or other obstructions >e.g. foreign bodies U tips of cotton budsY?
ar wa"
'nspecting the Tympanic 0embrane
0ove the otoscope in order to see several different views of the drum.
8ormal tympanic membrane should appear pearly grey, concave, roughly circular >W1cm indiameter?.
'nspecting the Tympanic 0embrane
1Ittic >pars flaccida?
#I %ateral process of malleus
7I+andle of malleus
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SENSES – VISUAL – THE EYE
%ook for signs of perforation.
2erforation of ear drum
ar "amination
)lowly retract the otoscope5auriscope from the ear.
Change the speculum on the otoscope5auriscope and e"amine the other ear.
$inally document what was seen in both ears, the condition of the tympanic membrane and the
e"ternal auditory meatus
3asic hearing tests
(etailed hearing tests are usually performed in audiology clinics.
patient with normal hearing should hear e!ually as well in both ears.
Tuning fork tests: ;eber test and inne test
$ree field voice testing >whisper from
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SENSES – VISUAL – THE EYE
inne Test
'nterpretation of results is as follows:
'f the sound is now heard, the inne 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?
inne Test
inne Test
The whispered voice test
+as the advantage of not needing any e!uipment.
2atients are told that they will be asked to repeat three numbers.
The e"aminer stands out of view of the patient >to prevent lip reading? while covering one of the
patients ears and rubbing the e"ternal auditory meatus with a gentle circular motion.
This serves to mask sound input from the non-test ear.
The e"aminer then fully e"hales >which reduces voice volume? and standing .K= m >arms length? from
the ear being tested whispers 7 numbers.
't is very important to pay attention to the loudness of the whispering.
$ailure to repeat =H or more of the numbers on two trials is considered a fail and suggests a 7 d3O
hearing loss.
;hispered voice test
)tand 1-# feet behind client so they can not read your lips.
#? 'nstruct client to place one finger on tragus of left ear to obscure sound.
7? ;hisper word with # distinct syllables towards clients right ear.
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SENSES – VISUAL – THE EYE
%ight enters the eye thru a small hole called the pupil and is focused on the retina, which is like a
camera film.
'ris >colored ring of the eye? controls the amount of light entering the eyeR closes when light is bright
and opens when light is dim.
)clera: the tough white sheet that covers the outside of the eye
The ye
ye also has a focusing lens, which focuses images from different distances on the retina.
The ye
Ciliary muscles in ciliary body control the focusing of lens automatically.
'mage formed on the retina is transmitted to brain by optic nerve.
The image is finally perceived by brain.
Three %ayers
of the yeball
)clera: outer fibrous layer, helps keep the shape of the eye
Choroid: middle blood rich layer supplying nutrition to the eye structures
etina: inner colored >pigmented? nerve layer of the eye.
ye Care 2ractitioners
ye Care 2ractitioners
*phthalmologist
a medical doctor who specialiAes in eye care.
*ptometrist
optometric doctor trained to provide refractive correction and diagnose5treat common issues.
*phthalmic medical practitioner
)imilar to an optometrist >in the &F?.
*culist
*lder term for either an ophthalmologist or optometrist.
*cularist
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SENSES – VISUAL – THE EYE
specialiAes in the fabrication and fitting of ocular prostheses for people who have lost eyes due to
trauma or illness.
*ptician
also called *ptical (ispenser
specialiAes in the fabrication and fitting of
spectacles. 2rescription for the spectacles must
be supplied by an ophthalmologist or
optometrist.
*rthoptist
specialiAes in ocular motility, which is the movement of the eye controlled by the e"traocular muscles.
4ision therapist
work with patients that re!uire therapy, such as low vision patients.
*phthalmic medical personnel
popularly called V*02V
is a collective term for allied health personnel in ophthalmology.
often used to refer to non-specialiAed personnel >unlike ocularists or opticians?.
(anger signs of 4isual (isorders 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?
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SENSES – VISUAL – THE EYE
intermittent dimming of vision
strabismus
cornea J 11 mm in newborn >congenital glaucoma?
red eye with ed ye (anger )igns
ed ye (anger )igns
blurred vision >keratitis, glaucoma, 'ritis?
ciliary flush - perilimbal con6unctival in6ection >'ritis?
corneal opacification or epithelial disruption >bacterial keratitis?
abnormal pupil: nonreactive, small5irregular. >glaucoma, iridocyclitis, 'ritis?
proptosis
'ritis
2roptosis
lso called "ophthalmos
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
C*8T'8&( :ed ye (anger )igns
increased intraocular pressure
colored halos >acute angle-closure glaucoma?
pain >glaucoma, 'ritis, bacterial keratitis?
u@s sign: sharp pain in covered >red? eye when uncovered eye is illuminated >'ritis?
photophobia >iridocyclitis, 'ritis?
Feratitis
laucoma
ye +ealth 2romotion
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SENSES – VISUAL – THE EYE
8utrition
nsure proper intake of nutrients necessary for optimum vision health in the daily diet
nsure 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
4itamin
absolutely essential for eye and vision health.
re!uired by the retina for its proper functions
recommended for those with poor night vision
+elps eyes ad6ust to light changes
0oistens the eyes, which can enhance visual acuity
has been shown to prevent the forming of cataracts
helps prevent blindness from macular degeneration
)ources: sweet potatoes, carrots, mangoes, spinach, and cantaloupe, yellow s!uash.
4itamin C
- n antio"idant
%inked to the prevention of cataracts
*ne study has shown that taking 7 to D mg supplemental vitamin C reduced cataract risk by K
percent, delay of macular degeneration, and eye pressure reduction in glaucoma patients.
)ources: orange 6uice, citrus fruits and broccoli, cauliflower, cabbage, and strawberries.
4itamin
&se as an antio"idant
+elps protect against cataracts and age-related macular degeneration.
clinical study has showed that taking vitamin can cut the risk of developing cataracts in half.
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SENSES – VISUAL – THE EYE
nother study also showed that the combination of vitamins C and had a protective effect against &4
rays.
)ources: wheat germ, dark green leafy vegetables >such as spinach?, sweet potatoes, avocado,
asparagus
Binc
*ur eyes actually contain the greatest concentration of Ainc in our body.
an essential element re!uired for the conversion of beta-carotene into vitamin .
)ources: *ysters, red meat and poultry
Chromium
plays a large role in muscle contraction including eye muscles
low levels of chromium are a ma6or risk factor for increased intraocular pressure
)ources: beef, liver, eggs, chicken, oysters, wheat germ, green peppers, broccoli, apples, bananas,
and spinach.
lutathione
n amino acid that protects the tissues surrounding the lens of the eyes
+elps prevent cataracts, glaucoma, retinal disease, and diabetic blindness.
)ources: garlic, eggs, asparagus, and onions, watermelon, asparagus, and grapefruits.
%utein and Aea"anthin
ccumulate within the retina and imbue a yellow pigment that helps protect the eye
2rotects photoreceptors of the retina from light damage
ct like sunglass filters to protect the eye
%ower the risk of cataracts and macular degeneration
re also antio"idants
)ources: dark, leafy greens , corn, oranges, papaya and s!uash.
inkgo 3iloba
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SENSES – VISUAL – THE EYE
'ncreases blood flow to the retina.
Can slow retinal deterioration which results in an increase of visual acuity.
2revention of ye 'n6ury
2rotect your eyes from the sun.
<raviolet radiation can harm your eyes.
&se a wide-brim hat and &4-absorbing eyewear to protect your eyes from harmful effects of the sun.
yewear should provide GG to 1 percent of &4- and &4-3 protection.
2revention of ye 'n6ury
egular eyeglasses do not provide enough safety protection.
2rotect your eyes with proper safety glasses.
'n6uries can be prevented if proper eye protection is used at home, in the workplace and playing sports.
&se appropriate lighting.
2roper lighting can help improve safety at home and prevent eye in6uries.
2revention of ye 'n6ury
Feep your children safe.
2ay special attention to where sharp items are placed.
'tems such as cosmetics, kitchen utensils and desk supplies can cause eye damage.
void flying or pro6ectile toys and any with sharp points and dangerous edges.
4isit eye doctor
>ophthalmologist? regularly.
ecommended regular eye e"am at least every # years.
arly detection of problems is key to treatment and prevention.
)pecific 2revention of ye 'n6ury
t home or outside:
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;ash your hands after using household chemicals.
;ear chemical safety goggles when using haAardous solvents and detergents, and do not mi" cleaning
agents around or near a child.
)pecific 2revention of ye 'n6ury
t home or outside:
Turn spray noAAles away from your face and the faces of others.
ead and follow directions when opening bottle-tops >such as wine, carbonated beverages?.
ead and follow directions when playing games and operating e!uipment.
)pecific 2revention of ye 'n6ury
t home or outside:
2rovide lights and handrails to improve safety on stairs.
Feep paints, pesticides and fertiliAers properly stored in a secure area.
3e sure to wear recommended protective goggles, helmets, and safety gear during the appropriate
activities.
&se guards on all power e!uipment.
2rotect eyes from the sun with either by a wind-brimmed hat or by wearing ultraviolet >&4?-protective
sunglasses
8ever look directly at the sun >especially during an eclipse?.
)pecific 2revention of ye 'n6ury
t play:
ecommended protective eyewear should be worn during the appropriate sports and recreational
activities.
helmet with a polycarbonate face mask or wire shield should be worn during the appropriate sports.
$ireworks should be handled with care and only be used by adults.
ppropriate protective eyewear should be worn during sporting and recreational activities.
2rotective eyewear should be worn when using lawnmowers, as debris may be pro6ected into the air.
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SENSES – VISUAL – THE EYE
t school, it is important to wear protective eye wear when performing science or lab e"periments.
2revention of ye )train
0ost common symptoms of eye strain, which may be attributed to prolonged computer screen or tv
viewing.
)ymptoms may include:
red, watery, irritated eyes
tired, aching, or heavy eyelids
problems with focusing
muscle spasms of the eye or eye lid
headache
backache
)ymptoms of eye strain are often relieved by:
resting the eyes
changing the work environment
wearing the proper glasses.
&sing proper lighting when using a computer
2revention of ye )train when &sing a Computer
2osition the video display terminal >4(T? slightly further away than where you normally hold reading
material.
2osition the top of the 4(T screen at or slightly below eye level.
2lace all reference material as close to the screen as possible to minimiAe head and eye movements
and focusing changes.
0inimiAe lighting reflections and glare.
Feep the 4(T screen clean and dust-free.
)chedule periodic rest breaks to avoid eye fatigue.
Feep the eyes lubricated >by blinking? to prevent them from drying out.
Feep the 4(T screen in proper focus.
Consult ophthalmologist
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some individuals who normally do not need glasses may need corrective lenses for computer work.
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