Professional Nursing 2 Concept Guide for Exam 3.
Concept guide is property of Rasmussen College. Do not share or post this guide on the internet. This is to
be used only for your education.
Cataracts- lens opacity that distorts the image; common with older adults
- Early symptoms- slightly blurred vision and decreased color perception. Pt thinks glasses are
smudged.
- Later symptoms- blurred and double vision occur. Pt has difficulties performing ADL’s
- Treatment- surgery is the only cure
- Teaching- Antiplatelet drugs (aspririn, Plavix) needs to be d/c’d prior to surgery. call doctor for
increased pain, DO NOT bend over from waist, lift anything more than 10 lbs, or perform
strenuous activities, and use stool softeners to avoid constipation
Glaucoma- increase in intraocular pressure causing tissue necrosis leading to irreversible blindness. Pt
has tunnel vision. Pt has gradual loss of peripheral vision.
- Treatment- Non-surgical: Eye drops are used to reduce the production of or decrease absorption
of aqueous humor. It is important to teach to apply punctual occlusion to prevent systemic
absorption of eye drop. Oral glycerin and IV mannitol are given for angle-closure glaucoma to
rapidly reduce IOP.
Surgical: only used when drugs are not effective at controlling IOP. Two common procedures=
laser trabeculoplasty and trabeculectomy.
- Medications- Prostaglandin Agonist (Latanoprost) drug should not be used if cornea is not intact
also teach that medication darkens eye color ; Beta-adrenergic blockers (Carteolol) not for
people with asthma or COPD , if pt has DM check BS frequently because they cause
hypoglycemia ; Carbonic Anhydrase inhibitors (Brinzolamide) not for pt with allergies to sulfa,
teach pt to shake drug before applying.
- Diagnostic tests- tomonetry measures IOP normal pressure is 10-21 mm Hg. Visual field testing
by perimetry, and gonioscopy determines if angle is open or closed.
Retinal Detachment- separation of the retina from the epithelium.
- Symptoms- sudden bright flashes or light (photopsia) or floating dark spots in the affected eye.
- Teaching- post-surgical correction of retinal detachment, pt should be taught to avoid activities
that cause rapid eye movement like reading and writing.
Macular Degeneration- deterioration of the macula; effects central vision, causing blind spots directly
ahead.
- Symptoms- patients describe mild blurring and distortion at first & reduced central vision.
Hearing impaired
- Medications/ Ototoxic- Meds that cause ototoxicity include Vancomycin, loop diuretics like
furosemide, NSAIDs and chemotherapy agents like cisplatin.
- Communication- pt may isolate themselves. Social isolation can lead to depression so encourage
pt and family to discuss their feelings. Nursing priorities focus on facilitating communication and
reducing anxiety. Communicate with pt by using pictures and writing, use assistive devices like
hearing aids, lip-reading and sign language can increase communication.
- Types of hearing loss and causes:
, Conductive hearing loss- obstruction of sound wave d/t foreign body obstruction in external
canal.
Sensorineural hearing loss- defect in the cochlea (8th cranial nerve), or the brain (exposure to
loud noise or music damages the cochlear hair leading to hearing loss).
Mixed conductive-sensorineural hearing loss- results from both conductive and sensorineural
hearing loss.
- Meniere’s disease- Endolymphatic fluid that distorts the entire inner-canal that decreases
hearing by dilating the cochlear duct, causing vertigo and tinnitus. Occurs in people between
20-50 yr olds. HIGH RISK FOR FALLS!!
- Symptoms- Three features: tinnitus, one-sided sensorineural auditory sensory perception loss,
and vertigo; headache & fullness of affected ear.
- Mastoiditis- Infection of the mastoid air cells caused by progressive otitis media. Untreated
middle ear infection progresses to mastoiditis. If mastoiditis is not properly treated, it can lead
to brain abscess, meningitis, and death.
- Assessment of hearing loss
Different tests- Audioscopy- handheld device used to generate tones of varying
intensities to test hearing. ; Weber test- place vibrating tuning fork on the middle of the
patient’s head. Pt should equally hear vibration in both ears. ; Rinne- compares hearing
by air conduction with hearing by bone conduction (Place tuning fork on mastoid
process). Normally sound is heard 2 to 3x’s longer by air then by bone conduction.
Potential symptoms (hearing loss)-tilting head to one side or leaning forward when
listening to another person speak; frequently asking speaker to repeat themselves or
stating “what?” and “huh?”; pt does not respond to whispered questions; pt is startled
when unexpected sound occurs in the environment; pt answer doesn’t match what
speaker asked.
- Otitis Media- Infection in the middle ear causing inflammation of the mucosa, leading to
swelling and irritation of the ossicles, followed by purulent inflammatory exudate. If not treated
correctly can cause permanent conductive hearing loss. On examination, eardrum is retracted
and redness is present.
- Patient teaching- remain current on all immunizations, proper handwashing to minimize
infection, complete all abx as prescribed, avoid head trauma.
- Aging adult hearing changes
Pinna becomes elongated d/t loss of SQ tissues and decrease in elasticity= Normal; be careful
when you position pt on left side that war doesn’t fold under head.
Hair in canal becomes coarser and longer (especially in men)= Normal; frequent ear irrigation is
needed to prevent cerumen clumping.
Cerumen is drier and impacts more easily= Teach to irrigate ear canal weekly or whenever pt
notices change in hearing
Tympanic membrane loses elasticity and may appear dull and retracted= Do not use this finding
as the only indication for otitis media.
Hearing acuity decreases= Assess hearing with voice test or the watch test. If deficit present
refer pt to specialist to determine hearing loss. DO NOT assume all older adults have hearing
loss!
Ability to hear high-frequency sounds is lost first= Have problems hearing f, s, sh, and pa
sounds. Provide quiet environment when speaking and face pt, avoid standing in front of bright
lights or windows b/c it interferes with lip reading. Speak slowly, clearly, and in a deeper voice
and emphasize beginning word sounds.
Concept guide is property of Rasmussen College. Do not share or post this guide on the internet. This is to
be used only for your education.
Cataracts- lens opacity that distorts the image; common with older adults
- Early symptoms- slightly blurred vision and decreased color perception. Pt thinks glasses are
smudged.
- Later symptoms- blurred and double vision occur. Pt has difficulties performing ADL’s
- Treatment- surgery is the only cure
- Teaching- Antiplatelet drugs (aspririn, Plavix) needs to be d/c’d prior to surgery. call doctor for
increased pain, DO NOT bend over from waist, lift anything more than 10 lbs, or perform
strenuous activities, and use stool softeners to avoid constipation
Glaucoma- increase in intraocular pressure causing tissue necrosis leading to irreversible blindness. Pt
has tunnel vision. Pt has gradual loss of peripheral vision.
- Treatment- Non-surgical: Eye drops are used to reduce the production of or decrease absorption
of aqueous humor. It is important to teach to apply punctual occlusion to prevent systemic
absorption of eye drop. Oral glycerin and IV mannitol are given for angle-closure glaucoma to
rapidly reduce IOP.
Surgical: only used when drugs are not effective at controlling IOP. Two common procedures=
laser trabeculoplasty and trabeculectomy.
- Medications- Prostaglandin Agonist (Latanoprost) drug should not be used if cornea is not intact
also teach that medication darkens eye color ; Beta-adrenergic blockers (Carteolol) not for
people with asthma or COPD , if pt has DM check BS frequently because they cause
hypoglycemia ; Carbonic Anhydrase inhibitors (Brinzolamide) not for pt with allergies to sulfa,
teach pt to shake drug before applying.
- Diagnostic tests- tomonetry measures IOP normal pressure is 10-21 mm Hg. Visual field testing
by perimetry, and gonioscopy determines if angle is open or closed.
Retinal Detachment- separation of the retina from the epithelium.
- Symptoms- sudden bright flashes or light (photopsia) or floating dark spots in the affected eye.
- Teaching- post-surgical correction of retinal detachment, pt should be taught to avoid activities
that cause rapid eye movement like reading and writing.
Macular Degeneration- deterioration of the macula; effects central vision, causing blind spots directly
ahead.
- Symptoms- patients describe mild blurring and distortion at first & reduced central vision.
Hearing impaired
- Medications/ Ototoxic- Meds that cause ototoxicity include Vancomycin, loop diuretics like
furosemide, NSAIDs and chemotherapy agents like cisplatin.
- Communication- pt may isolate themselves. Social isolation can lead to depression so encourage
pt and family to discuss their feelings. Nursing priorities focus on facilitating communication and
reducing anxiety. Communicate with pt by using pictures and writing, use assistive devices like
hearing aids, lip-reading and sign language can increase communication.
- Types of hearing loss and causes:
, Conductive hearing loss- obstruction of sound wave d/t foreign body obstruction in external
canal.
Sensorineural hearing loss- defect in the cochlea (8th cranial nerve), or the brain (exposure to
loud noise or music damages the cochlear hair leading to hearing loss).
Mixed conductive-sensorineural hearing loss- results from both conductive and sensorineural
hearing loss.
- Meniere’s disease- Endolymphatic fluid that distorts the entire inner-canal that decreases
hearing by dilating the cochlear duct, causing vertigo and tinnitus. Occurs in people between
20-50 yr olds. HIGH RISK FOR FALLS!!
- Symptoms- Three features: tinnitus, one-sided sensorineural auditory sensory perception loss,
and vertigo; headache & fullness of affected ear.
- Mastoiditis- Infection of the mastoid air cells caused by progressive otitis media. Untreated
middle ear infection progresses to mastoiditis. If mastoiditis is not properly treated, it can lead
to brain abscess, meningitis, and death.
- Assessment of hearing loss
Different tests- Audioscopy- handheld device used to generate tones of varying
intensities to test hearing. ; Weber test- place vibrating tuning fork on the middle of the
patient’s head. Pt should equally hear vibration in both ears. ; Rinne- compares hearing
by air conduction with hearing by bone conduction (Place tuning fork on mastoid
process). Normally sound is heard 2 to 3x’s longer by air then by bone conduction.
Potential symptoms (hearing loss)-tilting head to one side or leaning forward when
listening to another person speak; frequently asking speaker to repeat themselves or
stating “what?” and “huh?”; pt does not respond to whispered questions; pt is startled
when unexpected sound occurs in the environment; pt answer doesn’t match what
speaker asked.
- Otitis Media- Infection in the middle ear causing inflammation of the mucosa, leading to
swelling and irritation of the ossicles, followed by purulent inflammatory exudate. If not treated
correctly can cause permanent conductive hearing loss. On examination, eardrum is retracted
and redness is present.
- Patient teaching- remain current on all immunizations, proper handwashing to minimize
infection, complete all abx as prescribed, avoid head trauma.
- Aging adult hearing changes
Pinna becomes elongated d/t loss of SQ tissues and decrease in elasticity= Normal; be careful
when you position pt on left side that war doesn’t fold under head.
Hair in canal becomes coarser and longer (especially in men)= Normal; frequent ear irrigation is
needed to prevent cerumen clumping.
Cerumen is drier and impacts more easily= Teach to irrigate ear canal weekly or whenever pt
notices change in hearing
Tympanic membrane loses elasticity and may appear dull and retracted= Do not use this finding
as the only indication for otitis media.
Hearing acuity decreases= Assess hearing with voice test or the watch test. If deficit present
refer pt to specialist to determine hearing loss. DO NOT assume all older adults have hearing
loss!
Ability to hear high-frequency sounds is lost first= Have problems hearing f, s, sh, and pa
sounds. Provide quiet environment when speaking and face pt, avoid standing in front of bright
lights or windows b/c it interferes with lip reading. Speak slowly, clearly, and in a deeper voice
and emphasize beginning word sounds.
