NURS 621: Adult/Gero. 1
Exam 1 Study Guide Eyes • Ears • Nose • Throat
EYES
**Is the patient having discomfort or pain?**
Injected—dilated vessels causing redness/pink conjunctivae
Visual Acuity Tests—always perform with any patient eye
complaint Slit Lamp—enlarge eye structures
Eye Exam
1. Visual Acuity Blepharitis
2. Fundal Exam (look for optic disc & macula) • Most common ocular disease
3. Numb & Fluoresceine • Inflammation
4. Slit Lamp • Redness, scaling, and
Documentation/ HPI crusting of lids
➢ Duration ❖ Treatment:
➢ Injection • Warm compresses BID
➢ Drainage • Diluted baby shampoo
➢ EOM Intact • Bacitracin
➢ PERRLA • Erythromycin
➢ Fundal Exam • Azithromycin drops
➢ Lid Issues
Chalazion
Hordeolum-Stye • Granulation tissue from an
• Acute unresolved hordeolum
• Erythematous, Tender lump within eyelid • Slow-developing, Painless, hard
• Infection of hair follicle mass within eyelid
• Blocked meibomian gland or infection of sebaceous glands • Blocked meibomian gland
❖ Treatment: ❖ Treatment:
• Warm compresses QID • Typically self-limiting
• Do NOT squeeze/pop the abscess • Refer to ophthalmology if persists
• Antibiotic drops if persistent edema
• Prevention – good hygiene practices
Glaucoma
1
, Increased intraocular pressure leading to progressive damage of optic nerve
• Open Angle (uncontrolled HTN, DM patients not uncommon)
o Slow, progressive loss of peripheral vision, poor night vision, vision loss, halos around lights
• Closed Angle
o Medical Emergency!!
o Sudden eye pain/pressure, headache, nausea, rainbow around lights at night, blurred vision
Macular Degeneration
Progressive deterioration of the retina
• Loss of central vision
Conjunctivitis
• Bacterial (S. Aureus, S. Pneum., M.Cat., H. Influ., N. Gon.)
o Inflammation of conjunctiva
o Highly Contagious—direct contact with secretions or
contaminated surfaces
o Redness Unilateral at onset
o Purulent discharge Eyelids “glued” shut in morning
o Eyelid edema
❖ Treatment:
• Erythromycin Ointment QID x5-7 days
• Polymyxin-trimethoprim drops (not for contact lenses) 1-2 drops QID
x5- 7 days
• Fluoroquinolone Ophthalmic drops (contact lenses) 1-2 drops QID x5-7 days
• Azithromycin drops 1 drop BID x2 days, then 1 drop daily x5 days
• Allergic
o Bilateral redness Stringy discharge Crusty in morning Hx. allergy sx.
o Watery discharge Itching Diffuse Injection
❖ Treatment:
• Cold compresses **Do NOT give corticosteroids** Red Flags Conjunctivitis
• Lubricants • Reduced visual acuity
• Topical antihistamines, decongestants, NSAIDS, mast cell stabilizers • Ciliary Flush
o Naphcon-A 1 drop QID PRN up to 3 days • Severe Photophobia
o Zaditor (mast cell stabilizer) 1drop every 8-12 hours • Severe FB sensation
o Olopatadine 0.1% or 0.2% 1 drop BID • Corneal Opacity
o Ketorolac 1 drop QID • Fixed Pupil
• Systemic Antihistamines • Severe Headache w/nausea
• Viral
o Adenovirous—highly contagious
o Gritty burning Watery/serous drg daily
o URI symptoms
o Morning crusting Unilateral on onset—bilateral within 1-2
days
❖ Treatment: Conjunctivitis Patient Teaching
• Antihistamine/Decongestant drops 1-2 drops QID PRN up to 3 weeks • B & V are contagious—no
• Lubricant drops school/work/daycare until 24
• Cool compresses hours of treatment has
• Daytime sx. Improve within 5-7 days; morning crusting up started
to 2 weeks • Good handwashing
• Do not share linens,
• Chlamydia washcloths, etc
• NO contact lenses x1 week
• New contact lenses, 2
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