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Neurological 10

  1. Eye trauma
  2. Foreign body:
    1. use eversionprocedure
    2. if foreign body has penetrated, do not remove
    3. irrigate eye with sterile normal saline eye irrigant
  3. Corneal abrasion
    1. disruption of the cells and loss of superficial epithelium
    2. caused by trauma, chemical irritant, foreign body, or lack of moisture
    3. findings: severe pain, blurred vision, halo around lights, lacrimation, inability to open eye
    4. diagnosis by fluorescein sodiumdye
    5. abrasions heal usually within 48 hours, usually with no scarring or visual deficit
    6. treatment includes short-acting analgesic drops, eye rest
  4. Corneal laceration
    1. same causes, findings as abrasions, but lacerations are serious emergencies
    2. surgery is generally required
    3. follow care for client undergoing eye surgery (see points to remember at the end of this section)
  5. Penetrating injury
    1. do not remove object
    2. do not apply pressure of any kind to the eye or the object
    3. cover the injured eye to protect movement of the object. may use a cup or eye patch
    4. cover uninjured eye with eye patch to avoid sympathetic movement
    5. get client to emergency room immediately
    6. surgery will be required
  6. Chemical irritants
    1. flush eye with plenty of water or sterile normal saline
    2. get client to emergency room immediately
    3. alkaline substances penetrate the cornea rapidly and must be removed quickly
    1. acids coagulate the eye's proteins and often result in relatively superficial, reversible damage
  7. Ultravioletburns
    1. occur from sun exposure or welding flashes
    2. irritate epithelium, which swells and scales off (desquamation)
  8. Management
    1. general pharmacotherapy for eye trauma
      1. topical anesthetics
      2. antibiotics
      3. mydriatic-cycloplegic agents: prevent pupillary constriction
  9. General management of any eye trauma
    1. irrigation of affected eye
    2. bilateral dressings to rest eyes by decreased movement
    3. tinted glasses for photophobia to reduce discomfort
    4. assist client with activities of daily living as indicated

The Ear

  1. Structures of Ear (illustration)
    1. External auditory meatus
    2. Middle ear
      1. Tiny, air-filled cavity containing three small bones: incus (anvil), malleus (hammer) and stapes (stirrup)
      2. These bones (ossicles) are connected by joints and supported by muscles
      3. Ossicles bridge the tympanic membrane and the oval window
      4. Ossicles magnify small sounds by transmittting them from the tympanic membrane to the oval window.
    3. Inner ear (illustration)
      1. Contains the sensory receptors for sound and equilibrium
      2. Connected to nasopharynx by the eustachian tube
      3. Tube opens during swallowing to equalize inner ear pressure to atmospheric pressure
      4. Composed of fluid-filled membranous labyrinth in a similarly shaped bony labyrinth
      5. Membranous labyrinth components include the cochlea and the vestibular apparatus
      6. Cochlea: a spiral tube (illustration)
      7. Within the cochlea is a membranous duct with a triangular cross section:
        1. side one lies against wall of bony labyrinth
        2. side two is made up of Reissner's membrane
        3. side three is Organ of Corti (basilar membrane) which contains the tectorial membrane, connected by hairs to sound-receptor cells
        4. hairs of receptors convert sound waves to neural impulses
        5. impulses travel via the acoustic or eighth cranial nerve to the brain
      8. Vestibular apparatus: reflects body position (illustration)
        1. surrounded by perilymph and temporal bone
        2. consists of membranous saccule, utricle, and semicircular canals
        3. in these canals, static and dynamic equilibrium receptors send impulses to the brain regarding body position
  2. Ear Disorders
    1. External ear
      1. Swimmer's ear
        1. diffuse bacterial otitis externa
        2. preventable by using 70% alcohol to cleanse ears after swimming
      2. Otitis externa
    2. Meniere's disease
      1. Definition - inner ear disorder: endolymphatic system dilates and volume of endolymphexpands
      2. Etiology unknown
        1. usually develops between ages 40 and 60
        2. acute attack may require hospitalization
        3. client may average two to three attacks per year
      3. Findings
        1. attacks intermittent
        2. three recurrent and progressive findings
          1. vertigowith prostrating nausea and vomiting
          2. tinnitus
          3. hearing loss (on involved side) persists and progresses
      1. Management
        1. expected outcomes: prevent hearing loss and control vertigo
        2. medical
          1. cholinergic blocking agentssuch as atropine
          2. antihistaminesor decongestants
          3. during remission:
            • diuretics to decrease fluid
            • vasodilatorssuch as histamine
            • vestibular suppressants such as diazepam (valium)
            • adrenergic neuron-blocking agents such as epinephrine
            • low-salt diet
        3. surgical
          1. decompression of endolymphatic sac: insertion of endolymphatic subarachnoid shunt
          2. labyrinthectomy: client will lose all hearing in affected ear
      1. Nursing interventions during an acute attack of Meniere's disease
        1. bed rest in quiet, dark room
        2. avoid unnecessary movement of client especially the head
        3. give general care of clients with nausea and vomiting
        4. restrict salt and water intake
        5. have client avoid tobacco, caffeine, and high triglycerides
        6. institute precautions to prevent client from falling
    3. Otosclerosis
      1. Formation of new bone in labyrinth fixes stapes to oval window
      2. Hereditary degenerative disorder results in conduction deafness
      3. Etiology unknown
      4. Assessment: findings
        1. hearing loss
        2. tinnitus
        3. bone conducts more sound than air does
      5. Management
        1. expected outcome: improvement of hearing in affected ear
        2. medical: use of hearing aid
        3. surgical: stapedectomy - replacement of stapes with prosthesis
      6. Postoperative care
        1. clients are to avoid anything that might displace prosthesis, such as coughing, blowing nose, swimming
        2. give antibiotics as ordered
        3. limit activity as ordered and tolerated
        4. give pain medications and/or antiemeticsas ordered
        5. post-operatively assess facial nerve function for asymmetry
        6. keep ear dry
        7. instruct client not to fly for six months