Exam 1 · Week 1 · Standalone study page
M1 · Sensory Disorders — Eye & Ear
This page keeps all of the original course information, while reducing the decision to one module: pressure, vision loss, hearing and safety.
▸M1Sensory Disorders — Eye & EarWeek 1
💡 The one idea
Every eye emergency is either pressure or detachment. Ask two questions and most questions answer themselves: did it come on suddenly, and does it hurt.
Sudden + painful = closed-angle glaucoma. Sudden + painless = retinal detachment.
| Open-angle glaucoma | Closed-angle glaucoma | |
|---|---|---|
| Onset | Gradual, over years | Sudden, over hours |
| Pain | None | Severe + nausea/vomiting |
| Vision | Peripheral lost first — “tunnel” | Blurred, halos around lights |
| Pupil | Normal | Fixed, mid-dilated |
| Treatment | Lifelong drops (beta blockers, prostaglandins) | Surgical emergency — iridotomy |
🚨 The drug trap that shows up every year
Never give anticholinergics or atropine to a patient with closed-angle glaucoma.
They dilate the pupil, which jams the drainage angle shut and spikes the pressure. Watch for this hidden inside antihistamines, TCAs, scopolamine and pre-op orders.
👁️ Retinal detachment
A painless curtain or shadow moving across vision, often after floaters and flashes of light.
It is the one condition that gets face-down positioning after repair, so the gas bubble presses the retina back.
👓 Cataract
A clouded lens, not a pressure problem. Painless, gradual, cloudy or yellowed vision, glare at night.
Surgery is elective and done one eye at a time.
👂 Conductive vs sensorineural, in one line each
Conductive — sound cannot get in. Wax, fluid, perforation, otosclerosis. Often fixable.
Sensorineural — the hair cells or nerve are damaged. Noise, age, ototoxic drugs. Usually permanent.
Ototoxic offenders: aminoglycosides loop diuretics high-dose aspirin cisplatin
⭐ Meniere’s — three symptoms, one disease
Vertigo + tinnitus + fluctuating hearing loss. Caused by too much endolymph in the inner ear.
Nursing priority is safety — the vertigo causes falls. Low-sodium diet and diuretics reduce the fluid.
⭐ High-yield — what the exam actually asks
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- Open-angle glaucoma is gradual and painless and takes peripheral vision first; lifelong beta-blocker drops. Closed-angle is sudden severe pain + halos + N/V and is a surgical emergency.
- Cataract is a clouded lens, not a pressure problem. Surgery only, non-urgent, one eye at a time.
- Retinal detachment = painless curtain across the vision. Emergency. The only one that gets face-down (prone) positioning post-op, about 2 weeks.
- Macular degeneration takes central vision and spares peripheral. Amsler grid at home catches wavy lines; wet type gets anti-VEGF injections.
- Diabetic retinopathy: annual dilated exam for every diabetic regardless of symptoms. Real prevention is tight A1C and BP control.
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- Eye drops:
5–10 minbetween different drops; occlude the inner canthus2 minto block systemic absorption. - Meniere's: low sodium, low caffeine and alcohol to cut inner-ear fluid (not for blood pressure). Meclizine + a diuretic, and fall precautions during vertigo.
- External otitis hurts when you move the tragus or pinna — that is what separates it from otitis media.
- Ruptured tympanic membrane: the pain suddenly relieves. Keep the ear dry, no swimming or flying, usually heals on its own.
- Ototoxic drugs: furosemide, aspirin/NSAIDs, aminoglycosides (gentamicin), vancomycin, erythromycin. Worse at high dose over time.
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- New hearing loss teaching: face her, cut background noise, get her attention first, and rephrase rather than repeat louder.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
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- Newly blind (diabetic retinopathy): the priority is keep frequently used items in consistent locations. The cue word is recently — someone blind twenty years can be left to ask for help, someone blind three weeks cannot.
- Perimetry is just formal visual field testing. If she will not fixate, coach her to hold the center light — do not cancel the test and do not medicate her. Wanting to look at the moving thing is normal, not an inability to complete the test.
- Hold the timolol the morning of tonometry so the pressure you measure is not already treated. And timolol is a beta blocker — the drops reach the bloodstream, so a client who says she feels dizzy on them gets a pulse and blood pressure check.
- Their vocabulary warning: acute = closed = angle-closure, and chronic = open. Same two conditions, four names, and the exam may use any of them.
- Prognosis ruling: vision already lost to chronic open-angle is gone for good — treatment only stops further loss. Vision lost in an acute closed-angle attack usually comes back if the pressure is relieved that day.
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- Acute closed-angle presents as fixed dilated pupil + hazy cornea + severe pain with vomiting, coming on over minutes to an hour. The pupil is fixed because the pressure has paralyzed the nerve; the cornea is hazy because fluid is being forced into it.
- Their glaucoma risk list: family history, over 60, diabetes, hypertension, corticosteroid use, thin central cornea, high myopia. They explicitly said not risks: corrective lenses, vitamin A, sunglasses — sunglasses actually prevent cataracts and retinal injury.
- Anticholinergic and decongestant eye drops dilate the pupil → contraindicated specifically in closed-angle. The reverse is pilocarpine, a cholinergic that constricts the pupil and unbunches the iris off the canals of Schlemm.
- Their matrix grid, cataract vs open-angle vs AMD: central vision loss = AMD; peripheral = open-angle; halos + glare + cloudy vision = cataract; raised IOP and a blocked drainage system = open-angle only; all three are commonest in old age.
- Same grid, treatment row: cataract is surgical, glaucoma is pharmacologic (the drops), and wet AMD is pharmacologic too — intraocular bevacizumab or ranibizumab injections.
- Cataract post-op yes-list: avoid bending and lifting, eye shield, antibiotic + anti-inflammatory drops, do not touch the eye. No warm compresses, and sleep on the NON-operative side. Do not tell her to resume normal activity — ask what her normal activity is.
- Viral conjunctivitis: cool compresses, and no antibiotic drops. Do not promise it clears in 2–3 days — a week or two is normal. Telling the three apart: allergic itches, viral comes with a cold, bacterial pours purulent discharge.
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- Weber louder in one ear tells you only that the two ears are unequal. The next step is the Rinne test — not charting a type of loss, not calling the provider.
- Their tuning-fork positions: Weber on the forehead, heard equally in both ears when normal. Rinne on the mastoid, then in front of the ear — normal is air conduction outlasting bone conduction.
- Swimming class + severe ear pain + purulent discharge = otitis externa, swimmer's ear. Otitis media is behind the eardrum, so it only drains once the tympanic membrane ruptures — far less likely.
- The one mismatched pair they flagged: labyrinthitis is not "gradual hearing loss without vertigo" — the vertigo is severe enough that people arrive on a stretcher. Otosclerosis = conductive loss from abnormal bone growth; Meniere's = vertigo + tinnitus + fluctuating hearing loss.
- Meniere's management: antihistamine + diuretic (the theory is too much endolymph), plus a low-sodium diet. Not high sodium, not more caffeine, not deliberate head movements.
- The ototoxic pairing to memorize is aminoglycoside + loop diuretic (gentamicin + furosemide); vancomycin belongs on the list too. What is ototoxic is usually nephrotoxic as well. On gentamicin the priority is monitor for early hearing loss and report it so the dose can change — not fluids, not noise avoidance.
- Labyrinthitis is viral and resolves over weeks; BPPV is brief, movement-triggered and caused by a loose otolith. Labyrinthitis + 4 vomits in 3 hours → the priority becomes fluid and electrolyte assessment, not the vestibular suppressant, which takes an hour to work anyway.
- Vertigo is a fall risk: do not discharge until she can walk. Their line was that otherwise she gets as far as the parking lot and comes back with a fracture or a head injury.
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- On a priority question, all four options can be correct actions — you cannot eliminate on accuracy, only on order. Their words: "I actually am going to do all four of these things."
- Calc: 2,500 mL over 12 h =
208.3 mL/hr— but the item asked in liters, so the answer is2.5 Land there is no calculation at all. The faculty themselves went to mL/hr on the recording and had to back up. Read the units, and round only at the very end.
⚠️ Exam traps
- Glaucoma is a pressure problem; cataract is a lens problem. Different answer every time.
- Retinal detachment being painless does not make it less of an emergency.
- Sensorineural loss is usually permanent; conductive loss is often fixable.
🧪 What confirms it — every test, all thirteen
The thing to know first: almost nothing here is a blood test. Eyes and ears are diagnosed by looking and by measuring — a chart, a pressure, a tuning fork, a scope. Blood work shows up in only two places: a culture when something is infected and draining, and the routine pre-op panel before surgery. If a question offers you a serum level for glaucoma or Meniere, it is the wrong answer.
| Eye disorder | What confirms it | What it shows |
|---|---|---|
| Vision impairment & blindness | Snellen chart (distance), Rosenbaum or Jaeger card (near), confrontation visual fields | Legal blindness = 20/200 or worse in the better eye with correction, or a visual field of 20° or less |
| Glaucoma | Tonometry · ophthalmoscopy · gonioscopy · perimetry (visual fields) | Tonometry gives the number: normal IOP 10–21 mmHg. Ophthalmoscopy shows cupping of the optic disc. Gonioscopy is what tells open-angle from closed. Perimetry maps the peripheral loss |
| Cataracts | Visual acuity · slit-lamp examination · ophthalmoscopy | A dulled or absent red reflex, and the opacity visible on slit lamp. No pressure change — that is the giveaway against glaucoma |
| Retinal detachment | Indirect ophthalmoscopy · ocular ultrasound if the view is blocked | Gray, billowing retina with a visible tear. Ultrasound is used when vitreous hemorrhage hides the retina. No lab confirms this — it is an emergency on sight |
| Macular degeneration | Amsler grid · ophthalmoscopy · OCT · fluorescein angiography | Amsler grid shows wavy lines and a central blind spot. Ophthalmoscopy shows drusen in dry AMD. OCT and fluorescein angiography are for wet AMD, to find the leaking new vessels |
| Conjunctivitis | Usually clinical · culture and Gram stain of the exudate · fluorescein stain | Culture when it is severe, recurrent, or in a newborn. Fluorescein stain rules out a corneal abrasion or ulcer — that is the one you must not miss |
| Enucleation | CT or MRI, ocular ultrasound · routine pre-op labs | Not a diagnosis — it is the surgery. Imaging stages the tumor or the trauma first; CBC and coagulation studies are the ordinary pre-op panel |
| Ear disorder | What confirms it | What it shows |
|---|---|---|
| Hearing loss | Weber and Rinne tuning-fork tests · pure-tone audiometry · tympanometry | Weber lateralizes to the bad ear in conductive loss, to the good ear in sensorineural. Rinne: air > bone is normal and also sensorineural; bone > air means conductive. Audiometry puts a number on it |
| Otitis externa | Otoscopy · culture of the drainage if severe or not settling | Swollen, red canal and pain when the tragus or pinna is moved — that movement pain is what separates it from otitis media. In a client with diabetes, think malignant otitis externa: CT and ESR |
| Acute otitis media | Otoscopy · pneumatic otoscopy or tympanometry · tympanocentesis if it keeps coming back | A bulging, red, immobile tympanic membrane with the landmarks lost. Tympanometry confirms the drum is not moving. Pain is not worse on moving the pinna |
| Tympanic membrane rupture | Otoscopy · audiometry · tympanometry · culture if draining | The perforation is visible. Audiometry shows a conductive loss; tympanometry is flat |
| Meniere disease | The clinical triad · audiometry · electronystagmography (ENG/VNG) · caloric testing · MRI | Audiometry shows a low-frequency sensorineural loss that fluctuates. There is no confirming lab — it is a clinical diagnosis of vertigo, tinnitus and hearing loss, with MRI used to rule out an acoustic neuroma |
| Inner ear disorders (labyrinthitis, vestibular neuritis, BPPV) | Dix-Hallpike for BPPV · Romberg · ENG/VNG · caloric testing · audiometry · MRI | Dix-Hallpike reproducing vertigo and nystagmus is the BPPV diagnosis. MRI is to exclude a central cause. CBC and cultures only if it is infectious |
If you only memorise four: tonometry for glaucoma, Amsler grid for macular degeneration, Weber and Rinne for which kind of hearing loss, and Dix-Hallpike for BPPV.
⚠️ What it turns into — the complication for each one
This is the section the cards above do not have, and it is the one the exam likes, because it is where “so what?” lives. Two patterns carry most of it: an untreated eye disorder costs sight permanently, and an untreated ear infection spreads inward — to the mastoid, the labyrinth, and in the worst case the meninges.
| Disorder | What it turns into |
|---|---|
| Vision impairment & blindness | Falls and fractures, medication errors from misread labels, depression and social withdrawal, loss of driving and independence |
| Glaucoma | Permanent optic nerve damage — peripheral vision first, then total, and none of it comes back. Untreated acute closed-angle can blind the eye within 24 to 48 hours |
| Cataracts | Untreated: progressive loss and falls. After surgery: endophthalmitis, raised IOP, retinal detachment, lens dislocation. Sudden pain or vision loss post-op is never expected — report it |
| Retinal detachment | Permanent loss of that field if it is not reattached quickly, recurrence, scarring inside the eye, and raised risk of detachment in the other eye |
| Macular degeneration | Permanent loss of central vision and legal blindness, with reading, faces and driving gone. Wet AMD can take central vision in days — new distortion on the Amsler grid is same-day urgent |
| Conjunctivitis | Keratitis and corneal ulceration with scarring, spread to the other eye and the whole household, and in the newborn gonococcal infection that blinds |
| Enucleation | Infection, hemorrhage, implant extrusion, socket contracture — and grief and altered body image, which are real complications and get nursed. The remaining eye is now the only eye |
| Hearing loss | Isolation and depression, being mistaken for confused or cognitively impaired, and missed alarms, traffic and warnings |
| Otitis externa | Malignant (necrotising) otitis externa in diabetes or immunocompromise — Pseudomonas eating into the skull base, causing osteomyelitis and cranial nerve palsy. Also canal stenosis and chronic infection |
| Acute otitis media | Perforation, mastoiditis, cholesteatoma, chronic effusion causing conductive loss and speech delay in a small child, labyrinthitis, and rarely meningitis or brain abscess. Check behind the ear for mastoid tenderness |
| Tympanic membrane rupture | Chronic perforation, recurrent infection, cholesteatoma, ossicular damage and permanent conductive loss. After head trauma, clear drainage may be CSF |
| Meniere disease | Falls and injury from attacks with no warning, progressive permanent sensorineural hearing loss, loss of work and driving, anxiety and depression |
| Inner ear disorders | Falls, permanent hearing loss after labyrinthitis, chronic imbalance. An untreated acoustic neuroma grows into facial nerve involvement and brainstem compression |
🪂 After middle ear surgery — the discharge teaching
Stapedectomy, tympanoplasty, mastoidectomy, grommets. The page describes these procedures but this is the part that gets examined: what she may and may not do afterwards. One idea runs through all of it — anything that raises pressure in the middle ear can shift the graft or the prosthesis, so for several weeks she has to stop doing those things.
| Teach | Why |
|---|---|
| No bending from the waist, no heavy lifting, no straining for several weeks — and move and turn the head slowly | All of it raises middle-ear pressure and can displace the prosthesis or graft. Slow movement also guards against the dizziness that is normal early on |
| Sneeze and cough with the mouth open. Do not blow the nose. | A closed-mouth sneeze drives pressure straight up the eustachian tube into the repair |
| Expect hearing to be worse at first, and to take weeks to settle | Packing and swelling sit in the ear. Hearing does not improve the moment she wakes up — if she expects that, she will think the surgery failed |
| Keep the ear dry. Cotton ball coated in petroleum jelly to shower, no swimming or diving, hair washing about a week out or when the surgeon says | Water reaching the middle ear through the repair means infection |
| No air travel until cleared; avoid crowds and anyone with a cold | Cabin pressure changes act on the repair; an upper respiratory infection travels up the eustachian tube |
| The dressing and packing come out when the surgeon says, not on a day she picks | A common wrong answer is the client naming her own date |
| Report: fever, increasing pain, purulent or foul drainage, sudden loss of hearing, worsening vertigo — and any facial drooping or weakness | The facial nerve runs through the temporal bone beside the surgical field. Facial weakness after ear surgery is never expected |
Exam shape: “which statement indicates understanding?” The right answer is nearly always the one about restricting movement, bending and straining. The trap answer is the client expecting her hearing back straight away.
🎤 From Dr. Halecka’s week 1 lecture
Her numbers and her wording, taken from the Monday recording. Where a figure here differs from the textbook, hers is the one on your exam — and she said outright that everything covered Monday and Tuesday is on the sensory quiz.
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- Normal IOP: 12–20, teetering to 21. Over 22 is suspicious. Her number. The textbook range you will also see is 10–21 — if an option sits at 22 or above, it is abnormal either way.
- Legal blindness is 20/200, and she wants you able to explain it: at 20 feet the client sees what a normal eye sees at 200 feet.
- Astigmatism is a misshapen cornea — football-shaped, not round. Corrected with a specially shaped lens. Myopia is nearsighted, hyperopia is farsighted, emmetropia is normal.
- Multiple eye drops: wait 5 to 10 minutes between different medications. After instilling, gentle pressure on the lacrimal sac — the inner corner — for 2 minutes. She noted almost nobody actually does the 2 minutes; the exam expects it.
- Glaucoma is pressure; cataract is the lens. She called glaucoma “hypertension of the eye”. Open-angle: fluid reaches the drainage canal — the trabecular meshwork — but the canal is clogged, like hair in a shower drain. Closed-angle: something physically blocks the flow — infection, a fast-growing tumor, trauma.
- Open-angle is not an emergency — gradual, often bilateral, peripheral vision closing in, often asymptomatic for years. Closed-angle is an emergency: severe pain to the point of nausea and vomiting, bradycardia, sweating, corneal edema, usually unilateral.
- The unreactive pupil in closed-angle is cranial nerve III — oculomotor. She asked this directly in class and the first answer given was II.
- Open-angle is treated with lifelong drops, not surgery. Timolol and “any of the -olols” — it is a beta blocker, so teach the client to check heart rate and blood pressure and expect dizziness. Closed-angle goes to emergency surgery. Pilocarpine also named.
- Cataract is protein build-up clouding the lens. Classic complaint: cannot drive at night because of glare and headlight reflection, plus halos. Painless. Gray or bluish, not brown. No eye drop fixes it — surgical removal and lens replacement, outpatient, conscious sedation.
- One eye at a time, for safety, with roughly a month between — sometimes 3 to 6.
- Post-op teaching is identical for glaucoma and cataract surgery. Sunglasses for 24 hours, do not sleep on the operative side, nothing that raises IOP — coughing, sneezing, straining, bending — a stool softener and fiber so she is not straining at stool, and no lifting over 5 to 15 lb. She linked it explicitly: the same rules as raised ICP after neurosurgery.
- Expected versus unexpected after eye surgery. Expected: clear drainage, slight pain. Unexpected — report: yellow or green drainage, blood, severe pain, nausea and vomiting.
- Vision does not come back straight away — best vision is 4 to 6 weeks or more. Clients expect to see immediately, and that is the trap answer.
- Before IV contrast: BUN and creatinine for kidney function, and ask about iodine and shellfish allergy.
- Amsler grid → macular degeneration. Tonometry → glaucoma. Ophthalmoscope is the nurse’s tool; the slit lamp is the ophthalmologist’s, magnifying about 40 times. Eye ultrasound is not routine — it means trauma or tumor.
- Caring for the client who cannot see: clock method for the meal tray, large print, explain before you touch, increase lighting, keep items in exactly the same place, call bell is the lifeline and must be within reach, clear the clutter because the fall is on your watch, bed alarm, and recorded or talking discharge instructions for someone with nobody at home to read to them.
- Common causes of blindness she wanted named: diabetes, glaucoma, cataracts, macular degeneration, ageing, trauma, genetics.
👁️ The seven optic disorders, section by section
Every disorder below is laid out in the same six sections, in the same order, so you can go straight to the one you want. They stay closed until you open them.
Vision Impairment and BlindnessOpenClose
Definition and Overview
Reduced visual function that glasses, contact lenses or surgery cannot fully correct. Legal blindness in the United States is a best-corrected acuity of 20/200 or worse in the better eye, or a visual field of 20° or less. Low vision is functional impairment short of that — she can still use what sight she has, with help.
Causes and Risk Factors
Age is the largest factor. The four leading causes in adults are cataract, glaucoma, macular degeneration and diabetic retinopathy. Also uncorrected refractive error, trauma, stroke, retinopathy of prematurity, and the two chronic diseases underneath so much of it — diabetes and hypertension.
Clinical Manifestations
Reduced acuity, loss of visual field, trouble reading, driving or recognising faces, bumping into things, falls, squinting or turning the head to use a better part of the field, and withdrawal from company because conversation has become hard work.
Assessment and Diagnostic Findings
Snellen or tumbling-E acuity, visual fields by confrontation or formal perimetry, ophthalmoscopy, tonometry, and a functional assessment — what she can and cannot do at home. Assess fall risk every time.
Medical Management
Treat the cause where there is one. Refractive correction, then low-vision aids: magnifiers, large print, high contrast, screen readers, talking devices. Orientation and mobility training and referral to vision rehabilitation.
Nursing Management and Client Education
Say who you are when you come in, and say when you are leaving — do not let her discover she is talking to an empty room. Sighted guide: she takes your arm just above the elbow and walks half a step behind; you never grab or steer her. Orient her to the room and then do not move her belongings or the furniture. Clock-face positions for the meal tray. Good non-glare lighting. Announce steps, curbs and doorways before you reach them. Encourage independence — doing it for her is not kindness.
GlaucomaClosed-angle is an emergencyOpenClose
🖼️ InfographicsGlaucoma
Definition and Overview
An optic neuropathy caused by raised intraocular pressure damaging the optic nerve. The vision it takes does not come back. Two forms behave completely differently: open-angle is chronic and silent; closed-angle is sudden and a surgical emergency.
Causes and Risk Factors
Age over 40, family history, diabetes, hypertension, severe myopia, eye trauma and long-term corticosteroids. African ancestry raises open-angle risk; Asian ancestry raises closed-angle risk. Anticholinergics and mydriatics can precipitate an acute closed-angle attack — that is why the drug history matters.
Clinical Manifestations
Open-angle: painless, gradual, takes peripheral vision first — the “tunnel” — and is often symptomless until a great deal is already gone. Closed-angle: sudden severe eye pain and headache, halos around lights, blurred vision, nausea and vomiting, a red eye, a fixed mid-dilated pupil and a globe that feels hard.
Assessment and Diagnostic Findings
Tonometry — normal intraocular pressure is 10–21 mmHg. Ophthalmoscopy for cupping of the optic disc. Visual field testing (perimetry) maps what has been lost. Gonioscopy looks at the angle itself; OCT measures the nerve fiber layer.
Medical Management
Open-angle — lifelong topical drops: prostaglandin analogues (latanoprost), beta blockers (timolol), alpha agonists, carbonic anhydrase inhibitors; then laser trabeculoplasty or trabeculectomy. Closed-angle — emergency: systemic acetazolamide, osmotic mannitol and miotic pilocarpine to break the attack, then laser peripheral iridotomy.
Nursing Management and Client Education
The drops are for life and they are not for symptoms. She will feel no different on them — that is the point, and it is why people stop and lose their sight. Occlude the inner canthus 1–2 min to cut systemic absorption, and leave 5–10 min between different drops. Timolol is a beta blocker even in the eye: watch for bradycardia and bronchospasm, and never stop it abruptly. Avoid anticholinergics and mydriatics in anyone at risk of closed-angle. Sudden pain with halos and vomiting is an emergency — same day, not next week.
CataractsOpenClose
Definition and Overview
A clouding of the normally clear lens. Painless, gradual, and the commonest cause of reversible blindness in the world. Note the distinction the exam leans on: a cataract is a lens problem, not a pressure problem.
Causes and Risk Factors
Ageing accounts for most. Then UV exposure, smoking, diabetes, long-term corticosteroids, blunt or penetrating trauma, previous intraocular surgery or inflammation, and congenital causes such as maternal rubella.
Clinical Manifestations
Painless gradual blurring; glare and halos, worst at night and when driving; colors look faded or yellowed; double vision in the one eye; needing a new spectacle prescription repeatedly; a diminished or absent red reflex, and late on a visibly cloudy gray-white pupil.
Assessment and Diagnostic Findings
Visual acuity, then ophthalmoscopy for the red reflex — reduced or absent is the finding. Slit-lamp examination confirms and grades it; glare testing shows the functional problem the acuity chart can miss.
Medical Management
No drug, drop or diet reverses a cataract. Surgery is the only treatment — phacoemulsification with an intraocular lens implant, as a day case under local anaesthetic, one eye at a time. It is not urgent: it is done when the cataract stops her doing what she wants to do.
Nursing Management and Client Education
After surgery: eye shield, especially at night, and dark glasses for glare. No bending at the waist, no straining, no lifting over about 10 lb / 4.5 kg, and avoid coughing, sneezing or vomiting if you can — anything that raises intraocular pressure. Mild itching and a little morning discharge are expected. Report sudden pain, decreasing vision, flashes or new floaters, or increasing drainage — those are bleeding, infection and detachment. Antibiotic and steroid drops as prescribed; vision sharpens over days to weeks.
Retinal DetachmentEmergencyOpenClose
🖼️ InfographicsRetinal Detachment
Definition and Overview
The retina — the light-sensitive layer at the back of the eye — separates from the tissue beneath it. A detached retina cannot function, and the loss becomes permanent if it is not treated promptly.
Causes and Risk Factors
Ageing and shrinkage of the vitreous, high myopia, previous cataract surgery, blunt or penetrating trauma, diabetic retinopathy, family history, and a previous detachment in the other eye.
Clinical Manifestations
A sudden increase in floaters; flashes of light; and then a dark curtain or shadow drawn across the field of vision that grows. It does not hurt — painlessness is what makes people wait, and waiting is what costs the sight.
Assessment and Diagnostic Findings
Retinal examination after pupil dilation, indirect ophthalmoscopy with scleral depression, and B-scan ultrasound when blood or cataract blocks the view. Acuity and visual fields document what has already gone.
Medical Management
Reattach the retina: laser photocoagulation, cryopexy (freezing), pneumatic retinopexy with a gas bubble, scleral buckle, or vitrectomy.
Nursing Management and Client Education
This is time-critical — the same day. After a gas bubble the positioning is the whole treatment: she may need face-down (prone) positioning for around two weeks so the bubble presses the retina back into place. No air travel and no high altitude while the bubble is there — it expands and the pressure rises dangerously. Eye shield, no straining or bending, report pain or falling vision, and keep every follow-up appointment.
Macular DegenerationOpenClose
🖼️ InfographicsMacular Degeneration
Definition and Overview
Degeneration of the macula, the central retina. It takes central vision and spares the periphery — the mirror image of glaucoma. The leading cause of irreversible central vision loss over 60. Dry (atrophic) is 90% and gradual; wet (neovascular) is 10%, sudden and far more damaging.
Causes and Risk Factors
Age over 60, and smoking — much the biggest thing she can change. Then family history, white ancestry, light-colored irises, hypertension, obesity, a high-fat diet and UV exposure.
Clinical Manifestations
Blurred or darkened central vision; a central blind spot (scotoma); straight lines look wavy or bent (metamorphopsia); difficulty reading and recognising faces. Peripheral vision stays, so she can still walk about safely — which is worth saying to her, because the diagnosis sounds like total blindness.
Assessment and Diagnostic Findings
The Amsler grid, which she also uses at home to monitor herself. Visual acuity, dilated fundus examination showing drusen, fluorescein angiography and OCT to find and follow the neovascular membrane.
Medical Management
Dry — no cure; AREDS2 antioxidants (vitamins C and E, lutein, zeaxanthin, zinc, copper) may slow it. Wet — intravitreal anti-VEGF injections (ranibizumab, aflibercept, bevacizumab), and photodynamic or laser therapy.
Nursing Management and Client Education
Stopping smoking is the single most useful thing she can do. Teach daily Amsler grid use and to report new waviness, blur or a new blank patch at once — wet AMD is treatable if it is caught early. Magnifiers, large print, high-contrast, strong lighting and audiobooks. Dark leafy greens and oily fish. Reassure her that peripheral vision remains, so independent mobility is preserved.
ConjunctivitisHighly contagiousOpenClose
🖼️ InfographicsConjunctivitis
Definition and Overview
Inflammation of the conjunctiva — “pink eye”. Bacterial, viral, allergic or irritant. Very common, and the infectious forms are highly contagious. Vision itself stays normal; severe pain or lost vision means it is something else.
Causes and Risk Factors
Bacteria (staphylococci, streptococci, H. influenzae; gonococcal or chlamydial in the newborn), viruses (adenovirus most often), allergens such as pollen and animal dander, and irritants like chlorine and smoke. Contact lens wear and poor hand hygiene run through most of it.
Clinical Manifestations
Redness, itching or a gritty “sand in the eye” feeling, tearing, discharge. Bacterial — thick yellow-green purulent discharge, lids stuck together in the morning. Viral — watery discharge, often with a cold, usually starts in one eye. Allergic — both eyes, itching dominates, watery stringy discharge.
Assessment and Diagnostic Findings
Usually clinical: inspect the discharge, the lids and the preauricular nodes (tender in viral). Culture if it is severe, recurrent, or in a newborn. Fluorescein staining if a corneal abrasion or ulcer is suspected.
Medical Management
Bacterial — topical antibiotic drops or ointment. Viral — supportive only: cool compresses and artificial tears; antibiotics do nothing. Allergic — topical antihistamine or mast-cell stabiliser, cool compresses, avoid the allergen. Neonatal gonococcal infection is an emergency and needs systemic treatment.
Nursing Management and Client Education
Hand hygiene is the whole battle. Do not share towels, flannels, pillows or eye make-up, and throw away the make-up she was using. No contact lenses until cleared, and discard the current pair and case. Wipe from the inner to the outer canthus, a clean surface each time, a separate cloth for each eye. Stay off work or school while there is discharge. Never let the dropper tip touch the eye or lashes.
EnucleationOpenClose
Definition and Overview
Surgical removal of the whole eyeball, leaving the optic nerve stump, the extraocular muscles and the rest of the orbital contents. It is done when an eye is beyond saving, or when keeping it endangers the other one.
Causes and Risk Factors
Intraocular malignancy (melanoma, retinoblastoma), severe trauma with no useful vision remaining, a painful blind eye, endophthalmitis that will not settle — and to prevent sympathetic ophthalmia, an autoimmune inflammation that can blind the remaining good eye after a penetrating injury to the other.
Clinical Manifestations
Depends on why it is being done: pain in a blind eye, no light perception, a mass found on imaging, or an infection that is not responding. The point to hold on to is that the presentation is the underlying disease, not the surgery.
Assessment and Diagnostic Findings
Acuity and light perception in both eyes, ultrasound, CT or MRI of the orbit, and histology for tumor. Assess the fellow eye carefully — from here on, it is her only eye and it is the priority.
Medical Management
Enucleation with an orbital implant placed at the same operation, a pressure dressing for the first 24–48 hours, antibiotics and analgesia. A custom ocular prosthesis is fitted about 4–6 weeks later, once the swelling has settled.
Nursing Management and Client Education
Expect the pressure dressing at first. Report bright red bleeding, fever, or pain that is increasing rather than settling — that is hemorrhage or infection. Teach prosthesis handling: wash hands, remove, clean and reinsert as taught, and do not let it dry out. Protect the remaining eye absolutely — polycarbonate safety glasses, always. With one eye there is no depth perception: warn her about steps and curbs, pouring hot drinks, and driving. Grief and body image are part of this care, not an afterthought — she has lost an eye, and saying so out loud helps.
👂 Weber and Rinne — which test tells you what
Two tuning-fork tests that answer two different questions. Weber tells you the side. Rinne tells you the type. Neither one alone gives you a diagnosis, and that is exactly what the exam tests.
| Hearing | Weber (the side) | Rinne (the type) |
|---|---|---|
| Normal | Heard equally in both ears. No lateralization. | AC > BC in both ears — air conduction outlasts bone, usually about twice as long. Called a positive Rinne. |
| Conductive loss outer or middle ear |
Lateralizes to the bad ear. The blocked ear is shielded from room noise, so the bone-conducted tone sounds louder there. | BC > AC in the affected ear — a negative Rinne. Sound cannot get through the outer or middle ear, but the bone route still works. |
| Sensorineural loss cochlea or CN VIII |
Lateralizes away from the bad ear, to the good one. The damaged nerve cannot hear it by either route. | AC > BC — still a positive Rinne, because air conduction is still the better of the two. Both are reduced; the ratio is what is preserved. |
| AC = BC | — | Equivocal. It is not an answer — it needs formal audiometry. |
The one line to keep: conductive goes to the bad ear, sensorineural goes away from it. And a positive Rinne is not the same as a normal ear — sensorineural loss is positive too, which is why Rinne alone never gives you the side.
Order — the two sources disagree. Your LSC exam-prep recording does Weber first: an unequal Weber tells you only that the ears differ, and Rinne is the next step to say which type. The NORCET-style graphic says to do Rinne first. For your exam, answer with the course: Weber shows a difference, Rinne explains it.
👂 The six otic disorders, section by section
Same six sections, same order. Ear problems split into outer, middle and inner — and where the problem sits tells you most of the answer.
Hearing LossOpenClose
🖼️ InfographicsWeber & Rinne hearing tests
Definition and Overview
Reduced ability to detect sound. Conductive — something in the outer or middle ear blocks conduction. Sensorineural — the cochlea or cranial nerve VIII is damaged. Mixed — both. Presbycusis is the age-related sensorineural loss, and it takes the high frequencies first — which is why consonants disappear before vowels do.
Causes and Risk Factors
Conductive: cerumen impaction, foreign body, otitis media or effusion, perforated tympanic membrane, otosclerosis. Sensorineural: ageing, noise exposure, ototoxic drugs (aminoglycosides, loop diuretics, high-dose salicylates, cisplatin, vancomycin), Meniere's, acoustic neuroma, congenital causes and infection.
Clinical Manifestations
Asking for things to be repeated, turning the volume up, struggling with consonants and in noisy rooms, tinnitus, withdrawing from conversation, and being thought confused when she simply cannot hear. Speaking too loudly suggests sensorineural loss; speaking too softly suggests conductive, because she hears her own voice through bone.
Assessment and Diagnostic Findings
Otoscopy first — is it just wax? Then the whisper test, and the tuning-fork pair: Weber lateralizes to the bad ear in conductive loss and to the good ear in sensorineural; Rinne is air > bone normally and in sensorineural, and bone > air in conductive. Then audiometry and tympanometry.
Medical Management
Remove the cause: cerumen removal, treat the infection, myringotomy and tubes, stapedectomy for otosclerosis. Hearing aids for sensorineural loss, cochlear implant for profound loss, assistive listening devices — and stop the ototoxic drug wherever that is possible.
Nursing Management and Client Education
Do not shout. Shouting raises your pitch, and the high frequencies are exactly what she has lost — it distorts the consonants further. Instead: get her attention first, face her with the light on your face so she can lip-read, speak at normal volume slightly slower, lower your pitch, cut the background noise, and rephrase rather than repeat the same words louder. Hearing aid care: turn it off with the battery door open, in a dry container away from heat; clean with a dry cloth; whistling means a poor fit or wax. New confusion in an older adult — check she has her hearing aid in and her glasses on before you conclude anything else.
Otitis ExternaOpenClose
Definition and Overview
Inflammation or infection of the external auditory canal — “swimmer's ear”. The infection sits outside the tympanic membrane, which is what separates it from otitis media.
Causes and Risk Factors
Water sitting in the canal after swimming, trauma from cotton buds, hearing aids or earbuds, humid weather, eczema or dermatitis, and either too much or too little cerumen. In diabetes and immunocompromise, watch for malignant otitis externa — a Pseudomonas infection that can invade the skull base.
Clinical Manifestations
Ear pain that is markedly worse when the pinna or tragus is moved or pressed — that is the giveaway. Itching, a red swollen canal, discharge, and conductive hearing loss if the canal swells shut. Usually no fever.
Assessment and Diagnostic Findings
Otoscopy shows a swollen erythematous canal with debris; the examination itself hurts. Pain on pinna traction distinguishes it from otitis media. Culture the discharge if it is severe or not responding, and in a diabetic assess specifically for the malignant form.
Medical Management
Topical antibiotic drops with or without a corticosteroid (ciprofloxacin, or neomycin/polymyxin/hydrocortisone). A wick if the canal is too swollen to admit drops. Analgesia, and keep the ear dry. Systemic antibiotics only for spreading infection or in diabetes and immunocompromise.
Nursing Management and Client Education
Nothing smaller than your elbow goes in your ear — no cotton buds, ever. Keep the ear dry: earplugs or a shower cap, no swimming until cleared, dry the ear after washing. Warm the drops in your hand first — cold drops in the ear cause vertigo. Straighten the canal to instil: adult, pull the pinna UP and BACK; child under 3, DOWN and BACK. Then lie with that ear uppermost for a few minutes. Finish the whole course.
Acute Otitis MediaOpenClose
Definition and Overview
Acute infection of the middle ear, with fluid trapped behind an intact tympanic membrane. Overwhelmingly a disease of small children, because their eustachian tube is shorter, wider and more horizontal, so it drains badly and organisms travel up it easily.
Causes and Risk Factors
It follows an upper respiratory infection. S. pneumoniae, H. influenzae, M. catarrhalis. Risk rises with age 6–24 months, daycare, bottle-feeding lying flat, passive smoke, pacifier use, cleft palate, Down syndrome and allergy. Breastfeeding protects.
Clinical Manifestations
Ear pain, fever, irritability, pulling or tugging at the ear in an infant who cannot tell you, poor feeding, trouble sleeping and hearing loss. If the drum perforates, the pain suddenly eases and purulent drainage appears — relief, not improvement.
Assessment and Diagnostic Findings
Otoscopy: a red, bulging, opaque tympanic membrane, loss of the light reflex, and reduced mobility on pneumatic otoscopy. Tympanometry confirms effusion. Always check for mastoid tenderness behind the ear.
Medical Management
Analgesia always. Many resolve alone, so watchful waiting for 48–72 hours is reasonable in a well child over two. Amoxicillin is first-line when antibiotics are indicated. Myringotomy with tympanostomy tubes for recurrent infection or persistent effusion.
Nursing Management and Client Education
Finish the entire antibiotic course even though the pain stops in a day or two. Feed infants upright — never propped with a bottle lying flat. No passive smoke. Keep pneumococcal and influenza immunisations current. With tubes in place, report a tube that falls out or drainage that persists. Report high fever, pain or swelling behind the ear, or a stiff neck — mastoiditis and meningitis are the complications worth catching.
Tympanic Membrane RuptureOpenClose
Definition and Overview
A tear or perforation of the tympanic membrane, from pressure, infection or direct injury. Most heal on their own within weeks.
Causes and Risk Factors
Acute otitis media with pus building up behind the drum, barotrauma from flying or diving, a blow to the ear or head, blast injury, a foreign body or cotton bud, skull fracture, and sudden very loud noise.
Clinical Manifestations
Sudden sharp ear pain that then eases abruptly, drainage that may be clear, purulent or bloody, conductive hearing loss, tinnitus and sometimes vertigo. Clear watery drainage after head trauma may be cerebrospinal fluid — that is an emergency, not an ear problem.
Assessment and Diagnostic Findings
Otoscopy shows the perforation and its size. Hearing assessment with Weber and Rinne, then audiometry; tympanometry. If CSF is suspected, the halo or ring test and beta-2 transferrin; CT for trauma.
Medical Management
Most need nothing but time and a dry ear. Antibiotics only if it is infected; analgesia as needed. Tympanoplasty or myringoplasty if it fails to heal or the hearing loss is significant.
Nursing Management and Client Education
Keep the ear completely dry — no swimming, and cotton wool coated in petroleum jelly for showering. No diving or flying until cleared. Do not instil anything into the ear unless it is prescribed — with a hole there, drops reach the middle ear. Do not blow the nose forcefully; sneeze with the mouth open. Report fever, increasing pain or foul-smelling discharge. Reassure her that the hearing usually returns as it heals.
Meniere DiseaseFalls riskOpenClose
🖼️ InfographicsMeniere's Disease
Definition and Overview
A disorder of the inner ear caused by excess endolymph (endolymphatic hydrops). It is chronic and it attacks without warning, which is what makes it so disabling — not the attack itself but never knowing when the next one comes.
Causes and Risk Factors
The cause is unknown. Associations include autoimmune disease, viral infection, head trauma, family history, allergy and migraine. Attacks are triggered by salt, caffeine, alcohol, nicotine and stress.
Clinical Manifestations
The classic triad — vertigo (severe, rotational, minutes to hours, with nausea and vomiting), fluctuating sensorineural hearing loss, and tinnitus — plus a sensation of fullness or pressure in the ear. Usually one ear. Between attacks she may be entirely well, which makes others doubt her.
Assessment and Diagnostic Findings
The history makes the diagnosis. Audiometry shows a low-frequency sensorineural loss. Weber and Rinne, electronystagmography and caloric testing assess the vestibular side, and MRI is done to exclude an acoustic neuroma.
Medical Management
Acute attack — antihistamines (meclizine), antiemetics, benzodiazepines, bed rest. Maintenance — low-sodium diet, diuretics, betahistine, and avoiding caffeine, alcohol and nicotine. Refractory — intratympanic gentamicin or steroids, endolymphatic sac decompression, or labyrinthectomy, which destroys the hearing on that side.
Nursing Management and Client Education
Safety comes first — the vertigo causes falls. During an attack: lie still in a quiet darkened room, no sudden head movements, side rails up, and call for help before getting up. Do not drive, operate machinery, climb ladders or swim alone — the attacks give no warning. The low-sodium diet is the single biggest lever she controls. Keep a diary of attacks and what preceded them; that is how the triggers get found.
Inner Ear DisordersOpenClose
Definition and Overview
The disorders of the cochlea and the vestibular apparatus, affecting hearing, balance or both: labyrinthitis, vestibular neuritis, BPPV, ototoxicity and acoustic neuroma.
Causes and Risk Factors
Viral or bacterial infection — labyrinthitis often follows a cold or an otitis media. Displaced otoliths cause BPPV. Ototoxic drugs: aminoglycosides, loop diuretics, high-dose salicylates, cisplatin, vancomycin. Head trauma, ageing, and a benign tumor of cranial nerve VIII in acoustic neuroma.
Clinical Manifestations
Vertigo, nystagmus, nausea and vomiting, imbalance and falls, sensorineural hearing loss and tinnitus. The pattern separates them: BPPV — brief seconds-long vertigo triggered by a change of head position, no hearing loss. Labyrinthitis — vertigo with hearing loss. Vestibular neuritis — vertigo without hearing loss. Acoustic neuroma — one-sided progressive hearing loss and tinnitus, later facial numbness.
Assessment and Diagnostic Findings
Romberg and gait, the Dix-Hallpike maneuver for BPPV, audiometry, electronystagmography and caloric testing, MRI with contrast if an acoustic neuroma is suspected — and a careful medication review for ototoxicity, which is the cause most often missed.
Medical Management
Vestibular suppressants short-term only (meclizine, antiemetics). Corticosteroids, and antivirals or antibiotics for labyrinthitis. Epley canalith repositioning for BPPV, which often works in a single session. Vestibular rehabilitation exercises. Stop the ototoxic drug. Surgery or stereotactic radiosurgery for acoustic neuroma.
Nursing Management and Client Education
Fall prevention runs through all of it. Move slowly and change position in stages — sit on the edge of the bed before standing. Good lighting, rugs and clutter gone, a stick or frame if she is unsteady. No driving while the vertigo is active. Report new one-sided hearing loss or tinnitus — that is the acoustic neuroma pattern and it needs imaging. On ototoxic drugs, report tinnitus, any change in hearing or new dizziness immediately: the damage can be permanent, but it is often reversible if the drug is stopped early enough.
🧠 Mind maps 2
One per disorder, built from the structure of your ATI chapter.
🎯 Who gets it
- AMD risk increases with smoking, hypertension, high cholesterol, and obesity.
- AMD risk rises after age 60, with family history, or light-colored eyes.
- Cataracts risk increases with advanced age, diabetes, heredity, and smoking.
- Cataracts risk rises with eye trauma, heavy sun exposure, and steroid use.
👀 What you see
- AMD: distorted objects, blurred vision, loss of central vision.
- AMD: poor depth perception; can progress to blindness.
- Cataracts: gradual painless vision loss, blurred vision, visible lens opacity.
- Cataracts: absent red reflex; reduced night vision and color perception.
🧪 What confirms it
- Ophthalmoscopy examines the fundus: retina, optic disc, macula, and vessels.
- Visual acuity testing uses Snellen and Rosenbaum eye charts.
- Fluorescein angiography checks blood flow adequacy to the retina.
- Cataracts are confirmed by viewing the lens with an ophthalmoscope.
🩺 What you do
- Wet AMD: laser therapy seals the leaking blood vessels.
- Wet AMD: ocular injections of bevacizumab or ranibizumab block vessel growth.
- Cataracts: check visual acuity with the Snellen chart regularly.
- Cataracts: increase room lighting and provide magnifiers or large-print materials.
💊 Drugs
- Atropine 1% ophthalmic dilates the pupil and relaxes eye muscles preop.
- Atropine has a fast onset but a long duration of action.
- Medication therapy is the priority treatment for glaucoma.
💬 What you teach
- AMD: eat antioxidant-rich foods with vitamin E and B12 as advised.
- AMD: use community resources for transportation and low-vision aids.
- Cataracts: atropine effects last
7 to 12 days; wear sunglasses for light sensitivity.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🎯 Who gets it
- Middle ear risk: recurrent colds/otitis media, enlarged adenoids, trauma, air pressure changes (diving, flying)
- Inner ear risk: viral or bacterial infection, damage from ototoxic medications
👀 What you see
- Middle ear: hearing loss, ear fullness or pain, red inflamed canal, bulging tympanic membrane, fever
- Middle ear: fluid or bubbles behind the TM, and a diffuse or absent light reflex
- Inner ear: hearing loss, tinnitus, dizziness or vertigo, vomiting, nystagmus, balance changes
🧪 What confirms it
- Audiometry is a noninvasive hearing test measuring frequency, pitch, and intensity
- Tympanogram measures TM and middle-ear mobility; useful for diagnosing middle ear disease
- Weber and Rinne tuning-fork exams determine whether hearing loss is present
- Otoscopy examines the external canal, tympanic membrane, and malleus
🩺 What you do
- Pull the auricle up/back in adults, down/back in children to straighten the ear canal
- A normal TM is pearly gray and intact, with a visible anterior light reflex
- Bulging TM with a diffuse or absent light reflex signals middle-ear fluid or infection
- Avoid touching the ear canal lining — it is painful and sensitive
💊 Drugs
- Meclizine (antihistamine/anticholinergic) treats vertigo from inner ear disorders
- Ondansetron treats nausea and vomiting from vertigo; avoid in certain cardiac rhythm disorders
- Diphenhydramine and dimenhydrinate (antihistamines) treat vertigo and nausea from inner ear disease
💬 What you teach
- Fast immediately before ENG/caloric testing; avoid caffeine, alcohol, sedatives, antihistamines for several days prior
- ENG is not performed on clients with a pacemaker — signals interfere with results
- During vertigo, rest in a quiet, darkened room and move the head slowly
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🎥 Lecture recordings 12
Tap a card to open that recording in Google Drive. The same list lives in the lecture library.
🖼️ Infographics 13
Tap a card to open the matching graphics in your infographic library.
📄 Simple Nursing handouts for this module — 7 of them, straight from your Drive.
📋 Active Learning Templates 2
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
📋 Disorders of the Eye6 parts
🖼️ InfographicsEye InjuryEye Cancer
Filled from ATI chapter 13, row by row from that chapter’s own sections — 12 of 12 rows have content.
2 rows came from outside your ATI chapter — 1 cite a source, 1 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
- This chapter covers three major eye disorders: age-related macular degeneration (dry vs wet), cataracts (lens clouding from aging, trauma, or steroid use), and glaucoma (optic nerve damage from elevated pressure), including risk factors, diagnostics, medications, and surgical care.
Health Promotion & Disease Prevention
- Wear sunglasses outdoors and protective eyewear for sports or hazardous work.
- Get annual eye exams, especially after age 40.
- Learn early glaucoma warning signs: reduced vision and mild eye pain.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
- AMD risk increases with smoking, hypertension, high cholesterol, and obesity.
- AMD risk rises after age 60, with family history, or light-colored eyes.
- Cataracts risk increases with advanced age, diabetes, heredity, and smoking.
- Cataracts risk rises with eye trauma, heavy sun exposure, and steroid use.
- Glaucoma risk increases with age, race, genetic predisposition, and hypertension.
- Glaucoma risk also rises with diabetes, severe myopia, and retinal detachment.
- Glaucoma can also stem from eye trauma, tumors, or infection.
Assessment — Expected Findings
- AMD: distorted objects, blurred vision, loss of central vision.
- AMD: poor depth perception; can progress to blindness.
- Cataracts: gradual painless vision loss, blurred vision, visible lens opacity.
- Cataracts: absent red reflex; reduced night vision and color perception.
- POAG: often asymptomatic early; headache and mild eye pain.
- POAG: gradual peripheral vision loss; halos seen around lights.
- POAG: IOP rises above
20 mm Hg, typically22 to 32 mm Hg. - Angle-closure glaucoma: sudden IOP spike to
30 mm Hgor higher.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Few eye disorders are diagnosed by blood test — assessment is visual and structural.
- Blood glucose and HbA1c for diabetic retinopathy risk.
- Inflammatory markers and autoantibodies for uveitis and scleritis.
- ESR and CRP urgently for suspected giant cell arteritis with visual loss — treatment starts before the biopsy.
- Lipids and blood pressure, since vascular disease drives retinal vein and artery occlusion.
Diagnostic Procedures
- Ophthalmoscopy examines the fundus: retina, optic disc, macula, and vessels.
- Visual acuity testing uses Snellen and Rosenbaum eye charts.
- Fluorescein angiography checks blood flow adequacy to the retina.
- Cataracts are confirmed by viewing the lens with an ophthalmoscope.
- Tonometry measures IOP; normal range is
11 to 21 mm Hg.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
- Wet AMD: laser therapy seals the leaking blood vessels.
- Wet AMD: ocular injections of bevacizumab or ranibizumab block vessel growth.
- Cataracts: check visual acuity with the Snellen chart regularly.
- Cataracts: increase room lighting and provide magnifiers or large-print materials.
- Cataracts: assess how reduced vision affects the client's daily function.
- Postop cataract care: prevent elevated IOP and prevent infection.
- Postop cataract care: give ophthalmic meds, control pain, teach fall prevention.
- Glaucoma: monitor for IOP above
20 mm Hgand light sensitivity. - Glaucoma: assess for eye aching and explain the disease process.
Medications
- Atropine 1% ophthalmic dilates the pupil and relaxes eye muscles preop.
- Atropine has a fast onset but a long duration of action.
- Medication therapy is the priority treatment for glaucoma.
Therapeutic Procedures
- Cataract surgery removes the lens and inserts a replacement intraocular lens.
- Replacement lenses can correct refractive errors and improve vision.
- Glaucoma surgery options include laser trabeculectomy, iridotomy, or shunt placement.
- Educate glaucoma surgery clients on adhering to their medication schedule.
💬 Around the patientClient Education · Interprofessional Care
Client Education
- AMD: eat antioxidant-rich foods with vitamin E and B12 as advised.
- AMD: use community resources for transportation and low-vision aids.
- Cataracts: atropine effects last
7 to 12 days; wear sunglasses for light sensitivity. - Cataracts: avoid activities that raise IOP, like bending, straining, or coughing.
- Cataracts: report sudden vision change, floaters, or pain with nausea and vomiting.
- Glaucoma: space different eye drops
5 to 10 minapart. - Glaucoma: apply gentle pressure to the inner eye corner after drops.
Interprofessional Care
- Consult an ophthalmologist for cataract surgery evaluation and care.
- Refer to an ophthalmologist when glaucoma surgery becomes necessary.
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from NEI, 2025.
- Glaucoma damages the optic nerve and can cause peripheral vision loss progressing to complete blindness if untreated.
- Vision already lost to glaucoma cannot be restored; treatment can only stop further damage from occurring.
- Because early glaucoma often has no symptoms, damage can progress silently before it is caught on screening.
National Eye Institute (NIH) · Glaucoma · open the source →
📋 Middle and Inner Ear Disorders6 parts
Filled from ATI chapter 14, row by row from that chapter’s own sections — 12 of 12 rows have content.
3 rows came from outside your ATI chapter — 2 cite a source, 1 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
- Covers middle ear conditions like otitis media and inner ear disorders like vertigo, Meniere's disease, and labyrinthitis — anatomy, hearing loss types, risk factors, diagnostics, nursing care, medications, procedures, and teaching.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from NIDCD, 2025.
- Sound at or below about 70 A-weighted decibels is unlikely to damage hearing even with long exposure.
- Repeated or prolonged exposure to sound at 85 dBA or higher can cause hearing damage, with louder sounds causing harm faster.
- Wearing earplugs or other hearing protection during loud activities is a key way to prevent noise-induced hearing loss.
- Noise-induced hearing loss is described as the only type of hearing loss that is completely preventable.
NIDCD (NIH) · Noise-Induced Hearing Loss (NIHL) · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
- Middle ear risk: recurrent colds/otitis media, enlarged adenoids, trauma, air pressure changes (diving, flying)
- Inner ear risk: viral or bacterial infection, damage from ototoxic medications
Assessment — Expected Findings
- Middle ear: hearing loss, ear fullness or pain, red inflamed canal, bulging tympanic membrane, fever
- Middle ear: fluid or bubbles behind the TM, and a diffuse or absent light reflex
- Inner ear: hearing loss, tinnitus, dizziness or vertigo, vomiting, nystagmus, balance changes
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Usually none — diagnosis is by examination and audiometry.
- Culture of ear discharge in persistent or resistant otitis externa or media.
- Drug levels for ototoxic medicines — aminoglycosides, high-dose loop diuretics, some chemotherapy.
- Autoimmune and syphilis serology in sudden sensorineural hearing loss.
- Glucose and lipids, since vascular disease contributes to inner ear ischemia.
Diagnostic Procedures
- Audiometry is a noninvasive hearing test measuring frequency, pitch, and intensity
- Tympanogram measures TM and middle-ear mobility; useful for diagnosing middle ear disease
- Weber and Rinne tuning-fork exams determine whether hearing loss is present
- Otoscopy examines the external canal, tympanic membrane, and malleus
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
- Pull the auricle up/back in adults, down/back in children to straighten the ear canal
- A normal TM is pearly gray and intact, with a visible anterior light reflex
- Bulging TM with a diffuse or absent light reflex signals middle-ear fluid or infection
- Avoid touching the ear canal lining — it is painful and sensitive
- ENG: ask simple questions to keep client alert; keep NPO and on bedrest until vertigo resolves
- Monitor ototoxic drug levels: gentamicin, furosemide, aspirin/NSAIDs, and cisplatin can damage hearing
- Routine audiometry is needed when a client receives ototoxic IV antibiotics
- Encourage slow position changes and assistive devices for clients with balance problems
- Scopolamine is contraindicated in angle-closure glaucoma; monitor eye pressure in open-angle glaucoma
Medications
- Meclizine (antihistamine/anticholinergic) treats vertigo from inner ear disorders
- Ondansetron treats nausea and vomiting from vertigo; avoid in certain cardiac rhythm disorders
- Diphenhydramine and dimenhydrinate (antihistamines) treat vertigo and nausea from inner ear disease
Therapeutic Procedures
- Myringotomy incises the TM to drain middle-ear fluid and prevent perforation
- A pressure-equalizing tube (grommet) replaces Eustachian tube function for
6-18 months - Stapedectomy removes the stapes and replaces it with a prosthesis, done via the ear canal
- Stapedectomy treats otosclerosis, a cause of conductive hearing loss in older adults
💬 Around the patientClient Education · Interprofessional Care
Client Education
- Fast immediately before ENG/caloric testing; avoid caffeine, alcohol, sedatives, antihistamines for several days prior
- ENG is not performed on clients with a pacemaker — signals interfere with results
- During vertigo, rest in a quiet, darkened room and move the head slowly
- Avoid caffeine and alcohol; space fluid intake evenly and reduce salt to control vertigo
- Take a diuretic, if prescribed, to reduce fluid in the semicircular canals
- After ear surgery, avoid rapid movements and bending from the waist for weeks
- After cochlear implant surgery, the device stays off until programmed
2-6 weekslater
Interprofessional Care
- Vestibular rehab combines biofeedback, physical therapy, and stress management for frequent vertigo
- Postural training teaches positions to avoid and exercises that can stop a vertigo attack
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2023.
- Acute mastoiditis is most often a complication of an untreated or inadequately treated middle ear infection.
- Infection erodes through the bony walls of the mastoid air cells, which can lead to pus collecting behind the ear.
- Adults with mastoiditis typically present with severe ear pain, fever, and headache along with redness and swelling behind the ear.
- Untreated mastoiditis can spread inward to cause meningitis, a brain abscess, or venous sinus thrombosis, complications seen in 6 to 23 percent of cases.
StatPearls (NCBI Bookshelf) · Mastoiditis · open the source →
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
- Open-angle glaucoma is gradual and painless and takes peripheral vision first; lifelong beta-blocker drops. Closed-angle is sudden severe pain + halos + N/V and is a surgical emergency.
- Retinal detachment = painless curtain across the vision. Emergency. The only one that gets face-down (prone) positioning post-op, about 2 weeks.
- Diabetic retinopathy: annual dilated exam for every diabetic regardless of symptoms. Real prevention is tight A1C and BP control.
- Eye drops:
5–10 minbetween different drops; occlude the inner canthus2 minto block systemic absorption. - New hearing loss teaching: face her, cut background noise, get her attention first, and rephrase rather than repeat louder.
- Perimetry is just formal visual field testing. If she will not fixate, coach her to hold the center light — do not cancel the test and do not medicate her.
- Acute closed-angle presents as fixed dilated pupil + hazy cornea + pain with vomiting. Chronic open-angle eats peripheral vision first.
- Their glaucoma risk list: family history, over 60, diabetes, hypertension, corticosteroid use, thin central cornea, high myopia. They explicitly said not risks: corrective lenses, vitamin A, sunglasses.
- Anticholinergic and decongestant eye drops dilate the pupil → contraindicated specifically in closed-angle.
- The ototoxic pairing to memorize is aminoglycoside + loop diuretic (gentamicin + furosemide). On gentamicin the priority action is monitor for early hearing loss and report so the dose can change — not fluids, not noise avoidance.
- Labyrinthitis is viral and resolves over weeks; BPPV is brief and movement-triggered. Labyrinthitis + 4 vomits in 3 hours → the priority becomes fluid and electrolyte assessment, not the vestibular suppressant.
- Cataract post-op yes-list: avoid bending and lifting, eye shield, antibiotic + anti-inflammatory drops, do not touch the eye. No warm compresses, no operative-side positioning.
- Calc: 2,500 mL over 12 h =
208.3 mL/hr— but if the item asks in liters the answer is2.5 L. They flagged this as a units trap. Round only at the very end.
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