Conjunctivitis and Hearing

loss

Submitted by:
Pamo, Joshua
BSN III – D

Submitted to:
Prof. Frayda E. Castro
Clinical Instructor
 CONJUNCTIVITIS
is an inflammation or swelling of the conjunctiva. The conjunctiva is the thin
transparent layer of tissue that lines the inner surface of the eyelid and covers the white part
of the eye. Often called "pink eye," conjunctivitis is a common eye disease, especially in
children. It may affect one or both eyes. Some forms of conjunctivitis are highly contagious
and can easily spread in schools and at home. While conjunctivitis is usually a minor eye
infection, sometimes it can develop into a more serious problem.

INCIDENCE

 It is common to children
 Viral conjunctivitis is a common ocular disease in the United States and worldwide.

PATHOPHYSIOLOGY

The surface tissues of the eye and the ocular adnexa are colonized by normal flora
such as streptococci, staphylococci, and corynebacteria. Alterations in the host defense, in
the bacterial titer, or in the species of bacteria can lead to clinical infection. Alteration in the
flora can also result from external contamination (eg, contact lens wear, swimming), the use
of topical or systemic antibiotics, or spread from adjacent infectious sites (eg, rubbing of the
eyes).
The primary defense against infection is the epithelial layer covering the conjunctiva.
Disruption of this barrier can lead to infection. Secondary defenses include hematologic
immune mechanisms carried by the conjunctival vasculature, tear film immunoglobulins, and
lysozyme and the rinsing action of lacrimation and blinking.

RISK FACTORS/CAUSE

 More prevalent in children and elder people as compared to adults.

 If a person is suffering from respiratory infections
 If the immune system of a person becomes weak due to some other disease such as diabetes.
 A person is at high risk of having conjunctivitis if he/she is taking corticosteroids
 A person exposed to chemicals may also suffer from pink eye infection
CAUSES OF CONJUNCTIVITIS

 Viruses
 Bacteria
 Irritants such as shampoos, dirt, smoke, and pool chlorine
 Allergies, like dust, pollen, or a special type of allergy that affects some contact lens
wearers

MANIFESTATIONS

 Redness in the white of the eye or inner eyelid

 Increased amount of tears
 Thick yellow discharge that crusts over the eyelashes, especially after sleep
 Green or white discharge from the eye
 Itchy eyes
 Burning eyes
 Blurred vision
 Increased sensitivity to light

MEDICAL MANAGEMENT
DIAGNOSTIC PROCEDUR

Patient history to determine the symptoms the patient is experiencing, when the symptoms
began, and the presence of any general health or environmental conditions that may be
contributing to the problem.

Visual acuity measurements to determine the extent to which vision may be affected.

Evaluation of the conjunctiva and external eye tissue using bright light and magnification.

Evaluation of the inner structures of the eye to ensure that no other tissues are affected by
the condition.

Supplemental testing may include taking cultures or smears of conjunctival tissue,

particularly in cases of chronic conjunctivitis or when the condition is not responding to
treatment.
TREATMENT
The appropriate treatment for conjunctivitis depends on its cause:

 Allergic conjunctivitis—The first step should be to remove or avoid the

irritant, if possible. Cool compresses and artificial tears sometimes relieve
discomfort in mild cases. In more severe cases, non-steroidal anti-
inflammatory medications and antihistamines may be prescribed. Cases of
persistent allergic conjunctivitis may also require topical steroid eye drops.

 Bacterial conjunctivitis—This type of conjunctivitis is usually treated with

antibiotic eye drops or ointments. Improvement can occur after three or four
days of treatment, but the entire course of antibiotics needs to be used to
prevent recurrence.

 Viral Conjunctivitis—There are no available drops or ointments to eradicate

the virus for this type of conjunctivitis. Antibiotics will not cure a viral
infection. Like a common cold, the virus just has to run its course, which may
take up to two or three weeks in some cases. The symptoms can often be
relieved with cool compresses and artificial tear solutions. For the worst cases,
topical steroid drops may be prescribed to reduce the discomfort from
inflammation, but do not shorten the course of the infection. Some doctors
may perform an ophthalmic iodine eye wash in the office in hopes of
shortening the course of the infection. This newer treatment has not been well
studied yet, therefore no conclusive evidence of the success exists.

 Chemical Conjunctivitis—Treatment for chemical conjunctivitis requires

careful flushing of the eyes with saline and may require topical steroids. The
more acute chemical injuries are medical emergencies, particularly alkali
burns, which can lead to severe scarring, intraocular damage or even loss of
the eye.

PHARMACOLOGY

Drug name: Gentamycin Sulfate

Classification: Aminoglycoside
 Mechanism of Action: bactericidal: inhibit protein synthesis in susceptible
strains of gram negative bacteria, appears to disrupt functional integrity of
bacterial cell membrane, causing cell death.
Indication: Treatment of superficial ocular infections due to strains
of microorganisms susceptible to gentamicin

Nursing Diagnosis

Acute pain related to inflammation of the conjunctiva

Nursing Interventions

 Teach proper hand washing technique and instruct patient to keep hands away of eyes
 Use disinfected equipment for eye examination
 Encourage patient to avoid sharing personal cloths with others
 Apply warm compress over eye and instill eye drops/ointment as ordered. Some eye
drops contain antihistamines or other medications that can be helpful for people with
allergic conjunctivitis.
 If pink eye affects only one eye, don’t touch both eyes with the same cloth. This reduces
the risk of spreading an infection from one eye to the other.
 Instruct patient to clean eye discharge with tissue and dispose carefully.
 Replace eye cosmetics and do not share
 Teach the patient to install eye drops and ointments correctly without touching tip of
container with eye or lashes
 Encourage patient to stay away from school for at least 7 days
 Instruct to use dark black eye glasses to avoid bright light and contamination
 Advise patient to use and take care of contact lenses correctly
 Advise patient to avoid rubbing eyes
 Administer antihistamines and mast cell stabilizers (for allergic conjunctivitis) as
ordered.
 Administer decongestants, steroids and anti-inflammatory eye drops as ordered.
References

https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-
vision-conditions/conjunctivitis

http://www.diseasefix.com/page/what-are-the-causes-and-risk-factors-of/3690/

https://www.webmd.com/eye-health/eye-health-conjunctivitis#1
HEARING LOSS

– Disruption in the normal process that may occur in either the outer, middle, or inner ear,
whereby sound waves are not conducted to the inner ear, converted to electrical signals
and/or nerve impulses are not transmitted to the brain to be interpreted as sound.

INCIDENCE

Hearing impairment is considered the most prevalent impairment worldwide. Almost

600 million, an estimated 10% of people worldwide, have mild or worse hearing impairment.
250 million have moderate or worse hearing impairment. Two thirds of the world’s hearing
impaired population reside in developing countries.

 About 20 percent of Americans, 48 million, report some degree of hearing loss.

 At age 65, one out of three people has a hearing loss.

 60 percent of the people with hearing loss are either in the work force or in educational
settings.

 While people in the workplace with the mildest hearing losses show little or no drop in
income compared to their normal hearing peers, as the hearing loss increases, so does
the reduction in compensation.

 About 2-3 of every 1,000 children in the United States are born with a detectable hearing
loss in one or both ears.

 Almost 15% of school-age children (ages 6-19) have some degree of hearing loss

PATHOPHYSIOLOGY

The major forms of hearing loss are classified as

-conductive, in which transmission of sound impulses from the external ear to the junction of
the stapes and oval window is interrupted

-sensorineural, in which impaired cochlear or acoustic (eight cranial) never function prevents
transmission of sound impulses within the inner ear or brain

-mixed, in which conductive and sensorineural transmission dysfunction combine.

RISK FACTORS/CAUSES
1. Diabetes: The vascular problems that can happen with diabetes can have an impact
on the part of the ear needed to sense incoming sounds. Reduced blood flow to the
inner ear can increase the risk of permanent hearing loss.

2. Heart Disease: Not only can reduced blood flow from heart disease affect the hearing
on its own, but it can worsen the damaging effect that noise can have on the hearing
as well.

3. Stress: The ability to concentrate can be greatly affected. This means that for
someone with a hearing loss, the added effort needed to follow a conversation
combined with poor concentration can mean complete communication breakdown.

4. Obesity: There is no hard and fast rule that hearing loss and weight gain go hand in
hand, but some studies have shown that people with a higher body-mass-index are at a
greater risk of having difficulty hearing. Like diabetes and heart disease, researchers
think this is because increased weight could reduce blood flow to the ears.

5. Aging. Degeneration of delicate inner ear structures occurs over time.

6. Loud noise. Exposure to loud sounds can damage the cells of your inner ear. Damage
can occur with long-term exposure to loud noises, or from a short blast of noise, such
as from a gunshot.

7. Heredity. Genetic makeup may makes it more susceptible to ear damage from sound
or deterioration from aging.

8. Occupational noises. Jobs where loud noise is a regular part of the working
environment, such as farming, construction or factory work, can lead to damage
inside the ear.

9. Recreational noises. Exposure to explosive noises, such as from firearms and jet
engines, can cause immediate, permanent hearing loss. Other recreational activities
with dangerously high noise levels include snowmobiling, motorcycling or listening
to loud music.

10. Some medications. Drugs, such as the antibiotic gentamicin and certain
chemotherapy drugs, can damage the inner ear. Temporary effects on your hearing —
ringing in the ear (tinnitus) or hearing loss — can occur if you take very high doses of
aspirin, other pain relievers, antimalarial drugs or loop diuretics.
 11. Some illnesses. Diseases or illnesses that result in high fever, such as meningitis, may
damage the cochlea
CAUSES

Causes of hearing loss depend on the type; congenital, sudden, noise- induced or presbycusis

Congenital hearing loss

-Dominant, autosomal dominant, autosomal recessive, or sex linked trait

-Maternal exposure to rubella during the first trimester or syphilis during pregnancy
-prematurity, low birth weight, serum bilirubin level above 20mg/dl
-Use of ototoxic drugs during pregnancy, trauma or prolonged fetal anoxia during delivery or
congenital abnormalities of the ears, nose or throat.

Sudden deafness

-Acute infection, especially mumps and other bacterial and viral infections

-Metabolic disorder, such as diabetes mellitus and hypothyroidism

-Vascular disorders, such as hypertension and arteriosclerosis

-Use of ototoxic drugs, such as ethacrynic acid, furosemide, gentamicin, quinine,

streptomycin and tobramycin

-Neurologic disorders, such as multiple sclerosis and neurosyphilis

-Blood dyscrasias, such as leukemia and hypercoagulation

Noise-Induced hearing loss

-Prolonged exposure to loud noise 85-90dB)

-Brief exposure to extreme loud noise (greater than 90dB)

Presbycusis

-Loss of hair cells in the organ of corti (otologic effect of aging)

MANIFESTATIONS

Signs and symptoms of hearing loss may include:

 Muffling of speech and other sounds

  Difficulty understanding words, especially against background noise or in a crowd of
people

 Trouble hearing consonants

 Frequently asking others to speak more slowly, clearly and loudly

 Needing to turn up the volume of the television or radio

 Withdrawal from conversations

 Avoidance of some social settings

MEDICAL MANAGEMENT

Tests to diagnose hearing loss may include:

 Physical exam. The doctor will look into the ear for possible causes of the hearing loss,
such as earwax or inflammation from an infection. The doctor will also look for any
structural causes of the hearing problems.

 General screening tests. The doctor may ask you to cover one ear at a time to see how
well you hear words spoken at various volumes and how you respond to other sounds.

 Tuning fork tests. Tuning forks are two-pronged, metal instruments that produce
sounds when struck. Simple tests with tuning forks can help the doctor detect hearing
loss. A tuning fork evaluation may also reveal whether hearing loss is caused by
damage to the vibrating parts of the middle ear (including the eardrum), damage to
sensors or nerves of the inner ear, or damage to both.

 Audiometer tests. During these more-thorough tests conducted by an audiologist, you

wear earphones and hear sounds directed to one ear at a time. The audiologist presents a
range of sounds of various tones and asks to indicate each time you hear the sound.

TREATMENT

 Removing wax blockage. Earwax blockage is a reversible cause of hearing loss. The
doctor may remove earwax by loosening it with oil and then flushing, scooping or
suctioning out the softened wax.
  Surgical procedures. Surgery may be necessary if you've had a traumatic ear injury or
repeated infections that require the insertion of small tubes that help the ears drain.

 Hearing aids. If hearing loss is due to damage to the inner ear, a hearing aid can help
by making sounds stronger and easier for the patient to hear. An audiologist can discuss
with the patient the potential benefits of using a hearing aid, recommend a device and
fit with it.

 Cochlear implants. If you have severe hearing loss, a cochlear implant may be an
option for the patient. Unlike a hearing aid that amplifies sound and directs it into your
ear canal, a cochlear implant compensates for damaged or nonworking parts of you’re
the ear.

WHAT TO DO

1. When talking to a patient with hearing loss who can read lips, stand directly in from of
him/her with the light on your face, and speak slowly and distinctly.
2. Asses the degree of hearing impairment without shouting.
3. Approach the patient within his visual range and get his attention by raising your arm or
waving; touching him may unnecessarily startle him/her
4. Write instructions on a tablet, if necessary to make sure the patient understands
5. If the patient is learning to use a hearing aid, provide emotional support and
encouragement
6. Inform staffs members and hospital personnel of the patient’s disability and his/her
established method of communication
NURSING DIAGNOSIS

 Impaired verbal communication related to disturbed auditory perceptions as

evidenced by difficulty discerning and understanding words.

NURSING INTERVENTIONS

NURSING INTERVENTIONS RATIONALE

Learn patient needs and pay attention to The nurse should set aside enough time
nonverbal cues. to attend to all of the details of patient
care. Care measures may take longer to
 complete in the presence of a
communication deficit.
Place important objects within reach. To maximize patient’s sense of
independence.
Provide an alternative means of An alternative means of communication
communication for times when (e.g., flash cards, symbol boards,
interpreters are not available (e.g., a electronic messaging) can help the
phone contact who can interpret the patient express ideas and communicate
patient’s needs). needs.
Never talk in front of patient as though he This increases the patient’s sense of
or she comprehends nothing. frustration and feelings of helplessness.
Clarify your understanding of the Feedback promotes effective
patient’s communication with the patient communication.
or an interpreter.
Keep distractions such as television and To keep patient focused, decrease
radio at a minimum when talking to stimuli going to the brain for
patient. interpretation, and enhance the nurse’s
ability to listen.
Avoid talking with others in front of the Excluding the patient from an interaction
patient as though he or she comprehends increases the patient’s sense of
nothing. frustration and feeling of helplessness.
Maintain eye contact with patient when Patients may have defect in field of
speaking. Stand close, within patient’s vision or they may need to see the
line of vision (generally midline). nurses’ face or lips to enhance their
understanding of what is being
communicated.
Give the patient ample time to respond. It may be difficult for patients to respond
under pressure; they may need extra time
to organize responses, find the correct
word, or make necessary language
translations.
References

http://www.northcountyaudiology.com/hearing-loss-resources/glossary-of-audiology-terms/

http://www.hearingspecialists.ca/2016/08/five-risk-factors-hearing-loss/

http://hearinghealthmatters.org/hearinginternational/2011/incidence-of-hearing-loss-around-
the-world/

https://www.mayoclinic.org/diseases-conditions/hearing-loss/symptoms-causes/syc-
20373072

https://www.mayoclinic.org/diseases-conditions/hearing-loss/diagnosis-treatment/drc-
20373077

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