2.9 Neurological and Sensory Motor HEARING/VISION Flashcards
Hearing loss
what is it
Common problem – 50% of those over age 75
Develops due to lesions in outer ear, middle ear, inner ear or central auditory pathways
Hearing loss Classifications
Classifications:
Conductive - transmission of sound is disrupted (cerumen, edema, stenosis, tumors, perforated tympanic membrane, scarring) hearing loss across all frequencies
Sensorineural - sound waves get to the inner ear but reception/interpretation is decreased or distorted (commonly caused by impulse or continuous noise damage to hair cells & organ of Corti = high frequency hearing loss)
Presbycusis - aging-related degeneration of cochlear hair cells, gradual hearing loss progressing across adulthood
Behavioral cues to hearing loss
Increased voice volume Head position with “good ear” toward speaker Ask for repetition Respond inappropriately to conversation Can appear confused Decreased socialization Difficulty in groups
DIAGNOSIS
hearing loss
Audiometry
Diagnose conductive & sensorineural hearing loss
Pt sits in soundproof room & responds to sounds when heard
Identifies type & pattern of hearing loss
Hearing loss treatment
Hearing aids
Hearing aids
Amplification of sounds, doesn’t correct or treat the disease problem
Challenges: denial, vision problems, manual dexterity, cost
Types: in-canal, in the ear, and behind the ear
Hearing loss treatment
Surgery
Surgery
Conductive - reconstruction
Sensorineural – cochlear implants
Nursing care
Interventions for hearing
Promote socialization
Promote communication
Interventions: Make sure hearing aids are clean & functional Get attention before speaking Face patient!! Reduce environmental noise Low pitch, avoid shouting Short sentences Assess understanding as you go Write it down
Vertigo
what is it
Sensation of movement (whirling, rotation) when there is none
Symptom caused by various problems-often RT inner ear
Vertigo Assessment
Assessment:
Is the world spinning or are you light-headed?
Is it related to movement?
Are you having problems with your balance?
Are you experiencing nausea and vomiting?
How long does the sensation last?
Ringing in your ears (tinnitus)?
Autonomic symptoms (sweating, hypotension, salivation, pallor)?
Vertigo Intervention
Interventions: gradual position change, turn whole body, sit down immediately, meds
Most common cause of vertigo
The most common causes of vertigo are inner ear infections or diseases of the ear such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere’s disease
benign paroxysmal positional vertigo (BPPV)
BPPV can occur when calcium builds up in canals of the inner ear, causing brief dizziness that lasts from 20 seconds to one minute. It is usually brought on by trauma to the head or by moving the head in certain positions.
Vestibular neuritis
what is it
Vestibular neuritis is brought on by an inner ear infection that causes inflammation around the nerves that help the body sense balance. It results in a severe bout of vertigo that can last a day or more and sometimes includes hearing loss. “A person is dizzy for a day or two and then off balance,” Hansen explained. TheCleveland Clinicsays 95 percent of patients make a full recovery and never have it again.
Meniere’s disease
what is it
Meniere’s disease is caused by the buildup of fluid and pressure in the inner ear and can cause dizziness along with ringing in the ears and hearing loss.
EPISODIC (occurring occasionally) & VARIABLE
Symptoms: vertigo, tinnitus, progressive hearing loss (often in one ear)
Meniere’s disease
diagnosis
treatment
Diagnosis: hx & PE, audiometry, vestibular testing, glycerol test (osmotic effects pulls some of excessive fluid)
Treatment:
Symptomatic management & diet (no ETOH, caffeine, low sodium)
Meds: diuretics, motion sickness meds (meclizine), nausea meds
Visual impairment types/causes
Macular degeneration Diabetic retinopathy Glaucoma Cataracts Total blindness
Age-related Macular degeneration
what is it?
Dry?
Wet?
Damage to the retina (macula provides focus/central vision)
DRY (nonexudative)
Accumulation of drusen deposits (small yellow or white spots on the retina)
Nutrition slows progress – vitamins, lutein, betacarotene
WET (exudative)
Develops from progression of dry
Leakage from weak blood vessels, scarring
Treatment: injections that prevent new vessel growth, laser
Risk: age, Caucasian, smoking
Cataracts what is it
Opacification of the lens due to clumping of protein that blocks light and blurs vision
Common >50% of those over 80 y.o.
Cataracts
risks
surgery
Risk: age, sunlight, smoking, trauma, DM, steroids
Surgery:
surgical removal of lens & replacement intraocular lens implanted outpatient surgery eye drops pre & post op
Glaucoma
what is it
Damage to optic nerve from increased intraocular pressure (due to overproduction or impaired drainage of fluid); blocks visual impulses to brain
Loss of peripheral vision
Open angle glaucoma- most common, gradual impaired drainage thru trabecular meshwork, painless, both eyes
Closed angle glaucoma – rapid or gradual onset, systemic S/S with exac: HA, N/V, pain, blurred vision, halos, one eye, pupil may be fixed
Glaucoma
risk
meds
surgery
Risks: age, African American, DM,HTN, high eye pressures
Meds:
Beta blockers (↓production of aqueous humor)
Prostaglandin (↑aqueous outflow)
Carbonic anhydrase inhibitor (↓production of aqueous humor &↓ IOP)
Surgery: laser holes into trabecular network, fistula or tubes for drainage
Retinal tears & detachment
what is it
s/s
surgery
separation of the retina, or sensory portion of the eye from the choroid, the pigmented vascular layer
usually spontaneous, but can be caused by trauma
MEDICAL EMERGENCY
S/S: floaters, flashes of light, blurred/curtained vision, painless
Positioning so gravity pulls retina into contact with choroid
Surgery for tears: cryotherapy or laser to “weld” layers back together
Surgery for detachment: pneumatic retinopexy (use air/gas bubble)to pressure area back against the wall, scleral buckle or vitrectomy
Nursing care of visually impaired
Recognize vision changes – patterns associated with disease
Teach S/S to report
Large print books
Lighting
Set up meal trays with clock description
Orientation to room, assist with ambulation
Positioning
Post op: avoid coughing, lifting, protective eyewear, do not rub eyes
Eye drop administration
Technology
