Chapter 45 Sensory Perception Flashcards
What are some sensory impressions?
Consciousness Arousal and awareness Memory Affect Judgment Awareness of reality Language
What is sensory perception?
Ability to receive and interpret sensory impressions.
What is sensory deficit?
Change in reception and/or perception. Deficits can affect any of the senses.
What is sensory deprivation?
Reduced sensory input either from internal or external environment.
What can sensory deprivation be a result of?
Illness
Trauma
Isolation
What is sensory overload?
Excessive, sustained and unmanageable multi sensory stimulation.
What are some factors that contribute to loss of vision?
Presbyopia (blurred vision) Cataracts Glaucoma Diabetic retinopathy Macular degeneration Infection Inflammation Injury Brain tumor
Some factors that contribute to hearing loss include:
Obstruction Tympanic Membrane Perforation Ear Infections Otosclerosis (abnormal bone growth in middle ear)
What is sensorineural hearing loss (SNHL)?
Hearing loss occurs when there is damage to the inner ear (cochlea) or to nerve pathways from inner ear to brain.
What are some factors that contribute to SNHL?
Exposure to loud noises
Ototoxic medications
Aging
Acoustic neuroma (slow growing tumor of the nerve that connects ear and brain)
For clients who are hearing impaired what can a nurse do to make them more comfortable?
Sit and face client
Encourage use of hearing devices
Try lowering vocal pitch before increasing volume
Write down what clients do not understand
For clients who are visually impaired what can a nurse do to make them more comfortable?
Call clients by name before approaching them
Identify yourself
Give specifics of room
Explain interventions before touching
What is aphasia?
Disorder caused by damage to parts of the brain that control language. It can make reading, writing and speaking difficult.
Most common in stoke victims
How can a nurse make a patient who has aphasia comfortable?
Speak clearly and slowly
Do not shout
Pause between statements to allow time to understand
Check comprehension
Reinforce verbal with nonverbal communication (gestures)
Acknowledge any frustration in communicating.
What are ways a nurse can teach ways to reduce hazards at home?
Visual hazards (throw rugs, walkways) Auditory (use flashing light alarms) Olfactory (smoke and carbon monoxide) Gustatory (read dates on food packages) Tactile (protect and inspect body parts that lack sensation)
With complications of sensory deprivation and overload a nurse should minimize overall stimuli and provide meaningful stimulation. What are some ways to achieve this?
Minimize glare
Manage pain effectively
Allow for adequate sleep and rest periods
Amplify phones
Reduce unpleasant orders
Increase touch if acceptable (back rubs, hand holding)
What visual acuity constitutes legal blindness?
Visual acuity of 20/200 or less with corrective lenses
Reduced visual acuity can be either which two things?
Unilateral (one eye)
Bilateral (both eyes)
Regarding a client with reduced vision what can a nurse do in health promotion or disease prevention?
Advise sunglasses use
Avoid rubbing eyes
Eye examination regularly
What is the most significant factor for visual sensory alterations?
Age
Age related loss of the eyes ability to focus in close objects?
Presbyopia
Opacity of lens
Cataracts
Loss of peripheral vision
Glaucoma
Microaneurysms
Diabetic retinopathy
Loss of central vision
Macular degeneration
During assessment of visual acuity, what are examples of subjective data?
Frequent headaches Frequent eye strain Blurred vision Poor judgement of depth Diplopia (double vision)
During assessment of visual acuity, what are examples of objective data?
Tendency to close or favor one eye
Poor hand eye coordination
What is a ophthalmoscopy?
Allows visualization of back part of the eyeball (fundus) including retina, optic disc, macula and blood vessels.
What are two visual acuity tests?
Snellen and Rosenbaum eye charts
What does Tonometry measure?
Intraocular pressure (expected range 10 to 21 mm Hg), that range is elevated with glaucoma especially angle-closure glaucoma.
What is a Gonioscooy?
Allows visualization of the iridocorneal angle or anterior chamber of the eyes.
Slit lamp, a diagnostic procedure, allows for what?
Visualization if anterior portion of the eye, such as cornea, anterior chamber and lens.
When dealing with clients with reduced vision a nurse should monitor?
Visual acuity using Snellen and Rosenbaum eye charts
External and internal eye structures (ophthalmoscope)
Functional ability
Which visual acuity chart does the client stand further away for?
Snellen, 20 ft away
Rosenbaum, client holds chart 14in away from eyes.
Patient centered care, nurses should assess how clients adapt to the environment with reduced vision to maintain safety how?
Increase the amount of light in a room
Arrange home to remove hazards
Provide phone with large numbers
Patient centered care, what are some adaptive devices that a nurse can provide for reduced vision?
Magnifying lens Large print books Talking devices (clocks and watches)
What is a medication a client could be prescribed for reduced vision and what does it provide?
Anticholinergics, such as atropine ophthalmic solution)
It provides mydriasis (dilation of pupil) and cyclopgia (ciliary paralysis) for examinations and surgeries.
What should the client be educated on when using anticholingerics?
Reduced accommodation
Blurred vision
Photophobia
With systemic absorption there could be anticholingeric effects (tachycardia, decreased secretions)
What type of foods should be recommended for bad vision?
Foods rich in antioxidants (leafy green vegetables)
What is hearing loss?
The difficulty in hearing or accurately interpreting speech and other sounds due to a problem in the middle or inner ear.
What is conductive hearing loss?
Alteration in the middle ear that blocks soundwaves before they reach the inner ear.
What is sensorineural hearing loss?
Alteration in inner ear that involves cranial nerve VIII or cochlear damage.
Regarding a client who is hearing impaired what can a nurse do in health promotion or disease prevention?
Advise clients to not place any objects in the ear
Use commercial ceruminolytic (ear drops that soften cerumen)
Wear ear plugs in high noise level
Which types of medications should be used for hearing loss?
Ototoxic medications (aminoglycosides, monobactams)
The two causes of conductive hearing loss are:
History of middle ear infections
Older age (otosclerosis)
Some causes of sensorineural hearing loss are:
Prolonged exposure to loud sounds
Ototoxic medication
Infectious processes
Age related (presbycusis - decreased ability to hear high pitch sounds)
Subjective data for conductive hearing loss is?
Hears better in a noisy environment.
Objective data for conductive hearing loss is.
Speaks softly
Obstruction in external canal (packed cerumen)
Tympanic membrane findings (holes, scarring)
What does the Rinne test demonstrate in sensorineural hearing loss:
Rinne test, demonstrates expected response of air conduction is greater then bone conduction (AB > BC), but length of time is decreased for both.
Subjective data for sensorineural hearing loss is?
Tinnitus (ringing)
Dizziness
Heard poorly in noise environment
Objective data for sensorineural hearing loss is?
Speaks loudly
No otoscopic findings
Diagnosis of acoustic neuroma (benign tumor cranial nerve VIII)
What are three types of hearing exams?
Audiometry (identifies whether loss is sensorineural and/or conductive)
Tympanogram (measures mobility of the tympanic membrane and middle ear structures relative to sound to diagnosis disorders of middle ear)
Otoscopy (allows visualization of external auditory canal, tympanic membrane (TM), and melleus bone visa me through TM.
Where do Nurses typical use audiometry screening for hearing loss?
In schools or older adult settings
During an otoscopic examination what should the nurse be looking for?
Tympanic membrane should be pearly gray and intact and provide complete structural separation of outer and middle ear.
Light reflex should be visible from center of TM anteriorly (5 o’clock right ear; 7 o’clock left ear)
During an otoscopic exam if the canal curves which way should you pull the auricle of the ear to straighten and enhance visualization?
Pull up and back of adults
Down and back of children younger than 3 years
When dealing with clients that are receiving Ototoxic medications for more than 5 days. What should be checked on the client?
Hearing.
Reduced ______ function that occurs with aging increases the risk for ototoxicity.
Renal
Ototoxic medications include:
Multiple antibiotics (gentamicin, amikacin, metronidazole (Flagly))
Diuretics - furosemide (Lasix)
NSAIDs - aspirin, IBprofen (Advil)
Chemotherapeutic agents - (Abiplatin)
Name and describe two surgical interventions for hearing loss:
Tympanoplasty, surge rival reconstruction of middle ear structure
Myringoplasty, an eardrum repair
What are the appropriate nursing actions for a client that had hearing loss surgery?
Place sterile ear packing postoperatively
Position client flat with operative ear facing up for 12 hr.
Tympanoplasty and Myringoplasty are for sensorineural or conductive hear loss?
Conductive
In sensorineural hearing loss the Weber test lateralizes to the affected ear or the unaffected ear?
unaffected ear.
In conductive hearing loss what does the Rinne test demonstrate?
Air conduction of sound is less than or equal to bone conduction (AB < or = BC)
In conductive hearing loss the Weber test lateralizes to the affected ear or unaffected ear?
affected ear.
