Common Vision Deficits - Myopia - Hyperopia - Presbyopia - Astigmatism - Cataracts - Glaucoma

- Macular degeneration - Strabismus

Sensation, Perception, & Cognition Flashcards by Kaylie Krauzyk

Sense Organs

* Eyes

* Ears

* Nose

* Tongue

* Skin

* Sense of body & space

We have to sense & respond to sensory input

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The Senses

Our senses provide us with information about our internal & external environments

Our senses enable people to experience the world

Allows body to respond to changing situations & maintain homeostasis

Sensory experience involves 4 components in the nervous system;

Stimulus
Reception
Perception
Arousal mechanism

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A ___ is a trigger that stimulates a receptor

The meaning depends on reception & processing

i.e. seeing/touching something

stimulus

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___ is the process of receiving the stimuli from the nerve endings

Reception

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Reception occurs through receptors, such as;

thermoreceptors

proprioceptors, &

photoreceptors

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Located in the skin, muscles, tendons, ligaments, joint capsules

Nerve endings in skin or body

Coordinate input to enable us to sense the position of our body in space

proprioceptors

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In the skin and detect variations in temperature

thermoreceptors

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In retina of the eyes; are what detect visible light & allow us to see and interpret that stimuli

photoreceptors

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Components of the Sensory System: ___

___ is the ability to interpret sensory impulses

Ability to give meaning to impulses

Affected by:

location of receptor
# of receptors activated
frequency of action potentials
any changes to the above

Perception

99% of stimuli is discarded by the brain

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Components of the Sensory System: ___

___ is composed of consciousness and alertness

Mediated by the ___ (___)

Affected by environment, medications

Arousal

reticular activating system (RAS)

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Located in the brainstem and controls our consciousness and alertness

Neurons make connections between spinal cord, cerebellum, thalamus, & cerebral cortex

Relays visual, auditory, & other stimuli to help keep us awake, attentive, & observant

Without this stimuli, CNS becomes lethargic

reticular activating system (RAS)

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Components of the Sensory System: Response

Factors affecting response:

Intensity of stimulus (excites more receptors; i.e. bright vs dim light)

Contrasting stimuli (from cold outside going into garage then into home)

Adaptation to stimuli (nurses accustomed to things in the environment)

Previous experience

This requires people to be alert and receptive to stimulation

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What Affects Sensory Function?

Age/Stage of life

Culture (nature, type, & amt of interaction & stimulation; ppl are comfortable w/; preferences in space, eye contact, & touch)

Illness

i.e. MS slows transmission of nerve impulses
issues w/circulation like peripheral arterial disease that might impair function of sensory receptors in the brain; can alter our perception & response
i.e. diabetes ⇒ diabetic retinopathy
HTN also damages retina of eyes

Medication (aspirin & furosemide that are ototoxic)

Stress

Personality

Lifestyle

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Sensory Alterations

Impaired Vision

Impaired Hearing / Smell (anosmia)

Impaired Taste / Kinesthetic Sense / Tactile Perception

Impaired Vision

Affects ALL aspects of daily living

macular degeneration loss of visual field > CVA

orbital trauma

Age-related changes; refractive errors; cataracts; glaucoma; diabetic/hypertensive retinopathy

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Signs of Sensory Deprivation

(the state of the RAS depression that is caused by a lack of meaningful stimuli)

Irritability / confusion / reduced attention span
Decreased problem-solving ability / drowsiness / depression
Preoccupation w/Somatic complaints / delusions

High Risk Groups

Disabled/homebound elders
Children in orphanages
Prisoners
People dealing w/language issues and are unable to interpret in foreign areas

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Nursing Interventions: Sensory Deprivation

Focus is on prevention (keep that we are experiencing through our senses the environment around us)

Support the senses (glasses, hearing aids)

Orientation

> Calendar w/current date; view of environment

Provide Stimuli

> Regular contact, touch

> Television, radio

> Pet therapy

> Smells/aromatherapy

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Sensory Overload (complex sensory environment [i.e. hospital setting] that contributes to our sensory overload)

Irritability

Confusion

Reduced attention span

Decreased problem-solving ability

Drowsiness

* 1st (5) are same as sensory deprivation

Muscle tension

Anxiety

Inability to concentrate

Decreased ability to perform tasks

Restlessness

Disorientation

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Nursing Interventions: Sensory Overload

* Minimize stimuli

> Less light, less noise

> Less television, less bluelight

> Calm tone

> Reduce noxious odors

* Provide rest

* Teach stress reduction strategies

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Common Vision Deficits

Myopia
Hyperopia
Presbyopia
Astigmatism
Cataracts
Glaucoma

Macular degeneration
Strabismus

Irregular curvature of the lens or cornea, causing blurred vision

Astigmatism

farsightedness

Hyperopia

clouding of the lens of the eye

cataracts

crossed eyes; can lead to permanent vision loss

strabismus

nearsightedness

myopia

? vision loss caused by increased pressure in the eye

glaucoma

? change associated with aging, lens is less elastic and less able to accomodate to near objects

presbyopia

? loss of central vision d/t damage to the macula lutea leading cause of visual impairment in adults over the age of 50; slow, progressive loss of central and near vision

macular degeneration

Visual Changes in the Older Adult \* The vitreous humor becomes thinner, and floaters appear in the visual field \* Presbyopia occurs \* Ciliary body contracts and the lens thickens \* Peripheral vision decreases \* Tear production decreases (e.g., dry eyes)

\* Loss of visual acuity \* Decreased ability to accomodate to distance vision \* Sudden changes in illumination \* Decrease in night vision

Nursing Interventions: Visual Deficits Ensure client has proper glasses available Provide sufficient light Protect eyes in sunlight Provide a magnifying lens or large-print materials

Evaluate \> Client's ability to perform ADL's \> Client's ability to remain safe in the environment \> Any needs for assistance \* Keep in mind increased risk for falls

Common Hearing Deficits: Hearing Loss Hearing loss may result from injury or disease in structures of the ear, the nerves, or brain Inability to hear impairs the ability to communicate, and hinders social interactions Changes in the older adult \> i.e. drier cerumen \> ear scarring \> presbycusis (gradual loss of hearing in both ears)

Common Hearing Deficits Conduction deafness / nerve deafness Presbycusis / central deafness Tinnitus / impacted cerumen Otosclerosis / otitis media

? Is progressive, sensorineural hearing loss

presbycusis

? Middle ear infection

otitis media

? Ringing in the ear; inner ear damage

Tinnitus

? Damage to cranial nerve VIII or cochlear receptors

Nerve deafness

? Hardening of bones in middle ear that leads to poor sound transmission; genetic

otosclerosis

? Occurs from damage to auditory areas in the temporal lobes; from tumors, CVA, meningitis

Central deafness

Nursing Interventions: Hearing Deficits \* Hearing aids and care \* Closed-caption TV \* Masks to see mouth \* Regular inspection of ear canals \* Teach techniques to improve communication \* Promote safety \* Assess for social isolation

A few more sensory changes in the Older Adult...

Taste \* Taste buds atrophy and decrease in #, so there is less ability to perceive tastes \* Dry mouth may alter sense of taste \* Risk for nutritional deficiency

Smell \* Atrophy and loss of olfactory neurons decreases the ability to perceive smell, which may alter the sense of taste Touch \* Loss of sensory nerve fibers and changes in the cerebral cortex decreases the ability to perceive light touch, pain, and temp variations

Changes of the Older Adult: Kinesthesia (how we view our bodies in space) \* Changes include a decrease in muscle fibers and a diminished conduction speed of nerve fibers \* This results in slowed reaction times, decreased speed and power of muscle contractions, and impaired balance **Think SAFETY**

Level of Consciousness \* Indicator of cerebral function \* Most common assessment tool: Glascow Coma Scale (GCS) \* Document objective, specific facts in the nursing notes \* Max score of 15

Components of the Nursing Assessment \* Client history \* Physical examination \* Risk factors for impaired sensory perception \* Mental status \* LOC \* Environment \* Support network

Nursing Interventions: Altered Level of Consciousness \* Continue orientation to reality \* Safety measures \* Attend to body systems \> Eye care \> Range of motion \> Skin & oral care \> Urinary drainage \> Bowel management \> Nutrition

Nursing Interventions: The Confused Client \* Reorient frequently \> Your name, day, date, time \> Provide clocks, calendars \> Use as many belongings as possible \* Maintain a safe environment

\* Communicate clearly & slowly \> Use gestures \* Limit choices \* Promote feelings of security \* Use alternative therapies \* Provide care continuity \* Differentiate between delirium (that's acute & reversible) & dementia \*

Seizures Abrupt onset of disturbance of electrical activity in the brain Generally last few sec to 5 min; about 3 min ? Is a common type; widespread electrical activity; tonic-clonic

generalized

? Begin w/electrical discharge from one side in a limited area of the brain i.e. aka focal seizure Missed in children; *no physical movements happen*

partial seizures

Nursing Interventions: Clients at Risk for Seizures \* Pad the head, foot, & siderails of bed \* Suction and O₂ should be at the head of the bed, readily avail for use \* Do not attempt to open the mouth during a seizure, or try to insert a tongue blade \* Maintain a safe environment for the client \* Turn to side-lying position to avoid aspiration \* Sleep deprivation lowers the threshold for seizures

\* Aura stage \* Tonic stage \* Clonic stage \* Postictal stage