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Sensory Exam Flashcards

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1
Q

Most common changes in the aging eye are those in the ___.

what happens?

A 
lens
partially or totally opaque
loses elasticity
peripheral vision losses
depth perception decreases
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2
Q

what is Snellen’s chart

A

Used to test visual acuity

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3
Q

what does 20/20 vision mean

A

the patient can read at 20 feet what the normal eye can read at 20 feet

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4
Q

visual impairment starts at what number/

A

20/70

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5
Q

how to test intraocular pressure

A

puff of air

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6
Q

what is the whisper voice test

A

plug one ear, whisper in the other

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7
Q

what is the Rinne test

A

differentiates between conductive and sensorineural hearing loss. Place an activated tuning fork to mastoid process and in front of the ear

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8
Q

What is the Weber test

A

place tuning fork on top of head and see if they can hear the same from both ears

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9
Q

What is Romber’s test

A

have the patient stand with eyes open and then closed. Observe for swaying. Some swaying is ok!

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10
Q

what is Audiometric testing

A

When the patient is placed in a sound proof room with head phones and raises hand when sounds are heard

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11
Q

What is tympanometry

A

Used to measure compliance of the tympanic membrane and determine problems of the middle ear. It determines the amount of pressure in the middle ear.

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12
Q

What is a caloric test

A

Warm or cold water is irrigated into the ears.

Nystagmus is a normal response. If no nystagmus, it is indicative of Menier’s disease

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13
Q

S/S of any eye disorder

A

visual disturbances, pain, redness, secretions, itchiness, sensation of pressure in the eyes

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14
Q

possible Nursing Dx for eye disorders

A

acute pain
anxiety r/t visual-sensory deficit
deficient knowledge

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15
Q

define conjunctivitis

A

inflammation of conjunctiva due to a virus or bacteria
contagious (whether bacterial or viral)
aka pink eye

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16
Q

s/s of conjunctivitis

A

redness
crusting exudate
itching

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17
Q

define Blepharitis

A

chronic inflammation of eyelid margins

2 types seborrheic and ulcerative

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18
Q

define hordeolum

A

a sty, staph abscess in the sebaceous gland at base of eyelash

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19
Q

define keratitis

A

inflammation of cornea

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20
Q

s/s of keratitis

A 
Pain
inflammation
Decreased vision
photophobia
spasms
If untreated, patient may suffer loss of vision
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21
Q

define Hyperopia

A

farsightedness

light rays focused behind retina

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22
Q

define myopia

A

nearsightedness

light rays focused in front of the retina

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23
Q

define astigmatism

A

unequal curvatures in the shape of cornea which causes blurred vision.

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24
Q

define presbyopia

A

crystalline lenses lose elasticity, causing decrease ability to focus on close objects

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25
Q

s/s of refractive errors

A

Difficulty reading or seeing objects
Eyestrain causing headaches
Myopia – holding reading material close to eyes
Hyperopia – holding reading materials farther from eyes

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26
Q

Therapeutic interventions for refractive errors

A

Corrective lenses
Laser assisted in situ keratomileus (LASIK)
Photorefractive keratectomy (PRK) – laser

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27
Q

causes of blindness

A

Trauma

Complications of diseases (HTN, Diabetes, cataracts, glaucoma, malnutrition, infection)

Caused when the ray of light on their way to the optic nerve is obstructed or by disease of the optic nerve

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28
Q

Dx test for blindness

A 
Visual field exam
Tonometry
Slit-lamp microscope exam
Retinal angiography
Ultrasonography
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29
Q

Define diabetic retinopathy

A

Vascular changes in retinal blood vessels

It’s due to the excess glucose, changes in the retinal walls, and formation of microaneurisms and constriction of blood vessels

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30
Q

define retinal detachment and name s/s

A

Separation of retina from choroid layer of eye which allows for fluid to enter the space between the layers

Signs & Sx: sudden change in vision, Flashing lights or floaters

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31
Q

Dx test of retinal detachment

A

indirect ophthalmoscopy

visualization of the retina

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32
Q

complications of retinal detachment

A

Increased intraoccular pressure and posses threat for further detachments

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33
Q

Define glaucoma

A

Group of diseases characterized by abnormal pressure within the eyeball
Pressure causes damage to cells of the optic nerve
Types:
Acute angle closure glaucoma
Primary open able glaucoma

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34
Q

s/s of acute angle closure glaucoma

A 
ophthalmic emergency
unilateral, rapid onset
severe pain
 blurred vision
rainbows around lights
eye redness
steamy-appearing cornea
Photophobia
 tearing
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35
Q

s/s of primary open able glaucoma

A 
bilateral, gradual onset
painless at times
mild aching
headaches
halo around lights
frequent visual changes not corrected with eyeglasses
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36
Q

Dx test for glaucoma

A

tonometry: used to detect increased IOP

Normal IOP – 12 to 20 mm Hg

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37
Q

eye drop treatment for glaucoma

A

1st line treatment is focused on opening the aqueous flow using cholinergic agents (miotics) which constrict the pupil causing the iris to pull away from the drainage canal, allowing aqueous fluid to flow freely.

2nd type of medication used to slow production of aqueous fluid
Steroids may also be ordered to decrease inflammation

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38
Q

surgical management of glaucoma

A

Used when medication not able to control IOP
Focused on creating an area for aqueous humor to flow freely thus preventing increased intraocular pressure
Cataracts are painless

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39
Q

define cataract

A

Opacity in the lens of the eye that may cause a loss of visual acquity
Vision diminished because light rays are unable to get to retina through clouded lens

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40
Q

factors contributing to cataract development

A 
Age			
UV radiation		
Diabetes
Smoking
Steroids
Alcohol
Nutrition
Intraocular Infections
Trauma
Congenital Defects
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41
Q

surgical treatment for cataracts

A

Only treatment

Removal of cloudy lens one eye at a time

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42
Q

complications of cataract surgery

A 
Inflammation
Increased IOP
Macular edema
Retinal detachment
Vitreous loss
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43
Q

risk factors for macular degeneration

A 
Older than 60 years old
Family history of macular degeneration
Diabetes
Smoking
Frequent exposure to UV light
Caucasian
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44
Q

s/s of macular degeneration

A

Dry type is slow, progressive loss of central & near vision
Usually both eyes, but can be affected differently

Wet type – onset sudden of visual loss
Blurred vision
Distortion of straight lines
Dark or empty spots
Decreased ability to distinguish colors
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45
Q

types of macular degeneration

A

Dry (atrophic)

Wet (exudative)

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46
Q

therapeutic interventions for DRY (ATROPHIC) macular degeneration

A

No treatment
Most do not lose peripheral vision or become totally blind
Most are classified as legally blind
Special low-vision lenses can enhance remaining vision

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47
Q

therapeutic interventions for WET (EXUDATE) macular degeneration

A

If diagnosed early – laser photocoagulation can seal the leaking blood vessels, which will slow rate of vision loss
Meds: antiangiogenic – prevents new blood vessels from forming

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48
Q 
define each type of eye trauma
Foreign body
Burns
abrasions/lacerations
penetrating wounds
A

Foreign bodies – most common cause of corneal injury (dust in eyes, then rub eyes causing further irritation)

Burns – chemical, UV and direct heat

Abrasions & Lacerations – due to something dragging across the eye

Penetrating wounds – most serious due to eye structures may be permanently damaged

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49
Q

therapeutic intervention for foreign body trauma

A

NS flush to irrigate object out of eye or to a point where it can be taken out with a swab; topical antibiotic ointment for infection prevention

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50
Q

therapeutic intervention for chemical burn eye trauma

A

15 to 20 minute irrigation (the sooner the better) of tap water is fine to use at work site; sterile solution used in the hospital; topical antibiotic ointment for infection prevention

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51
Q

therapeutic intervention for abrasions and lacerations to eye

A

anti-infective ointments or drops after cleansing the eye with NS

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52
Q

therapeutic intervention for penetrating wounds to the eye

A

eye specialist will treat these; cover both eyes to prevent ocular movement; stabilize any protruding objects; DO NOT REMOVE OBJECT

53
Q

most common disability in the US

A

hearing loss

acquired or congenital

54
Q

define conductive hearing loss

A

Any interference with the conduction of sound impulses through the external auditory canal, eardrum, or middle ear.
Caused by the interference with the sound wave ability to reach the inner ear
This is a mechanical problem

55
Q

correction for conductive hearing loss

A

Infection, foreign bodies and impacted cerumen can be corrected
Hearing devices may improve hearing loss if cause cannot be corrected

56
Q

define sensory hearing loss

A

originates in the cochlea & involves hair cells & nerve endings

57
Q

define sensorineural hearing loss

A

Results from disease or trauma to the sensory or neural components of the inner ear

58
Q

define presbycusis hearing loss

A

hearing loss caused by the aging process

59
Q

causes of sensorineural hearing loss

A 
Complications of infections (measles, mumps, meningitis)
Ototoxic drugs
Trauma
Noise
Neuromas
Arteriosclerosis
Aging process
60
Q

define external otitis and its cause

A

Caused due to exposure to moisture, contamination or trauma
Perfect environment for pathological growth
Staphylococci most common causative organism
most common infection

61
Q

define ear infection

A

Localized infection
ear canal furuncle or abscess due to hair follicle infected
Carbuncle forms when several hair follicles involved in forming the abscess
Most furuncles and carbuncles erupt and drain spontaneously

62
Q

s/s of ear infection

A 
Ear pain (early indication if pain with gentle pull on pinna) – pain may occur with jaw movement or otoscope insertion
Pruritus 
Inflammation present
Redness
Drainage
Fever is a possibility
63
Q

Dx test of ear infection

A

CBC (WBC elevation)
Cultures of drainage
Rinne’s test and weber’s test to detect hearing loss

64
Q

therapeutic interventions for ear infection

A

Topical (drops/ointment) or systemic antibiotics
Topical or systemic steroids
Thoroughly cleanse ear before topical treatment

65
Q

risk factors for impacted cerumen

A 
Large amounts of ear hair
Work in dusty or dirty environments
Improper cleaning
Older age
Hearing aids
66
Q

s/s of impacted cerumen

A

Hearing loss
Feeling of fullness
Feeling of blocked ear
Otoscopic exam shows cerumen blocking ear canal

67
Q

Dx test for impacted cerumen

A 
Otoscopy
Audiometric testing
conductive loss in affected ear
Whisper voice
Rinne’s test
conductive loss in affected ear
Weber test
conductive loss in affected ear
68
Q

makes found in the ear

A

Benign masses are usually Sebaceous gland cysts

Malignant tumors such as basal cell carcinoma on the pinna and squamous cell in the ear anal may develop and spread

69
Q

s/s of masses in the ear

A 
Changes in appearance of skin
Impaired conductive or sensorineural hearing loss
Pain 
Ear drainage
Facial paralysis (progressed)
Visualization of mass during otoscopy
70
Q

Dx studies for masses in ear

A 
Otoscopy
Biopsy
Imaging 
Audiometric studies
Demonstrates hearing impairment
71
Q

s/s of trauma to ear

A 
Lacerations
Contusions
Hematomas
Abrasions
Erythema
Blistering
Itching
Decreased hearing
Pain
Swelling
72
Q

Dx studies for trauma to the ear

A 
Otoscopic examination – use caution not to push foreign object farther in
Imaging studies – to determine extent
Evaluate conductive hearing loss:
Audiometric test
Whisper voice test
Rinne’s test
Weber’s test
73
Q

therapeutic interventions for trauma to the ear

A

debridement, surgical repair, or application of protective covering

74
Q

Therapeutic measures for external ear disorders

A

Topical or systemic antibiotics
Analgesics are used to control pain
Steroids are used to treat inflammation
Make sure the ear is thoroughly cleaned prior to topical treatment
Cerumen may be removed with installations or irrigation
Do not irrigate if patient has history of perforated eardrum

75
Q

define otis media

A

Most common disease of middle ear
General term for inflammation of middle ear, mastoid, & Eustachian tube
Commonly follows URI
Nasopharyngeal mucosa becomes edematous & discharge produced
Fluid, pus, or air builds up in the middle ear and the Eustachian tube becomes blocked which impairs middle ear ventilation

76
Q

s/s of otis media

A 
Fever
Earache
Feeling of fullness in ear
Purulent drainage
Pain
Conductive hearing loss
N/V
Redness on otoscopic exam
77
Q

Dx tests for otis media

A 
CBC (elevated WBC)
Ear cultures
Imaging studies
Conductive hearing loss present on
Audiometric studies
Rinne’s test
Weber’s test
Whisper test
78
Q

complications of otis media

A

Spontaneous perforation of tympanic membrane
Pain with perforation
Hearing loss
Cholesteatoma, Tympanosclerosis, and Mastoiditis
Due to Repeated infections

79
Q

therapeutic interventions for otis media

A 
Antibiotics 
Oral analgesics 
Ear drops (for pain)
Surgical 
Myringotomy – with tubes
Myringoplasty – reconstruction of perforated tympanic membrane
80
Q

define Otosclerosis

A

Hardening of the ear
Due to formation of new bone along the stapes
Causes the stapes to become immobile and causes conductive hearing loss

81
Q

s/s of otosclerosis

A

Progressive hearing loss
Bilateral conductive hearing loss (soft, low tones)
Tinnitus
Otoscopic exam – pinkish/orange tympanic membrane

82
Q

Dx studies for otosclerosis

A 
Audiometric testing
Imaging studies 
Whisper voice test
Rinne’s test 
Weber’s test
83
Q

therapeutic interventions for otosclerosis

A 
No cure
Hearing aids 
Ossiculoplasty
Total or partial ossicular replacement (prosthesis)
Stapedectomy
84
Q

nursing management for otosclerosis

A 
Operative ear upward when lying in bed
Ear plug (keep area aseptic)
Activity as ordered
Use caution d/t dizziness
Instruct not to cough, sneeze, blow nose, vomit, fly in plane, lift heavy objects or shower
85
Q

Nursing Dx for Middle Ear, Tympanic Membrane & Mastoid Disorders

A

Risk for infection r/t broken skin, pressure necrosis, chronic disease, or surgical procedure

Acute pain r/t fluid accumulation, inflammation, or infection

Fear r/t hearing loss

86
Q

define Labyrinthitis

A

Inflammation or infection of inner ear

Caused by Viral or bacterial pathogens

87
Q

s/s of labyrinthitis

A 
Vertigo
Tinnitus
Sensorineural hearing loss
Pain
Fever
N/V
88
Q

nursing management of labyrinthitis

A

Symptom management
Safety education while on sedatives and bedrest
Avoid turning head quickly

89
Q

define Meniere’s Disease

A

Balance disorder
Cause unknown
disturbance in fluid physiology of the endolymphatic system

90
Q

s/s of Meniere’s Disease

A 
Triad of Symptoms:
Vertigo
Hearing loss
Tinnitus
can also have n/v
91
Q

Dx test for Meniere’s Disease

A

audiometric, neurological, radiographs

92
Q

therapeutic interventions for Meniere’s disease

A

symptomatic management and prophyloactic treatment between attacks
Salt restriction, Avoid caffeine, alcohol & tobacco
Surgical Treatment – only when medical management has failed

93
Q

Name the proper sequence as they are involved in the process of producing a visual image from beginning to end

A 
cornea
aqueous humor
lens
vitreous humor
retina
optic nerve
occipital lobe
94
Q

name the proper sequence in the process of hearing when sound waves enter the ear canal

A 
eardrum
malleus
incus
stapes
oval window
fluid in the cochlea
hair cells in the organ or court
eighth cranial nerve
temporal lobes
95
Q

define nystagmus

A

constant involuntary cyclical eyeball movement

96
Q

define tropia

A

deviation of the eye away from the visual axis

97
Q

define accommodation

A

adjustment of the eye for distance to focus the image on the retina by changing lens curvature

98
Q

define ptosis

A

drooping of the upper eyelid as a resolute of paralysis

99
Q

define arcus senilus

A

opaque white ring around the periphery of the cornea in aged persons from deposits of fat

100
Q

Name purpose of test and normal test results

Snellen chart

A

visual acuity

20/20 for both eyes

101
Q

Name purpose of test and normal test results

visual fields

A

peripheral vision

equal to examiner’s

102
Q

Name purpose of test and normal test results

cardinal fields of gaze

A

extraocular movement

follows in all fields without nystagmus

103
Q

Name purpose of test and normal test results

accommodation

A

pupillary response to near and far distance

eyes turn inward and pupils constrict when focusing on a near object

104
Q

Name purpose of test and normal test results

Rinne

A

differentiate between conductive and sensorineural hearing loss
air conductive greater than bone conduction

105
Q

Name purpose of test and normal test results

Weber

A

hearing acuity

heard equally

106
Q

Name purpose of test and normal test results

Romberg’s

A

balance/vestibular function

able to maintain standing position without loss of balance

107
Q

Which of the following would indicate that the patient has a normal corneal light reflex?

  • the eye focuses the image in the center of the pupil
  • the eyes converge to focus on the light
  • constriction of both pupils occurs in response to bright light
  • light is reflected at the same spot in both eyes
A

-light is reflected at the same spot in both eyes

symmetrical eye muscle strength keeps the eyes in the same position, and the light is reflected in exactly the same place

108
Q

When testing visual fields, the nurse examines which of the following parts of vision?

  • peripheral vision
  • near vision
  • distance vision
  • central vision
A

peripheral vision

109
Q

Which of the following terms would indicate to the nurse that a substance is toxic to the ear?

  • otoplasty
  • otalgia
  • ototoxic
  • tinnitus
A

ototoxic

otoplasty is ear repair
otalgia is ear pain
tinnitus is ringing in the ears

110
Q

Which of the following tests would the nurse use as an initial screening test to determine hearing loss?

  • Romberg’s test
  • Otoscopic examination
  • Caloric test
  • Whisper voice test
A

Whisper voice test

111
Q

Which of the following would the nurse use to document a finding that the patient’s ear is draining?

  • Otorrhea
  • Otalgia
  • Ototoxic
  • tinnitus
A

otorrhea

112
Q

Which of the following terms indicates that the patient has a hearing loss caused by aging?

  • otoplasty
  • otalgia
  • presbycusis
  • tinnitus
A

presbycusis

which is loss of high pitched sounds due to aging

113
Q

Which of the following explanations would the nurse give to the patient who had a Snellen chart finding of 20/80?

  • You can see at 80 feet what those with normal vision can see at 20 feet.
  • You can see at 20 feet what those with normal vision see at 80 feet.
  • You can see four times farther than those with normal vision can see
  • Your vision is normal
A

You can see at 20 feet what those with normal vision see at 80 feet

the first distance recorded when conducting the Snellen test is the distance from which the patient can clearly read the alphabetical line on the chart. The second distance recorded is the distance from which a person with normal vision can see the same alphabetical line

114
Q

In planning safe care for the older adult, which of the following conditions does the nurse recognize would cause visual problems? SATA

  • glaucoma
  • cataracts
  • arcus senilis
  • macular degeneration
  • estropia
  • presbycusis
A

glaucoma
cataracts
macular degeneration
estropia

115
Q

In which of the following statements does the nurse understand is true concerning air conduction of sound in the ear?

  • it is caused by the vibration of bones in the skull
  • it is less efficient than bone conduction
  • it is heard longer than bone conduction
  • it is caused by transmission of heat through the air
A

-it is heard longer than bone conduction

116
Q

Which of the following statements would the nurse understand is true when checking normal auditory acuity using the Rinne test?

  • The patient perceives sound equality in both ears
  • Air conduction is heard longer than bone conduction in both ears
  • Bone conduction is heard longer than bone conduction in both ears
  • The patient’s left ear will perceive the sound better than the right ear
A

Air conduction is heard longer than bone conduction in both ears

117
Q

Define Carbuncle

A

several hair follicles forming an abscess

118
Q

Define Cholesteatoma

A

epithelial cyst like sac filled with skin and sebaceous material

119
Q

define mastoiditis

A

complication of otis media

120
Q

define barotrauma

A

pressure in the middle ear caused by atmospheric changes

121
Q

Which of the following type of eyedrops is given to constrict the pupil, permitting aqueous humor to flow around the lens

  • osmotic
  • myotic
  • mydriatic
  • cycloplergic
A

myotic

mystics lower intraocular pressure by stimulating pupillary and ciliary sphincter muscles

122
Q

which of the following procedures does the nurse understand is used to correct otosclerosis

  • myringotomy
  • myringoplasty
  • mastoidectomy
  • stapedectomy
A

stapedectomy

involves removing or replacing part of all the stapes with a prothesis

123
Q

A nurse understands that labyrinthitis is treated primarily with which of the following drug categories

  • antihistamines
  • antispasmodics
  • anti-inflammatories
  • antiemetics
A

antihistamines

124
Q

Which of the following types of hearing loss does the nurse understand is most improved with the use of a hearing aid?

  • conductive
  • sensorineural
  • mixed
  • central
A

conductive

125
Q

which of the following would the nurse teach the patient is the most common site for ear infections

  • outer ear
  • inner ear
  • middle ear
  • semicircular canal
A

middle ear

126
Q

Which of the following would e a symptom the nurse expects to find during examination of a patient with macular degeneration? SATA

  • decreased ability to distinguish colors
  • sudden loss of vision
  • loss of near vision
  • loss of central vision
  • loss of peripheral vision
  • increased periodic dizziness
A

decreased ability to distinguish colors
oss of near vision
loss of central vision

127
Q

Which of the following would the nurse explain to the patient is the triad of symptoms associated with Meniere’s disease?

  • hearing loss, vertigo, and tinnitus
  • nystagmus, headache, and vomiting
  • nausea, vomiting, and pain
  • nystagmus, vomiting, and pain
A

hearing loss, vertigo, and tinnitus

128
Q

Which of the following is usually the first symptom of a cataract that the nurse would expect a patient to report during an examination?

  • dry eyes
  • eye pain
  • blurring of vision
  • loss of peripheral vision
A

blurring of vision

due to clouding of the lens

129
Q

Which of the following is a symptom that the nurse would expect to find during assessment of a patient experiencing acute angle-closure glaucoma?

  • flashing lights
  • lens opacity
  • halos around lights
  • vertigo
A

halos around lights

NURSING LPN (11 decks)

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