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Medsurg 3 - Sensory, Endocrine, DM, Neuro > Sensory Impairment > Flashcards

Sensory Impairment Flashcards

1
Q

Lens

A

Sits behind the iris

Made of flexible tissue which focuses light/images on the retina

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2
Q

Retina

A

A light sensitive layer of the eye

Creates nerve signals that create an image.

It has its own blood supply

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3
Q

Macula

A

Oval shaped pigmented area in the center of the retina responsible for high acuity vision

Consider its blood supply (retina)

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4
Q

Angle

A

Where the iris meets the cornea

Outflow of aqueous happens here

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5
Q

Myopia

A

Near sighted

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6
Q

Hyperopia

A

Farsighted

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7
Q

Presbyopia

A

Lens becomes larger, firmer, and inflexible

Results in inability to focus on near objects

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8
Q

Uncorrectable Impairmemts

A

Partial or total blindness

20/200 with correction

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9
Q

Vision Assessment

A

Details of current vision loss

Health history

Functional limitations

Emotional consequences

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10
Q

Vision Planning

A

Adjustment to the impairment

Verbalized feelings related to the loss

Identify coping strategies

Engage in meaningful activities

Maintain safety

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11
Q

Vision Interventions

A

Eye health promotion
- protection, nutrition

Emotional Support

Techniques:

  • Eye contact
  • Assistive devices
  • Service animals
  • Sight guided technique
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12
Q

Sight Guided Technique

A

Walk in front of patient

Offer elbow

Describe obstacles

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13
Q

Cataracts

A

Accumulation of water

Alterations in the lens fiber which affect transparency

Gradual visual changes (blurry) and glare worse at night

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14
Q

Cataracts: Non-surgical care

A

Non-surgical Care of Cataracts

  • Corrective lenses
  • Increasing amount of light
  • Reducing glare
  • Surgical Considerations
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15
Q

Cataracts - Surgical Care

A

Most common surgery in the US

Outpatient/local anesthesia

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16
Q

Cataracts - Surgical Care - Preop

A

Health history

Assess vision in non-operative eye

Anxiety and medications to dilate the eye

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17
Q

Cataracts - Surgical Care - Preoperative

A

Lens removed and replaced

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18
Q

Cataracts - Surgical Care - Post-Operative

A

Eye drops (anti-inflammatory, ABX)

Avoid activities that increase intraocular pressure (bending, lifting, etc…)

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19
Q

Nursing Dx - Cataracts

A

Disturbed sensory perception - visual

Self-care deficits related to visual deficit

Anxiety related to lack of knowledge about surgical procedure

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20
Q

Cataracts - Planning / Goals

A

Make informed decisions about options

Minimize anxiety

Understand and comply with postoperative therapy

Maintain physical/ emotional comfort

Remain free of infection / complication

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21
Q

Cataracts - Interventions

A

Pre- op teaching (setting expectations)

Post operative care (table 22-3):

  • Proper hygiene
  • S/s of Infections
  • Post op restrictions
  • Eye medications
  • Adherence to follow up
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22
Q

Cataracts - Older Adults

A

Maintaining safe independence

Surgical considerations

Emotional support

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23
Q

Retinopathy

A

Microvascular damage to the retina causing retinal edema and hard exudate
- microaneurysms, rupture, blockage

Most common in patients with:
DM
HTN

Blurred/progressive vision loss

Can be sudden

Control BP/A1C to prevent microvascular damage

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24
Q

Age Related Macular Degeneration - Dry

A

Dry - Abnormal accumulation of extra cellular deposits in the retina

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25
Age Related Macular Degeneration - Wet
Wet - Growth of new blood vessels in the retinal epithelium which may leak and form scar tissue
26
Age Related Macular Degeneration - Risk Ractors
Aging Family History Smoking UV light exposure
27
Age Related Macular Degeneration - Manifestations
Blurred/darkened vision Blind spots Distorted vision
28
Age Related Macular Degeneration - Collaborative Care
Not usually reversible Injections to inhibit growth of blood vessels (wet) Smoking cessation Eye Care (nutrition, vitamin C, E, Beta Carotene, Zinc) Maintain independence/assistive devices
29
Glaucoma (General)
Aqueous production (inflow) exceeds reabsorption (outflow) Intraocular pressure becomes elevated and optic nerve atrophy occurs Loss of peripheral vision/colored halos around lights Outflow occurs at the angle where the iris meets the cornea
30
Glaucoma - Open Angled
Trabecular meshwork becomes clogged More gradual / preventable
31
Glaucoma - Closed angle
Lens bulges forward because of the aging process and closes the angle prohibiting outflow. Worsens with pupil dilation Sudden - Nausea - Vomiting - Eye pain
32
Glaucoma - Collaborative Care - Diagnosis
Diagnostic tests (routine screening) Puff pressure test Normal pressure : 10-21 Open Angle (gradual): 22 - 32 Angle Closure (more acute): > 50
33
Glaucoma - Collaborative Care - Medications
Mitotics - constrict pupil to increase outflow Decrease aqueous production
34
Surgical Options
Focus on the trabecular mesh Create opening in the iris
35
Glaucoma - Collaborative Care - Emergency Care
Angle closure glaucoma needs emergency treatment
36
Glaucoma - Assessment
Knowledge about condition Psychological response Caregiver assessment
37
Glaucoma - Diagnosis
Risk for injury and self-care deficits Acute pain related to pathophysiologic process Non-Compliance related to the inconvenience/side effects of medications
38
Glaucoma - Planning/Goals
No progression of visual impairment Understand Disease process and rationale for therapy Comply with all aspects of therapy No post op complications Safely function within own environment Obtain relief from pain associated with disease and/or surgery
39
Glaucoma - Implementation
Health promotion (screening) Treatment compliance Surgical teaching if indicated Knowledge of meds - Most convenient time - Change if side effects - How are eye drops administered
40
Glaucoma - Gerontological Considerations
Other systemic illnesses Additive effect of glaucoma medications on other beta blockers Some medications contraindicated in heart failure and heart block, COPD and asthma Occlude puncta to avoid systemic absorption
41
Conductive Hearing Loss
Outer or inner ear prevent transmission of sound - Impacted earwax (cerumen) - Infection (otitis media) - Patient speaks softly (can hear self)
42
Sensorineural Hearing Loss
Impairment of the inner ear or cranial nerve 7 (vestibulocochlear nerve) - Noise/trauma - Aging (presbycusis) - Ototoxic Drugs (aspirin, NSAIDS, antibiotics (amimoglycosides, erythromycin, vancomycin) loop diuretics, chemo - Environmental exposure to toxins - Can hear muffled sounds
43
Mixed Conductive/Senorineural Hearing Loss
Beware of fixing one problem and not the other
44
Central Hearing Loss
Hearing issue is in brain and mostly inherited
45
Functional Hearing Loss
No apparent reason for hearing loss, may be psychological
46
Tinnitus
Degree of hearing loss Inner ear nerve damage from noise or medications Classified by decibels loss (Normal 0-15)
47
Hearing Loss - Manifestations
``` Answering questions inappropriately Not responding when not looking at the speaker Asking others to speak up Irritability with others who do not speak up Straining to hear Cupping the hand around the ear Reading lips Patient may be unaware of loss of hearing Withdrawal Suspicion Loss of self esteem/insecurity Undetected until you try to communicate ```
48
Hearing Loss - Assessment
History of hearing loss Medications Environmental exposure
49
Hearing Loss - Diagnosis
Disturbed sensory impairment: hearing
50
Hearing Loss - Planning (Goals)
Prevent further hearing loss Remain free from harm
51
Hearing Loss - Health Promotion
Control environmental/occupational noise Listen to headphones at 50% Immunizations - especially rubella before pregnancy or wait to become pregnant Limit/Monitor ototoxic medication/chemicals
52
Hearing Loss- Interventions -Assistive Devices
Hearing aids - Expensive - Must not be in denial - Must be able to manipulate small objects - Fear of getting lost - Proper care and storage
53
Hearing Loss- Interventions -Speech Reading
Verbal - speak normal and slow, simple sentences Non-verbal aids - hand movements, eye contact, use touch
54
Hearing Loss- Interventions -Assistive Devices Cochlear Implant
Used for severe/profound deafness after acquiring speech and language skills
55
Hearing Loss- Interventions - Sign Language
Use interpreter during consent or discharge
56
Hearing Loss- Interventions -Assistive Devices
Amplify sound Spoken word into text Sounds into light Animals to alert the owner
57
Hearing Loss- Interventions -Ear Drops
Drops should be administered at room temperature to avoid pain and dizziness The tip of the applicator or dropper should not be allowed to come into contact with anything. The head should be positioned to allow the medication to flow into the ear canal; this position should be maintained for 1 to 2 minutes.
58
Cerumen in External Ear - Symptoms
Otalgia (earache) Hearing Loss Tinnitus Vertigo
59
Cerumen in External Ear- Care
Cotton swabs are for the external ear only Use syringe to gently irrigate the external canal with body temperature water May cause a little dizziness Place a couple of drops of mineral oil in the ear and let sit for 5-10 minutes Irrigation can be done
60
Hearing Loss - Gerentological Considerations
Presbycusis- age related hearing loss from noise pressure - Loss of Peripheral auditory sensitivity - Decline in word recognition - Psychologic and communication issues - Loss of high pitched sounds (consonants) - Difficult to understand spoken words - Resistant to hearing aids - Cost - Inability to maintain small parts

Medsurg 3 - Sensory, Endocrine, DM, Neuro (2 decks)

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