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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
Q

Age Related Macular Degeneration - Wet

A

Wet -

Growth of new blood vessels in the retinal epithelium which may leak and form scar tissue

26
Q

Age Related Macular Degeneration - Risk Ractors

A

Aging

Family History

Smoking

UV light exposure

27
Q

Age Related Macular Degeneration - Manifestations

A

Blurred/darkened vision

Blind spots

Distorted vision

28
Q

Age Related Macular Degeneration - Collaborative Care

A

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
Q

Glaucoma (General)

A

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
Q

Glaucoma - Open Angled

A

Trabecular meshwork becomes clogged

More gradual / preventable

31
Q

Glaucoma - Closed angle

A

Lens bulges forward because of the aging process and closes the angle prohibiting outflow.

Worsens with pupil dilation

Sudden

  • Nausea
  • Vomiting
  • Eye pain
32
Q

Glaucoma - Collaborative Care - Diagnosis

A

Diagnostic tests (routine screening)

Puff pressure test
Normal pressure : 10-21
Open Angle (gradual): 22 - 32
Angle Closure (more acute): > 50

33
Q

Glaucoma - Collaborative Care - Medications

A

Mitotics - constrict pupil to increase outflow

Decrease aqueous production

34
Q

Surgical Options

A

Focus on the trabecular mesh

Create opening in the iris

35
Q

Glaucoma - Collaborative Care - Emergency Care

A

Angle closure glaucoma needs emergency treatment

36
Q

Glaucoma - Assessment

A

Knowledge about condition

Psychological response

Caregiver assessment

37
Q

Glaucoma - Diagnosis

A

Risk for injury and self-care deficits

Acute pain related to pathophysiologic process

Non-Compliance related to the inconvenience/side effects of medications

38
Q

Glaucoma - Planning/Goals

A

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
Q

Glaucoma - Implementation

A

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
Q

Glaucoma - Gerontological Considerations

A

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
Q

Conductive Hearing Loss

A

Outer or inner ear prevent transmission of sound

  • Impacted earwax (cerumen)
  • Infection (otitis media)
  • Patient speaks softly (can hear self)
42
Q

Sensorineural Hearing Loss

A

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
Q

Mixed Conductive/Senorineural Hearing Loss

A

Beware of fixing one problem and not the other

44
Q

Central Hearing Loss

A

Hearing issue is in brain and mostly inherited

45
Q

Functional Hearing Loss

A

No apparent reason for hearing loss, may be psychological

46
Q

Tinnitus

A

Degree of hearing loss

Inner ear nerve damage from noise or medications

Classified by decibels loss (Normal 0-15)

47
Q

Hearing Loss - Manifestations

A 
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
Q

Hearing Loss - Assessment

A

History of hearing loss

Medications

Environmental exposure

49
Q

Hearing Loss - Diagnosis

A

Disturbed sensory impairment: hearing

50
Q

Hearing Loss - Planning (Goals)

A

Prevent further hearing loss

Remain free from harm

51
Q

Hearing Loss - Health Promotion

A

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
Q

Hearing Loss- Interventions -Assistive Devices

A

Hearing aids

  • Expensive
  • Must not be in denial
  • Must be able to manipulate small objects
  • Fear of getting lost
  • Proper care and storage
53
Q

Hearing Loss- Interventions -Speech Reading

A

Verbal - speak normal and slow, simple sentences

Non-verbal aids - hand movements, eye contact, use touch

54
Q

Hearing Loss- Interventions -Assistive Devices

Cochlear Implant

A

Used for severe/profound deafness after acquiring speech and language skills

55
Q

Hearing Loss- Interventions - Sign Language

A

Use interpreter during consent or discharge

56
Q

Hearing Loss- Interventions -Assistive Devices

A

Amplify sound

Spoken word into text

Sounds into light

Animals to alert the owner

57
Q

Hearing Loss- Interventions -Ear Drops

A

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
Q

Cerumen in External Ear - Symptoms

A

Otalgia (earache)

Hearing Loss

Tinnitus

Vertigo

59
Q

Cerumen in External Ear- Care

A

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
Q

Hearing Loss - Gerentological Considerations

A

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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