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Adult Health II > Sensory Issues > Flashcards

Sensory Issues Flashcards

1
Q

Review the anatomy of the Eye

A

Slide 1

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2
Q

Assessment of the eye:

A 
History
External assessment
Visual fields, & eye movement
Eye position- exophthalmos, enophthalmos
Eye lids and lashes
Blink response
Conjunctivae, sclera
Light reflex- accommodation v. light reflex
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3
Q

Fundus

A

Fundus is normally orange-red color- darker on darker complexion
Normal look to blood vessels
Optic Disc where blood vessels converge is yellowish to pale pink with well defined margins
Macula responsible for central vision- always temporal to optic disc

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4
Q

Age Related Changes

A

Smaller pupils, do not dilate easily- night vision a problem
Lens less elastic- near object difficult to see
Lens becomes opaque-  color perception
Decreased depth perception, peripheral
Eyes recessed in socket- tissue folds on lids
Decreased strength of muscles of eye movement

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5
Q

Conjunctivitis

A 
Conjunctiva covers inner lid and external eye
Inflammation from bacteria or virus
Extremely contagious- “Pink Eye”
Redness and itching, gritty sensation
Tearing and discharge
Inflamed preauricular nodes
Treated with antibiotic drops and pills
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6
Q

Nursing Issues with Eye Infections

A 
Pain	
Analgesics, warm compresses
Protect from sun
Visual changes
No contact lenses, handwashing, blurring
Risk for spread of infection
Handwashing, wash eyes separately, may use baby tearless shampoo especially for blepharitis
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7
Q

Cataracts

A 
Likely after age 70
Cumulative exposure to UV (sun)
Reduced O2 uptake by lens
Dehydration of lens, opacity
Immature to “ripe”
Immature= some light getting through, useful vision
Ripe= poor vision, poor light penetration
Tend to be bilateral
Trauma or chemical irritation
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8
Q

Symptoms of Cataracts

A 
Blurred vision
Photophobia
Sensitivity to glare
Vision better in low light
Cloudy appearance of lens
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9
Q

Pre-op Care for Cataract Surgery

A

Mydriatic medication pre-operatively to produce mydriasis or dilitation of the eye
Educate patient on need to have someone available as will have limitation in vision due to eyepatch, can’t drive
Need to frequently instill drops after surgery

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10
Q

Nursing Care after Cataract Surgery

A

Leave eye patch on with shield
For 24 hrs limit activity to sitting, resting in bed or limited walking in house
Do not rub eye
Do not lift more than 5 lbs- why?
Do not strain, or bend over, avoid reading, why?
Eye drops as ordered
No aspirin, take Tylenol for pain

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11
Q

Additional Patient Teaching

A 
Report eye pain not relieved by Tylenol
Report headache, nausea, severe itching
Report swelling of eye 
Eye patch should not put pressure on eye
Tearing is normal
Hazards of monocular vision
Unrelieved eye pain and nausea sign of increased intraocular pressure
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12
Q

Case: The nurse is performing an assessment on a client with a suspected diagnosis of cataract. The chief clinical manifestation that the nurse would expect to note in the early stages of cataract formation is:

A

A. Eye Pain
B. Floating spots
C. Blurred vision
D. Diplopia

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13
Q

Glaucoma

A 
Painless increased intraocular pressure
Optic nerve atrophy
Visual field loss
Common preventable cause of blindness
5 times more likely in African Americans than whites
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14
Q

Pathophysiology of Glaucoma

A

Decreased outflow of aqueous humor
Increased production of aqueous humor
Extra fluid caused increased pressure on retina- which is painless.
Decrease outflow + increased production = increased pressure on retina

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15
Q

Pathophysiology of Glaucoma

A

Fluid produced in ciliary bodies, travel around the iris from the posterior chamber to the anterior chamber, through Canal of Schlemm and the trabecular mesh, to be absorbed into the vascular supply.

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16
Q

Open Angle Glaucoma

A

Outflow impaired but still about to get through

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17
Q

Open Angle Glaucoma

A 
Occurs over time
Vision changes are often not noticed
Loss of peripheral vision
Difficulty adapting to dark
Halos around lights
As pressure increases, acuity decreases
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18
Q

Angle Closure Glaucoma

A

Angle of Iris blocks drainage of aqueous humor through canal of Schlemm
Requires immediate intervention to prevent damaging increase in ocular pressure

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19
Q

Angle Closure

A

Narrow angle, closed angle
With dilation of pupil the angle closes completely
This occurs quickly and the increased pressure caused damage to retina and permanent blindness
Happens in darkness, emotional distress which cause pupil dilation
Must avoid mydriatic drugs- atropine, anticholinergics
Symptoms- sudden H/A, red conjunctiva, cloudy cornea, N&V

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20
Q

Angle Closure Glaucoma

A

Iridectomy often produces a keyhole appearance to the pupil

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21
Q

Treatment of Glaucoma

A

Meds are not a cure, but can control sx
Cholinergics (miotics)- pilocarpine gtts
Beta-adrenergic blockers- timoptic gtts
Several systemic meds that decrease production of aqueous humor
For Closed Angle- diuretics to bring intraocular pressure down quickly- mannitol (osmotic diuretic)

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22
Q

Timoptic (timolol maleate)

A

Beta adrenergic antagonist, miotic- drops
Relaxes iris- constricts (miosis)
Reduces production of aqueous humor
Usually given every 12 hrs
Antihypertensive, antianginal, migraines- oral
Adverse effects- bronchospasm (COPD), bradycardia, syncope
NSAIDS antagonize hypotensive effects

23
Q

Pilocarpine hydochloride

A

Cholinergic
Contraction of ciliary muscle, increasing outflow of aqueous humor, induces miosis
Apply gentle pressure to nasolacrimal duct for 1-2 minutes after instilling to prevent systemic effects
Usually given 3-4 times per day
Adverse effect- anticholinergic
Bronchospasm (COPD), tachycardia, dry mouth, urinary retention

24
Q

Nursing Issues with Glaucoma

A

Loss of vision is permanent- grieving
Treatment prevents further loss of vision
Teach instillation of eye drops- frequent and lifelong
Remember cross-contamination with drops
Issues with diuretics- K loss, dehydration

25
Case: The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would the nurse include in the plan of care.
A. Decrease fluid intake to control the intraocular pressure. B. Avoid over use of eyes. C. Decrease the amount of salt in the diet. D. Eye medication will need to be administered lifelong.
26
Retinal Detachment
Painless separation of retina from choroid (vascular layer between sclera & retina) – dense with blood vessels- deprived of blood supply More often with advanced age, trauma Shadow or black area in vision, flashes of light as retina pulls away Areas of detachment look bluish-gray
27
Treatment of Retinal Detachment
No medical treatment Laser Photocoagulation-burns edges and prevents further damage. Pneumatic Retinopexy-instillation of gas bubble that rises to the location of the tear and puts pressure on the retina to connect to the choroid. Scleral Buckling-surgical procedure to place retina back in contact with choroid from outside of eye.
28
Case: The nursing is caring for a client with a diagnosis of detached retina. Which assessment sign would indicate that bleeding has occurred as a result of retinal detachment?
A. Complaints of a burst of black spots or floaters. B. A sudden sharp pain in the eye. C. Total loss of vision. D. A reddened conjuctiva.
29
Diabetic Retinopathy
Leading cause of blindness Progressive disorder causing microscopic damage to the blood vessels of retina Microaneurysms of capillaries, dilated & tortuous veins Aneurysms rupture and cause small areas of scar tissue Progressive retinal ischemia stimulated new vessels to grow- ineffective
30
Diabetic Retinopathy
Blot hemorrhages, scar is yellow, Large new blood vessl cover macula , aneurysms in blood vessels of eye , cotton wool spots-scar tissue
31
Vision with Diabetic Retinopathy
If hemorrhage close to macula, central vision is more damaged
32
Treatment for Retinopathy
Photocoagulation- stop leaking of fluid onto retina | Vitrectomy- remove bloody vitreous, replace it with normal saline to maintain shape of eye
33
Nursing Care after laser surgery
Outpatient procedure Vision blurry for a day, can’t drive Mild pain, H/A, sensitivity to light for a few days-OTC pain meds, and patch Spots in vision from laser disappear over time Minimize increased intraocular pressure
34
Macular Degeneration
Age-related degeneration of macula Central vision loss “Dry”- atrophy of outer retina and underlying tissues “Wet”- serous fluid from choroid leaks into retina and macula No known cure Dietary supplements show some promise
35
Macular Degeneration
Dry- thinning of retinal tissue with yellowish spots of debris from cell breakdown- scar tissue Wet- domes of fluid appear on retina causing visual change of distorted lines, with dark, blurry white out in center of vision Supplements- Vit C + Vit E + Beta-carotene + zinc, and egg yolks (leutene) No effective treatment or cure
36
Retinitis Pigmentosa
``` Progressive, genetic disease Loss of peripheral vision progressing to total blindness Caused by production of unstable protein Loss of night vision in childhood, early No treatment or cure Should have genetic counseling ```
37
Corneal Transplant
Keratoplasty- use of donor corneas to improve clarity of vision (cadavers) Local anesthesia Visual return is slow, sutures distort the vision Rejection is a problem
38
Emergencies of the eye:
- Blunt - Penetrating - Chemical
39
Blunt
Treatment begins immediately See physician immediately to determine extent of injury Ice Visual acuity assessed
40
Penetrating
Never remove Notify physician immediately Visual acuity assessed
41
Chemical
Irrigate x 10 min immediately | Visual acuity assessed.
42
Hearing Loss: 2 types
- Conductive | - Sensioneural
43
Conductive Hearing Loss
problem with conducting sound waves through outer ear, tympanic membrane, middle ear (ossicles) and the inner ear (oval window/round window). May occur in conjunction with sensorineural hearing loss.
44
Sensioneural Hearing Loss
cause lies in the vestibuluocochlear nerve (Cranial nerve VIII), the inner ear or central processing centers of the brain.
45
Conductive Loss
Ear obstruction-cerumen (ear wax) obstruction, foreign body, cotton, insects, toys Infection-external canal, labrynthitis (infection of the inner ear), chronic otitis media Otosclerosis-hardening of structures of inner ear (genetic) Tympanic membrane injury This hearing loss can be corrected
46
Dealing with Hearing Loss
``` Be sure you have patient’s attention Speak directly at patient Don’t turn your back when talking Use more than one word- better for context Lower tone of voice Don’t shout Use a picture board ```
47
Sensioneural Loss
Presbycucis-damage to labrynth in older adults- high pitch hearing loss Noise-induced- repeated acoustic trauma Tumors of temporal bone Acoustic neuroma-unable to interpret stuimuli related to position and movement This hearing loss is not usually able to be treated Tinnitus-ringing, roaring, chirping in ear
48
Meniere's Disease
Affects both vestibular and auditory function Excess endolymph in labrynth Hearing loss fluctuates in early stage, but becomes permanent Vertigo is severe- spinning in nature Vertigo increases with movement-avoid sudden movement Encourage slow head movements Dietary restriction such as salt and fluid reduces the amount of endolymphatic fluid Decrease ability to hear, may affect some occupations
49
Signs of Hearing Loss
``` Failure to respond to verbal communication Inappropriate verbal responses Excessively loud speech Strained facial expressions Tilting of head when listening Constant need for clarification Faulty speech TV/radio too loud Most hearing loss is gradual and goes unnoticed ```
50
Hearing Aides
In ear canal Behind ear In eyeglasses Body worn- box carried in shirt pocket All amplify sound in a controlled manner, but do not change the quality of the sound Newer aides can select a particular range of sounds to amplify
51
Vertigo
Balance responsibility of eyes, labyrinth, muscles, joints, cerebellum Subjective- in motion in a stable environment Objective- stable in a moving environment Often accompanied by N&V, nystagmus, salivation, sweating, hypotension Dizziness is the lack of balance Lightheadedness, movement within head
52
Tests for Inner Ear
Electronystagmography-water in ear canal while monitoring for eye motion. Normal response-nystagmus. Absent nystagmus indicates vestibular dysfunction Weber test (tuning fork on top of head) If sensorineural loss, lateralize to non-affected Air conduction normally greater than bone Rinne test (tuning fork on mastoid If sensorineural loss,  air conduction Glycerol test-osmotic diuretic to pull fluid from inner ear may improve dizziness or hearing loss. X-rays, CT- mastoid, middle ear ossicles
53
Case: A client with Meniere’s disease is experiencing severe vertigo. Which instructions would the nurse give to the client to assist with controlling vertigo?
A. Increase fluid intake to 3000 ml a day. B. Avoid sudden head movements. C. Lie still and watch the television. D. Increase sodium in the diet.

Adult Health II (7 decks)

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