Sensory/Perception Flashcards
- diagnostic evaluation where the client wears headphones and signals when a sound is heard.
- measures the frequency, decibels (loudness) and pitch that is heard
Audiometry
What sounds are the first to be lost as we age?
Higher pitched sounds
- diagnostic evaluation that measures the compliance of the tympanic membrane
- compliance decreases with middle ear disease
Tympanogram
-diagnostic evaluation that measures the auditory brain Stem response to clicks by means of electrodes on the forehead
Auditory Brain Stem Response
- diagnostic evaluation that measures the action potential during nystagmus
- used to assess for Meniere’s Disease and the interaction between the vestibular system and the oculomotor system
Electrostagmography
-diagnostic evaluation that investigates postural control, interaction between proprioception, oculomotor and vestibular system
Platform Posturography
-the body’s sense of its position
Proprioception
-unit of loudness
Decibels
-a unit of frequency equal to one cycle per second
Hertz
-diagnostic evaluation that assesses compensatory eye movements by the spinning of a rotary chair clockwise and couterclockwise
Sinusoidal Harmonic Acceleration
-diagnostic evaluation that allows the health care professional to look inside the middle ear
Middle Ear Endoscopy
What are some symptoms that might indicate hearing loss or problems?
- failure to respond to speck
- inappropriate response to speech
- asking for repetition
- increased volume of TV or radio
- excessively loud speech
- faulty speech articulation
- abnormal awareness of sounds
- strained facial expression/tilting head when listening
As a nurse what is the best approach to take when communicating with someone who may have hearing issues?
- speak straight to the person and let them see your lips
- make sure to gain their attention before speaking
- direct your voice to their “good” ear
- decrease of eliminate background noises
- utilize other forms of communication when necessary (ie use writing)
What kind of hearing aid would be appropriate for mild to moderate hearing loss?
- in the canal hearing aid
- in the ear hearing aid
What kind of hearing aid would be appropriate for severe hearing loss?
-in the ear hearing aid
What kind of hearing aid would be appropriate for profound hearing loss?
-behind the ear hearing aid
Sight/Vision Issues by Stage of Development:
- retina may not be completely developed
- increased risk of stabismus, retinopathy of prematurity, refractive errors, colour identification deficits
Premature Infant
-condition in which the eyes are not properly aligned with each other
Strabismus
-involuntary rapid eye movement
Nystagmus
Sight/Vision Issues by Stage of Development:
- visual acuity is 20/100 or 20/400
- lens is more spherical, cannot accommodate to both near and far objects
- sees best at a distance of 8 inches
- ability to distinguish colour and details is decreased
- eye movement may be uncoordinated
- sclera may have bluish tinge
- eye colour established around 6-9 months
Neonate or Infant
-term used to express normal visual acuity (the clarity or sharpness of vision) measured at a distance of 20 feet
20/20 (meaning the client has the ability to see clearly at 20 feet what SHOULD be seen at 20 feet)
Sight/Vision Issues by Stage of Development:
- eyeball continues to grow until 3 years and then slows
- visual acuity is 20/50
- at risk for injury from toys,
Toddler
Sight/Vision Issues by Stage of Development:
- visual acuity by age 6-7
- adult size of eye achieved by age 14
- at risk for injury from toys, sports, activities
School Age Children
Sight/Vision Issues by Stage of Development:
- refractive disorder presbyopia
- structural changes to eyelids and tissue around the eye
- vitreous humour shrinkage
- disorders such as cataracts, glaucoma, macular degeneration, retinal detachment
- other retinal changes r/t chronic diseases such as diabetes, HT, etc
Older Adult
Visual Diagnostic Assessment:
-examiner shines light into the patient’s eye and observes the reflection (reflex) off the patient’s retina. While moving the streak or spot of light across the pupil the examiner observes the relative movement of the reflex then uses a phoropter or manually places lenses over the eye (using a trial frame and trial lenses) to “neutralize” the reflex
Retinoscopy
Visual Diagnostic Assessment:
-a test that measures the eyes’ need for corrective lenses (refractive error)
Refraction
Visual Diagnostic Assessment:
-a method of measuring the pressure in the eye
Tonometry
Visual Diagnostic Assessment:
-scans that create images of the interior of the body using xrays or a magnetic field/pulses
CT or MRI scan
Visual Diagnostic Assessment:
-test that measures the eye’s ability to see details at near and far distances
Visual Acuity
Visual Diagnostic Assessment:
-examination of the eye that includes evaluation of the cornea, eyelids, conjunctiva and surrounding eye tissue using bright light and magnification
External Eye Examination
Visual Diagnostic Assessment:
-a test that allows a health professional to see inside the fundus of the eye and other structures using a lighted tool
Direct and Indirect Opthalmoscopy
aka Fundoscopy
Visual Diagnostic Assessment:
-inspection of the iris to assess whether the anterior angle of the eye is open or closed
Slit Lamp Examination
Visual Diagnostic Assessment:
-the imaging of deep structures of the body by recording the echoes of pulses of ultrasonic waves directed into the tissues and reflected by tissue planes where there is a change in density
Ultrasonagraphy
Visual Diagnostic Assessment:
- photographs with specially designed cameras through the dilated pupil of the patient of the inner lining of the eye
- it is a painless procedure producing a sharp view of the retina, the retinal vasculature, and the optic nerve head (optic disc) from which the retinal vessels enter the eye
Colour Fundus Photography
Visual Diagnostic Assessment:
- test is done to see if there is proper blood flow in the blood vessels in the two layers in the back of your eye (the retina and choroid)
- a dye is injected into a vein and the evaluator watches through a special camera as the dye travels through the eye
Fluorescein Angiography
Visual Diagnostic Assessment:
- an examination of the front part of the eye to check the angle where the iris meets the cornea
- it is used to distinguish between open-angle glaucoma and closed-angle glaucoma
Gonioscopy
Visual Diagnostic Assessment:
-an eye examination that can detect dysfunction in central and peripheral vision which may be caused by various medical conditions such as glaucoma, stroke, brain tumours or other neurological deficits
Perimetry Testing
What Visual Acuity Tests are employed for Infants?
- ability to follow an object
- pupillary light reflex
- blink reflex to bright light
- assess for coordinated motor function
What Visual Acuity Tests are employed for Toddlers?
- Allen test
- corneal light reflex to assess for strabismus
What Visual Acuity Tests are employed for School Age Children?
-Snellen E Chart
What Visual Acuity Tests are employed for Pre-School Children?
-Snellen E Chart
What Visual Acuity Tests are employed for Adults and Older Adults?
- Snellen E Chart
- Jaeger Cards
- eyesight abnormality resulting from the eye’s faulty refractive ability
- distant objects appear blurred
- light rays that enter each eye are focused in front of the retina, instead of on the retina
Nearsightedness/Myopia
- eyesight abnormality resulting from the eye’s faulty refractive ability
- near objects appear blurred
- light rays that enter each eye are focused beyond the retina, instead of on the retina
Farsightedness/Hyperopia
-a vision condition that causes blurred vision due either to the irregular shape of the cornea, the clear front cover of the eye, or sometimes the curvature of the lens inside the eye
Astigmatism
- appears as clouding of the lens of the eye
- proteins in the lens begin to break down and the lens becomes cloudy - what the eye sees may appear blurry
Cataract
What are the risk factors for cataracts?
- age
- genetics
- UV light
- environmental factors
- lifestyle factors
What does medical management of cataracts entail?
- antioxidants
- glasses
- contact lense
- bifocals
- magnifying lenses
What does surgical management of cataracts entail?
-extracapsular extraction surgery (with or without phacoemulsification) and lens replacement
- a group of eye conditions that lead to damage to the optic nerve due to increased pressure in the eye, also known as intraocular pressure (IOP)
- causes loss of peripheral visiiona
Glaucoma
What is the normal measure of intraocular pressure?
10-21 mm/Hg
or 12-15 mm/Hg according to glaucoma slide
What does medical management of glaucoma entail?
-systemic and topical ocular medications that lower intraocular pressure by decreased production or increased outflow of aqueous humour
What does surgical management of glaucoma entail?
-laser trabeculoplasty, laser iridotomy, filtering procedures, drainage implants or shunts to improve drainage of aqueous humour
What is involved in sensory perception?
- stimulus
- receptor
- impulse conduction
- perception
From which organ do 70% of the body’s sensory input come?
Eyes
What are the two primary functions of the ears?
Hearing & Maintaining Equilibrium
What are the three auditory ossicles of the middle ear?
Malleus, Incus & Stapes
How does sound conduction work?
- Sound waves enter external auditory canal
- Tympanic membrane vibrates
- Brainstem auditory nuclei transmit impulses
What are the 5 tastes mediated by the taste buds?
Sweet Salty Sour Bitter Umami
What are some factors that affect Sensory Perception?
- congenital/hereditary conditions
- culture (care differs from one culture to another, can determine how much stimulation is “normal”)
- stress
- isolation
- medication/illness
- lifestyle & personality
Ears/Hearing Issues by Stage of Development:
- eustachian tubes are shorter and wider
- fetus can hear by approx 20 weeks
Neonate
Ears/Hearing Issues by Stage of Development:
- hearing loss
- normal changes can limit functional ability
Adults
Ears/Hearing Issues by Stage of Development:
- at risk for damage from ruptured tympanic membrane
- injuries from play
Children
- a hearing test, primarily for evaluating loss of hearing in one ear (unilateral hearing loss)
- performed by placing a vibrating tuning fork against the patient’s mastoid bone and asking the patient to tell you when the sound is no longer heard - once they signal they can’t hear it, quickly position the still vibrating tuning fork 1–2 cm from the auditory canal, and again ask the patient to tell you if they are able to hear the tuning fork
- air conduction should be 2x > than bone conduction
Rinne Test
- a hearing test, primarily for evaluating loss of hearing in one ear (unilateral hearing loss)
- place base of a vibrating tuning fork on the midline vertex of the client’s head and ask whether they hear the sound equally in both ears
Weber Test
What are some tests that evaluate hearing?
- gross tests of hearing
- Rinne and Weber tests
- audiometry
- speech audiometry
- tympanometry
- acoustic reflex
-an exam that tests your ability to hear sounds which vary based on their loudness (intensity) and the speed of sound wave vibrations (tone)
Audiometry
-an examination used to test the condition of the middle ear and mobility of the eardrum (tympanic membrane) and the conduction bones by creating variations of air pressure in the ear canal
Tympanometry
-an involuntary muscle contraction that occurs in the middle ear of mammals in response to high-intensity sound stimuli
Acoustic Reflex
What are the four types of cataracts?
- Secondary
- Traumatic
- Radiation
- Congenital
What are the risk factors for cataracts?
- age
- genetics
- environmental
- diabetes mellitus
- drugs
-refers to the reddish-orange reflection of light from the eye’s retina that is observed when using an ophthalmoscope or retinoscope from approximately 30 cm / 1 foot
Red Reflex
When is surgical intervention indicated for cataracts?
-when vision and ADLs are affected
What are the three types of Glaucoma?
Open-angle glaucoma
Angle-closure glaucoma
Congenital glaucoma
Type of Glaucoma:
- 90% of all glaucoma
- Chronic, gradually progressive, bilateral
- May not be symmetric
- Flow obstructed
- Painless
- Gradual loss of peripheral vision
Open-angle glaucoma
Type of Glaucoma:
- 5–10 %
- Corneal flattening, bulging of iris into anterior chamber
- Intraocular pressure rises abruptly
- Episodes typically unilateral
- Pupil dilation blocks aqueous outflow
- Avoid medications that cause mydriasis
- Severe eye and facial pain, seeing halos
- General malaise, nausea and vomiting
- Abrupt decrease in visual acuity
Angle-closure glaucoma
-a dilation of the pupil, usually defined as having a non-physiological cause
Mydriasis
Ears/Hearing Issues by Stage of Development:
- changes in the inner ear involve atrophy of the organ of corti and cochlea, and degeneration of the stria vascularis
- gradual hearing loss affects the auditory nerve, which makes words sound garbled, and the ability to localize sound is also impaired
- result is that communication dysfunction is accentuated when background noise is present
Older Adults
What are the three main types of hearing loss?
Conductive Hearing Loss
Sensorineural Hearing Loss
Presbycusis
Type of Hearing Loss:
- Hair cells of cochlea degenerate with aging
- Higher pitched tones, conversational speech lost initially
- Gradual hearing loss
- Often described as unsociable or paranoid
Presbycusis
Type of Hearing Loss:
- Disruption in transmission of sound
- Obstruction
- Loss of hearing at all sound frequencies
Conductive Hearing Loss
Type of Hearing Loss:
- Affects inner ear, auditory nerve pathway
- Noise exposure
- Ototoxic drugs
- Tumors, vascular disorders, degenerative diseases
- Loss of high frequency tones
- Speech discrimination is difficult
Sensorineural hearing loss
What are some of the risk factors for loss of hearing at an early age?
- Very low birth weight
- Bilirubin greater than 16 mg/dL
- Aminoglycocide medication administration
- Low Apgar score at 1 or 5 minutes
- Bacterial meningitis
- Mechanical ventilation for over 5 days
- Syndromes associated with hearing loss
- Perception of sound, noise without stimulus
- Usually associated with hearing loss
- Early identification key element
- Treat underlying causes
Tinnitus
What are some reconstructive surgeries available for the middle ear?
Stapedectomy
Tympanoplasty
Assistive Hearing Device:
- Microphone, speech transmitter
- Receiver/stimulator, electrodes
- Function similar to way ear normally processes
- Provides sound perception, not normal hearing
Cochlear Implant
Assistive Hearing Device:
- Microphone, amplifier, speaker, earpiece, volume
- Canal hearing aids
- In-ear style
- Behind-ear hearing aid
- Body hearing aid
Hearing Aids
