WEEK 1-Sensory Preception Flashcards
define tinnitus
Hearing sounds when no actual outside sound is occurring, such as ringing, buzzing, roaring, clicking, hissing, or humming noises.
define Meniere’s disease
A hearing disorder caused from excessive buildup of fluid in the ear that leads to vertigo, tinnitus, and hearing loss.
define cataracts
A clouding of the lens of the eye that causes vision to be blurry, hazy, or less colorful.
define macular degeneration
An irreversible degeneration of the macula that leads to loss of central vision as clients age.
define glaucoma
An increase in intraocular pressure due to the buildup of fluid, or aqueous humor, that causes compression of the optic nerve.
define retinal detachment
A visual disorder that occurs when the retinal tissue detaches from the blood vessels in the posterior eye.
external structures of the eye
extrinsic eye muscles, upper and lower eyelids, sclera, conjunctiva, and lacrimal structures.
three layers of the eye
fibrous, vascular, and neural
three fluid filled chambers
(anterior, posterior, and vitreous
fibrous layer of the eye
the outermost layer and contains the sclera and transparent cornea.
vascular layer of the eye
middle layer is the vascular layer that consists of the iris, choroid, and ciliary body.
neural layer of the eye
The innermost neural layer holds the retina, optic nerve, and visual pathway.
what is the anterior and posterior chambers filled with
clear fluid called aqueous humor
aqueous humor
Aqueous humor is secreted from the choroid and is necessary to maintain intraocular pressure within the eye.
vitreous chamber
the biggest of the three chambers and contains a gel-like liquid that is found between the lens and retina.
This vitreous liquid maintains the shape of the eye and is needed for the transmission of light.
photoreceptors
also known as rods and cones, are located within the retina and are responsible for receiving signals, processing them, and transmitting them to the brain through the optic nerve.
Rods are useful for vision in low light and assist in the detection of images in peripheral vision. Cones allow the eye to differentiate changes in color.
macular degeneration aka AMD
occurs when the component of the retina responsible for central vision is not able to function.
age-related macular degeneration (AMD)
AMD leads to blurred vision that is noticed most often while reading and progresses to distorted vision in the center of the eye field.
This condition occurs when there is a buildup of photoreceptor waste products, called drusen, that accumulate beneath the retina.
dry AMD vs. wet AMD
Dry AMD is more commonly diagnosed and causes the outer portion of the retina to break down and develop areas with increased accumulation of drusen.
Wet AMD is triggered by the abnormal growth of blood vessels underneath the retina. The vessels leak blood and fluid under the center portion of the retina (macula), causing distorted vision.
how is AMD a risk to older people?
Globally, AMD is the most common cause of irreversible blindness and vision loss in people over the age of 65.
risk factors for developing AMD
smoking, hypertension, elevated cholesterol levels, obesity, and a family history of AMD. People who have light skin pigment or light-colored eyes are also at an increased risk for developing AMD
Co-morbidities with AMD
people who are at a higher risk for stroke, myocardial infarction, hypertension, hyperlipidemia, or renal disease should complete regularly scheduled eye examinations.
what is there a correlation diesase with AMD?
renal and AMD correlate
A nurse is teaching a client who has macular degeneration about ADLs that may become more difficult to perform as the condition progresses. Which of the following will the nurse include in the teaching?
showering, driving, reading a book
what can people with dry AMD experience?
People who have dry AMD will notice gradual blurring of their vision, which can impair night vision, diminish central vision, and make reading progressively more difficult
what can people with wet AMD experience?
Wet AMD progresses more rapidly and causes sudden blurred vision or blind spots in the center of the visual field.
diagnostic tests for AMD
This examination will identify changes in the macula, the presence of drusen deposits, and bleeding. A fundoscopy or ophthalmoscopic examination will be performed with the client’s pupils dilated, with medicated eye drops to enable the provider to visualize the rear of the eye.
CNS relations to AMD
Clients who have AMD are more likely to also develop narrowing and thickening of the carotid arteries, hypercholesterolemia, hyperlipidemia, and increased buildup of blood vessel plaque, which places them at a higher risk for developing central nervous system health conditions, such as stroke.
what is priority for people with AMD
fall risk-make sure things aren’t in the way on the floor
what is a lifestyle change that can help with AMD
lowering smoking
define cartaracts
cloudy or opaque areas around on the eye lens
These areas alter the passage of light through the eye lens, which may cause painless blurred vision or glare. Cataracts develop as the lens becomes denser and less transparent due to proteins and fibers in the lens breaking down .
what is the most common risk factor for developing cataracts
age, as cataracts typically affect adults over the age of 65
risk factors for developing cataracts
Advanced age
Diabetes mellitus
Hypertension
History of eye inflammation
Previous traumatic eye injury
Use of steroids
Previous eye surgery
Family history
Overexposure to sun or ultraviolet (UV) rays
Smoking
Alcohol use disorder
Obesity
correlation with cataracts
There is a correlation between the development of cataracts and chronic hypertension and diabetes mellitus.
Poorly controlled blood pressure and blood glucose levels decrease adequate blood flow causing damage to the lens of the eye.
cataracts safety considerations
same as AMD-fall risk
client education with cataracts
Provide instruction on lifestyle modifications that should be implemented, including smoking cessation, alcohol reduction, and dietary changes that include an increase in leafy green vegetables. Information will be provided on the importance of medication compliance and its impact on the recovery process.
A nurse is teaching a client who is an older adult about eye health. Which of the following instructions should the nurse include?
Increase the amount of fruits and green leafy vegetables in their diet.
surgery for cataracts
Cataract extraction surgery involves removing the cloudy opaque lens and implanting an artificial intraocular lens (IOL).
The technique most often used is phacoemulsification, a mechanically assisted extracapsular procedure.
A nurse is providing preoperative teaching to a client who is scheduled for bilateral eye cataract extraction surgery. Which of the following instructions should the nurse include in the teaching?
“You will need to stop taking aspirin one week before the surgery.”
A nurse is providing postoperative medication teaching to a client who had bilateral eye cataract extraction surgery. Which medications should the nurse include in the teaching?
Antibiotics eye drops
b
Steroid eye drops
c
Anti-inflammatory eye drops
define glaucoma
Glaucoma develops slowly over time but progressively causes increased ocular pressure against the optic nerve.
This is due to a change in the volume or a decrease in absorption of the aqueous humor
types of glaucpma
common form is open wide or wide angle glaucoma ( It develops slowly as the outflow of aqueous humor is reduced, and changes in vision are gradual. contacts don’t help)
other one is angle-closure or narrow-angle glaucoma (has a sudden onset of vision loss and is considered an urgent situation requiring emergent treatment. This form of glaucoma is due to the complete obstruction of aqueous humor outflow.)
risk factors for glaucoma
age over 60 has greater risk but it can come at any age
Other factors that contribute to glaucoma include previous eye trauma or injury, chronic health conditions, and family history.
correlations with glaucoma
There are several chronic medical conditions that are associated with the development of glaucoma, including high blood pressure, diabetes, and hyperlipidemia
normal intraocular pressure (tonometry)
11-21 mmHg
safety considerations for glaucoma
same as AMD and cataracts (fall risk)
A nurse is caring for a client who has glaucoma. Which of the following manifestations should the nurse expect?
Client reports seeing halos around lights.
define retinal detachment
Retinal detachment occurs when retinal tissue in the posterior of the eye pulls away or detaches from the blood vessels that provide oxygen and nourishment to the retina.
what does retinal detachment usually bring
Retinal detachment often creates dark floaters or a sensation of a curtain being placed in the field of vision.
diabetic retinopathy
An eye disorder that may occur in individuals who have diabetes and results in a deficit in vision acuity and possible permanent loss of vision caused by diminished blood flow to the rear of the eye.
match vision change with correct eye condition
blurry or hazy vision: cataracts
diminished peripheral vision: glaucoma
blind spots in the center of the vision field: macular degeneration
Seeing floating dark spots moving through all vison fields: retinal detachment
safety considerations for retinal detachment
To promote a safe home environment, clients and caregivers should always be instructed to keep rooms well-lit, keep floors free of clutter, and remove all area rugs.
A nurse is caring for a client who reports a loss of peripheral vision. Which of the following assessments will the nurse perform to assess peripheral vision?
Confrontational visual field test
A nurse is caring a client who reports a sudden onset of blurry vision with blind visual spots. Which of the following medications should the nurse anticipate the provider prescribing?
Dilating eye drops
three structures of the ear
external
middle
inner
external ear
pinna
auditory canal
middle ear
tympanic membrane
three ossicle bones (malleus, incus, and stapes)
inner ear
holds the organs for hearing and balance: the spiral-shaped cochlea and the fluid-filled semicircular canals. The cochlea, which is pea-sized, is separated into the scala vestibuli, which is filled with plasma-like fluid called perilymph, and the scala media, which is filled with a thicker fluid called endolymph.
cochlea function
Transduces physical vibrations into electrical impulses
malleus, incus, and stapes function
Transfers and amplifies sound waves into physical vibrations
external ear function
collect and transmits sound waves from the outside enviroment
tympanic membrane function
Transfers and amplifies air vibration from external ear to the ossicles
Vestibulocochlear nerve function
transmits electrical impulses to the auditory cortex of the brain
A nurse is assessing a client’s hearing. Which of the following tests should the nurse perform to screen for hearing loss?
Finger rub test
Whispered voice test
Audiometry
define tinnitus
perception of sound when no actual external noise in present
frequently described as ringing, roaring, or constant sound in the ears.
lifestyle modifications for tinnitus
Lifestyle modifications may help control the intensity of tinnitus. Instruct the client to wear headphones when in noisy or loud environments, turn down music, reduce salt intake, and decrease the use of nicotine, caffeine, and alcohol
A nurse is planning care for a client who is experiencing tinnitus. Which of the following should the nurse recommend to include in the plan?
Monitor blood pressure
c
Monitor blood glucose levels
d
Remove cerumen from external ear canal
e
Wear hearing protection
meniere’s disease
Meniere’s disease is a progressive disorder that develops from an excessive buildup of endolymphatic fluid in the inner ear and leads to debilitating vertigo, tinnitus, and hearing loss.
Common Manifestations of Meniere’s Disease
Vomiting
Nausea
Blurry vision
Cold sweats
Trembling
Hearing loss
Headaches
Imbalance
Congestion in the ear
Ear fullness
A nurse is caring for a client who has Meniere’s disease. Which of the following manifestations should the nurse expect?
Extreme dizziness
Hearing ringing
Hearing loss
Feeling of fullness in the ears
healthy food recommendations to client who has AMD
fruits and vegetables high in antioxidants (bluberries, grapes, kale, spinach)
foods high in zinc (red meats, dairy, eggs, grains)
foods high in omega-3 fatty acids (salmon, soybeans, flax seeds, chia seeds)
treatment for AMD
there is no cure for dry AMD but there is modifications
increasing the client’s daily intake of carotenoids lutein and zeaxanthin may slow the disease’s progression.
also smoking cessation will help treat the symtpoms
why are hypertension and DM related to cataracts?
poorly managed blood glucose and poorly managed blood pressure can lead to diminished blood flow to the lens of the eye
what can cataracts be mistaken for
mudged eyeglasses or ill-fitting contact lenses.
condition is typically pain-free
levels of intraocular pressure that considered elevation
21-32 mmHg
medications for glaucoma
alpha agonists
beta-blockers
carbonic anhydrase inhibitors
Prostaglandin analogs
Describe the pathophysiology associated with the development of a detached retina.
retinal tissue in the posterior of the eye pulls away or detaches from the blood vessels that provide oxygen and nourishment to the retina
vitreous humor can become more serous or liquid consistency (thins out), causing it to collapse and pull away from the retina
vitreous humor vs aqueous humor
Aqueous humor is a water-like fluid that lies in front of the lens.
Vitreous humor is a gel-like substance that lies behind the lens and in front of the retina
what would be a correlation with retinal detachment
age-related changes in consistency with vitreous humor
inflammatory disorders like lupus
diabetic retinopathy
macular degeneration
eye tumors
traumatic eye incidents
family history
nearsightedness
what can increase the risk of detachment of the retina
diabetes and hypertension
previous eye surgery
psychosocial aspects related to retinal detachment
clients feel
depressed
anxious
fearful
and that there life has been reduced in quality
tonometer is associated with what sensory disorder
glaucoma
it reads the intraocular pressure in your eyes
confrontational visual field test
to assess client’s peripheral vision
what can contacts prevent
oxygen from getting to your eyes so therefore can build up extra blood vessels in your eyes to make up for that
what can diabetics loose
eyes, feet, kidneys
what is average blood glucose level
fasting is 70-100 mg/dL
random one is usually about 125 mg/dL
prediabetic blood glucose
100-125 mg/dL
diabetic blood glucose
above 125 mg/dL
ototoxic medications
ototoxic means bad for the ears
examples would be Lasix’s because it can lead to tinnitus
gentamycin
conditions correlating with AMD
cardio (poor blood flow to eyes) and renal (not enough RBCs and protein)
eye ointments
from inner canthus to outer canthus (TEST Q)
clinical judgement for AMD
assess: diminished central vision
analysis: indications of AMD and risk for falls
planning: home safety plan
implementation: take meds, no smoking, healthy diet (education)
eval: safe home environment
conditions correlating with cataracts
diabetes and hypertension
what does DOUBLE VISION go with?
cataracts
clinical judgement for cataracts
Assessment: blurred vision/DOUBLE VISION
Analysis: indication of cataracts and risk of injury
Hypothesis: safety and daily living
Planning: address safety and treatment needs
Implementation: ensure safety (preop and postop)
Evaluation: progressive improvement of vision
surgical treatment for cataracts
IOL and extraction of cloudy lens
pre-op nursing considerations for cataract surgery
relax because we don’t want to give high blood pressure, education about procedure, prepare
post-op nursing considerations for cataract surgery
don’t lift above 10 lbs, no super strenuous activity, education about safety considerations, don’t lay flat
open angle vs closed angle glaucoma
open-angle: little drainage (which means increased pressure) of aqueous humor (mild pain)
closed-angle: NO drainage of aqueous humor (intense pain) (worse because there is no drainage at all)
conditions that correlate with glaucoma
HTN
diabetes
hyperlipidemia
clinical manifestations of glaucoma
EARLY: halos around lights/blurry vision
LATER: worsening peripheral vision
conditions that correlate with retinal detachment
IMPORTANT
hypertension and diabetes
clinical presentation of retinal detachment
blurred vision
floaters or photopsia
what eye condition has the curtain-like shadow?
retinal detachment
IMPORTANT: TEST Q
what is the most common sensory disorder
hearing loss
hearing loss
conductive vs sensorineural
conductive hearing loss
treatable
result of EXTERNAL ear condition
sensorineural hearing loss
often permanent
result of damage to INNER ear
cochlear hair follicle or auditory nerve
Lasixs
cause tinnitus so they are considered ototoxic
IV push LOW and SLOW
what can ototoxic drugs cause?
tinnitus
important: TEST Q
tinnitus testing
test for…
anemia
thyroid function
heart disease
conditons that correlate with tinnitus
Meniere’s and thyroid disease
Meniere’s disease
excessive endolymphatic fluid
is Meniere’s disease genetic?
YES! it is autoimmune
test Q!
safety for Meniere’s disease
consistent spinning so at risk for falls
Meniere’s disease: diet
reduce sodium
where salt goes, water goes. so decrease sodium to reduce fluid in ears
medications for Meniere’s disease
diuretics to reduce fluids
corticosteroids
motion sickness pills for the vertigo
three main medication classes for glaucoma
cholinergic agonists
cholinesterase inhibitors
beta-adrenergic blockers
others wound include:
alpha-adrenergic agonists
carbonic anhydrase inhibitors
beta-adrenergic blockers
eye drops provide topical therapy for lowering IOP for clients with OPEN-ANGLE GLAUCOMA
they can also help provide emergency treatment for acute closed-angle glaucoma
prototype and other drugs for beta-adrenergic blockers
eye drops for lowering IOP for open-angle glaucoma (and emergency treatment for closed-angle glaucoma)
the prototype drugs are:
betaxolol (Betaoptic)
timolol (Timoptic)
expected pharm action for beta-adrenergic blockers
decrease production of aqueous humor, thereby decreasing intraocular pressure
adverse drug reactions to beta-adrengenic blockers
aka betaxolol (Betaoptic) and timolol (Timoptic)
topically: stinging, burning, eye discomfort
absorb them systematically through admin: bradycardia, hypotension, bronchospasm
contraindicated in clients with AV heart block, bradycardia, asthma, COPD
interventions for administering beta-adrenergic blockers
take HR first and measure vital signs on reg basis after admin
admin of beta-adrenergic blocker
aka betaxolol or timolol
clean hands
after instillation, hold pressure on the eye dropper to sac for 60 SECONDS
cholinergic agonists
provide topical therapy to lower IOP in glaucoma
aka muscarinic agonists
prototype for cholinergic agonists
pilocarpine
aka Isopto Carpine
solution or gel
expected pharm action for cholinergic agonists
aka Isopto Carpine or pilocarpine
increase availability of acetylcholine at muscarinic receptor sites
pupil constricts, allows the drainage of aqueous humor
adverse effects of cholinergic agonists
most common: decreased visual acuity
risk for retinal detachment
interventions for cholinergic agonists
after admin, admin a mild analgesic for a headache that does not resolve shortly after admin
hold pressure over puncta and sac for at least a minute
safety concern for cholinergic agonists eye drops
constrict pupil
so vision at night is bad and vision in low lit places
keep lights on and assist to bathroom
keep night light on at home to minimize risk of falls
admin of cholinergic agonists
same as other eye drops
contraindications and precautions of cholinergic agonists
do not admin to people with acute inflammatory eye disorders or retinal detachment!
use cautiously with clients who have chronic respiratory disorders or hypertension
cholinesterase inhibitors
topical therapy that helps lower IOP in glaucoma
prototype and other drugs for cholinesterase inhibitors
echothiophate
aka Phospholine Iodide
pharm action for cholinesterase inhibitors
breakdown of acetycholine, allowing more acetycholine to be available for use of muscarinic receptors in the body
similar action of cholinergic agonists!!!
adverse reactions for cholinesterase inhibitors
primary: decreased visual acuity or myopia (nearsightedness)
interventions for cholinesterase inhibitors
same as cholinergic agonists (fall risk, poor vision, dark out is bad)
observe pupil and lack of red reflex (could indicate CATARACT)
admin of cholinesterase inhibitor
instill in the evening and at least 5 MINUTES before or after instilling any other eye drops
worsening vision with cholinesterase inhibitors?
could be ineffective with controlling IOP and could mean the client is developing cataracts
contraindications for cholinesterase inhibitors
history of retinal detachment
cardiac or respiratory disease
hyperthyroidism
urinary tract blockage
Parkinson’s disease
interactions with cholinesterase inhibitors
insects and herbacides that contain organophosophates
drug class is the first line of therapy for treatment of open-angle glaucoma?
beta blockers
