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Sensory Health Deviations

I. The Eye
A. Internal Structures of Eye
1. Conjunctivae--thin, transparent mucous membranes--lines eyelid and
covers eyeball

2. Eyeball has 3 layers


a. Outer--the fibrous coat
1. Sclera--Opaque, "White of eye"; posterior 5/6 of eye;
2. Cornea--dense, transparent, avascular (gets O2 from
atmosphere); remaining anterior 1/6 of eye; Bends
and directs light to retina;

b. Middle layer--Uvea or uveal tract; vascular and pigmented;


1. Iris--colored part in front of lens; has opening called pupil.
2. Ciliary body--Around outer edge of iris;
Connects choroid with iris; Secretes aqueous
humor.
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3. Choroid--Posterior, largest of middle coat; A dark brown


membrane between sclera and retina; Consists of
many blood vessels supplying nutrients to retina.
Absorbs light

c. Internal Layer--Retina--Seeing tissue of eye found in back of


eye--Like film in a camera; Optic nerve fibers throughout;
When focused light hits retina, picture taken and messages sent to
brain through optic nerve; Bordered externally by choroid and sclera
and internally by vitreous (a gel-like substance that maintains
spherical shape of eye.)

1. Retina contains:
a. Blood vessels--nourishment

b. Photoreceptors
1. Rods--responsible for peripheral vision
2. Cones--responsible for central vision and color
3. Two main cavities within eyeball:

c. Anterior cavity (by iris)--filled with acqueous humor


which is continuously being made; secreted
by ciliary body each; Aq. humor flows in and
out to maintain intraocular pressure in
normal range of 12 - 20. Continuously
replaced; Drains out canal of Schlemm
(trabecular meshwork) into systemic
circulation for a fairly constant
IOP.
a. Anterior chamber between cornea and iris
b. Posterior chamber between iris and lens

d. Vitreous Body/chamber (between lens and retina)--


filled with vitreous humor, a gelatinous mass
(about 99% water) which gives shape to posterior eye
and holds retina in place; Not continuously replaced.
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c. Crystalline lens separates ant. Cavity and vitreous


body; transparent, colorless, biconvex structure;
Bends light entering eye so that it converges on
retina to form images. Accomodation is the process
whereby lens changes shape and refractive ability
to adjust vision at near or far distances. (Cataracts due
to cloudy crystalline lens)

B. Giving eye meds


1. Careful of abbreviations

2. OLOL- beta-blockers- given for glycoma


- Can cause wheezing- check BS and HR

3. Wear Gloves

4. Turn head form midline

5. Two drops of same med wait one minute b/w drops

6. Irrigating eye- flush eye outward

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C. Assessment of eye
1. PERRLA
2. Consensual response- pupil exposed to the light demonstrated a
direct response to the light, and the pupil not exposed to
the light demonstrated a similar constriction
3. Accommodation- is the process by which the eye increases optical
power to maintain a clear image (focus) on the
retina
4. Visual acuity--Snellen chart at 20 ft distance
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5. Refractive errors:
a. Emmetropia- normal refraction
b. Hyperopia- Farsightedness
c. Myopia- nearsighted
d. Presbyopia- due to aging

D. Disorders of the Eye and Nursing Management


1. External Eye Disorders
a. Hordeolum - Sty

1. S&S:
- Swelling
- Pain

2. Treatment:
a. Warm Compress

b. Eyelid hygiene- wash w/baby shampoo

c. Nasulamyde- topical antibiotic

d. No makeup

e. I & D

f. Hand washing

b. Conjunctivitis- pink part infected

1. Allergic
- Wearing makeup
- Foods
- Dog/cat hair

SSx-
- Hyperemia- redness
-↑ Lacrimation – Tearing
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Tx-
- Steroid Drops

2. Bacterial Conjunctivitis “Pink Eye”


SSx-
- Hyperemia
- Photophobia
- Lots of purulent thick drainage
Tx-
- Antibiotic- topical
- can go away quickly

c. Corneal Disorders -- Keratitis (corneal ulcer)


a. Causes
- Trauma

b. S&S:
-

c. Prevention and treatment important:


1. Hand washing
2. Use Gloves
3. Antibiotic/steroid drops/ antifungal q-15-30min.
4. Eye/Eyelid hygiene
5. Eye Patch
6. Safety

Treatments:
a. Surgery

b. Eye Removal

c. Arthroplasty- corneal transplant


- Redness
- Swelling
- Impaired Vision
- Pain
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* Signs of refection of cornea transplant – Notify


DR.

d. Post-op care [applies to all eye surgeries]:


1. Patch/Protective shield

2. Sensory Perceptual alteration

a. Bed low rails up


b. Call bell in reach
c. Frequently touch and orient pt.
d. need items in reach
e. food plate- use clock system
f. no straw
g. Approach on good side
h. Positioning- don not lye on bad side
i. No bending over
j. No straining
k. Open mouth with sneezing
l. No lifting over 5lbs
m. shield at night- about 1 month
n. eyelid care- keep clean
o. Teach to apply eye drops
p. prevent vomiting

4. Blindness now called visual impairment;


Know method of walking client with visual impairment;
Provide orientation as needed (room, plate, equipment);
Don’t move things without permission and orientation to change.
Consider sensory impairment and provide personal contact
(touch, etc.) as needed, especially with acute loss of
vision due to eye patches or disease/injury.
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II. The Ear


A. Function of the Ear
1. Organ of hearing
Hearing Impairment---Common--one out of every five affected; Can
range from slight to total hearing loss

a. Types of Hearing Impairment:

1. Air Conduction Hearing Loss (transmission deafness);


Interference in sound conduction through external canal, eardrum, or middle ear.
Inner ear usually not involved.
Causes: foreign bodies in external canal, Upper resp. infections, allergies,
eustachian tube blockage, middle ear infection, tumors. Usually correctable by
medical or surgical treatment.

2. Sensorineural Hearing Loss or Bone Conduction Hearing Loss;


Most common inner ear disorder. Loss of hearing involves cochlea and hearing
nerve. May be temporary or permanent. Caused by: viral infection in inner ear,
ototoxic drugs (ASA, loop diuretics, garamycin, vancomycin), noise trauma, tumors,
presbycusis. Often preventable but usually not correctable. Acoustic Neuroma of
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8th Cranial Nerve; most common benign tumor and although benign, as it grows it
exerts pressure toward brain stem and is life threatening.

b. Prevention of Hearing Impairment: Early, adequate tx of disease,


Prevention of trauma, Early detection of hearing loss, Monitoring side effects of
ototoxic drugs, Monitoring noise pollution --Important to avoid nose greater than
85 - 95 dB, Periodic ear exam

c. Clinical Manifestations of Hearing Impairment: Irritability,


Ringing in ears, Better understanding in small groups, Avoiding large groups,
Withdrawing from social interactions, Frequently asking people to repeat
statements, Straining to hear, Turning head to favor one ear or leaning forward,
Failing to respond when not looking in the direction of the sound, Answering
questions incorrectly, Shouting in conversation, Raising volume on TV or radio

2. Organ of balance
- Semicircular Canals

B. Structure of the Ear and Health Deviations of Each Structure


1. External Ear

a. Pinna/Auricle

b. External Auditory Canal/Meatus/or Ear Canal

c. Disorders of the External Ear--S&S:


- Ear Pain - Fever
- Otorrhea - drainage from the ear
1. Infections
a. External otitis (Swimmers Ear)- infection of the ear canal

b. Fungal Infection- Impaired immune system

c. Purupl/Boils
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Early Warning signs of Hearing Loss


1. Irritability
2. Ringing in ears
3. Better understanding in small groups avoiding large groups
4. Withdrawing from social interactions
5. Frequently asking people to repeat statements
6. Straining to hear; turning head to favor one ear or leaning forward
7. Failing to respond when not looking in direction of sound
8. Answering questions incorrectly
9. Shouting in conversation
10. Raising Volume on TV or Radio

Guidelines for communication with the hearing impaired


1. Attempt to have conversation in quiet room with minimal distraction
2. Make sure that there is plenty of light in room
3. Position yourself directly in front of the client. Move closer to the better
hearing ear. Get the attention of the client before you begin to speak
4. Do no sho9ut, this only raises frequency of sound of voice and often makes
understanding more difficult
5. Keep hands and other objects away from your mouth when talking to the client
use appropriate hand movement
6. Validate with client to make sure statements are understood by asking the client
to repeat what was said
7. Rephrase sentences and repeat info to aid in understanding
8. If the can’t hear at all, write message on paper if client able to read

2. Obstructions
a.
b. Swollen canal- tumor, blunt trauma (boxer)
c. Bug- use mineral oil to remove
d.
e.

d. TX of External Ear Problems:


- Ear wick (like small tampon w/meds on it)
- Clean ears with wash cloths
- If have infection don’t want water to get down in ear, use cotton ball
with Vaseline and put another cotton ball on top of the Vaseline one
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- Analgesics- warm compress

2. Tympanic Membrane (Eardrum) Membrane between external ear canal and


middle ear space; Separates canal from middle ear and
protects middle ear; Conducts sound vibrations from external ear
to ossicles; Should be pearly gray and shiny.

a. Types of Disorders of Tympanic Membrane


1. Infections

2. Trauma
Inside- fluid builds up and can burst tympanic membrane
Outside- slapped
* Concern about ossicles- air conduction

b. S&S of Disorders of Tympanic Membrane

c. TX of Tympanic Membrane Problems:

1. Antibiotics

2. Surgery
- tubs- myringotomy - pressure won’t build up
- repair myringoplasty
- Tympanoplasty
- Mastoidectomy- to remove infected air cells within the
mastoid bone

3. Middle Ear (Tympanic Cavity


a. Contains Three Ossicles (tiny bones)--malleus, incus, stapes--transmit sound
vibrations mechanically from air molecules of external ear to fluid
molecules of inner ear. Important to avoid noise greater than
85 - 95 dB.
b. Eustachian Tube--Connects middle ear to nasopharynx for purpose of
equalizing pressure on both sides of eardrum
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c. Disorders of the Middle Ear--must be evaluated by indirect means

Infections--usually from microorganisms via eustachia tube


1. Otitis Media- inflammation of middle ear
Acute or Chronic
- Tympanic membrane can rupture

2. Otosclerosis- Harding of the bones


- Women during pregnancy
- Air conduction hearing loss
- Remove stapes- put in artificial one

3. Eustachian Tube Disorders--will get in Peds

d. S&S of Middle Ear Problems


- don’t lie on side with fracture
- Body fluid will go that way
- Air conduction hearing loss
- outoreia

e. Treatment of Middle Ear Problems--


- Antibiotics
- Decongestants
- Antihistamines
- disalvimanuver
- Surgery procedures
- Tubes

4. Inner Ear (Labyrinth)--closed, fluid-filled space; deep within the temporal


bone; Contains sense organs for hearing and balance, and the
eighth cranial nerve

a. Structures of Inner Ear

1. Bony labyrinth--a rigid capsule that surrounds and protects the


membranous labyrinth; made up of cochlea and semicircular
canals (looks like snail shell)
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2. Membranous labyrinth--Lies within bony labyrinth but doesn’t fill it;


Bathed in a fluid called perilymph which communicates with
cerebrospinal fluid via the cochlea duct. (on outside)
Contains fluid called endolymph--cushions and protects Organs of
Corti against abrupt movements of head. (on inside) Contains
Vestibule which houses utricle and saccule each of which are
vestibular receptors that position the head as it relates to the
pull of gravity; contain tiny hair cells that move with position changes.

3. Semicircular Canals--for balance; sense rotational positional


movements; contain tiny hair cells; connect with utricle

4. Cochlea--contains Organ of Corti --End organ for hearing. Bathed in


endolymph. Contains tiny hair receptor cells. Sound enters
external ear canal and causes movement of tympanic membrane.
This movement displaces the ossicles (malleus, incus, stapes).
They amplify the force of the sound and transmit to the cochlea. The
periplymphatic fluid is set into motion (endolymph
movement) which subsequently stimulates the receptor hair
cells in the Organ of Corti. These signals are transformed from
vibratory energy into electrical impulses by the hair cells and then
sent as electrical impulses to the brain via the acoustic nerve to
the temporal cortex of the brain to be interpreted. (Cochlea=
hearing; Vestibule= balance)

b. Disorders of the Inner Ear

1. Hearing Impairment
- Exposure to loud noises
- Drugs- ototoxic
- vancomycin
- gycomycin
- Lasix
- Aspirin

2. Tinnitus- Ringing in the ears


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- head noises
- can be so sever patients have commited suicide
- Tinnitus masques or white noise- takes place of noise- like hearing aid-
makes another tolerable noise

3. Balance Disorders
- Inner ear

a. Labyrinthitis
- Condition of inner ear caused by a virus
- N/V

b. Presbycusis
- impaired hearing because of old age
- Along with vision loss

c. Meniere’s Disease or Syndrome


- To much fluid in inner ear
- can last minute, hours, to days

1. Tinitus- head noise


2. Hearing Impirment
3. Vertigo- Dizziness
- usually on both sides
- comes on rapidly
Exsasurbausicous

-Avoid foods with Na


-Avoid smoking
-Avoid caffeine
-Antimedics/antiverigo meds
-Diuretics

4. Acoustic Neuroma--benign tumor of 8th cranial nerve; dangerous due to


expansion in brain; removal results in loss of hearing in that ear; death
without removal; must catch early
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