SENSORY CONCEPTS

EYES
Review Of Systems
• Supplies about 70% of all
sensory information of the
brain.
Conjunctiva
• a thin, transparent mucous membrane that
lines the lid
• serves to lubricate the eye

• Lacrimal apparatus
• lubricates and protects the cornea and
conjunctiva by producing & absorbing tears
Sclera
• white of the eye
• maintains the shape of the eye

Cornea
• works with the sclera to give the eye its shape
• allows light to enter the eye
• is a powerful refracting surface, providing much of
the eye's focusing power
Extraocular muscles (6)
• surrounded by layers of soft, fatty tissue
• protect the eye and enable it to turn easily

Choroid
• second layer of the eye
• lies between the sclera and the retina
• contains the blood vessels that provide
nourishment to the outer layers of the retina
Iris
• gives color to the eye
• divides the space between the cornea and lens
into anterior and posterior chambers

Pupil
• circular aperture in the iris
• changes size as the iris adapts to amount of
light entering the eye
Lens

• a biconvex, avascular, colorless and

transparent structure

• refracts and focuses incoming light onto the

retina for processing
Retina

• innermost layer in the eye

• converts images into electrical impulses;

sent along the optic nerve to the brain where
the images are interpreted
• Retinal cones
• best in bright light
• color discrimination

• Retinal rods
• outer part
• supports night vision (low light)
• sensitive to movement
• provides peripheral vision
Macula

• located in the back of the eye; center of the retina.

• has fovea centralis

• has the highest concentration of cones
• produces the sharpest vision
• used to see details clearly
EYE BALL (fluid sections)

Vitreous humor
• a clear, transparent, avascular, gelatinous fluid
• fills the space in the posterior portion of the eye

Aqueous humor
• smaller section
• canal of Schlemm provides a drainage system
for the aqueous humor from the eye into the
bloodstream
COMMON EYE
DISORDERS
C
A
T • Lens opacity or cloudiness
A
R • AKA: senile lntrmt
A
C
T
 Risk Factors
1. Aging
2. Injury
3. Smoking
4. Obesity
5. Diabetes Mellitus
6. Eye conditions - Myopia
- Retinal detachment
Clinical Manifestations
1. Distortion of vision
Type of blindness Legal
2. Light scattering

3. Reduced visual acuity

4. Photophobia

5. Milky-white appearance
Surgical Management
Most
Extracapsular Cataract Extraction - economical

Intracapsular Cataract Extraction

Phacoemulsification
c. least invasive
Nursing Interventions
Preoperative Care

• Ambulatory
•
• 5 - 7 days: no anticoagulants
commie the
• 6 - 8 hours: NPO to
blood vessels of
• 1 hour: mydriatics /
the eye
-

prevent bleeding
Postoperative Care

• Expect mild headache

• Eye patch -

ideal :
bilateral
• Unaffected side: 3 nights
• Avoid increase in IOP
 GLAUCOMA
“Silent thief of sight”
• An increase in IOP causing optic nerve
damage

Normal IOP: 10-21 mmHg

Diagnostic: Tomo retry

Risk Factors

Family History Migraine

Trauma
Age

Myopia
Diabetes Mellitus

Cardiovascular disease
 Open Angle Closed Angle /
Angle Closure

Progression Gradual sudden

Status ( cam • I
narrowed Closed
Schemm)
IOP
122-24 550-70
Blindness TOTAL -

Peripheral → Antal
Clinical Manifestations

- Halos around lights

- Ocular pain
- Headache
- Nausea and vomiting
- Redness and swelling of the conjunctiva
 Medical Management
Main goal:
1. Cholinergics (miotics): Pilocarpine -

mainstay
-

pociantioviswbr
2. Adrenergic agonists: Epinephrine SIE
SIE PBP ,
's PAR
3. Beta blockers (timolol)
S/E i lo AR
4. Alpha-adrenergic agonist (apraclonidine, brimonidine)
SIE b. BP
i

Nursing Management: Advise STRICT COMPLIANCE

Surgical Management

Laser Trabeculoplasty

Trabeculectomy
Retinal Detachment

The separation of
retina from the choroid
and vitreous humor.
Risk Factors
Trauma

Aging process
Myopia greater that -6
Diabetes Mellitus
Clinical Manifestations

Flashes of lights

Floaters

Field loss of vision

Blindness: spot
Surgical Management
 Scleral Buckling

• Depressing the sclera to force choroid

closer to retina.

• Scleral buckle or silicon band is used.

• Has a high success rate.

Pneumatic Retinopexy

• A gas bubble, silicone oil, or perfluorocarbon

carbon and liquids may be injected into the
vitreous cavity to help push the sensory retina
upwards.

• Least invasive procedure.

 Nursing Management

• Promote bedrest

• Keep client quiet in bed with eyes covered

• Position: Unaffected

• Avoid IOP increase

EARS
Review Of Systems
 Assessment of Ear
• Inspection of the ear

– Adults: Pull pinna BACKWARD and UPWARD

– Pedia: Pull pinna BACKWARD and DOWNWARD

COMMON EAR
DISORDERS
 Meniere’s
Disease
AKA: Endolymphatic hydrops
• Abnormal inner ear fluid balance caused by
malabsorption in the endolymphatic sac or a
blockage in the endolymphatic duct.
Risk Factors and Etiology

Family History

Male

Age between 20 to 60 years old

 Clinical Manifestations

Vertigo Headache

Aural fullness Nausea and vomiting

Tinnitus Hearing loss (unilateral)

↳ Sensorineural
Medical Management
Antihistamines -

To suppress the vestibular center

meclizine (Antivert)

Tranquilizers To control vertigo by sedation.

diazepam (Valium)

Diuretics To alleviate edema

hydrochlorthiazide
 Surgical Management
GOAL: To control vertigo
 Endolymphatic Sac Decompression

• A shunt or drain is inserted in the

endolymphatic sac through a postauricular
incision.
 Middle and Inner Ear Perfusion

• Ototoxic medications administered by

infusion into the middle and inner ear.
* May cause permanent hearing loss to the
Affected ear
 Vestibular Nerve Sectioning

• Has the greatest success

• Cutting of the Vestibule

• Requires Vestibular rehab

 Nursing
Management
 Nursing Interventions
Priority: Safety

Diet: Low sodium

Restrict fluids

Avoid: Alcohol
Aspirin
 OTOSCLEROSIS
Fixation of the stapes caused by the growth of bone, preventing
transmission of vibrations.
 Pathophysiology
Formation of new and abnormal spongy bone

Fixation of stapes

Prevent efficient transmission of sound

Progressive conductive loss

 Clinical Manifestations

• Hearing loss

• Possible tinnitus

• Presence of spongy bone in the labyrinth

• Bone conduction is better than air conduction

 Medical Management

Sodium flouride

Hearing aid
 Surgical
Management
Stapedectomy
Removal of the diseased portion and replacement
with a prosthesis

Only regains 70% of hearing

 Nursing
Management
 Postoperative care:
▪Position:

▪Avoid:
▪Pressure increase
▪Physical activity for one week
▪Exercise or sports for 3 weeks
▪Straining

▪Seek assistance when ambulating

for the 1 time
st