3/9/2017. Chapter 52. Care of the Patient with a Sensory Disorder. Anatomy and Physiology of the Sensory System. The Eye. Eye Ear

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1 Chapter 52 Care of the Patient with a Sensory Disorder All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Eye Ear Anatomy and Physiology of the Sensory System All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 2 The Eye An approximately 1-inch sphere Composed of three layers The fibrous tunic: composed of the sclera and cornea The vascular tunic: the middle layer of the eye that contains the choroid, ciliary body, and iris The innermost tunic of the eye is the retina All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 3 1

2 Chamber of the Eye The anterior chamber contains the aqueous humor The posterior chamber contains the vitreous humor All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 4 Physiology of Vision Four basic processes are needed for vision Refraction Accommodation Constriction Convergence All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 5 The Ear External ear Middle ear Inner ear All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 6 2

3 External Ear The auricle External auditory canal Contains cilia Contains ceruminous glands All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 7 Middle Ear The tympanic cavity The auditory canal Malleus (hammer) Incus (anvil) Stapes (stirrup) All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 8 Inner Ear Semicircular canal Vestibule Cochlea All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 9 3

4 Normal Aging Changes Crystalline lens hardens Loss of accommodation Macular degeneration Presbycusis Calcification of the ossicles Tinnitus All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 10 Disorders of Refraction Astigmatism Strabismus Myopia Hyperopia All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 11 Myopia Commonly referred to as nearsightedness Treated with prescription lenses Refractory surgery can also be effective in correcting myopia All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 12 4

5 Hyperopia Commonly referred to as farsightedness Most commonly treated with prescriptive lenses All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 13 Astigmatism Defect in the curvature of the eyeball structure Commonly treated with prescriptive lenses All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 14 Strabismus Inability of the eyes to focus in the same direction All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 15 5

6 Inflammatory Disorders of the Eye Hordeolum, Chalazion, Blepharitis Common inflammations of the eyelids Assess for visual problems and eyelid changes Monitor eyelid for drainage Antiinfectives may be prescribed Lid scrubs may be ordered Nursing interventions are aimed at preventing the spared of infection All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 16 Inflammatory Disorders of the Eye cont d Conjunctivitis Inflammation of the conjunctiva Commonly referred to as pink eye Characterized by inflammation of the eyelid with purulent drainage and crusting Medical treatment is similar to that of blepharitis Nursing interventions are aimed at the prevention of spreading infection All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 17 Inflammatory Disorders of the Eye cont d Keratitis Inflammation of the cornea Severe eye pain is the most common symptom Medical management is usually topical antibiotic therapy Nursing interventions include controlling pain, promoting safety, and preventing complications All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 18 6

7 Noninfectious Disorders of the Eye Sjögren s Syndrome An immunologic disorder characterized by deficient fluid production by the lacrimal, salivary, and other glands, resulting in abnormal dryness of the mouth, eyes, and other mucous membranes Risk factors include female gender and advanced age Characterized by eye fatigue, red eyes, stringy mucus in eyes, photosensitivity, and blurred vision Diagnosed by Schirmer s test Medical management includes artificial tears and cyclosporine Nursing interventions are aimed at treating pain and replacing eye moisture All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 19 Noninfectious Disorders of the Eye cont d Ectropion and Entropion Ectropion is the outward turning of the eyelid Entropion is the inward turning of the eyelid Medical treatment for either is to reduce conjunctival and corneal irritation and inflammation All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 20 Disorders of the Lens Cataracts A crystalline opacity or clouding of the lens Symptoms include blurred vision, difficulty reading fine print, diplopia, photosensitivity, glare, and difficulty driving at night Treatment of cataracts is generally surgery Nursing interventions are aimed at postsurgical care All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 21 7

8 Disorders of the Retina Diabetic Retinopathy A disorder of retinal blood vessels characterized by capillary microaneurysms, hemorrhage, exudates, and the formation of new vessels and connective tissue Only occurs in diabetics Symptoms include microaneurysm characterized by floaters or white spots on the visual field Indirect ophthalmoscopy shows dilated and tortuous vessels Surgical intervention includes early photocoagulation, cryotherapy (cryopexy), and/or vitrectomy All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 22 Disorders of the Retina cont d Age-Related Macular Degeneration Characterized by slow, progressive loss of central and near vision Two types Wet type has sudden new vessel growth in the macular region Dry type is nonvascular The hallmark sign is the appearance of drusen in the fundus and loss of central vision Medications can be used to stop the growth of the new blood vessels All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 23 Disorders of the Retina cont d Retinal Detachment The separation of the retina from the choroid in the posterior area of the eye Symptoms include a sudden or gradual development of flashes of light, followed by floating spots, a cobweb, a hairnet, and loss of a specific field of vision The treatment of choice is early corrective intervention Laser photocoagulation Cryotherapy Electrodiathermy Scleral buckling All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 24 8

9 Glaucoma Two types Open angle represents 90% of cases Progresses slowly May have no symptoms Closed angle Abrupt angle closure is an emergency Characterized by sudden onset of eye pain Diagnosis is made through tonometry Medical management includes the use of miotics and can include a trabeculotomy Nursing interventions are aimed at providing patient education and keeping the patient safe All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 25 Corneal Injuries Abrasions and lacerations Penetrating wounds Medical treatment varies depending on causative agents Nursing interventions are aimed at promoting safety and preventing further complications All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 26 Surgeries of the Eye Enucleation Keratoplasty (corneal transplant) Vitrectomy All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 27 9

10 Enucleation Surgical removal of the eyeball Often necessary after eye trauma and sometimes due to malignant tumors Nursing interventions Aid patient in expressing feelings Apply dressing over eye socket to control hemorrhage Treat pain Provide patient teaching about how to remove, cleanse, and replace prosthesis All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 28 Keratoplasty (Corneal Transplant) Removal of the full thickness of the patient s cornea followed by surgical implantation of a cornea from a human donor Provide presurgical teaching After surgery, ensure that correct postoperative positioning is maintained Use safety measures Treat pain Advise patient to avoid bending, lifting, or straining All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 29 Vitrectomy The removal of excess vitreous fluid caused by hemorrhage and replacement with normal saline Postoperative management includes the prescription of topical eye medication for 4-6 weeks The patient is required to maintain a position on the abdomen or sitting forward resting the nonoperative side of the head on a table to allow air that is in the eye to float against the retina This position is maintained 4-5 days All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved

11 Types of Hearing Loss Conductive Sensorineural Mixed hearing loss All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 31 Conductive Hearing Loss Sound is inadequately conducted through the external or middle ear to the sensorineural apparatus of the inner ear Common causes are buildup of cerumen and otitis media Can also be caused by foreign bodies, otosclerosis, and stenosis of the external auditory canal All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 32 Sensorineural Hearing Loss Sound is conducted through the external and middle ear in a normal way, but a defect in the inner ear results in its distortion, making discrimination difficult Trauma, infectious processes, presbycusis, congenital conditions, or exposure to ototoxic drugs may cause this type of hearing loss All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved

12 Mixed Hearing Loss Combined conductive and sensorineural hearing loss All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 34 Care of a Hearing Aid Do Handle with care Wash ear mold or plug daily in mild soap and water Dry ear mold or plug thoroughly before reconnecting it to the receiver Always keep extra batteries and cord available When hearing aid is not in use, turn aid off and open battery compartment If hearing aid whistles, reinsert ear mold All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 35 Care of a Hearing Aid cont d Do Check for cracks in tubing or ear mold Check to see that ear mold and hearing aid are inserted in the correct ear Check that ear mold or hearing aid is properly inserted Check that volume control wheel is turned to appropriate settings All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved

13 Care of a Hearing Aid cont d Don t Put hearing aid on heated surface Wash hearing aid Drop hearing aid Wear hearing aid in bath or shower Wear hearing aid overnight Ignore a hearing aid that is whistling Use in contact with cream, oil, or hair spray when hearing aid is on All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 37 Tips for Communicating with Blind People Announce your presence when entering the room Talk in a normal tone of voice Do not try to avoid common phrases in speech, such as See what I mean? Introduce yourself with each contact (unless wellknown to the person) Explain any activity occurring in the room Announce when you are leaving the room, so the blind person is not put in the position of talking to someone who is no longer there All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 38 Resources for the Hearing-Impaired Office for the deaf and hard of hearing Directory of resources for the deaf and hardof-hearing services All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved

14 Inflammatory Disorders of the Ear External otitis Acute otitis media Labyrinthitis All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 40 External Otitis An inflammation or infection of the external canal or the auricle of the external ear Caused by allergies, bacteria, fungi, viruses, or trauma Characterized by erythema, scaling, pruritus, edema, watery discharge, and crusting Medical management includes steroids and eardrops Nursing interventions include cleaning the ear canal, applying heat, and instilling or teaching to instill eardrops All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 41 Acute Otitis Media Inflammation or infection of the middle ear Usually caused by Haemophilus influenzae and Streptococcus pneumoniae Most frequently occurs in children Characterized by fullness in the ear and deep, throbbing pain Nursing interventions are aimed at relieving pain and preventing complications All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved

15 Labyrinthitis Inflammation of the labyrinthine canals of the inner ear The most common cause of vertigo There is no specific treatment Usually treatment is antibiotics and antivertigo agents Nursing interventions are aimed at relieving vertigo All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 43 Obstructions of the Ear Usually caused by impaction or excessive secretion of cerumen or by foreign bodies, including insects Feeling of occlusion in the ear, tinnitus, buzzing Medical management includes removal of cerumen by irrigation or cerumen spoon, removal of foreign bodies or insects The nurse should assist in ear irrigation All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 44 Otosclerosis Chronic progressive deafness caused by the formation of spongy bone, with a resulting immobility of the joint Slowly progressive hearing loss with a low- to medium-pitched tinnitus Medications such as fluoride, vitamin D, and calcium carbonate are sometimes used to attempt to stabilize the hearing loss Nursing diagnoses and interventions of otosclerosis are specific to postsurgical stapedectomy care. All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved

16 Surgeries of the Ear Stapedectomy: removal of the stapes Tympanoplasty: repair of the tympanic membrane Myringotomy: surgical incision of the tympanic membrane All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved

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