306- Neurosensory

Card Set Information

Author:
KristaDavis
ID:
176215
Filename:
306- Neurosensory
Updated:
2012-10-13 13:38:15
Tags:
306 Neurosensory
Folders:

Description:
Exam 3
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user KristaDavis on FreezingBlue Flashcards. What would you like to do?


  1. Effects of Sensory Impairment
    • Independence
    • Self-Esteem
    • Safety Issues
    • Interaction with others and environment
    • Overall quality of life
  2. Population at Risk for Neurosensory Impairment
    • **Leading Causes Associated with Aging
    • 2/3 of affected population over 65 years
  3. What makes up the 1st Outer Layer of the Eye
    • Cornea
    • Sclera
  4. White protective outer coat
    Sclera
  5. Transparent structure that allows for the entry of light
    Cornea
  6. What makes up the 2nd Middle Layer of the Eye
    • Iris
    • Ciliary Body
    • Choroid
  7. Rich,vascular coat lines posterior segment of eye – nourishes retina
    Choroid
  8. Produces aqueous humor – Maintain IOP – Controls shape of lens (focuses light onto retina)
    Ciliary Body
  9. What does the 3rd back lining of the eye do
    Forms retina – complex nervous tissue layer – converts light rays into elec. Signals/relays via optic nerve to brain/interpretation of vision
  10. Eye Assessment: Ocular History
    • Visual disturbance?
    •   * Pain?
    •   *Are both eyes affected?
    •   * Discharge? (how long has this been going on)
    •   * Duration
    •   * Other disease processes
    •   * Visual & Cranial history (cranial nerves)
    •   * Medications – can affect intraocular pressure
    •   * Family history
    •   * Nutrition
  11. What is checked during the Eye Assessment
    • •Pupillary Function
    • •Assessment of EOM -- 6 fields of gaze
    • •Visual Acuity
    • •Color Vision
    • •Stereopsis Testing --depth perception, ability to see 3D
    • •Tonometry
    • •Slit Lamp Microscopy
    • •Opthalmoscopy
    • •Inspection
  12. Visual Acuity Test
    Snellen Chart
  13. Color-Blindness
    Ishiria
  14. Normal IOP (tonometry)
    • 10-22 mmHg
    • important with glaucoma
  15. Inability of the eye to bend light rays
    Refraction Errors
  16. Causes of Refraction
    • –Irregularities of corneal curvature
    • –Focusing power of lens
    • –Length of eye
  17. Symptoms of Refraction Errors
    • –Blurred vision
    • –Headache
    • –Eye strain
    • –Ocular discomfort
  18. Near Sightedness-- Light Rays focus IN FRONT of the retina
    Myopia
  19. Correction for Myopia (nearsightedness)
    Concave Lens
  20. Hyperopia
    Far-Sightedness-- Light rays focus BEHIND the retina
  21. Correction for Hyperopia
    Convex Lens
  22. Age Related change of lens- becomes less elastic
    Presbyopia 
  23. Difference between Hyperopia and Presbyopia
    Presbyopia-- loss of accomodation
  24. Correction of Presbyopia
    • Reading Glasses
    • Bifocal Lens
  25. Corneal surface irregularly curved/unevenly shaped
    No single focus of light
    Astigmatism
  26. Absence of Lens
    Aphakia
  27. Causes of Aphakia
    –Congenital defect

    –Surgical Removal- IOL implant

    –Trauma causing dislocation
  28. Correction of Aphakia
    • Thick glasses 
    • Aphakic glasses can magnify 25% (not used freq because of surgery 
  29. Nursing Care for Contact Lens
    • Know pattern of wear
    • Daily or extended wear
    • Remove in emergency/surgery
    • Teach detection of problems
    • Remove immediately if problems (RSVP)
    • Teach prevention of infection/complications
    • Redness, Sensitivity,Vision problems, Pain
  30. Laser to reshape central corneal  surface
    Photorefractive keratectomy
  31. Fold back corneal flap
    Laser removes some of internal   layers
    Earlier visual stability
    LASIK (Laser assisted in-situ keratomileusis) 
  32. 2 plastic rings placed b/w corneal layers, removable
    (IOL implants)
    Implants (Intracorneal ring segments)
  33. BCVA
    Best Corrected Visual Acuity
  34. Assessment for Visual Acuity
    •   - Length of impairment? (acute- glycoma v. chronic)
    •   - Effects on ADL functioning?
    •   - Coping Strategies?
    •   - Support Systems?
  35. Interventions for Visual problems: Resources
    • –American Foundation for the Blind
    • –Center for the Visually Impaired

    •www.cviatlanta.org
  36. Optical Assisstive Devices
    •Braille or Audio books

    •Cane or guide dog

    •Closed circuit TV

    •High powered magnification
  37. NonOptical Assisstive Devices
    • •Hold book closer to eyes.  Sit closer to TV
    • •Contrast enhancement – white on black, black felt-tip marker
    • •Increased lighting
    • •Large type print
  38. Assessment Findings for Eye Trauma
    Pain, photophobia, redness, swelling, ecchymosis, tearing,  absent eye movements, drainage, abnormal vision, prolapsed globe, abnormal IOP
  39. Eye Trauma Interventions
    • •ABC’s
    • •Determine mechanism of injury
    • •Assess for other injuries
    • •Chemical exposure- flush eye
    • •Do NOT put pressure on eye!
    • •Instruct Not to blow nose!
    • •Stabilize foreign object
    • •Cover eye with dry sterile patch & protective shield (if not chemical)
    • •Keep NPO, Elevate HOB 45 degrees
    • •No eye meds. unless dr. order
    • •Analgesia, Reassurance, Monitor pain.
    • •Anticipate surgical repair for penetrating, globe rupture, or avulsion
  40. Tearing Away
    Avulsion
  41. Types of Extraocular Inflammation/Infection
      - Hordeolum (sty)

      - Chalazion

      - Blepharitis

      - Conjunctivitis

      - Keratitis
  42. Tender – Infx sebaceous glands in lid – Warm moist compresses (aka...sty)
    Hordeolum
  43. May evolve from hordeolum – Inflammation of seb gland – nonpainful – more chronic – mary need removal
    Chalazion
  44. Bilat inflammation lid margins – red/scales/crusts – C/O Itching/burning/irritation – Simultaneous with conjunctivitis,   Seborrhea Hair/Eyebrows related - Conscientious hygiene (hair, too) – gentle cleansing of lid margins
    Blepharitis
  45. Inflam/infx of cornea – Bact/Viral (herpes simplex)
    Keratitis
  46. Types of Conjunctivitis Infections
    • –Bacteria – Staph. aureus --pink eye
    • –Viral
    • -Chlamydial -- blindness
  47. Signs/Symptoms of Conjunctivitis
    redness, tearing, foreign body sensation, drainage, photophobia
  48. Treatment of Conjunctivitis
    Strict handwashing, individual towels/wipes, antibiotic drops, assess for STD
  49. Infection/Inflammation of the Cornea
    Keratitis
  50. S/S of Keratitis
    Pain, photophobia
  51. Treatment of Keratitis
    • No corticosteroids for HSV!
    • –Antibiotics
    • –(viral) Acyclovir
    • –Good hygiene – contact lens, soiled drsg, direct contact
    • –Discard possibly contaminated products
    • –Hot/cold packs, dark glasses, analgesics
    • –Eye drops (stagger for max absorption)
    • –Corneal Transplant
  52. Leading Cause of Blindness in Adults within the US
    • Intraocular Disorders
    • (ie:  Cataracts, Retinal Detachment, Age-Related Macular Degeneration, Glaucoma)
  53. Causes of Cataracts
    age, congenital (maternal rubella), radiation/UV exposure, corticosteroids, trauma
  54. S/S of Cataracts
    gradual decline in vision, abn. color perception, glare
  55. Collaborative Care for Cataracts
    • •No non-surgical cure
    • •Visual aids
    • •Mydriatics to dilate pupil
    • •Cycloplegic- paralysis of  accommodation
  56. Surgical Management of Cataract
    • Phacoemulsification
    • Lens Replacement
  57. Pre-op Cateract Removal Care
    • –Eye drops – Mydriatics, Cycloplegics, NSAIDs, antibiotics
    • –Antianxiety meds
    • –NPO X 6-8 hrs
  58. Post-op Cataract Removal Care
    • –Topical antibiotics & corticosteroids
    • –Mild analgesia prn
    • –Eyeshield & activity restrictions per MD
    • –Home within few hrs
  59. Patient/Family Teaching
    • •Pre-op - Expect photophobia and transient stinging/burning from eye drops
    • •Will not have depth perception until patch removed
    • •Expect minimal pain/scratchiness in operative eye
    • •Call MD for   pain, redness, purulent drainage, or   visual
    • acuity
    • •Environmental safety measures
    • •Administration of eye drops
    • •Avoid stooping, bending, coughing, lifting
    • •Wear eye shield at night
    • •Health promotion – wear sunglasses, good nutrition (Vit. C & E)
  60. Retinal Detachment
    •Separation of sensory retina and pigment epithelium• •Fluid accumulation between layers •1 out of 10,000 people yearly•Untreated usually results in blindness
  61. Risk Factors for Retinal Detachment
    • •Severe Myopia
    • •Aphakia
    • •Proliferative Diabetic Retinopathy
    • •Ocular Trauma
  62. Detaching Retina
    •   - Photopsia –light flashes
    •   - Altered field of vision – floaters/cobweb/hairnet
  63. Detached Retina
    • “Curtain coming down”
    •   - Small detachment may not be noticed, cobweb
  64. Collaborative Care for Retinal Break
    •   - Laser photocoagulation
    •   - Cryopexy
  65. Collaborative Care for Detachment
    •   - Scleral Buckling
    •   - Vitrectomy
    •   - Pneumatic retinopexy
  66. Intense light beam – inflammatory response – Scar seals break
    Laser Photocoagulation
  67. Freezes area to seal
    Cryopexy
  68. Removal of vitreous (jellylike substance fills space between lens and retina)
    Vitrectomy
  69. Injection of gas to form bubble/close retinal break
    Retinopexy
  70. Post Operative (Retina Detachment Procedures) Nursing Management
    •   - Positioning
    •   - Activity
    •   - Topical medications as ordered
    •   - Pain Assessment
  71. ARMD
    Age-Related Macular Disorder
  72. Risk Factors for ARMD
    • –Increasing Age
    • –Smoking History
    • –Hypertension
    • –Overweight
    • –Hyperopia
    • –Family History
    • –Wet ARMD
    • –Use of thyroid hormones/HCTZ’s
    • –Arthritis
  73. Most Common ARMD
    Central Vision Loss after age 60
  74. Retinal Pigment Epithelium
    • - Nourish Macula
    • - Remove metabolic waste
    • - Aging decreases efficiency
  75. ARMD dry form starts with the _______ and results in _____
    • drusen-
    • results in atrophy and degeneration of macular cells; 
  76. Blind Spots
    Scotomas
  77. Distortion of Vision
    Metamorphopsia
  78. Atrophy of macular cells
    Decreased functioning
    Gradual blurring of vision
    Nonexudative ARMD (dry)
  79. Development of abnormal blood vessels in/near macula
    - May have abrupt onset
    - Progress rapidly over days/weeks
    - Distinct area of blurred/darkened/distorted vision
    (if left untreated, will cause permanent blindness b/c blood vessels leak and create scar tissue)
    Exudative ARMD (wet)
  80. Appearance of drusen
    Opthalmoscopy
  81. Test that defines the involved area of the eye
    Amsler Grid Test
  82. Defines the extent and type of disease
    Fluorescein Angiography
  83. Collaborative Care: Photodynamic Therapy (PDT)
    • -Wet ARMD
    • - Seals leaking blood vessels
    • - IV injection of verteporfin dye to visualize vessels
    • -“Cold” Laser activates dye to close vessels
    • -Prevents further vision loss
  84. Collaborative Care: Intraocular injections
    • Lucentis-
    • -preserves vision, monthly, side effects-  conjunctival hemorrhage, eye pain, inflammation, and floaters
  85. Collaborative Care that has very slow progression
    High Dose Vitamin Therapy
  86. Nursing Management: POST PDT
    Avoid Direct Sunlight Exposure
  87. Nursing Management: Psychologican Implications
    • Encourage that remaining vision can be retained
    • Arrange social supports
  88. Nursing Management: Patient Education
    • Information for independent ADL functioning
    • - Organize aids for low vision
    • - Reduce glare when outside
  89. 2nd Leading Cause of Blindness in the US
    Glaucoma
  90. Increased Intraocular Pressure (IOP)

      * Congestion of aqueous humor
      - flows between iris & lens
      - nourishes cornea and lens

      *Leads to optic nerve damage/atrophy

      *Peripheral visual field loss
    Glaucoma
  91. What is Outflow Dependent on?
    • intact drainage system - Trabecular meshwork
    • (Open angle (45 degrees) between iris and cornea) 
  92. Risk Factors for Glaucoma
    • •Family History
    • •African American
    • •Age
    • •Diabetes
    • •Cardiovascular disease
    • •Migraine Syndromes
    • •Myopia
    • •Eye Trauma
    • •Prolonged use of topical or systemic corticosteroids
  93. 90% of cases
    Develops slowly 
    No Pain or pressure
    Decreased outflow through trabecular meshwork 
    Loss of Peripheral Vision
    “Tunnel Vision”
    IOP = 22-32 mmHg
    **in most cases the patient may not know they have this until significant damage has already occurred
    Open Angle Glaucoma
  94. IOP for primary open angle glaucoma
    22-32 mmHg
  95. Symptoms of primary angle closure glaucoma
    • Definite symptoms-Sudden severe pain, N&V, colored halos around lights, blurred vision, ocular redness, “frosted cornea”
    • Outflow decreased due to decreased angle between Iris and Cornea
    •   - Bulging Lens  - age
    •   - Pupil Dilation
    •   - Drug Induced
    •   - Trauma, neoplasms
    • **VERY SERIOUS...PATIENT CAN LOSE EYE
  96. IOP level for primary angle CLOSURE glaucoma
    50 mmHg or greater
  97. Collaborative Care for Glaucoma
    • •Prevention of Optic Nerve damage
    • •Damage control/not cure
    • •Pharmacologic Therapy
    • •Surgical Management
  98. Initial Treatment in POAG- ocular
    • Beta-Adrenergic Blockers
    •   - Timolol (Timoptic)
    •   - Decrease aqueous humor (AH) production
    •   - Contraindicated in bradycardia/asthma/COPD

    • Alpha Adrenergic Agonists
    •   - Propine
    •   - Decreased AH production/Increased Outflow
    •   - Systemic effects
    •   - Punctal Occlusion
  99. S/E of Beta-Adrenergic Blockers
    • Discomfort/blurred vision/low blood pressure -
    • ***Watch for postsystemic absorption
  100. S/E of Alpha Adrenergic Agonists
     Redness/tachycardia/hypertension
  101. Cholinergic Agent (miotics)
    • Pilocarpine
    •   - Iris sphincter contraction opens meshwork
    •   - Increase AH outflow
    •   - Decreased visual acuity 
  102. Carbonic Anhydrase Inhibitors
    • Diamox (systemic)
    •   - Decreases AH production – Diuretic effect
    •   - Extremity tingling/tinnitus/GI disturbances
    •   - ? Sulfa allergy/electrolytes/high dose ASA therapy

    • Azopt (topical)
    • Stinging/redness/blurred vision (SE)
  103. S/E of Cholinergics
    • Decreased visual acuity due to miosis –
    • S/E headaches/vomiting/hypotension
  104. Because Carbonic Anyhdrase Inhibitors act as a diuretic, you should monitor ______ closely
    Electrolytes
  105. Types of Surgical Intervention for POAG
    • •Argon Laser Trabeculoplasty (ALT)
    •   - Outpatient/ only Topical Anesthetic
    •   - Laser to meshwork – Opens spaces – Increase outflow

    • •Trabeculectomy
    •   - Filtering procedure
    •   - Removal of part of iris/meshwork
    •   - Increase AH outflow

    • •Cyclocryotherapy
    •   - Freezes parts of ciliary body
    •   - Decreased production of AH
  106. Medications given for the Eye
    Miotics (cholinergic agents)

    • Hyperosmotics – Glycerin liquid/Mannitol
    •   - Increases extracellular osmolarity
    •   - Reduces IOP
  107. Creates opening in iris to eliminate blocking of pupil
    Laser iridotomy/Surgical Iridectomy
  108. Nursing Management: Eye Assessment
    •   - Compliance with treatment
    •   - Psychologic reaction
    •   - Support systems
    •   - Changes in visual acuity/visual fields/Opthalmoscopy
  109. Nursing Management: Planning
    •   - No progression of disease
    •   - Understand disease
    •   - Compliance
    •   - No Postoperative complication
  110. Nursing Management: Implementation
    • Teaching
    •   - Risks
    •   - Prevention
    •   - Medication administration / Other meds?
    •   -  Safety at home / referrals
    •  PACG
    •   - Requires acute intervention – medication
    •   - Comfort measures
    •   - Postoperative teaching (also POAG)
  111. Nursing Management: Evaluation
    • Expected Outcomes
    • – No further loss of vision/compliance/safely function/relief from pain
  112. Auditory Assessment: Symptoms
    Pain, dizziness, vertigo, tinnitus, hearing deficit
  113. Auditory Assessment: Past History
    • –Childhood problems
    • –Head trauma
    • –Surgeries
    • –Allergies
  114. Ototoxic Medications
    Aspirin, Loop Diuretics, Aminoglycoside antibiotics, Antimalarial, Neoplastic agents
  115. External Ear Disorders
    • Trauma 
    • –Hematoma
    • –aspirate, antibiotics
    • –Assess hearing

    • External Otitis
    • –Pain w/ movement of auricle/tragus
    • –Drainage, Fever, Dizziness, Impaired Hearing

    • *Collaborative & Nursing Care
    • •C&S of drainage
    • •Warm compresses
    • •Antibiotic drops/systemic
    • •Mild Analgesics
  116. Administration of Ear Drops
    • •Ear drops at room temp.
    • •Do Not touch dropper to ear
    • •Position ear so drops can run down canal – hold position X 2 minutes after given
    • •Handle material saturated with drainage carefully
  117. Cerum Impaction
    • •Discomfort, decreased hearing (conductive hearing loss), otalgia, tinnitus, vertigo, cough
    • •Bradycardia (Vagal)
    • •Irrigation of ear canal
  118. Acute Otitis Media
    –Pain, fever, malaise, h/a, decreased hearing

    • Collaborative Care:
    • •Antibiotics
    • •Myringotomy
    • •Antihistamines - adults
  119. Chronic Otitis Media
    • •Drainage
    • •Hearing loss
    • –Destruction of ossicles
    • –TM perforation
    • –Fluid in middle ear
    • •Ear pain, nausea, dizziness

    • Complication: 
    • **Cholesteatoma
    • –Skin overgrowth that destroys adjacent bone & tissue
  120. Diagnoses of Chronic Otitis Media/auditory problems
    Otoscopy, C&S, audiogram, sinus xrays, MRI, CT
  121. Collaborative Care for Auditory Prob
    • •Antibiotics (systemic)
    • •2% acetic acid drops
    • Tympanoplasty
    • –Reconstruction of TM &/or ossicles
    • Mastoidectomy
    • Removal of diseased tissue/infection source
  122. Nursing Management: Auditory Prob
    • •Pre-op teaching
    • •Avoid complications
    • –Avoid blowing nose, coughing, sneezing
    • •If must, leave mouth open
    • –Assist with getting up first time
    • Dizziness & loss of balance
    • –Cotton ball dressing – endaural incision
    • –Mastoid drain w/ post-auricular incision
    • –Monitor tightness of dressing over ear to prevent necrosis
  123. Chronic Otitis Media with Effusion 
    •Inflammation/Accumulation of fluid

    Etiology:  Eustachian tube malfunction, chronic otitis media, URI, barotrauma, overgrowth of adenoids

    • •Collaborative Care:
    • –Decongestants, Antihistamines, Corticosteroids, Antibiotics
    • –Chewing gum, swallowing, Valsalva
    • –Myringotomy w/ ventilating tube placement
    • Teach
    • – No H2O in ear or swimming
    • –Adenoidectomy
  124. Insertion of Tubes into the Ears
    Myringotomy
  125. Otosclerosis
    • •Spongy bone overgrowth from labyrinth causing fixation of stapes
    • •Conductive hearing loss – common, young adults.
    • •Reddish blush of TM - from vascular/bone change

    • •Collaborative Care:
    • –Stapedectomy – stapes removed & prosthesis implant
    • –Na Fluoride w/ Vit. D & Ca Carbonate – retard bone resorption & encourage calcification of bony lesions

    • •Post-Op Nursing Care:
    • –Avoid sudden movements
    • –Avoid coughing, sneezing, lifting, bending, straining with BM
  126. Inner ear problem, cause unknown, excessive accumulation of endolymph until the membranous labyrinth ruptures, mixing high potassium endolymph with low potassium perilymph; ANS- pallor, sweat, N/V, glycerol test po with audiograms. Improvement = dx
    Meniere's Disease
  127. Collaborative Care for Meniere's Disease
    • –Acute:  Antihistamines, anticholinergics, antiemetics, benzodiazepines -Valium & Meclizine(Antivert)
    • –B/T attacks:  vasodilation, diuretics, antihistamines, low Na diet, no caffeine or nicotine
    • Vestibular nerve resection – alleviate vertigo & preserve hearing
    • Labyrinth Ablation – loss of vestibular & cochlear hearing function
  128. Nursing Care: Meniere's Disease
    • Goals:  Minimize vertigo & ensure safety
    • •Reassure not life threatening
    • •Bedrest; Quiet, dark room; comfortable position
    • •Avoid sudden head movements or position changes
    • •Keep emesis basin within reach
    • •Side rails up, bed in low position
    • •Assist when getting OOB
    • •IV meds & fluids.  Monitor I&O.
    • •After attack, assist w/ ambulation – unsteady.
  129. Inflammation/infection of inner ear affecting cochlear &/or vestibular portion of labyrinth
    Labrynthitis
  130. •Complete destruction causes permanent hearing loss & extreme unsteadiness
    *Nystagmus
    •Viral – Lasts 7-10ccd.  No tinnitus or hearing loss.  Usually due to acute otitis media.
    Manifestations of Labrynthitis
  131. Conductive Hearing Loss
    • –Impacted cerumen
    • –Otitis externa
    • –Trauma
    • –Otitis media
    • –Otosclerosis Tumors
  132. Sensorineural Hearing Loss
    • –Trauma
    • –CNS infections
    • –Presbycusis
    • –Vascular
    • –Ototoxic drugs
    • –Tumors
    • –Meniere’s disease
  133. Mixed Hearing Loss
    Barotrauma, Cholesteatoma, Otosclerosis, Temporal bone fractures
  134. –May speak softly b/c own voice sounds loud
    –Hears better in noisy environment
    –Treat underlying cause
    –Hearing aids unnecessary usually
    Conductive Hearing Loss
  135. –Hear sound but cannot understand speech
    –Decreased hearing of high-pitched sounds (consonants)
    –Lack of understanding of problem by others
    –Hearing aids help, but sounds still muffled
    Sensorineural Hearing Loss
  136. Manifestations of Hearing Loss
    Asking others to speak up

    Answering questions inappropriately

    Not responding when not looking at speaker

    Straining to hear

    Cupping hand around ear

    Showing irritability when others don’t speak up

    Behaviors:  Irritability, Denial, Withdrawal, Suspicion, Loss of self esteem, Insecurity
  137. Health Promotion for Hearing Loss
    •Environmental Noise Control

    •Immunizations - MMR

    • •Ototoxic Drugs
    • Salicylates
    • Loop diuretics
    • Aminoglycoside antibiotics
    • Antineoplastics
    • Antimalaria
    • Manifestations- dizziness, tinnitus, hearing loss
  138. Hearing Aid Care
    • Keep in cool, dry place
    • Disconnect/remove battery
    • Clean ear molds weekly
  139. Communication with Hearing Impaired
    • –Draw attention with hand movements
    • –Have speaker’s face in good light
    • –Avoid covering mouth or face with hands
    • –Avoid chewing gum or food
    • –Maintain eye contact
    • –Avoid distracting environment
    • –Move closer to better ear
  140. Communicating with Verbal Aids
    • –Speak normally and slowly!
    • –Do not over exaggerate facial expressions
    • –Do not over enunciate
    • –Use simple sentences
    • –Rephrase sentence; use different words
    • –Write name or difficult words
    • –Avoid shouting
    • –Speak in normal voice into better ear
  141. Gerontologic Considerations for Hearing Impaired
    • •Unwillingness to use aid
    • •Difficulty with care and handling
    • •Acceptance of loss with aging

What would you like to do?

Home > Flashcards > Print Preview