sensory perception

stereopsis

depth perception

normal intraocular pressure

10 - 20 mmHg

diagnostic tests for visual impairment

Snellen, Jaegar, TNO Stereopsis Test

cataracts

excessive epithelial growth to cell layers of eye lens

manifestations of cataracts

• gradual blurry vision/cloudiness

• halos around bright lights/glare

age-related macular degeneration

most common cause of irreversible vision loss

wet AMD

• abnormal growth of blood vessels in/near macula that leak blood & fluid

• can occur at any age

dry AMD

• nonexudative

• gradual lockage in retinal capillary arteries, which leads to macula ischemia & necrosis

• drusen deposits

manifestations of age-related macular degeneration

• blurring of vision w/ drusen deposits

• straight lines appear crooked

• letter in words appear broken

• lack of depth perception

• loss of central vision

• yellow discoloration of retina

• objects appear distorted

• blindness

management of cataracts

• medication

• surgery

management of age-related macular degeneration

• dietary changes (carotenes, vitamins B & E, antioxidants)

management of wet AMD

• injections

• laser tx

glaucoma

aqueous humor inflow > outflow

primary angle closure glaucoma

• outflow decreased

• mydriasis (pupil dilation)

angle closure glaucoma CI

atropine

chronic open angle glaucoma manifestations

• develops slowly

• eyes tire easily

• often unnoticed until peripheral vision is severely impaired

• tunnel vision

• halo around lights

• decreased accommodation

• IOP 22 - 32 mmHg

narrow angle closure glaucoma manifestations

• sudden onset

• excruciating pain in/around eyes

• N/V

• rainbow halos around lights

• blurred vision

• ocular redness

• pupil dilated/non-reactive

• photophobia

• IOP > 50 mmHg

glaucoma diagnostics

• slit lamp microscopy

• peripheral & central vision tests

• ophthalmoscopy

glaucoma drug therapy

• beta blockers (timolol maleate)

• carbonic anhydrase inhibitors (acetazolamide)

drugs that increase aqueous fluid outflow

cholinergic agents (pilocarpine)

acute angle closure glaucoma tx

• hyperosmotic drugs

• surgical iridectomy or iridotomy

• semi fowlers position

• no eye patch

• no darkened room

• place objects in front of pt

post glaucoma surgery

• sunglasses outdoors

• report s/s of infection

• avoid activities that increase IOP

• lie on opposite side or supine

• report severe pain/nausea

• no swimming

• now eye makeup for 4-6 weeks

retinal detachment

• separation of sensory retina & pigment epithelium w/ fluid accumulation btwn layers

• retinal breaks, holes, & tears

retinal detachment diagnostics

visual acuity, slit lamp microscopy

retinal detachment manifestations

• shade or curtain falling across one eye

• cobwebs, bright flashing lights, sudden floaters

retinal detachment tx

surgery (virectomy)

post retinal detachment surgery

• topical meds, prone positioning, pain control, avoid air travel for 3-4 weeks

• avoid getting wet for 24 hours

• wear hard eye guard at night & glasses in daytime

conductive hearing loss

occurs when sounds cannot get through outer ear &/or middle ear

conductive hearing loss manifestations

muffled sounds, sudden or steady hearing loss, otalgia, dizziness, difficulty understanding words

sensorineural hearing loss

• damage to cochlea/vestibulocochlear nerve following inner ear damage

• inability to understand speech

• air conduction > bone conduction

sensorineural hearing loss manifestations

• tinnitus

• inability to hear soft & high pitched sounds

perforated eardrum

trauma, chronic otitis media

perforated eardrum manifestations

tinnitus, pain, fullness of ear, vertigo

perforated eardrum diagnostics

otoscope

perforated eardrum tx

tympanoplasty

myringotomy

surgical incision into eardrum to relieve pressure

labyrinthectomy

tx vertigo if hearing is significantly impacted

stapedectomy

removal of stapes performed when surrounding tissue hardens/impairing stapes function

meniere’s disease

abnormality in inner ear fluid balance caused by a malabsorption or blockage

meniere’s disease manifestations

episodic vertigo, tinnitus, fluctuating sensorineural hearing loss

meniere’s disease tx

antihistamines (meclizine), antiemetics (promethazine), & sedatives (diazepam)

head and neck squamous cell carcinoma manifestations

• oral cancer

• hoarseness that does not go away, sore throat/burning, poor denture fitting, ear pain, airway obstruction

• dysphagia, dyspnea, ulceration, foul breath

partial laryngectomy

• partial removal of voice box

• temporary tracheostomy

• stoma closure over time

• may result in hoarseness or weak voice

total laryngectomy

• permanent stoma created for breathing

• may also require partial removal of pharynx, lymph nodes, & nearby muscles

• may include transesophageal puncture

post laryngectomy nutrition

• NPO (7-14 days after surgery)

• NG tube feedings