Alteration in Sensory

eye anatomy

external eye: extrinsic eye muscles, upper and lower eyelids, sclera, conjunctiva, and lacrimal structures.

eyeball → l / fluid chambers = anterior, posterior, vitreous (biggest w/ gel like liquid between lens and retina= shape of eye)

fibrous: sclera, transparent cornea

vascular: iris, choroid (retina that contains blood supply and connective cells) , ciliary body ( creates clear fluid)

neural : retina, optic nerve, and visual pathway

aqueous humor is secreted from choroid for intraocular pressure

photoreceptors (rods and cones) in retina → optic nerve

rods for vision in low light and peripheral image detection

cones color differential

macular degeneration

age-related macular degeneration (AMD): blurred vision → central vision not working

build up of waste product (drusen) beneath retina

• dry: outer retina to breakdown → drusen accumulation (gradual blurring = night vision, diminished central vision, diff reading)

• wet: abnormal growth of blood vessel → blood leak in center retina (macula) [ rapid → sudden blurred vision/ bling spots]

>65y, genetic

→ diff w/ ADL, read, vehicle, fall

~ to have thick carotid arteries, hypercholesterolemia, hyperlipidemia, inc plaque

lab/dx:

ophthalmological examination, fundoscopy (w/ dilation eye drops)

Fluorescein angiograph: eye blood flow

nursing:

assess: Snellen chart, asler grid

fall risk

smoking cessation, dietary changes, chronic health condition management, exercise routines, and follow-up appointment schedule

dietary: antioxidants, zinc, unsaturated fats, and omega-3 fatty acids

• Fruits and vegetables high in antioxidants:

  • Blueberries, grapes

  • Squash, broccoli, spinach, kale

• Foods high in zinc:

  • Red meats: beef, pork, lamb

  • Dairy: milk, cheese, yogurt

  • Eggs

  • Grains: whole-grain cereal, whole-wheat bread

  • Unsaturated fats: olive oil, canola oil, avocado

• Foods high in omega-3 fatty acids:

  • Salmon, soybeans, flax seed, chia seed

tx:

• carotenoids lutein and zeaxanthin = slow down

• wet AMD = anti-vascular endothelial growth factor (anti-VEGF) = slow abnormal vessel growth

  • ranibizumab, aflibercept, or brolucizumab

  • monthly into vitreous body of eye

• photodynamic therapy (PDT) = laser beam to target abnormal blood vessel

cataracts

cloudy/ opaque eye lens by 65<

or inc risk w/

• Advanced age 

• Diabetes mellitus 

• Hypertension 

• History of eye inflammation  

• Previous traumatic eye injury 

• Use of steroids 

• Previous eye surgery 

• Family history 

• Overexposure to sun or ultraviolet (UV) rays 

• Smoking 

• Alcohol use disorder 

• Obesity 

~ w. chronic HTN, DM

pt education: stop smoking, fruits/dark green leafy vegetables (vit C/E, lutein and zeaxanthin)

wear dark UV sunglasses

assess: visual acuity (Snellen chart) , ophthalmoscope and a slit-lamp biomicroscope, fundoscopy

tx:

surgery: remove lens and implant artificial intraocular lens (IOL) → phacoemulsification (mechanically assisted extracapsular procedure)

• pre op: ask for recent infection, check for anticoag/antiplatelet

• post op: check for sudden changes in eye pain, purulent drainage or bleeding, floaters, other changes in vision, or swelling around the external eye.

  • `no water in eye or any foreign object 1 week after surgery

  • avoid sneezing, cough, gagging

glaucoma

progressive increase ocular pressure against optic nerve due to change in volume or decrease absorption of aqueous humor

→ loss of peripheral vision, a halo effect when looking at lights, and decreased visual acuity when in darkness.

• open angle: gradual

  • corrective lenses don’t work

• closed angle: sudden vision loss = complete obstruction of aqueous humor outflow

inc risk:

• Clients older than 60

• Black or Hispanic clients

• Diabetes mellitus

• Hypertension

• Cardiac disease

• Hyperlipidemia

• History of eye injury or inflammation

• Previous eye surgery

• Family history

• Severe nearsightedness (myopia)

pt education: have extensie eye exam before 40

if high risk = annual

eye drops: tilt head and look up, pull lower lid and instill w/o touching eye → close eye for 3 mins

lab/ dx:

tonometry = measure eye pressure = 11-21 normal

visual field testing (perimetry)

tx:

decrease intraocular pressure by decreasing aqueous humor or decrease fluid produced

AB: reduce humor production and inc amount of fluid drained in eye

BB/ carbonic anhydrase inhibits: decrease humor volume

Prostaglandin analog: inc drainage

surgical:

laser trabeculoplasty: uses lasers on drainage angle tissue (trabecular meshwork)

→ laser thickens tissue = inc drainage ~1-2 months

trabeculectomy = drainage flap that will allow drainage

retinal detachment

retinal detaches from nourishment

from gel like humor to serous liquid → collapse and separate retina

→ dark floaters or sensation of curtain being placed in vision, blurry or distorted vision and seeing flashes of light (photopsia)

risk: consistency of the vitreous humor, diabetic retinopathy, macular degeneration, eye tumors, traumatic eye injuries (contact sports/ heavy lifitng), or inflammatory disorders, such as lupus, personal or family history of retinal detachments, previous cataract lens removal, and nearsightedness. 

pt education

not preventable by annual exams but can identify risk

Wearing eye protection during sports or dangerous activities

lab/dx: ophthalmological examination, fundoscopy, slit-lamp biomicroscope

assess: confrontational visual field test (peripheral)

check intraocular pressure (<10)

surgery:

scleral buckle: silicon band sewn in place on scelate → eye indention

pneumatic retinopexy/ pars plana vitrectomy: inject absorbable gas into vitreous cavity (8 weeks to reabsorb)

post op: instructed to lie face down for up to 3 months following surgery

ear anatomy

external: auricle/ auditory canal, hair folicles

middle: tympanic and ossicle bone (malleus, incus, and stapes)

inner: cochlea, semicircular canal,

• cochelea,= scala vestibuli w/ fluid perilymph (plasma like) scala media (endolymph)

ossicles transmit vibrations to endolymph fluid + hair folicles → neural impulse

hair and fluid are responsible for balance

hearing loss

risk; age-related changes to the structures of the ears, genetic predisposition, prolonged exposure to loud noise, and adverse reaction to ototoxic medications (cisplatin, furosemide).

s/s: difficulty w/ joint convos, balance, alarms, driving, dizzy,

pt education:

decrease exposure to loud or repetitive noises, regularly use ear protection (noise-canceling headphones, earbuds), and stop or decrease smoking

hearing screening, canals free of cerumen

→ erasable whiteboard for writing words, ensuring that the client can see the speaker’s mouth, or turning off obstructive noises that impede hearing.

Assistive listening devices

• Hearing aids

• Specialized FM radio headphones

• Television amplifiers

• Telephone amplifiers

Alerting devices (with flashing lights, vibration, or loud noise indicators)

• Doorbell with visual indicators

• Telephone with visual indicators

• Alarms with visual indicators

Communication devices

• Picture boards

• Computerized texting

s/s: not aware of deficit until told by other pts

lab/dx:

audiometry: delivery of diff frequencies and sound intensity

exam w/ otoscope'

tx:

hearing aids = mild-moderate loss

• improve sound quality, reduce feedback, and allow for easy volume modifications.

cochlear implants for severe SNHL

→ drilled to mastoid bone, electrode

position pt on side w/ surgery to face up

do not rotate or flex neck

no strenuous activity

soft foods to prevent jaw from closing

ear packed w/ iodoform gauze.

→ 2 weeks will become activated

tinnitus

ringing, roaring, or constant sound w/o external stim ( intermediate pr\\or continious)

• Constant ringing

• Loud buzzing

• Pulsating hum

• Low pitched roaring

• Clicking

• Hissing

• High pitched squealing

damage to cochlear hair components, abnormar ear activity,

or metabolic disorders, temporomandibular joint disorders (TMJD), or cranial nerve abnormalities​​​​​​​ and neuro conduction

subjective =

comorbidities: TMJD, frequent ear infections, migraines, Meniere’s disease, fibromyalgia, meningitis, excessive cerumen, thyroid disorders, Lyme disease, syphilis, and ototoxic medications (certain diuretics such as Furosemide, chemotherapy agents such as cisplatin, antibiotics such as gentamycin; acetaminophen; non-steroidal anti-inflammatory drugs).

lab/dx:

rule out:  anemia, thyroid issues, or heart disease

hearing testing, otoscopic exam, CN nerve, CT/MRI

pt education:

wear headphones when in noisy or loud environments, turn down music, reduce salt intake, and decrease the use of nicotine, caffeine, and alcohol.

Tinnitus Screener questionnaire

tx:

TMJD, dental treatment

Discontinuation or switching of medications that cause ototoxicity

CBT

meniere’s disease

progressive disorder that develops from an excessive buildup of endolymphatic

in the inner ear and leads to debilitating vertigo, tinnitus, and hearing loss.

inadequate fluid drainage from the ear, a history of an autoimmune disorder, a recent viral infection, or a genetic predisposition

comorbidities: migraines, rheumatoid arthritis, lupus, and ankylosing spondylitis.

pt education: plenty of rest, avoid excessive stressful situations, and limit caffeine. Reducing the intake of dietary salt

avoid foods high in sugar and decrease the use of nicotine, caffeine, and alcohol

s/s: vertigo

• Vomiting

• Nausea

• Blurry vision

• Cold sweats

• Trembling

• Hearing loss

• Headaches

• Imbalance

• Congestion in the ear

• Ear fullness (ear pressure)

lab/dx: Electronystagmography (ENG) → moniotor for manifestation of impaired gait

electrocochleography (ECOG) can be used to evaluate pressure within the ears

tx:

Diuretics are beneficial in reducing edema within the endolymphatic sac.

vertigo s/s : Motion sickness (meclizine, valium) and anti-nausea (promethazine, ondansetron)

Vestibular rehabilitation for balenced