NURS 5031 Study Guide Sensory Disturbances
Vision
- Obtain significant subjective and objective assessment data related to the visual system from a patient.
- Subjective: changes in vision, redness, itching, and drainage
- Objective: Discoloration, conjunctiva and sclera color, lens clarity, ptosis, snellen chart, extraocular movements, peripheral vision ability, PERRLA
- Describe the signs and symptoms associated with “ocular emergencies[b].”
- Retinal Detachment
- No pain
- Visual changes: “dark curtain or veil unilaterally”
- Risk factors:
- Trauma
- Advanced age (more watery vitreous humor)
- Family hx and cataract surgery
- Distinguish normal from common abnormal findings of a physical assessment of the visual system.
- PERRLA - Pupils equal, round, reactive to light and accommodation
- Link the age-related changes in the visual system to differences in assessment findings.
- If intraocular pressure testing is high - glaucoma? Probably? Idk really
- Visual Acuity Testing with Snellen chart bad - presbyopia (age-related)
- Failed perimetry testing - Macular Degeneration
- As we age:
- Pupil gets smaller
- Lens gets more rigid and starts to yellow
Presbyopia - age-related change to the lens
Decrease in tear production - can cause blurry vision
- Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the visual system.
Study | Purpose and Results |
Amsler Grid Test | Monitor macular problems
|
Perimetry testing | Detects changes in central + peripheral vision related to glaucoma, stroke, brain tumors, and neurologic issues
|
Refractometry | Measures refractive error
|
Ultrasonography | A-scan = determines correct lens power for a cataract surgery B-Scan = diagnoses ocular pathology like intraocular foreign body/tumors, vitreous opacity changes, and retinal detachments |
- Book doesn’t list any nursing responsibilities for these ¯\_(ツ)_/¯
- Compare and contrast the types of refractive errors and appropriate corrections.
- Types of refractive errors:
- Hyperopia - farsightedness - can’t accommodate for near objects
- Eyeball too short
- Myopia - nearsightedness - can’t accommodate for far objects
- Eyeball too long, or cornea/lens refracts too much light
- Presbyopia - loss of accommodation with age, lens less elastic
- Causes inability to focus on objects that are near
- Astigmatism - uneven curve of cornea, weird interactions with light
- Corrections:
- Lenses or glasses correct the way the light contacts the retina to correct for length changes
- Surgical therapy
- Laser - LASIK corrects for myopia and hyperopia + astigmatism by creating a flap in the cornea
- Photorefractive keratectomy - same idea but without the flap in the cornea
- Implant
- Refractive IOLs - For high degrees of myopia and hyperopia, the artificial lens is implanted to correct for refractive errors
- You can also implant a contact lens (phakic IOLs)
- Describe the common causes and assistive measures for severe visual impairment.
- I think this is kind of already covered in the other bullet points for visual problems.
- Discuss nursing measures that promote the health of the eyes.
- Wearing sunglasses, avoiding direct sun exposure
- Good nutrition
- Visual Aid use
- REMOVE RUGS
- Prepare frozen meals
- Audiobooks
- Explain the nursing management of the patient with intraocular and extraocular disorders.
- Intraocular
- Cataracts (opacity in the lens)
- Avoid raising BP after surgery
- Long-term corticosteroid use = higher complications
- Decrease room lighting
- Diabetic Retinopathy
- Blood vessels of the eyes leak fluid, causing edema and ischemia. New blood vessels form, but worsen problem
- Fix: Tight blood sugar control, education
- Central Serous Retinopathy
- Central retina develops a cyst
- Macular Degeneration
- Center of retina degenerates - causing loss of central vision
- Develops with age
- Genetic link between glaucoma and age-related macular degeneration
- Glaucoma
- Mgmt is all about reducing pressure in the eye
- Anti-hypertensive eye drops!
- Peripheral vision reduced
Sensory Disturbances - Hearing
- Obtain significant subjective and objective assessment data related to the auditory system from a patient.
- Subjective:
- Changes in hearing
- Ear pain
- Ear drainage
- Tinnitus
- Objective:
- Alignment and position of ears
- Size, shape, symmetry, color, and skin intact
- External auditory meatus discharge or lesions
- Distinguish normal from common abnormal findings of a physical assessment of the auditory system
- External ear:
- Normal: ears symmetric, auricles nontender, no lesions, auricle and mastoid areas not tender and no nodules
- Abnormal: swelling, redness, lesions, tenderness, nodules
- External auditory anal and tympanum:
- Normal: clear channel, tympanic membrane intact, landmarks and light reflexes intact, cerumen visible, no fluid behind membrane, part of malleus visible through membrane
- Abnormal: impacted cerumen, discharge in canal, retracted eardrum (malleus more horizontal) or bulging eardrum
- Hearing:
- Normal: able to follow conversation or hear low whisper, Rinne test AC>BC
- Abnormal: confusion and lack of understanding
- Link the age-related changes in the auditory system to differences in assessment findings.
- Cerumen becomes drier - muffled sounds
- Tympanic membrane becomes thicker/duller
- Ossicular joints degenerate - decreased hearing ability
- Loss of hair cells - high frequency sound loss
- Presbycusis -> sensorineural loss (can hear, but no understanding due to the loss of high frequency sound
- Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the auditory system.
- This is literally 11 tests long in the book 🤯- but the lecture only mentions the Rinne test so I assume that is what will be tested:
- Rinne Test
- Measures bone conduction (BC) versus air conduction (AC) with a metal tuning fork. Can diagnose Conductive hearing loss versus sensorineural hearing loss
- If AC > BC (Rinne positive) = NORMAL
- If AC > BC, (Rinne positive) but length of time is significantly shorter, its sensorineural loss (presbycusis)
- If BC > AC, (Rinne negative) = conductive hearing loss
- Explain the nursing management of common ear problems.
- Environmental noise control
- Most preventable cause of hearing loss
- Not reversible
- Avoidance of continued exposure to noise levels greater than 70dB is essential
- Promote immunizations (some viruses can cause deafness): measles, mumps, rubella
- Monitor patients who are exposed to ototoxic drugs and stop medication if they thew signs and symptoms
- External otitis: provide moist heat, mild analgesics, and topical anesthetic drops to control the pain (antibiotics for infection, corticosteroids for inflammation)
- Chronic otitis media: administer antibiotics, surgery may be necessary to repair tympanic membrane perforations, teach patient to change cotton ball dressing
- Hearing loss and deafness: use descriptive visual aids, provide ASL interpreter if necessary
- Describe common medications that can cause hearing loss.
- Medications that cause tinnitus:
- Antibiotics: erythromycin, vancomycin
- Cancer medications: vincristine
- Diuretics: bumetanide, furosemide
- Quinine medications: malaria
- Certain antidepressants: may worsen tinnitus
- Aspirin: taken in uncontrollably high doses (usually 12 or more a day)
- Compare the causes, management, and rehabilitative potential of conductive and sensorineural hearing loss.
- Sensorineural = presbycusis (age-related)
- Hearing aids may help, but that only makes the sounds louder and not necessarily clearer.
- Not really possible to reverse
- Conductive = impacted cerumen or otitis
- Can manage and treat the underlying causes (remove cerumen or reduce ear inflammation)