Transcript Few4y efewfwfny

Chapter 26
The Sensory System: Eye and Ear
Jodi Olenginski MSN, RN
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
Theory Objectives





Identify ways in which nurses can help
patients preserve their sight and hearing.
Identify signs and symptoms of eye problems.
Discuss tests and examinations used to
diagnose eye and ear disorders.
Perform nursing activities associated with
assessing the eye and ear.
Utilize the nursing process for patients with
disorders of the eye or ear.
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
1
Clinical Practice Objectives




Provide teaching for a patient who is to
undergo tests for a vision problem.
Perform focused assessments for disorders
of the eyes and ears.
Assist visually impaired patients to find
resources to maximize their vision.
Instruct a spouse in ways to effectively
communicate with a hearing-impaired
partner.
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
2
The Eyes

-
-
-
Structures of the eye
Eyeball
Sclera-White part of eye
Cornea( part of wall of eyeball)-refracts light
rays to the lens
Choroid (Part of middle layer, highly vascular)
Ciliary body- (middle layer produces aqueous
humor). Helps change eye shape for near
and far vision
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
3
EYE STRUCTURES
Iris- Colored portion of eye. Contain muscles
that constrict an dilate the pupil to regulate
the entrance of light.
Biconvex- transparent lens. Divides interior of
eyeball into two chambers. The anterior
chamber is filled with aqueous humor. The
posterior chamber contain vitreous humor
Retina- Inner coat of the eyeball contains
several layers. The layer with rods and cones
as receptor for light images and color.
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
4
Optic nerve- carries messages from nerve
cells in the retina to the brain.
 Optic disc- formed by the axons of the
ganglion cells of the retina
 Macula lutea-yellow spot that allows for visual
detail
Eyelids, conjunctiva, eyelashes
Lacrimal glands(upper outer area above eye).
Lacrimal ducts carry tears

Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
5
FUNCTIONS






ORBIT-protections eyeball
EYELASHES- Trap foreign particles
EYELIDS – Protect eye and distribute
moisture
Sebaceous glands- lubricate lids
Blinking-stimulate lacrimal gland to produce
tears
Lacrimal gland-secrete tears that moisten,
lubricate and cleanse surface of eye
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
6
Functions Continued




Tears-contain an enzyme that destroy
bacteria and prevent infection
Transparent cornea- allows light to hit the
lens. Assists with bending of light
rays(refraction)
Choroid- brown pigment absorb excess light
Ciliary process-secrete aqueous humor that
help maintain the shape of the anterior
chamber. The amount of the aqueous humor
determines the internal pressure of the eye
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
7
Functions cont



Retina’s rods and cones are photoreceptors
for light and color
Optic nerve- conducts nerve impulses from
retina to the brain
Optic disc-when pressures increase the disc
appears swollen or choked (Iincreased
intracranial pressure ICP)
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
8
AGING





Fat and elasticity decrease-sunken eyes
Arcus senilis-opaque ring outlining the cornea
caused by fatty deposits
Cornea flattens and becomes irregular
causing astigmatism..blurred vision
Sclera may develop a yellowish tinge or
bluish
Lens loses water and hardens-Cataracts form
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
9
AGING Con’t




Ability of iris to dilate decreases(causes
difficulty going from bright to dark)
Ciliary muscle has less ability for the eye to
accomodate., responsible for the gradual
extension of distance from which an object
can be read( presbyopia)
Pupils become smaller-reduces ability to see
in dim lighting
Color discrimination decreases
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
10
Aging Con’t



Moisture secretion decreases ( greater risk
for irritation and infection- may lead to keratits
( inflammation of the cornea) which may
compromise vision
Ectropion- eversion of the lower eyelid
Drooping of the upper lid- ptosis
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
11
Structures of the Eye
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
12
Visual Pathway
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
13

https://www.youtube.com/watch?v=gvozcv8p
S3c
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
14
Arcus Senilis
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
15
Ectropion
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
16
Eye Disorders


Causes-born blind..developed later in life,
injury, diabetes, HTN, glaucoma, macular
degeneration, AIDS
Prevention




Rest eyes when working on computer, TV etc
Vitamin A-prevents night blindness, slow
adaptation to darkness.
Carotenoids are precursor to vitamin A (green
leafy veggies, carrots, OJ, sweet potatoes etc)
Lutein and zeaxanthin (antioxidants)- may
prevent
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
17
Eye care
cataracts…found in yellow fruits and veg., red
and purple fruits and greens, kale, turnips
greens, corn
 Purulent discharge or excessive tearing may
warrant a Dr visit
 Prevent injury-protective wear, disgard make
up
 See a Dr. once in 20s,and twice in 30s unless
problem occurs. After 65, every 2 years
 Discard makeup every 6 months
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
18
Danger Signals of Eye Disease





Persistent redness of the eye
Continuing pain or discomfort about the eye,
especially following injury
Disturbance of vision
Colored light flashes or feeling a curtain has
been pulled over field of vision may signal
retinal detachment
Crossing of the eyes, especially in children
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
19
Danger Signals of Eye Disease
(cont.)



Growths on the eye or eyelids or opacities
visible in the normally transparent portion of
the eye
Continuing discharge, crusting, or tearing of
the eyes
Pupil irregularities, either unequal size of the
two pupils or distorted shape
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
20
Visual Loss



Retinopathy associated with diabetes mellitus
and hypertension
Diabetic retinopathy and open-angle
glaucoma among Latinos
Visual screening and check-up
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
21
The Tono-Pen Used to Check
Intraocular Pressure
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
22
Slit-Lamp Ocular Examination
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
23
Examination of the Eye with an
Ophthalmoscope
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
24
Assessment (Data Collection)




History-taking and systemic disorders(history
of DM, HTN, AIDS, Neuro muscular disorders
Medications with ocular side effects- digitalis,
corticosteroids, Indocin
Family history
Physical examination
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
25
Abnormalities of Lid Position
Entropion
 Ectropion
 Ptosis
OTHER ABNORMALITIES
Exopthalmos
Xanthelasma
Photophobia
Inability to raise eyebrow-facial nerve damage

Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
26
Xanthelasma
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
27
Exopthalmos
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
28
Expected Outcomes

The patient will






Compensate for decreased visual acuity and not
suffer sensory deprivation
Not experience injury
Verbalize decreased fear as treatment begins to help
condition
Seek assistance with home maintenance within 7
days
Explore other means of diversion than reading and
watching television
Demonstrate proper instillation of eye drops and will
verbalize the schedule for the eye drops
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
29
Nursing Interventions for the
Visually Impaired Patient





When communicating with these patients,
remember that the person has a vision
impairment; he is not deaf
Prevention of accidents
Pity is neither expected nor appreciated by
the visually impaired
Most patients prefer to feed themselves, if at
all possible
If a guide dog is present, don’t interfere with it
or pet it, as it is working
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
30
Audience Response Question 1
Which nursing action(s) demonstrate(s)
appropriate care of a visually impaired patient?
(Select all that apply.)
1.
Introduces self prior to touching
2.
Speaks slowly with a loud voice
3.
Keeps the door ajar
4.
Ensures ready access to the call button for
assistance
5.
Assists with feeding using the clock method
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
31
The Ears
Structures of the ear
Pinna-fleshy external ear
Auditory meatus-extends from pinna to
tympanic membrane. Lined with hair ad
glands that secrete cerumen( earwax)
Middle ear contains auditory bones and opens
to eustachian tube. The bones are
malleus(hammer), incus (anvil), and stapes
(stirrup)

Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
32
Structures con’t
Malleus attaches to tympanic membrane
Incus links malleus and stapes
Tympanic membrane separates middle and
external ear
Eustachian tube connects middle ear with the
throat
Inner ear-consists of vestibule, semi-circular
canal and cochlea
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
33
Con’t
Cochlea contains the organ of Corti which is
composed of sound receptors
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
34
Structures of the Ear
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
35
How is sound produced?
http://www.youtube.com/watch?v=XDgL-t38wik
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
36
Hearing Loss



Sensorineural hearing loss- acoustic nerve
Conductive hearing loss
Causes and prevention

Noise-induced hearing impairment
 Amplified music exposure
 Medications (vancomycin, furosemide, aspirin,
Ibuprofen
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
37
Common Causes of Conductive
Hearing Loss





Obstruction by impacted cerumen
Infection with labyrinthitis
Otosclerosis (abnormal bone growth in
middle ear) genetic, measles, stress fracture
Trauma and scarring of the tympanic
membrane
Congenital malformation of the outer or
middle ear
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
38
Common Causes of
Sensorineural Hearing Loss








Presbycusis( age related hearing loss)
Heredity with congenital loss
Ototoxic drugs
Loud noise exposure
Tumor (acoustic neuroma)
Ménière’s disease
Severe infection such as measles, mumps,
meningitis
Rubella in utero
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
39
Dangers of Ototoxic Drugs



Assess frequently when receiving a
potentially ototoxic drug
Signs of ototoxicity: ringing in the ears, subtle
changes in hearing ability, and difficulty in
hearing
Teach importance of immediate reporting of
symptoms
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
40
Diagnostic Tests and
Examinations


Visual examination
Tuning fork tests



Weber test and Rinne test
Test for nystagmus- involuntary jerking of
eye. May indicate tumor, inner ear problem or
paralysis of eye muscle
Romberg test –equilibrium . Positive test
may reveal problem with inner ear or
cerebellum
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
41
Examination of the Ear with an
Otoscope
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
42
Irrigating the External Ear Canal
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
43
General Goals for the Patient
with Problems of the Ear or
Hearing




Promote knowledge to protect hearing
Prevent infection and injury
Promote effective communication
Promote coping with hearing loss
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
44
Communicating with the
Hearing-Impaired Person




If the person uses a hearing aid, encourage
its use and see that it is situated, turned on,
and adjusted before beginning speaking
Be certain you have the person’s attention
before beginning speaking
Sit facing the person with the light on your
face rather than from behind you
Ask permission to turn down the volume or
turn off the television or radio
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
45
Communicating with the
Hearing-Impaired Person (cont.)


The best distance for speaking to a hearingimpaired person is 2½ to 4 feet. Place
yourself on eye level with the person. Do not
speak directly into the person’s ear as this
prevents the person from obtaining visual
cues while you are speaking
Do not smile, chew gum, or cover the mouth
while speaking
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
46
Communicating with the
Hearing-Impaired Person (cont.)




Use short, simple sentences. If the patient
does not appear to understand or responds
inappropriately, state the message again
using different words. Try to limit each
sentence to one subject and one verb
Give the person time to respond to questions
Ask for oral or written feedback to make
certain your message is understood
Avoid using the intercom system as it may
distort sound
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
47
When a Hearing Aid Does Not Work




Check that the switch is “on”
Examine the ear mold for attached wax or
dirt; clean the sound hole
Check the battery to see that it is inserted
correctly
Check the connection between the ear mold
and the receiver
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
48
When a Hearing Aid Does Not
Work (cont.)




Replace the battery. Batteries last an average
of 12 to 14 days depending on type of aid
Check placement of the ear mold in the ear; it
should fit snugly
Adjust the volume
If all else fails, take the hearing aid to an
authorized service center for repair
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
49
Cleaning the Hearing Aid




Turn the hearing aid off
Wash the ear mold with mild soap and warm
water; do not submerge in water
Use a pipe cleaner or toothpick to gently
cleanse the opening or short tube that fits into
the ear
Dry the mold completely before turning on the
aid or before reattaching it to the hearing aid
(if it is separate)
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
50
Common Problems of Patients with
Ear Disorders




Hearing impairment
Dizziness and vertigo, may accompany
nausea and loss of balance
Tinnitus –ringing in the ears
Rehabilitation for hearing loss

Lip reading (speech reading)
 Sign language
 Hearing aids
 Cochlear implant
 Hearing-assistive devices
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
51
Cochlear Implant
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
52
Audience Response Question 2
When communicating with a hearing-impaired
patient, the nurse must consider which
strategy(ies)? (Select all that apply.)
1.
Sit at eye level facing the patient.
2.
Chew gum.
3.
Enunciate clearly.
4.
Speak directly into the patient’s ear.
5.
Use simple sentences.
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
53
Community Care


Public education on the dangers of loud noise
and music
Encourage thorough evaluation of hearing
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
54