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Sensory/Perceptual Alterations 201/107 Module A

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Page 1: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Sensory/Perceptual Alterations 201/107

Module A

Page 2: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Eye Terminology/ Pathophysiology

• Refractive errors• Blindness• Infection/ inflammation• Cataracts• Retinal detachment• Retinopathy

Page 3: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Eye Terminology/ Pathophysiology

• Macular degeneration• Glaucoma• Enucleation• Trauma

Page 4: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Refractive Errors of the Eye

• Most common visual problem• Refraction is the bending of light rays• Prevents light rays from converging into a

single focus on retina• Non-surgical correction– corrective glasses– contacts– corneal molding to treat astigmatism

Page 5: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Refractive Errors of the Eye

• Surgical Correction– LASIK– PRK• Myopia– Near sightedness- can see up close, but not objects

in the distance– Most common refractive error– Images are bent & fall in front of retina, not on the

retina

Page 6: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Refractive Errors of the Eye

• Hyperopia– Farsightedness– Images are focused behind retina, not on retina• Presbyopia– Loss of accommodation for near vision– Lens loses its elasticity– Age 30’s to 40’s– Has difficulty with close reading without backing

away from the material

Page 7: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Refractive Errors of the Eye

• Astigmatism– Irregular corneal curvature– Incoming light rays are bent unequally– Can occur with other refractive errors– Treated with corneal molding

Page 8: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Blindness

• Visual acuity is measured with the Snellen Chart. Visual acuity is measured as a fraction. The top number is the distance to the chart. The bottom number is the distance at which a “normal eye” can read the line.

• Definition of Legal Blindness- visual acuity of 20/200 or < with corrective lenses or visual field no > 20 degrees

Page 9: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Blindness

• Nursing Diagnoses– Altered sensory perception R/T blindness– Risk for injury R/T inability to see potential dangers– Self-care deficit R/T visual impairment– Fear R/T inability to accurately interpret environment

Page 10: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Blindness• Goal: Make a successful adjustment to the

impairment– Orient client physically & verbally to the environment– Encourage self-care activities– Encourage independence– Use sight-guided technique when assisting with

walking– Encourage use of touch– Establish routine placement for tableware– Take the person’s hand & guide to find personal care

items

Page 11: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Blindness

• Goal: Verbalize feelings R/T loss– Allow expression of fears and feelings of anger– Help to identify coping strategies• Goal: Use of appropriate coping strategies– Provide emotional support– Provide diversion activities- radio, audio books– Referral to agencies: ex. American Foundation

for the Blind, Social & Rehabilitative Services

Page 12: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Eye Infections & Inflammation

• Hordeolum– Also called “sty”– Infection of sebaceous gland or an eyelash follicle

in the lid margin– Red, swollen, tender, painful area on skin surface

of eyelid. May have purulent drainage– Warm, moist compresses & anti-infective

ointment

Page 13: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Eye Infections & Inflammation

• Chalazion– Sterile inflammation of a sebaceous gland in the

eyelid– Painless swelling – Surgical excision if it interferes with vision

Page 14: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Eye Infections & Inflammation

• Blepharitis– Common chronic bilateral inflammation of lid

margins– Lids are red rimmed with scales or crusts– Treatment: warm, moist compresses, gentle

cleansing with baby shampoo, anti-infective ointment

Page 15: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Eye Infections & Inflammation• Conjunctivitis- infection or inflammation of

conjunctiva– Bacterial conjunctivitis- “pink eye”. Occurs most

commonly in children. Contagious. Present with tearing, redness, mucopurulent drainage, itching. Treat with antibiotic drops. Teach good handwashing, isolate linens, keep out of school or day-care. Teach to discard opened contact lens care products and eye make-up.

– Viral conjunctivitis- may treat with corticosteroid drops

– Inflammatory conjunctivitis- not contagious

Page 16: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Cataracts

• Opacity of the lens• Cataract removal is the most common surgical

procedure for older Americans• Risk factors– Aging– Trauma– Toxins– Long term use of corticosteroids– UV light exposure– Smoking

Page 17: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Cataracts

• Assessment findings– Dimmed vision, blurred vision, loss of visual acuity– Abnormal color perception– Sensitivity to glare– Pupil may appear white, gray, or opaque– Loss of red reflex

Page 18: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Cataracts

• Preoperative nursing care– Antibiotic drops if ordered– Mydriatic eye drops to dilate the pupils– Preoperative teaching: Avoid rubbing eyes after

surgery. Eye patch will be applied on affected eye & will be removed the following day at the postop appointment. Teach that surgery is done under local anesthesia with sedation to keep comfortable.

Page 19: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Cataracts• Postoperative care:– Antibiotic drops to prevent infection,

corticosteroid drops to decrease inflammation.– Avoid activities that increase IOP such as lifting,

stooping, straining– Wear eye shield as instructed– Glasses can only be prescribed when healing

process is complete, usually 6-8 weeks– Teach to look through central portion of lens

implant.– Avoid lying on operative side

Page 20: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Retinal Detachment

• Separation of the sensory retina & the underlying pigmented epithelium, with fluid accumulation between the two layers

• Risk factors– Eye Trauma– Increasing age– Diabetic Retinopathy– Personal or family history

Page 21: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Retinal Detachment

• Clinical manifestations– Impending retinal detachment- light flashes,

floaters, cobweb or hairnet appearance– Complete retinal detachment- painless loss of

vision “like a curtain” coming across field of vision

Page 22: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Retinal Detachment

Surgical Interventions-- Laser photocoagulation-uses intense focused light

beam which causes a scar. This seals the edges of the tear preventing fluid from accumulating.

-- Cryopexy- Uses extreme cold to produce scarring-- Scleral Buckling- Uses a silicon implant, may also use

encircling band to indent the globe of the eye. See picture Lewis, p 431

-- Pneumatic retinopexy- Injection of a gas to form a temporary bubble that helps close the retinal break.

Page 23: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Retinal Detachment

• Postoperative care– Topical antibiotics– Topical corticosteroids– Analgesics– Mydriatics to dilate the pupil– Special positioning may be prescribed by surgeon

depending on the extent & the area of detachment. May be on bedrest. May have to keep head positioned so that the bubble is in contact with the retinal break

Page 24: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Retinopathy

• Diabetic retinopathy is the leading cause of visual disability & blindness in persons with uncontrolled DM

• Hypertensive retinopathy is caused by high blood pressure which creates blockages in the small vessels of the retinal.

• Papilledema is swelling of the optic disc & nerve due to sustained, severe hypertension. This is a medical emergency. Treatment focuses on lowering the BP.

Page 25: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Macular Degeneration

• Most common cause of irreversible central vision loss in persons over 60.

• Family Hx is a major risk factor.• 2 types: wet & dry• Nutritional supplements have shown to slow

the progression

Page 26: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Primary open-angle Glaucoma• Characterized by – Increased intra-ocular pressure (IOP)– Optic nerve atrophy– Peripheral visual field loss– Tonometry measures IOP. IOP > 22 mmHGMuch more common in African- AmericansPrimary open-angle glaucoma accounts for 90% of

cases• Obstruction of the flow of aqeuous humor resulting

in build up of pressure (IOP)

Page 27: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Primary open-angle Glaucoma

• Pathophysiology• Imbalance between rate of secretion of

aqueous humor & rate of absorption of aqueous humor Increased IOPDecreased peripheral vision EdemaBlindness

Page 28: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Acute closed angle glaucoma• Rare• Medical Emergency• Requires surgery• Complete closure of the angle • Subjective assessment

Severe pain in & around eyeHeadacheRainbow halos around lightN & V

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Glaucoma• Medications are primary treatment– Beta adrenergic blockers- ex. Betoptic,

Timoptic, Betagan– Alpha adrenergic agonists- ex. Dipivefrin ( Propine),

Alphagan, Lopidine, Xalatan– Miotics- ex. carbachol, pilocarpine– Carbonic anhydrase inhibitors- ex. Azopt, Trusopt

eyedrops. Medication taken by mouth- Neptazane, Diamox

All 4 classes of drugs decrease aqueous humor production

Page 30: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Glaucoma

– The nurse should stress the importance of compliance with medications & follow-up appointments to treat, monitor, & prevent loss of vision. Life-long medications will most likely be required

– Beta blocker eye drops used to treat glaucoma can cause an additive effect if systemic beta blockers (ex. Tenormin, lopressor, toprol, corgard) are also prescribed. Some eye drops to lower IOP are contraindicated in patients with COPD.

Page 31: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Glaucoma Medications

• Goal of medical intervention is to decrease IOP.

• Avoid use of antihistamines or sympathomimetic drugs found in cold medicines. These cause mydriasis or dilation of the pupil. The opposite goal of treatment

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Enucleation

• Removal of the eye• Primary indication is a blind, painful eye, some

malignancies.• Emotional support• 6 weeks may be fitted for eye prosthesis

Page 33: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Eye Trauma

• Types of injuries– Blunt injury– Penetrating injury– Chemical injury– Foreign bodies90% of all eye injuries can be prevented by using

proper eye protection when participating in sports, woodworking, yard work. Comply with eye wear recommendations at place of employment

Page 34: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Types of Ophthalmic Drugs

• Topical anesthetics- for pain• Topical antibiotics• Steroids- decrease inflammation• Mydriatics- dilate the pupil for eye exam• Miotics- contract the pupil permitting better

drainage of intraocular fluid in glaucoma• Carbonic anhydrase inhibitors• Beta blockers

Page 35: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Ear Terminology/ Pathophysiology

• Hearing Loss/ Deafness• Trauma• External otitis• Impacted cerumen• Otitis Media• Otosclerosis• Meniere’s Disease

Page 36: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Symptoms of Hearing Loss

• Frequently asking people to repeat statements

• Loud volume on T.V. or radio• Withdrawal from social interactions• Better understanding in small groups• Using loud speaking voice• Turning head/ leaning forward to favor one

ear.

Page 37: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Auditory Assessment

• The unit for measuring loudness is the decibel.• Hearing loss is measured in decibels• 0-15 dB - normal hearing• >40-55 dB - moderate hearing loss• >90 - profound hearing loss15 dB are generated with shuffling paper in

quiet room. 40dB low conversation. 150 dB jet plane 100 feet away

Page 38: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Types of Hearing Loss• Conductive- sound waves are blocked to the

inner ear because of problem in external or middle ear. Causes- inflammation, obstruction external or middle ear, tumors, otosclerosis

• Sensorineural- Problem with sensory fibers in inner ear so the impulse to the brain is impaired. Often permanent. Causes- cranial nerve damage, medications, trauma, inherited disorders, prolonged exposure to loud noise, aging

Page 39: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Types of Hearing Loss

• Conductive/Sensorineural Hearing Loss- a mix of both types

Page 40: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Nursing Interventions

• Face the client when speaking• Speak slowly and clearly• Lower the pitch of your voice• Limit other noises when speaking to the

client, close the door, turn off T.V.

Page 41: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Hearing Loss/Deafness• Hearing Health Promotion– Increasing rate of hearing loss in young adults as a

result of prolonged amplified sound (I-pods, etc)– Industrial work environments- use of ear

protection– Immunizations- encourage MMR immunization– Ototoxic drugs & chemicals- salicylates, diuretics,

antineoplastic drugs (cisplatin), antibiotics (gentamycin), chemicals used in industry such as mercury

Page 42: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Assistive Devices & Techniques

• Hearing Aids• Lip reading- allows for approx 40% understanding.

Gestures & facial expression help to clarify the spoken message

• Sign language• Assistive Listening Devices• Service dogs for deaf• Special telephones• Computer programs

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Deafness

• Consult community resources such as National Assoc. for Deaf

• Teach safety precautions when crossing the street, driving

Page 44: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Ear Trauma

• Blows to the ear can cause conductive hearing loss. Foreign objects into the ear canal may cause perforation

• Head trauma that injures temporal lobe can affect hearing

• Emergency care of head injury- may find clear/ bloody drainage in ear canal. Sign of serious head injury. Fluid may be leaking CSF

Page 45: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

External Otitis

• Inflammation or infection of the epithelium of the auricle and ear canal.

• “Swimmer’s Ear”• Pain upon movement of the auricle or on

application of pressure to the tragus• Treatment- antibiotic and/or steroid ear

drops, anagesics

Page 46: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Impacted cerumen• Treat with irrigation of the ear canal with bulb

syringe or special device used in the healthcare providers office

• Use warm tap water. Place basin under the ear with towel around the neck so client does not get wet

• Lubricating drops may help loosen the earwax, so irrigation can be done.

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Impacted cerumen

• Irrigation is contraindicated if tympanic membrane is perforated.

• Teach to avoid cotton tipped applicator use in ear canal. May cause ruptured eardrum or may cause impaction of cerumen.

Page 48: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Otitis media

• Common childhood disease which often follows colds, allergies, sore throats, and blockage of the eustachian tube.

• Treatment – antibiotics (amoxicillin)• Otitis media with effusion- inflammation of

the middle ear with collection of serous or purulent drainage. May be chronic

Page 49: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Otitis media

• Surgical therapy- – myringotomy with tympanostomy tube placement– Myringoplasty- surgical repair of TM perforation– Mastoidectomy- removal of diseased tissue and

infection. Incision behind ear

Page 50: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Otosclerosis

• Autosomal dominant disease• Fixation of the stapes in the oval window• Hearing aids may be effective• Surgical intervention- stapendectomy with

prosthesis insertion• Progressive gradual hearing loss, may hear

ringing or roaring

Page 51: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Meniere’s Disease

• Inner ear disease– Episodic vertigo– Tinnitus– Fluctuating hearing loss– May have sudden, severe attacks of vertigo with N & VMay feel as if they are being pulled to the ground or

feel like they are whirling in space

Page 52: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Meniere’s Disease

• Nursing interventions -Keep in a quiet, dark room during an acute attack -Safety measures- siderails up, call for assistance to

get up Surgical intervention- surgical decompression of the

endolymphatic sac to reduce pressure on cochlear hair cells and to prevent further damage and hearing loss

Page 53: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Meniere’s Disease

• Treatment- o antihistamines- to decrease tissue edemao antiemetic- such as phenergan, tigano diuretics- such as diamox

Main medication is meclizine (antivert) to control nausea and vertigoo -Low salt diet

• Safety

Page 54: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Mastoiditis

• Swelling behind the ear and pain. Cellulitis on the skin over the mastoid process.

• Fever, malaise, tender and enlarged postauricular lymph nodes

• Most common treatment is simple/ modified mastoidectomy with tympanoplasty

Page 55: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Assistive Devices & Techniques

• Cochlear implant- Implanted electronic hearing device that stimulates the nerves of the inner ear. Ideal candidate is someone who became deaf after learning to speak. Extensive training and rehab are essential. Offers the profoundly deaf the ability to hear sounds including speech

Page 56: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Questions• Which task is appropriate to delegate to an

LPN who is working with the RN?• Administer eye drops to a child with

conjunctivitis.+• Review hand washing with a patient who has

an eye infection+• Show a client how to remove eye exudate+• Assess nutritional factors with a client with

macular degeneration

Page 57: Sensory/Perceptual Alterations 201/107 Module A. Eye Terminology/ Pathophysiology Refractive errors Blindness Infection/ inflammation Cataracts Retinal

Question

• A patient with a history of head trauma is in need of treatment for adult strabismus. What treatment would be considered appropriate for this patient?

• Rational

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THE END