Alterations in Sensory Perception
Vision
o Errors of refraction
Myopia
Hyperopia
Presbyopia
Astigmatism
o Cataracts
PATHO:
Cloudy lens
Epidemiology:
3rd leading cause of disability (behind arthritis and heart disease)
Most common cause of visual impairment
A common cause of preventable blindness
R/F:
Aging
Diabetes
UV light exposure
Trauma
Obesity
Malnutrition
Medications (ex. Steroids)
S/S:
Blurred vision
Light sensitivity
Poor acuity
Decreased contrast sensitivity
Reduced light transmission
DX:
Slit-lamp examination
Snellen chart
TX:
Reduce risk factors
Surgical removal of lens & replacement (one eye at a time)
Pre-Op
Dilating eye drops, steroid/antibiotic, same stuff w/peri-
op pt.
Post-Op
Eyepatch (usually hard - sleep with it on to protect eye)
May remove after 1 day
Sunglasses
Restricted activities that may increase intraocular
pressure (IOP)
Schedule of eyedrops (steroid & antibiotic for 10 days)
First 24 hr - r/f bleeding
After 24 hr - r/f infection
o Glaucoma "Dam that wont open"
PATHO:
, Increased IOP
Outflow of aqueous humor is blocked
Leads to optic nerve damage
2nd leading cause of irreversible blindness
Early S/S:
Increased IOP
Decreased ability to focus
Late S/S:
Ocular pain
Blurred vision w/halos around lights
Eye redness
N/V
Dilated; non-reactive pupil
Vision loss
Headaches
DX:
Measurement of IOP
Puff of air test
Central visual field testing
TX:
Decrease IOP
Pharmacologic
Increase drainage
Decrease production of aqueous humor
Topical meds
Surgery
Laser trabeculoplasty
S/E:
Eye pain
Pressure
Swelling
Inflammation
If these occur more than 1 day
= PROBLEMS
Care: eye drops for the rest of their lives
MEDS:
Pilocarpine - helps reduce IOP = increases outflow of the
aqueous humor
Beta blockers (eye drops) = decrease pressure in eye &
decreases fluid in aqueous humor
Nursing Care:
Tx is lifelong
Teach pt how to admin drugs and about them
Follow-up eye exams are CRITICAL
o Diabetic Retinopathy
o Macular Degeneration
PATHO:
Deterioration of central part of vision (macula)
, TX:
Photodynamic therapy - used to seal leaking blood vessels
Maximize independence
Alterations in Hearing
o Conductive Hearing Loss
PATHO:
Sound waves do not travel to inner ear
R/F:
Cerumen
Otitis media
Otosclerosis
Trauma
S/S:
Tinnitus
Inability to hear in group
Turning up volume of the tv
Asking to repeat questions
Not answering questions correctly
Behavioral changes - increased isolation
DX:
Diagnostic testing
TX:
Treat underlying cause
Hearing aids
o Meniere's Disease
PATHO:
Inner ear problem caused by too much production or not enough
reabsorption of endolymphatic fluid
Cause is generally not known
S/S:
Vertigo - whirling dizziness
Progressive sensorineural hearing loss
Tinnitus
Pressure or fullness in ear
n/v
DX:
Audiometry testing
TX:
No cure
Monitor pt safety
Adjust diet (low Na)
Lifestyle changes
Medication
Surgery
Cerebrovascular Accident (CVA) - Stroke
PATHO:
o Blood flow is not going to the brain (compromised blood flow)
Vision
o Errors of refraction
Myopia
Hyperopia
Presbyopia
Astigmatism
o Cataracts
PATHO:
Cloudy lens
Epidemiology:
3rd leading cause of disability (behind arthritis and heart disease)
Most common cause of visual impairment
A common cause of preventable blindness
R/F:
Aging
Diabetes
UV light exposure
Trauma
Obesity
Malnutrition
Medications (ex. Steroids)
S/S:
Blurred vision
Light sensitivity
Poor acuity
Decreased contrast sensitivity
Reduced light transmission
DX:
Slit-lamp examination
Snellen chart
TX:
Reduce risk factors
Surgical removal of lens & replacement (one eye at a time)
Pre-Op
Dilating eye drops, steroid/antibiotic, same stuff w/peri-
op pt.
Post-Op
Eyepatch (usually hard - sleep with it on to protect eye)
May remove after 1 day
Sunglasses
Restricted activities that may increase intraocular
pressure (IOP)
Schedule of eyedrops (steroid & antibiotic for 10 days)
First 24 hr - r/f bleeding
After 24 hr - r/f infection
o Glaucoma "Dam that wont open"
PATHO:
, Increased IOP
Outflow of aqueous humor is blocked
Leads to optic nerve damage
2nd leading cause of irreversible blindness
Early S/S:
Increased IOP
Decreased ability to focus
Late S/S:
Ocular pain
Blurred vision w/halos around lights
Eye redness
N/V
Dilated; non-reactive pupil
Vision loss
Headaches
DX:
Measurement of IOP
Puff of air test
Central visual field testing
TX:
Decrease IOP
Pharmacologic
Increase drainage
Decrease production of aqueous humor
Topical meds
Surgery
Laser trabeculoplasty
S/E:
Eye pain
Pressure
Swelling
Inflammation
If these occur more than 1 day
= PROBLEMS
Care: eye drops for the rest of their lives
MEDS:
Pilocarpine - helps reduce IOP = increases outflow of the
aqueous humor
Beta blockers (eye drops) = decrease pressure in eye &
decreases fluid in aqueous humor
Nursing Care:
Tx is lifelong
Teach pt how to admin drugs and about them
Follow-up eye exams are CRITICAL
o Diabetic Retinopathy
o Macular Degeneration
PATHO:
Deterioration of central part of vision (macula)
, TX:
Photodynamic therapy - used to seal leaking blood vessels
Maximize independence
Alterations in Hearing
o Conductive Hearing Loss
PATHO:
Sound waves do not travel to inner ear
R/F:
Cerumen
Otitis media
Otosclerosis
Trauma
S/S:
Tinnitus
Inability to hear in group
Turning up volume of the tv
Asking to repeat questions
Not answering questions correctly
Behavioral changes - increased isolation
DX:
Diagnostic testing
TX:
Treat underlying cause
Hearing aids
o Meniere's Disease
PATHO:
Inner ear problem caused by too much production or not enough
reabsorption of endolymphatic fluid
Cause is generally not known
S/S:
Vertigo - whirling dizziness
Progressive sensorineural hearing loss
Tinnitus
Pressure or fullness in ear
n/v
DX:
Audiometry testing
TX:
No cure
Monitor pt safety
Adjust diet (low Na)
Lifestyle changes
Medication
Surgery
Cerebrovascular Accident (CVA) - Stroke
PATHO:
o Blood flow is not going to the brain (compromised blood flow)
