Sensory Perception

Thalamus

relays sensory and motor input to and from the cerebral cortex

Corneal abrasion

scrape or scratch injury of the cornea; caused by small foreign body, trauma, or contact lens use.

CN I Olfactory

sense of smell

CN II Optic

sense of vision

S/S: of corneal laceration

severe eye pain, photophobia, tearing, decreased vision, inability to open eyelid; EMERGENCY- add small ice pack to decrease bleeding

Hordeolum

sty; an acute infection of a sebaceous gland of the eyelid

Enophthalmos

sunken eyes

trabeculectomy

surgical creation of a channel for fluid outflow to reduce intraocular pressure

Trabeculoplasty

surgical reconstruction of the trabecular meshwork of the canal of schlemm; procedure to treat open-angle glaucoma

Keratoplasty

surgical repair of the cornea (corneal transplant)

Otoacoustic Emissions (OAEs)

the low level of sound produced when the hair cells inside the inner ear vibrate

Tonometry

the measurement of intraocular pressure

sensorineural hearing loss

the most common form of hearing loss, also called nerve deafness; caused by damage to the cochlea's receptor cells or to the auditory nerves

Tympanometry

the use of air pressure in the ear canal to test for disorders of the middle ear

CN XII Hypoglossal

tongue movement

medial rectus

turns the eye in toward the nose

lateral rectus

turns the eye towards the side of the head

anisocoria

unequal pupil size

which way to pull pinna for an adult?

up and back

Cued speech

used by hearing impaired, to reduce uncertainty that is sometimes associated with lip reading.

laser trabeculoplasty

used to treat open-angle glaucoma by creating openings in the trabecular meshwork to allow the aqueous humor fluid to drain properly, reducing IOP

laser in situ keratomileusis (LASIK)

vision-enhancing surgery to correct nearsightedness, farsightedness, and astigmatism.

Hemiopia

visual loss often caused by a stroke in which half of the visual field is lost

Ototoxic drugs

-aspirin, aminoglycosides, vancomycin, erythromycin, loop diuretics (like furosemide), the anti-malarial medications, sildenafil (tadalafil, vardenafil) and cisplatin

Collaborative (tertiary) interventions for impaired vision

-orient the patient to their environment -communication -controlling sensory stimuli -safety measures

Development of an acoustic neuroma

1. tinnitus 2. sensorineural hearing loss 3. mild to moderate vertigo 4. damage to nearby cranial nerves

Legally blind

20/200 or poorer

A nurse knows that children with attention deficit-hyperactivity disorder (ADHD) may be learning disabled. What impact does this disability have on their education? 1. Will probably not be self-directed learners 2. Have intellectual deficits that interfere with learning 3. Experience perceptual difficulties that interfere with learning 4. Are usually performing two grade levels below their age norm

ADHD interferes with the ability to perceive and respond to sensory stimuli, resulting in a deficit in interpreting new sensory data. This makes learning difficult.

Partially sighted (school vision)

Acuity of 20/70 to 20/200 Education usually in public school system

Immediately after cataract surgery a client reports feeling nauseated. What should the nurse do? 1. Provide some dry crackers to eat 2. Administer the prescribed antiemetic 3. Explain that this is expected after surgery 4. Encourage deep breathing until the nausea subsides

An antiemetic will prevent vomiting; vomiting increases intraocular pressure and should be avoided.

Post-op care for cataract removal

Antibiotics (and steroid eyedrops) Discharge for 1 hour Dark glasses required Mild itching normal; pain indicates complications Reduce IOP Prevent infection; assess for bleeding

Which condition is associated with unevenly curved surfaces of the client's cornea? 1. Myopia 2. Hyperopia 3. Emmetropia 4. Astigmatism

Astigmatism is a refractive error caused by unevenly curved surfaces on or in the eye, especially of the cornea. These uneven surfaces distort vision.

Ways to prevent trauma to the eardrum

Avoid slapping over the ear, avoid excessive nose blowing

Activities that increase IOP

Bending from the waist, lifting objects that weight >10 lb, sneezing, coughing, blowing nose, straining BM, vomiting, sex, keeping head in dependent position, wearing tight shirt collars

Manifestations of hyperthyroidism

Blurred vision, exophthalmos (protrusion of the eyeball), fatigue, shallow respirations, and diaphoresis

Corneal ulceration

Caused by bacterial, protozoal, and fungal infections

A client with a history of closed-angle glaucoma is scheduled for abdominal surgery. Because the client is extremely anxious, surgery is to be performed under general anesthesia. What should the nurse teach the client to do to prevent respiratory complications postoperatively? 1. Deep breathing techniques 2. Performing productive coughing 3. Turning from side to side frequently 4. Pant breathing while gently closing the eyelids

Deep breathing is an intervention to prevent respiratory complications that does not increase intraocular pressure.

Which is a clinical manifestation of a cluster headache? 1. Vertigo 2. Neck rigidity 3. Phonophobia 4. Ipsilateral tearing of the eye

Ipsilateral tearing of the eye, or tearing on the same side as the headache, is a clinical manifestation of cluster headaches. Neck rigidity, vertigo, and phonophobia are manifestations of migraine headaches.

Otitis media (middle ear infection)

Diagnosed by redness of the eardrum observed during the otoscopic examination

How to care for chemical burns of the eye

Irrigate copiously with tap water for 20 min; evert upper eyelid to flush thoroughly; hold child's head with eye under tap of running lukewarm water; take child to ED; have child rest w eyes closed, keep room dark

Assessment findings for sensorineural hearing loss

Occasional dizziness, external canal that appears normal, tympanic membrane that appears normal

How to remove foreign object from eye

Examine eye for presence of foreign body; remove movable object with pointable corner of gauze pad lightly moistened with water; do not irrigate or attempt to remove penetrating object Caution the child against rubbing their eye

CN VII Facial

Facial expression and produces both saliva and tears.

Risk factors for glaucoma

Familial Over age 40 Diabetes Hypertension History of ocular problems

Open-angle glaucoma

Gradual loss of peripheral vision (tunnel vision), generally painless, decreased visual acuity, blindness if untreated

nystagmus

involuntary, jerking movements of the eyes

Signs of hearing impairment in infancy

lack of startle reflex; absence of reaction to auditory stimuli; absence of well-formed syllables by age 11 mo; general indifference to sound; lack of response to spoken word

Imipramine, 75 mg three times per day, is prescribed for a client. What nursing action is appropriate when this medication is being administered? 1. Telling the client that barbiturates and steroids will not be prescribed 2. Warning the client not to eat cheese, fermented products, and chicken liver 3. Monitoring the client for increased tolerance and reporting when the dosage is no longer effective 4. Having the client checked for increased intraocular pressure and teaching about glaucoma symptoms

Having the client checked for increased IOP and teaching about symptoms of glaucoma. Glaucoma is one of the side effects of imipramine, and the client should be taught about the symptoms.

S/S of increased IOP

Headache or brow pain; N/V; colored halos around lights; sudden blurred vision w decreased light perception

Assessment findings for conducive hearing loss

Hears best in a noisy environment, and otoscopic exam reveals obstruction in the external canal

Education for self-administering eye drops

If more than 1 drug is prescribed, wait 5-10 minutes to prevent 1 drug from washing out or diluting another drug. WASH HANDS, keep container clean, avoid touching tip to eye. Punctal occlusion immediately after instillation prevents systemic absorption of the drug

Causes of conducive hearing loss

Impaction of cerumen, presence of a foreign body, ruptured tympanic membrane

Manifestations of mastoiditis

Swelling behind the ear; cellulitis on the external scalp; tender, enlarged lymph nodes; pain w movement of the head

Wet macular degeneration treatment

management of pts geared toward slowing process and identifying further changes in visual perception. laser therapy to seal leaking blood vessels; ocular injections can improve vision.

Signs of post-op infection from cataract removal

Increasing eye redness, decrease in vision, increase in tears, and photophobia Creamy, white, dry, crusty drainage on eyelids and lashes is normal; yellow or green drainage must be reported

A nurse is teaching a client with a diagnosis of open-angle glaucoma. The nurse explains that the chief aim of treatment is to meet which goal? 1. Rest the eye. 2. Dilate the pupil. 3. Prevent secondary infections. 4. Control the intraocular pressure.

Individuals with glaucoma have increased intraocular pressure that must be returned to the expected range, or blindness will result.

Weber test

Test done by placing the stem of a vibrating tuning fork on the midline of the head and having the patient indicate in which ear the tone can be heard; tests for sensorineural hearing loss

Auditory Brainstem Response (ABR)

measurable responses in the brainstem to a series of acoustic stimuli

Nursing interventions for impaired sensory perception in restorative/continuing care

Maintaining healthy lifestyles, understanding sensory loss, socialization, promoting self-care

Weber test

Test for sensorineural hearing loss; done by placing the stem of a vibrating tuning fork on the midline of the head and having the patient indicate in which ear the tone can be heard

CN IX Glossopharyngeal

Muscles for swallowing. Sensation to posterior 2/3 of tongue and internal surface of tympanic membrane. Taste posterior 1/3 of tongue.

CN X Vagus

Muscles of pharynx and larynx, parasympathetic to neck, thorax, and abdomen, sensory from pharynx, larynx, and viscera, sensory from external ear.

Conjunctivitis treatment

Ophthalmic antibiotics, systemic ABX in some cases, caution use of steroids (may exacerbate viral infections)

A client who just has been diagnosed with primary open-angle glaucoma (POAG) refuses therapy. The nurse reinforces that it is important for the client to seek treatment. Which goal is the nurse trying to achieve? 1. Prevent cataracts 2. Prevent blindness 3. Prevent retinal detachment 4. Prevent blurred distance vision

POAG progresses gradually without symptoms; if untreated, blindness occurs; peripheral vision disappears until tunnel vision occurs in which there is only a small center field; without treatment, eventually all vision is lost.

Caloric testing

Place cool or warm water in the ear and looking for nystagmus. COWS- Cold opposite, Warm same which means that the fast phase of nystagmus is to the opposite side of the cold water

Which refractive error condition is due to a decrease in elasticity of the client's lens? 1. Myopia 2. Hyperopia 3. Presbyopia 4. Astigmatism

Presbyopia is an age-related problem in which the lens loses its elasticity and is less able to change its shape to focus the eye for close work. As a result, images fall behind the retina.

Whisper test

Test in which an examiner whispers a sentence and asks the patient to repeat it to provide general information about the client's hearing ability.

Choroid

middle, vascular layer of the eye, between the retina and the sclera

Limbic system

neural system located below the cerebral hemispheres; associated with emotions and drives

Emmetropia

normal vision

Lantanoprost (Xalatan)

Prostaglandin agonist that is used to treat glaucoma by lowering the IOP in the eyes by dilating the blood vessels in the trabecular mesh of the eye.

A client is admitted with a brain attack (cerebrovascular accident, CVA) with left-sided paralysis. The client leans to the left when placed in a sitting position and fails to respond to stimuli in the left visual field. What should the client's plan of care include? 1. Approaching the client from the left side 2. Keeping the client's head turned to the right 3. Teaching the client to use head movements to scan the left field of vision 4. Arranging the furniture in the client's room so that the door is in the right visual field

The client should be encouraged to make a conscious attempt to turn the head to the left so that the remaining vision can be used to scan the environment and to compensate for the vision lost in the left visual field. The client should be approached from the right side because the left visual field is impaired.

Collaborative (tertiary) interventions for impaired hearing

SURGERY- myringotomy, cochlear implants DRUG TX: antimicrobials, steroidal, analgesic ADAPTIVE METHODS- hearing aids, assistive listening, sign language

Tertiary interventions for impaired vision

SURGERY- visual acuity correction, cataracts, macular degenerative disease DRUG TX- beta-adrenergic prostaglandin analogs, adrenergic agonists, carbonic anhydrase inhibitors, antimicrobial, steroidal, analgesics ADAPTIVE METHODS- eyeglasses, contact lenses, braille, guide dogs

Signs of complications from cataract removal

Sharp, sudden pain in eye; bleeding or increased discharge; lid swelling; decreased vision; flashes of light or floating shapes Avoid activities that might increase IOP

Ectropion

outward turning of the rim of the eyelid

S/S: of a corneal disorder

pain, reduced vision, photophobia, eye secretions, cloudy or purulent fluid may be present on eyelids or lashes

Possible causes of visual impairment

prenatal/postnatal infections; retinopathy of prematurity; trauma; postnatal infections; others: sickle cell disease, juvenile rheumatoid arthritis, Tay-Sachs disease

electrocochleography

process of recording electric activity in the cochlea and the auditory nerve.

Which test helps a primary healthcare provider distinguish between conductive and sensorineural hearing loss? 1. Whisper test 2. Weber test 3. Tympanometry 4. Electrocochleography

Tuning fork tests help in differentiating conductive and sensorineural hearing loss. The Weber test and the Rinne test are two of the most common tuning fork tests performed to make this distinction.

hematoma (black eye)

Use flashlight to check for hemorrhage, apply ice for first 24 hours to reduce swelling if no hemorrhage is present, refer to ophthalmologist if hemorrhage present, have child rest w eyes closed

Causes of external otitis

Use of earrings, earphones, hairsprays

Primary prevention for preventing impaired sensory perception

Use of safety devices (eye protection, hearing protection), silver nitrate in newborn's eyes to prevent infection, proactive management of chronic conditions such as heart disease and diabetes

Visual fields test

Used to determine degree of peripheral vision

Secondary prevention for preventing impaired sensory perception

Vision screenings across the lifespan, hearing tests within 48 hours of birth in the hospital, screening for hearing recommended for all neonates by 1 mo of age (repeated by 3 mo if abnormal)

superior oblique muscle

pulls the eye downward

inferior oblique muscle

pulls the eye upward

electronystagmography (ENG)

recording of eye movements in response to electrical impulses to diagnose balance problems

External otitis media

red, swollen, tender skin; mild itching; reduced hearing; pain w movement of the pinna

A young adult who is unconscious after an accident is brought to the emergency department. The client's pupils are equal and responsive to light. As part of the neurologic assessment, the nurse applies a painful stimulus to the client's left lower leg. Which is an expected response in a healthy adult? 1. Withdrawing the leg 2. Making no movement 3. Plantar flexing the foot 4. Flexing the upper extremities

Withdrawing the leg is an appropriate response. Making no movement may indicate cortical or midbrain compression. Plantar flexion occurs with flexion posturing (decorticate posturing) or extension posturing (decerebrate posturing). Flexing the upper extremities, with leg extension and plantar flexion, indicates dysfunction of the cerebral cortex or lesions of the corticospinal tracts above the brainstem.

trachoma

a chronic conjunctivitis caused by exposure to Chlamydia trachomatis

Myopia (nearsightedness)

a condition resulting from a refractive error in which light rays entering the eye are brought into focus in front of the retina; results in blurred vision of distant objects

Corneal ulcer

a local inflammation of the cornea caused by injury or inflammation

Chalazion

a nodule or cyst, usually on the upper eyelid, caused by obstruction in a sebaceous gland

Hyperopia (farsightedness)

a refractive error in which light rays entering the eye are focused behind the retina; results in the clear vision of distant objects and the blurred vision of close objects.

strabismus

abnormal deviation of the eye; cross-eyed

Photophobia

abnormal intolerance to light

Signs of hearing impairment in children

abnormalities in speech development, learning disabilities

Presbycusis

age related hearing loss

myringotomy

an incision made in the tympanic membrane of the ear that relieves pressure and prevents spontaneous rupture of the eardrum by allowing fluid to escape from the middle ear into the ext auditory canal

First signs of macular degeneration

blurring of reading matter, distortion or loss of central vision, and distortion of vertical lines

Corneal infection

caused by abrasions which allow organisms to enter

astigmatism

caused by unevenness in the cornea and results in visual distortion

Detached retina

caused by vitreous traction on the retina; pt will see frequent flashes of light

Dry macular degeneration treatment

central vision loss reduces ability to read, write, recognize safety hazards, and drive. Suggest alternatives: large print books, public transportation; referrals to community resources that provide adaptive equipment

Trachoma

chronic, contagious form of conjunctivitis that typically leads to blindness

Cataract

clouding and blurring of the lens; opacity makes it difficult to see retina; results in decreased visual acuity No pain or eye redness

Perimetry

common test to screen the visual fields. Indicate when they see flashing light in peripheral vision.

Keratoconus

conical protrusion of the central part of the cornea

CN V Trigeminal

contains 3 branches; pain, temperature and motor innervation for muscles of mastication.

Diplopia

double vision

which way to pull pinna for a child?

down and back

Gonioscopy

examination of the angle of the anterior chamber of the eye to determine ocular motility and rotation and diagnose and manage glaucoma

CN III Oculomotor

eye movement

Symptoms of glaucoma

halos around lights at night, loss of peripheral vision, pain

CN VIII Vestibulocochlear

hearing and balance

Conductive hearing loss

hearing impairment caused by interference with sound or vibratory energy in the external canal, middle ear, or ossicles

Rinne test

hearing test using a tuning fork; checks for differences in bone conduction and air conduction

Presbyopia

impaired vision as a result of aging that causes an inability to focus on near objects

Conjuctivitis

inflammation of the conjunctiva (pink eye)

CN XI Accessory

innervates the sternocleidomastoid and trapezius muscles

CN IV Trochlear

innervates the superior oblique muscle

CN VI Abducens

innervates with the lateral rectus