Chap. 63- Patients With Eye and Vision Disorders and ati sensory perception

Following an ophthalmologic exam, an anxious client asks the nurse, "How serious is a refraction error?" Which of the following is the best response from the nurse? -"It means corrective lenses are required." -"It is nothing serious." -"Simple surgery can fix this problem." -"This is normal for anyone your age."

"It means corrective lenses are required."

hypoguesia

A decreased ability to taste.

A major role for nursing in the management of glaucoma is health education. Which of the following is the most important teaching point that the nurse should advise the patient of? - Keep a record of eye pressure measurements. -Participate in the decision-making process. -Adhere to the medication regimen. -Keep all follow-up appointments.

Adhere to the medication regimen.

presbyopia

Age-related farsightedness, or a gradual decrease in the ability to clearly see nearby caused by the loss of flexibility of the lens of the eye.

presbycusis

Age-related hearing loss is known as presbycusis and occurs gradually. Presbycusis is usually bilateral and is estimated to occur in half of all adults over 75 years of age.

aphasia

Aphasia is a disorder that affects a client's ability to articulate and understand speech and written language. Aphasia can occur suddenly or appear slowly over time and is caused by damage to the part of the brain that controls language. This damage can be caused by a brain injury, degenerative neurological disorders, dementia, or a cerebrovascular accident (CVA) or stroke.

The nurse is explaining metastatic rhabdomyosarcoma to a group of parents with children diagnosed with the disease. The most common site of metastasis in clients diagnosed with rhabdomyosarcoma is the: -brain. -lymph nodes. -bone. -lung.

Lung

Which is the most common cause of visual loss in people older than 60 years of age? -Retinal detachment -Macular degeneration -Cataracts -Glaucoma

Macular degeneration

macular degeneration

Macular degeneration affects the macula, which is the small, central portion of the retina. As the name implies, degeneration of the macula leads to a loss of central vision as clients age. In the U.S., macular degeneration is the number one cause of vision loss and blindness for clients over 65 years of age. Macular degeneration blurs the sharp central vision making driving, reading, and perhaps seeing facial features difficult. It is an irreversible disorder and its cause is not known, although genetics and environmental factors play a role in its development.

During an intial assessment, the nurse notes a symptom of a mild case of bacterial conjunctivitis and documents in the electronic medical record that the client is displaying which of the following ? -Mucopurulent ocular discharge -Elevated intraocular pressure -Severe pain -Blurred vision

Mucopurulent ocular discharge Bacterial conjunctivitis manifests with an acute onset of redness, burning, and discharge. There is papillary formation, conjunctival irritation, and injection in the fornices. The exudates are variable but are usually present on waking in the morning. The eyes may be difficult to open because of adhesions caused by the exudate. Purulent discharge occurs in severe acute bacterial infections, whereas mucopurulent discharge appears in mild cases.

To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treat inflammatory conditions of the eyes? Miotics NSAIDs Mydriatics Cycloplegics

NSAIDs : NSAIDs are used as an alternative in controlling inflammatory eye conditions and postoperatively to reduce inflammation. Miotics are used to cause the pupil to constrict. Mydriatics cause the pupil to dilate. Cycloplegics cause paralysis of the iris sphincter.

medication affects on sensory

NSAIDs can affect hearing and taste. Antibiotics can affect hearing, smell, and taste Loop diuretics can affect hearing. Antihypertensives can affect taste. Psychotropics can affect taste. Antihistamines can affect hearing, sight, smell, and taste. Aspirin can affect hearing.

To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treating inflammatory conditions of the eyes? -Nonsteroidal anti-inflammatory drugs (NSAIDs) -Mioticss -Mydriatics -Cycloplegics

Nonsteroidal anti-inflammatory drugs (NSAIDs)

otitis media

Otitis media is inflammation in or the accumulation of fluid in the middle ear and can result in conductive hearing loss. In most cases, conductive hearing loss is treatable with interventions like antibiotics, anti-inflammatory medications, or surgery.

Nursing students are reviewing information about the causes associated with low vision and blindness. The students demonstrate a need for additional review when they identify which of the following as a common cause in older adults? Macular degeneration Diabetic retinopathy Glaucoma Presbyopia

Presbyopia refers to the loss of accommodative power in the lens with age. It is not a common cause of low vision and blindness. The most common causes of low vision and blindness among adults 40 years and older are diabetic retinopathy, macular degeneration, glaucoma, and cataracts.

The nurse is reviewing the medical record of a client with glaucoma. Which of the following would alert the nurse to suspect that the client was at increased risk for this disorder? -Age younger than 40 years -Hyperopia since age 20 years -History of respitatory disease -Prolonged use of corticosteroids

Prolonged use of corticosteroids

The nurse is caring for a client ordered for multiple eye screening. Following which procedure will the nurse instruct the client on a yellow coloring to the skin and urine as being normal? -Retinal Imaging -Retinal Angiography -Retinoscopy -Ultrasonography

Retinal Angiography

Which of the following surgical procedures involves taking a piece of silicone plastic or sponge and sewing it onto the sclera at the site of a retinal tear? -Scleral buckle -Pneumatic retinopexy -Phacoemulsification -Pars plana vitrectomy

Scleral buckle The scleral buckle is a procedure in which a piece of silicone plastic or sponge is sewn onto the sclera at the site of the retinal tear. The buckle holds the retina against the sclera until scarring seals the tear. The other surgeries do not use this type of procedure.

When the patient tells the nurse that his vision is 20/200, and asks what that means, the nurse informs the patient that a person with 20/200 vision: -Sees an object from 20 feet away that a person with normal vision sees from 20 feet away. -Sees an object from 200 feet away that a person with normal vision sees from 200 feet away. -Sees an object from 200 feet away that a person with normal vision sees from 20 feet away. -Sees an object from 20 feet away that a person with normal vision sees from 200 feet away.

Sees an object from 20 feet away that a person with normal vision sees from 200 feet away.

tactile defensiveness

Severe sensitivity to touch that most people would find acceptable is known as tactile defensiveness. Clients who have tactile defensiveness often experience physical pain with otherwise nonpainful tactile stimuli, such as a hug, wearing clothing, or the feel of the wind on their skin. These clients tend to avoid touch as much as possible and withdrawal from tactile stimuli. It is also possible for a client to be under responsive to tactile stimulation. A client who has tactile hyposensitivity may not be able to feel extremes in temperature or have a limited ability to feel pain from bone fractures or lacerations. These clients may seek out tactile stimulation by frequently touching objects in their environment.

gustatory cells

Taste cells that contain specific receptors that allow for differentiation between sweet, sour, bitter, salty, or savory flavors.

A client accidentally splashes chemicals into one eye. The nurse knows that eye irrigation with plain tap water should begin immediately and continue for 15 to 20 minutes. What is the primary purpose of this first aid treatment? To hasten formation of scar tissue To prevent vision loss To eliminate the need for medical care To serve as a stopgap measure until help arrives

To prevent vision loss Prolonged eye irrigation after a chemical burn is the most effective way to prevent formation of permanent scar tissue and thus help prevent vision loss. After a potentially serious eye injury, the victim should always seek medical care. Eye irrigation isn't considered a stopgap measure.

auditory brainstem response (ABR) test, or the brain audio-evoked response (BAER) test

monitors the brain's response to sound. During this test, small electrodes are placed on the scalp to measure the brain's electrical activity in response to the sound of clicking noises.

A nurse is performing an eye examination. Which question would NOT be included in the examination? -"Are you able to raise both eyebrows?" -Have you experienced blurred, double, or distorted vision?" -"What medications are you taking?" -"Do any family members have any eye conditions?"

"Are you able to raise both eyebrows?"

Following an ophthalmologic exam, an anxious client asks the nurse, "How serious is a refraction error?" Which of the following is the best response from the nurse? "It is nothing serious." "It means corrective lenses are required." "Simple surgery can fix this problem." "This is normal for anyone your age."

"It means corrective lenses are required." : Refractive errors can be corrected with glasses or contact lenses. Telling a client that "nothing is serious" does not provide the necessary information to help alleviate fears. The word surgery can increase fears. If the refractive error is associated with aging, this is a normal finding but does not provide information about the condition.

Which client statement would lead the nurse to suspect that the client is experiencing bacterial conjunctivitis? -"My eyes hurt when I'm in the bright sunlight." -"It feels like there is something stuck in my eye." -"My eyes feel like they are on fire." -"My eyelids were stuck together this morning."

"My eyelids were stuck together this morning."

The nurse is giving a visual field examination to a 55-year-old male client. The client asks what this test is for. What would be the nurse's best answer? -"This test measures visual acuity." -"This test measures how well your eyes move." -"This test is to see how well your eyes are aging." -"This test measures peripheral vision and detects gaps in the visual field."

"This test measures peripheral vision and detects gaps in the visual field."

When assessing the pressure of the anterior chamber of the eye, a nurse normally expects to find a pressure of: -20 to 30 mm Hg. -10 to 20 mm Hg. -5 to 10 mm Hg. -over 30 mm Hg.

10 to 20 mm Hg.

A nurse practitioner examines a patient and documents a best corrected visual acuity (BCVA) ratio in his better eye that qualifies him for government financial assistance based on the definition of legal blindness. What is that ratio? -20/160 -20/200 -20/140 -20/120

20/200

When undergoing testing of visual acuity with a Snellen chart, the client can read the line labeled 20/50 but misses three letters on the line. The nurse documents this finding as which of the following? -20/20/50 -20/50 -20/50-3 -20/20 + 30

20/50-3

cateract

A cataract is a clouding of the lens of the eye that causes the client's vision to be blurry, hazy, or less colorful. Cataracts develop slowly and may occur in one or both eyes. Clients who have cataracts may have trouble reading, driving, or performing activities of daily living. Cataracts can be caused by previous eye surgeries, chronic diseases such as diabetes mellitus, and most commonly, older age. By age 75, approximately half of all Americans have cataracts.

tactile hyposensitivity

A client who has tactile hyposensitivity may not be able to feel extremes in temperature or have a limited ability to feel pain from bone fractures or lacerations. These clients may seek out tactile stimulation by frequently touching objects in their environment.

astigmatism

A defect in the eye making objects nearby and faraway look blurry or distorted.

phantom taste perception

A persistent, foul taste when the mouth is empty.

The nurse admits a client to the emergency department who has been referred by the eye clinic. Which condition is an emergency where the nurse should refer the client for medical treatment immediately? -Blepharitis -Hordeolum -Acute angle-closure glaucoma -Chalazion

Acute angle-closure glaucoma Acute angle-closure glaucoma results in rapid progressive visual impairment. Normal tension glaucoma is treated with topical medication. Ocular hypertension is treated with topical medication. Chronic open-angle glaucoma is treated initially with topical medications, with oral medications added later.

On ocular examination, the health care provider notes severely elevated IOP, corneal edema, and a pupil that is fixed in a semi-dilated position. The nurse knows that these clinical signs are diagnostic of the type of glaucoma known as: -Acute angle-closure. -Normal tension. -Chronic angle-closure. -Chronic open-angle.

Acute angle-closure.

Glaucoma

Another eye disease that can cause loss of vision is glaucoma. Glaucoma is an increase in intraocular pressure due to the buildup of fluid, or aqueous humor, that causes compression of the optic nerve. One of the first manifestations of glaucoma is the loss of peripheral vision. This loss of vision can progress to include the entire visual field, leading to blindness. Loss of vision due to glaucoma is irreversible; however, progression of vision loss can be slowed or prevented with early detection and treatment. Therefore, it is important for clients to have an annual comprehensive eye exam. Severe headache, eye pain, and blurred vision are considered emergent manifestations that require immediate medical treatment.

Which feature should a nurse observe during an ophthalmic assessment? -Internal eye function -Intraocular pressure -Appearance of the external eye -Visual acuity

Appearance of the external eye

A client who is blind is awaiting elective surgery. What should the nurse do to promote this client's control over their hospital environment? -Ask the client where to store his or her self-care items. -Arrange the meal tray in a way that is easiest for the nurse to assist the client. -Keep personal care items where the nurse knows their location. -Open all containers without prompting to be helpful.

Ask the client where to store his or her self-care items.

A nurse instructs a client to refrain from blinking after administering eye drops based on which rationale? Blinking keeps substances from entering the eye. Blinking causes the eye drop to be expelled from the conjunctival sac. Blinking limits the size of the conjunctival sac for the needed amount of eye drop. Blinking slows absorption of the instilled eye drops.

Blinking causes the eye drop to be expelled from the conjunctival sac. Blinking expels an instilled eye drop from the conjunctival sac, which interferes with the efficacy of the medication. Blood-ocular barriers keep foreign substances from entering the eye. The size of the conjunctival sac does change with blinking. It can hold only 50 uL.

diabetic retinopathy

Clients who have diabetes mellitus can experience damage to the blood vessels of retina, leading to blood leaking from the vessels. This condition is known as diabetic retinopathy and is the most common cause of impaired vision and blindness during adulthood. Diabetic retinopathy usually occurs in both eyes and is asymptomatic in its early stages. As it progresses, manifestations include seeing spots or floaters, and blurred vision. Over time, diabetic retinopathy can lead to blindness. A client can sometimes slow the progression of the disease if they maintain good control of their blood glucose level, blood pressure, and cholesterol level. Clients with diabetes should have an annual eye exam to monitor for diabetic retinopathy.

Comprehensive aphasia

Comprehensive aphasia, also called Wernicke's or fluent aphasia, is caused by damage to the temporal lobe of the brain. A client who has Wernicke's aphasia speaks in long sentences that have no meaning and often include unnecessary and made-up words. Wernicke's aphasia also causes a client to not understand what is being said and they are unable to comprehend that others can't understand what they are saying.

expressive aphasia

Expressive aphasia is also known as Broca's or nonfluent aphasia and is due to damage to the frontal lobe of the brain. A client who has Broca's aphasia may understand speech but be unable to speak the words they want to say. The client may speak in short phrases that the listener can understand, such as "hungry now". Clients who have expressive aphasia are often easily frustrated as they are aware of their speech difficulty.

What should the nurse recommend to a client with blepharitis? frequent washing of the face and hair warm soaks of the area incision and drainage sleeping with the face parallel to the floor

Frequent washing of the face and hair Frequent washing of the face and hair is recommended in a client with blepharitis because seborrhea or excessive oiliness of the skin of the face and scalp is associated with blepharitis. Warm soaks would be included for treatment of a sty. There is no benefit to sleeping with the face parallel to the floor.

The nurse should monitor for which manifestation in a client who has had LASIK surgery? -Excessive tearing -Cataract formation -Halos and glare -Stye formation

Halos and glare Symptoms of central islands and decentered ablations can occur after LASIK surgery; these include monocular diplopia or ghost images, halos, glare, and decreased visual acuity. These procedures do not cause excessive tearing or result in cataract or stye formation.

tinnitus

Hearing sound when no external sound is present, such as ringing, buzzing, roaring, clicking, hissing, or humming noises.

Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry red in color? -Milia -Molluscum contagiosum -Hemangioma -Xanthelasma

Hemangioma Hemangiomas are vascular capillary tumors that may be bright, superficial, strawberry-red lesions or bluish and purplish deeper lesions. Milia are small, white, slightly elevated cysts of the eyelid that may occur in multiples. Xanthelasma are yellowish, lipoid deposits on both lids near the inner angle of the eye that commonly appear as a result of skin aging or a lipid disorder. Molluscum contagiosum lesions are flat, symmetric growths along the lid margin caused by a virus that can result in conjunctivitis and keratitis if the lesion grows into the conjunctival sac.

A client has undergone enucleation. What complication of enucleation should be addressed by the nurse? -Hypotension -Nausea & Vomiting -Hemorrhage -Pueumonia

Hemorrhage

The nurse is obtaining a visual history from a client who has noted an increase in glare and changes in color perception. Which assessment would the nurse anticipate to confirm a definitive diagnosis? -Identification of opacities on the lens -Identification of white circle around the cornea -Identification of redness of the sclera -Identification of yellowish aging spot on the retina

Identification of opacities on the lens

myopia

Inability to see faraway objects clearly, also referred to as nearsightedness.

hyperopia

Inability to see nearby objects clearly, also referred to as farsightedness.

The client with chronic open-angle glaucoma is receiving timolol (Timoptic) eye drops. Which evaluation finding would indicate to the nurse the treatment is working? -Decrease in nausea and vomiting -Reduced peripheral vision -Intraocular pressure 15 mm Hg -Halos around lights

Intraocular pressure 15 mm Hg Timolol is a beta-blocker that is used topically to decrease the flow rate of aqueous humor in the eye. As flow rate decreases, the intraocular pressure decreases. IOP of 12 to 21 mm Hg is within normal range. Reduced peripheral vision, halos around lights, and blurred vision are all symptoms of open-angle glaucoma. Nausea and vomiting are more likely to occur with acute angle-closure glaucoma.

A client presents to the ED reporting a chemical burn to both eyes. Which is the priority nursing intervention? -Obtain the Material Safety Data Sheet (MSDS). -Assess the pH of the corneal surface. -Assess visual acuity. -Irrigate both eyes.

Irrigate both eyes.

A nurse conducted a history and physical for a newly admitted patient who states, "My arms are too short. I have to hold my book at a distance to read." The nurse knows that the patient is most likely experiencing: -Loss of accommodative power in the lens. -Opacity in the lens -Shrinkage of the vitreous body -Decreased eye muscle tone

Loss of accommodative power in the lens.

A nurse is teaching a client about medications for glaucoma. What is the main marker of glaucoma control with medication? Changing the opacity of the lens Lowering intraocular pressure to target pressure Reducing the appearance of optic nerve head Increasing the visual field

Lowering intraocular pressure to target pressure The main marker of the efficacy of the medication in glaucoma control is lowering of the intraocular pressure to the target pressure. Opacity of the lenses relates to cataract formation. The appearance of the optic nerve head and the visual field are not goals with glaucoma medication.

The nurse is performing an assessment of the visual fields for a patient with glaucoma. When assessing the visual fields in acute glaucoma, what would the nurse expect to find? Clear cornea Constricted pupil Marked blurring of vision Watery ocular discharge

Marked blurring of vision Glaucoma is often called the "silent thief of sight" because most patients are unaware that they have the disease until they have experienced visual changes and vision loss. The patient may not seek health care until he or she experiences blurred vision or "halos" around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around the eyes, and headache.

The nurse is assisting the eye surgeon in completing an examination of the eye. Which piece of equipment would the nurse provide to the physician to examine the optic disc under magnification? -Ophthalmoscope -Tonometer -Amsler grid -Retinoscope

Ophthalmoscope

A nurse is reviewing the medical records of several patients who have had their intraocular pressure (IOP) measured: Patient A: IOP 12 mm Hg Patient B: IOP 15 mm Hg Patient C: IOP 21 mm Hg Patient D: IOP 24 mm Hg Which patient would the nurse identify as having increased IOP suggesting glaucoma?

Patient D : When IOP is in balance, the pressure ranges from 10 to 21 mm Hg. Increased IOP greater than 21 mm Hg suggests glaucoma.

The nurse is preparing to administer medication to a client who has been diagnosed with glaucoma. Which information should the nurse include related to client teaching for each of the identified medications? Complete the following table by choosing from the list of options. Medication Client Teaching Pilocarpine Timolol maleate Acetazolamide

Pilocarpine "Use safety measures in dim lighting." Timolol maleate "It can cause hypotension." Acetazolamide "have your electrolyts checked" Pilocarpine can cause poor vision in dimly lit areas; therefore, the nurse should include appropriate instructions to the client to maintain safety. Timolol can cause hypotension and is contraindicated in clients who have asthma, chronic obstructive pulmonary disease (COPD), and/or heart failure/heart block. The client should have their serum electrolytes monitored because acetazolamide can lead to metabolic disturbances. Pilocarpine does not have to be refrigerated and can remain at room temperature for up to 8 weeks and then discarded. Pilocarpine causes vasodilation, not vasoconstriction. Timolol does not lead to dry mouth or an increase in heart rate. It can lead to bradycardia. Acetazolamide can lead to weight loss, not weight gain, and is not associated with the development of heart failure.

Which is an accurate statement regarding refractive surgery? -Refractive surgery may be performed on all clients, even if they have underlying health conditions. -Refractive surgery is an elective cosmetic surgery performed to reshape the cornea. -Refractive surgery will alter the normal aging of the eye. -Refractive surgery may be performed on clients with an abnormal corneal structure as long as they have a stable refractive error.

Refractive surgery is an elective cosmetic surgery performed to reshape the cornea.

obotoxicity

Some medications have the adverse effect of ototoxicity by causing damage to or dysfunction of the cochlea or vestibule. Ototoxicity can cause SNHL, tinnitus, dizziness, or impaired balance. The risk for ototoxicity is increased when a client takes more than one type of these medications concurrently.

ageusia

The inability to taste anything.A client who experiences a persistent salty, rancid, or metallic taste is said to have dysgeusia.

olofactory sensory neurons

There is a small patch of tissue inside the nose that stores the olfactory sensory neurons, which creates our ability to smell. Olfactory neurons are connected directly to the brain and each one has an odor receptor. Substances in the environment stimulate the odor receptor and send a message to the brain where the smell is identified. There are two pathways in which smells can reach the olfactory neurons: directly through the nares and via the opening between the roof of the throat and the nose.

conductive hearing loss

When sounds are not able to travel from the outer ear to the eardrum and middle ear, a client is diagnosed with conductive hearing loss. Common causes of conductive hearing loss include ear trauma, inflammation, cerumen impaction, perforated eardrum, or blockage by foreign body.

A client is discussing an audiometer test with a client. Which of the following statements should the nurse make? A"This test measures the brain's electrical response to sounds." B"You will wear headphones during the test." C"You will be asleep during the test." D"A small probe in your ear will measure the echoed response from your inner ear."

You will wear headphones during the test.

smell disorders

anosmia=inability to small. Hyposmia is the reduction in the ability to perceive odor parosmia, or an alteration in odor perception. A client who has parosmia may experience a distortion in smells, or previously pleasant smells become unpleasant. phantosmia is a disorder where a nonexistent smell is perceived.

otoacoustic emissions (OAE) test

assesses the response of the inner ear to sound waves. A small probe is placed into the auditory canal. A series of sounds are sent into the ear and the probe monitors the returning echo. Lack of an echoed response indicates the need for further testing

Eye exam should be done when?

child w/o vision problems and no family history should have an eye exam every one to two years until adulthood. Adults without vision problems should have an eye exam everyone to two years until age 65, when annual exams are recommended. An annual comprehensive eye exam is recommended for clients of all ages who have vision problems, eye disease, or a chronic illness that can affect vision

cateracts tests

clouding on the lens can be seen To diagnosis glaucoma a client undergoes a detailed eye exam that includes dilating the pupils with medicated eye drops and examining the optic nerve with a slit lamp. The eye care provider will also measure the intraocular pressure. Other tests used to assess for glaucoma include assessing the angle between the iris and the cornea and a visual field test that assess peripheral vision. Lastly, the eye care provider will measure the thickness of the cornea.

bone oscullator test

determines how effectively vibrations are transmitted through the ossicles. The test is performed by placing a bone oscillator against the client's mastoid bone and monitoring the response of the auditory nerve to the vibrations.

macular degeneration tests

dilated eye exam to allow the eye care provider to assess for the presence of drusen, or small yellowish deposits of protein and lipids under the retina. The provider will also look at the macula for evidence of color change. An Amsler grid test may also be performed. The client is shown a grid made of lines, like graph paper, and asked if the lines look straight or wavy, or if any section of the grid is missing. Additional diagnostic tests include fluorescein angiography, and specialized photography using infrared light waves.

electromyography (EMG)

electromyography (EMG) may be performed to determine if there is damage to the nerves leading to the muscles. During an EMG, very small needles are inserted into a muscle. The needles are attached by a wire to the EMG machine that records the electrical activity in the muscle. Damage to a nerve will alter this electrical activity.

A client suffered trauma to the sclera and is being treated for a subsequent infection. During client education, the nurse indicates where the sclera is attached. Which structure would not be included? eyelids cornea iris pupil

eyelids The sclera does not attach to the eyelids. The sclera protects structures in the eye, and connects directly to the cornea, anterior chamber, iris, and pupil

fluorescein angiography,

fluorescein angiography, where dye is injected into a peripheral vein, then photos are taken of the vessels in the eye as the dye flows through them.

global aphasia

global aphasia, which causes severe impairments in communication. Global aphasia is caused by significant damage to various language areas of the brain. Clients who have this type of aphasia have poor comprehension of language and may be unable to form words or sentences. expressive aphasia comprehensive aphasia global aphasia

Rinne test

helps determine if hearing loss is due to an issue with bone conduction or with the air conduction of sound via the auditory canal. The test is performed with a tuning fork that is vibrated and placed against the mastoid bone, and the client is asked to identify when they are unable to hear the sound. The tuning fork is then moved 1 to 2 cm away from the ear and the client indicates if they can still hear the sound.

Diabetic Neuropathies

is nerve damage that occurs in clients who have diabetes mellitus. Diabetic neuropathy occurs over time from high blood glucose levels and high levels of triglycerides in the blood, which can cause damage to the nerves and to the small blood vessels supplying blood to the nerves.

sensorineural hearing loss

is the most prevalent type of hearing loss. SNHL is hearing loss that occurs from problems either in the inner ear or on the vestibulocochlear (auditory) nerve (cranial nerve VIII). SNHL can occur in newborns due to a chromosomal abnormality, such as Down syndrome, or from a congenital infection like cytomegalovirus, herpes simplex, or syphilis. Noise-induced SNHL has become more prevalent among adolescents and young adults from prolonged exposure to loud music and an increased use of headphones and ear buds. Noise-induced SNHL in adults can occur due to job-related exposure to loud noises over a long period of time. Other causes of SNHL include trauma to the ear, heart disease, diabetes mellitus, meningitis, measles, and tumors on the vestibulocochlear nerve.

Refraction assessment

looks at the back of the eye as the light passes through the cornea and lens. If the light fails to focus correctly, then the client likely needs corrective glasses, contact lenses, or even refractive surgery. The refraction assessment is performed on each eye using either a computerized refractometer, or via a manual assessment using lenses of various prescription strengths.

Snellen chart

measures how accurately the client can read lines of letters of various sizes. The client sits or stands 20 feet away from the chart and, with both eyes open, reads the smallest line of letters they can see. The client then covers one eye at a time, reading the smallest line of letters they can see with each individual eye. When a client reads the line of letters marked 20/20 it means they can see what the average person sees on the chart when they are 20 feet away. If a client wears glasses or contacts, visual acuity testing should be performed both with and without their corrective lenses.

idiopathic neuropathy

neuropathy due to nerve damage of an unknown cause

peripheral neuropathy

occurs following damage to or malfunction of a peripheral nerve. Peripheral neuropathy most often affects the feet and hands, but it can occur in other parts of the body. Manifestations include weakness, numbness, burning, tingling, pain, inability to detect temperature, and hyporeflexia. Two other types of neuropathy include idiopathic neuropathy and diabetic neuropathy.

A client has developed diabetic retinopathy and is seeing the physician regularly to prevent further loss of sight. From where do the nerve cells of the retina extend? optic nerve oculomotor nerve trochlear nerve trigeminal nerve

optic nerve The nerve cells of the retina extend from the optic nerve.

The nurse realizes that a client understands how to correctly instill ophthalmic medications when the client: pulls the tissue near the cheek downward to instill medication. wipes the lids and lashes prior to instillation in a direction toward the nose with moistened, soft gauze. allows the tip of the container to touch the eyelid while administering the medication. rubs the eye after administering medication.

pulls the tissue near the cheek downward to instill medication. Explanation: Pull the cheek downward to form a sack in the lower lid. Instill the drops into the conjunctival pocket. The lid and lashes would be wiped in a direction away from the nose to avoid contamination. The tip of the container will be contaminated if it touches eye or eyelid. Do not rub the eye because it may irritate the eye.

three types of hearing loss:

sensorineural, conductive, and mixed loss.

Tactile Hypersensitivity

tactile hypersensitivity has a peripheral and/or central nervous system that is overly sensitive to sensory input, specifically tactile stimuli. The client may be unable to wear clothing that has a zipper or a shirt that has long sleeves.

otosclerosis

the abnormal growth of bone in the middle ear. This condition begins gradually in one or both ears, usually in early to mid-adulthood, and occurs more frequently in women. Mixed hearing loss occurs when a client experiences both SNHL and conductive hearing loss at the same time.

audiometer test

the most common hearing test performed to assess hearing. During an audiometer test, a client wears earphones and various sounds at different decibel levels are played in each ear. The client identifies when they can hear each sound.