NURS 5031 Study Guide Sensory Disturbances 

Vision

• Obtain significant subjective and objective assessment data related to the visual system from a patient.
• Subjective: changes in vision, redness, itching, and drainage
• Objective: Discoloration, conjunctiva and sclera color, lens clarity, ptosis, snellen chart, extraocular movements, peripheral vision ability, PERRLA
• Describe the signs and symptoms associated with “ocular emergencies^[b].” 
• Retinal Detachment
• No pain
• Visual changes: “dark curtain or veil unilaterally”
• Risk factors:
• Trauma
• Advanced age (more watery vitreous humor)
• Family hx and cataract surgery
• Distinguish normal from common abnormal findings of a physical assessment of the visual system.
• PERRLA - Pupils equal, round, reactive to light and accommodation
• Link the age-related changes in the visual system to differences in assessment findings.
• If intraocular pressure testing is high - glaucoma? Probably? Idk really
• Visual Acuity Testing with Snellen chart bad - presbyopia (age-related)
• Failed perimetry testing - Macular Degeneration
• As we age:
  • Pupil gets smaller
  • Lens gets more rigid and starts to yellow

    • Presbyopia - age-related change to the lens

    • Decrease in tear production - can cause blurry vision 
      
      

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• Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the visual system.

• Book doesn’t list any nursing responsibilities for these ¯\_(ツ)_/¯
• Compare and contrast the types of refractive errors and appropriate corrections.
• Types of refractive errors:
• Hyperopia - farsightedness - can’t accommodate for near objects
• Eyeball too short
• Myopia - nearsightedness - can’t accommodate for far objects
• Eyeball too long, or cornea/lens refracts too much light
• Presbyopia - loss of accommodation with age, lens less elastic
• Causes inability to focus on objects that are near
• Astigmatism - uneven curve of cornea, weird interactions with light
• Corrections:
• Lenses or glasses correct the way the light contacts the retina to correct for length changes
• Surgical therapy
• Laser - LASIK corrects for myopia and hyperopia + astigmatism by creating a flap in the cornea
• Photorefractive keratectomy - same idea but without the flap in the cornea
• Implant
• Refractive IOLs - For high degrees of myopia and hyperopia, the artificial lens is implanted to correct for refractive errors
• You can also implant a contact lens (phakic IOLs)
• Describe the common causes and assistive measures for severe visual impairment.
• I think this is kind of already covered in the other bullet points for visual problems.
• Discuss nursing measures that promote the health of the eyes.
• Wearing sunglasses, avoiding direct sun exposure
• Good nutrition
• Visual Aid use
• REMOVE RUGS
• Prepare frozen meals
• Audiobooks
• Explain the nursing management of the patient with intraocular and extraocular disorders.
• Intraocular
• Cataracts (opacity in the lens)
• Avoid raising BP after surgery
• Long-term corticosteroid use = higher complications
• Decrease room lighting
• Diabetic Retinopathy
• Blood vessels of the eyes leak fluid, causing edema and ischemia. New blood vessels form, but worsen problem
• Fix: Tight blood sugar control, education
• Central Serous Retinopathy
• Central retina develops a cyst
• Macular Degeneration
• Center of retina degenerates - causing loss of central vision
• Develops with age
• Genetic link between glaucoma and age-related macular degeneration
• Glaucoma
• Mgmt is all about reducing pressure in the eye
• Anti-hypertensive eye drops!
• Peripheral vision reduced

Sensory Disturbances - Hearing

• Obtain significant subjective and objective assessment data related to the auditory system from a patient.
• Subjective:
• Changes in hearing
• Ear pain
• Ear drainage
• Tinnitus
• Objective:
• Alignment and position of ears
• Size, shape, symmetry, color, and skin intact
• External auditory meatus discharge or lesions
• Distinguish normal from common abnormal findings of a physical assessment of the auditory system
• External ear:
• Normal: ears symmetric, auricles nontender, no lesions, auricle and mastoid areas not tender and no nodules
• Abnormal: swelling, redness, lesions, tenderness, nodules
• External auditory anal and tympanum:
• Normal: clear channel, tympanic membrane intact, landmarks and light reflexes intact, cerumen visible, no fluid behind membrane, part of malleus visible through membrane
• Abnormal: impacted cerumen, discharge in canal, retracted eardrum (malleus more horizontal) or bulging eardrum
• Hearing:
• Normal: able to follow conversation or hear low whisper, Rinne test AC>BC
• Abnormal: confusion and lack of understanding
• Link the age-related changes in the auditory system to differences in assessment findings.
• Cerumen becomes drier - muffled sounds
• Tympanic membrane becomes thicker/duller
• Ossicular joints degenerate - decreased hearing ability
• Loss of hair cells - high frequency sound loss
• Presbycusis -> sensorineural loss (can hear, but no understanding due to the loss of high frequency sound
• Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the auditory system.
• This is literally 11 tests long in the book 🤯- but the lecture only mentions the Rinne test so I assume that is what will be tested:
• Rinne Test
• Measures bone conduction (BC) versus air conduction (AC) with a metal tuning fork. Can diagnose Conductive hearing loss versus sensorineural hearing loss
• If AC > BC (Rinne positive) = NORMAL
• If AC > BC, (Rinne positive) but length of time is significantly shorter, its sensorineural loss (presbycusis)
• If BC > AC, (Rinne negative) = conductive hearing loss
• Explain the nursing management of common ear problems.
• Environmental noise control
• Most preventable cause of hearing loss
• Not reversible
• Avoidance of continued exposure to noise levels greater than 70dB is essential
• Promote immunizations (some viruses can cause deafness): measles, mumps, rubella
• Monitor patients who are exposed to ototoxic drugs and stop medication if they thew signs and symptoms
• External otitis: provide moist heat, mild analgesics, and topical anesthetic drops to control the pain (antibiotics for infection, corticosteroids for inflammation)
• Chronic otitis media: administer antibiotics, surgery may be necessary to repair tympanic membrane perforations, teach patient to change cotton ball dressing
• Hearing loss and deafness: use descriptive visual aids, provide ASL interpreter if necessary 
• Describe common medications that can cause hearing loss. 
• Medications that cause tinnitus:
• Antibiotics: erythromycin, vancomycin
• Cancer medications: vincristine
• Diuretics: bumetanide, furosemide
• Quinine medications: malaria
• Certain antidepressants: may worsen tinnitus
• Aspirin: taken in uncontrollably high doses (usually 12 or more a day)
• Compare the causes, management, and rehabilitative potential of conductive and sensorineural hearing loss.
• Sensorineural = presbycusis (age-related)
• Hearing aids may help, but that only makes the sounds louder and not necessarily clearer.
• Not really possible to reverse
• Conductive = impacted cerumen or otitis
• Can manage and treat the underlying causes (remove cerumen or reduce ear inflammation)