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8/6/2019 Nursing Care of Patients With Sensorineural Disorders
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M. Tayseer (2008)
International Academy for Health Sciences International Academy for Health Sciences
Al Ahsa·a Male Academy Al Ahsa·a Male Academy
Nursing Care of PatientsNursing Care of Patients
with Sensorineural with SensorineuralDisordersDisorders
P repared By:P repared By:
Nursing Department Nursing Department
8/6/2019 Nursing Care of Patients With Sensorineural Disorders
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M. Tayseer (2008)
The special Senses The special Senses
Sight.Sight.
Hearing.Hearing. SmellSmell
Taste. Taste.
Balance.Balance.
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M. Tayseer (2008)
Definitions continuedDefinitions continued
Myopia (nearsighted)Myopia (nearsighted) ± ± can see objects closely; distant objectscan see objects closely; distant objectsblurred; image f ocuses in front of retinablurred; image f ocuses in front of retina
Hyperopia (farsighted)Hyperopia (farsighted) ± ±
distant objects cleardistant objects clear ± ±
near onesnear onesblurred; image behind retinablurred; image behind retina
Astigmatism Astigmatism ± ± unevenness iin corneaunevenness iin cornea ± ± vision distorted vision distorted ± ± cancanby myopic or hyperopicby myopic or hyperopic
�� PresbyopiaPresbyopia ± ± f orm of hyperopiaf orm of hyperopia ± ± aging aging ± ± lens less elastic; ey elens less elastic; ey ecancan¶¶t accommodate f or neart accommodate f or near
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M. Tayseer (2008)
External StructuresExternal Structures
Ey ebrow s, ey elashes, ey elids, bony orbit and fat pads all protectEy ebrow s, ey elashes, ey elids, bony orbit and fat pads all protectey eey e
Blinking Blinking ± ± tears distribution/controls lighttears distribution/controls light
Muscles innervated by CN VII facial nerveMuscles innervated by CN VII facial nerve ConjunctivaConjunctiva ± ± transparent mucous membranetransparent mucous membrane ± ± f orms pocketf orms pocket
under ey elidunder ey elid
ScleraSclera ± ± collagencollagen ³³ w hite w hite´́ ey eey e ± ± protectsprotects ± ± y ellow ish w ith age duey ellow ish w ith age dueto lipid deposits or blue due to thinning (also in infant)to lipid deposits or blue due to thinning (also in infant) ± ± dark dark
pigmentedpigmented CorneaCornea ± ± allow s light entry allow s light entry ± ± Trigeminal nerve (CN V) Trigeminal nerve (CN V)
innervates; avascularinnervates; avascular ± ± OO22 from tear film; from tear film; norm=clear,transparent and shiny norm=clear,transparent and shiny
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M. Tayseer (2008)
Lacrimal apparatusLacrimal apparatus ± ± gland and ductsgland and ducts
Pro vides tears to moisten ey e and pro vide OPro vides tears to moisten ey e and pro vide O22to coroneato coronea
Extraocular musclesExtraocular muscles ± ± 3 3 pairs; ey es mo ve inpairs; ey es mo ve insame direction (conjugate mo vement)same direction (conjugate mo vement)
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M. Tayseer (2008)
External StructuresExternal Structures
IrisIris ± ± pro vides ey epro vides ey e¶¶s colors color ± ± can be diff in somecan be diff in some
Pupil constricts from muscles innervated by CN IIIPupil constricts from muscles innervated by CN III ± ±dilate via CN V dilate via CN V
Pupil size affected by ANSPupil size affected by ANS
SNSSNS ± ± dilatesdilates
PNSPNS ± ± constrictsconstricts
Cry stalline lensCry stalline lens ± ± behind irisbehind iris ± ± bends light ray sbends light ray s
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M. Tayseer (2008)
A ssessment A ssessment
Health History Health History ± ± ocular/nonocularocular/nonocular
Question re sy stemic disease, STD, Diabetes,Question re sy stemic disease, STD, Diabetes,HTN, C A, R A, AIDS, MS, MD,MGHTN, C A, R A, AIDS, MS, MD,MG
Thy roid diseases Thy roid diseases
Meds: Beta blockersMeds: Beta blockers ± ± tx glaucoma,tx glaucoma,corticosteroids, OTCcorticosteroids, OTC
Visual acuity tests Visual acuity tests ± ± hx strabismus, amblyopia,hx strabismus, amblyopia,cataracts, glaucoma, retinalcataracts, glaucoma, retinal
Surgery and hx head injury Surgery and hx head injury
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M. Tayseer (2008)
Physical ExaminationPhysical Examination
Inspect ocular structureInspect ocular structure
Judge ability to judge closeness/distance Judge ability to judge closeness/distance
Extraocular muscle f xExtraocular muscle f x
Visual fields Visual fields Pupil f x Pupil f x ± ± anisocoria (not =)anisocoria (not =)
IOP w ith TonoIOP w ith Tono--penpen
Depth perceptionDepth perception
Visual A
cuity Visual A
cuity ± ±
Snellen chartSnellen chart Slit lampSlit lamp-- brightly illuminatesbrightly illuminates
OpthalmoscopeOpthalmoscope ± ± bl/vessels and optic discbl/vessels and optic disc ± ± red reflex w illred reflex w illdecrease w ith cataractsdecrease w ith cataracts ± ± look f or nicks/narrow ing look f or nicks/narrow ing
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M. Tayseer (2008)
Structures and FunctionsStructures and Functions
A
uditory System A
uditory System External earExternal ear ± ± auricle ( pinna) external auditory canalauricle ( pinna) external auditory canal
Auricle Auricle ± ± cartilage/connective tissuecartilage/connective tissue
Auditory canal Auditory canal ± ± S shapedS shaped ± ± 11´́ long long
Lined w ith fine hairs and sebaceous glands plusLined w ith fine hairs and sebaceous glands plusceruminous ( w ax ) glandsceruminous ( w ax ) glands
Fx Fx ± ± keep free of debris/bacteriakeep free of debris/bacteria
Ty mpanic membrane (eardrum) Ty mpanic membrane (eardrum) ± ± receive sound w avesreceive sound w avesfrom the external ear/canal; separates external auditory from the external ear/canal; separates external auditory canal from earcanal from ear
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M. Tayseer (2008)
Middle EarMiddle Ear
Continuous from nasal phary nx via eustachian tube by mucucousContinuous from nasal phary nx via eustachian tube by mucucousmembranesmembranes
Cavity is an aiir space in temporal boneCavity is an aiir space in temporal bone
3 3 tiny bo
nes: maleeus, incus and stap
es ( o
ssicular chain)tiny bo
nes: maleeus, incus and stap
es ( o
ssicular chain) ± ± vibrations from the ty mpanic membr. Cause fluid in inner ear to vibrations from the ty mpanic membr. Cause fluid in inner ear to mo ve and stimulate receptors hearing mo ve and stimulate receptors hearing
Cavity filled w ith arCavity filled w ith ar ± ± atmospheric pressure equalizes during atmospheric pressure equalizes during s w allow ing/y a w ning s w allow ing/y a w ning
CN VII (facial nerve) crosses o ver middle earCN VII (facial nerve) crosses o ver middle ear Can be damaged by trauma, skull f x, infectionsCan be damaged by trauma, skull f x, infections
Air conduction Air conduction ± ± problems in mid ear cause hearing lossproblems in mid ear cause hearing loss
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M. Tayseer (2008)
Inner EarInner Ear
CochleaCochlea ± ± organ of Corti = pitch soundsorgan of Corti = pitch sounds
Vestibulocochlear nerve (CN VIII) sends sound Vestibulocochlear nerve (CN VIII) sends soundto brain to process/interpretto brain to process/interpret
Nerv ous stimuli by vestibular portio of VIIINerv ous stimuli by vestibular portio of VIII
Patholog y sensorineural hearing lossPatholog y sensorineural hearing loss(sensitivity to high(sensitivity to high--pitched tones)pitched tones)
Central hearing loss= difficulty in understanding Central hearing loss= difficulty in understanding the meaning of words heardthe meaning of words heard
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M. Tayseer (2008)
A ssessment A ssessment
Vestibular sy stem included since so close Vestibular sy stem included since so close
Health history Health history
? Childhood infections: otitis media? Childhood infections: otitis media
surgery : my ring otomy surgery : my ring otomy perf orated eardrumperf orated eardrum
mumps? Measles? Scarlet fever?mumps? Measles? Scarlet fever?
Congenital d/t infectionsCongenital d/t infections
Teratogenic meds Teratogenic meds
Hypoxia during Hypoxia during 11stst trimester pregnancy trimester pregnancy
Head injury? Impacted cerumenHead injury? Impacted cerumen
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Hx s w imming Hx s w imming
Occupational hxOccupational hx
Recreational hxRecreational hx
Use of E TOH and NaUse of E TOH and Na
MeniereMeniere¶¶s diseases disease ± ± sx > evening sx > evening
Vertig o? Chronic? Vertig o? Chronic?
Sleep patterns?Sleep patterns? Pain in ear?Pain in ear?
Clues: posturing headClues: posturing head ± ± appropriate responsesappropriate responses
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M. Tayseer (2008)
ConjunctivitisConjunctivitis
Infection or inflammation of conjuctivaInfection or inflammation of conjuctiva
CommonCommon
Epidemics common in children due to poor
Epidemics common in children due to poorhy gienehy giene
Most common organismMost common organism ± ± Staph, streptStaph, streptpneumoniae, haemophilus influenzaepneumoniae, haemophilus influenzae
Irritation, tearing, redness, mucopurulentIrritation, tearing, redness, mucopurulentdrainagedrainage ± ± spreads from affected ey e to spreads from affected ey e to unaffected ey eunaffected ey e
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M. Tayseer (2008)
Nursing CareNursing Care
Acute ey e pain Acute ey e pain
Extreme anxiety re fear of loss ey esightExtreme anxiety re fear of loss ey esight
Disturbed sensory perceptionDisturbed sensory perception
Careful asepsis to prevent spreadCareful asepsis to prevent spread
Proprr disposal w astesProprr disposal w astes
Teaching re med aministration Teaching re med aministration
Acute = dark room w ith modifications Acute = dark room w ith modifications
Med administration may be hourly or more oftenMed administration may be hourly or more often
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M. Tayseer (2008)
CataractsCataracts
Opacity of cry stalline lensOpacity of cry stalline lens
Third leading cause of preventable blindness Third leading cause of preventable blindness
Most common cause self Most common cause self --declared visual disability indeclared visual disability in
USUS
5050% age% age 6363--7575 some degree of f ormationsome degree of f ormation
>>7575 == 7070% incidence% incidence
Most common surgical procedure in US >Most common surgical procedure in US >6565 Congenital cataractsCongenital cataracts commoncommon ± ± 11::250250
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M. Tayseer (2008)
PathophysiologyPathophysiology
Most are senile cataracts (aging)Most are senile cataracts (aging)
Other causesOther causes ± ± maternal rubella, trauma,maternal rubella, trauma,
radiation orU V,sy stemic corticosteroids or
L Tradiation or
U V,sy stemic corticosteroids or
L Ttopic corticosteroids and ocular inflammationtopic corticosteroids and ocular inflammation
Aged Aged ± ± accumulation of w ater and alterations inaccumulation of w ater and alterations inlens fiberlens fiber
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M. Tayseer (2008)
Signs/Symptoms CataractsSigns/Symptoms Cataracts
Decrease in visionDecrease in vision
Abnormal color perception Abnormal color perception
Glare dy e to light scattering Glare dy e to light scattering
W orse at night w hen dilatation W orse at night w hen dilatation
Secondary glaucoma if IOPSecondary glaucoma if IOP
DiagnosisDiagnosis ± ±
visual acuity visual acuity ± ±
ophthalmoscope or slitophthalmoscope or slitlamplamp
³³ w hite w hite´́ pupilpupil
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SurgerySurgery
NPO f orNPO f or 66--8 8 hrs. preophrs. preop
Dilating drops + nonsteoridal inflammatory Dilating drops + nonsteoridal inflammatory ey edropsey edrops
My driaticsMy driatics
Cy cloplegics (anticholinergic)Cy cloplegics (anticholinergic) ± ± cause my driasiscause my driasis
PrePre--op anxiety medsop anxiety meds
IntraoperativeIntraoperative ± ± extracapsular extractionextracapsular extraction( pharmacoemulsification or( pharmacoemulsification or ³³scooping scooping ́́ ) )
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M. Tayseer (2008)
Intracapsular lensIntracapsular lens
PostPost--op: No bending or stooping, coughing orop: No bending or stooping, coughing or
lifting lifting Ey eshields at nightEy eshields at night
Visual acuity , IOP at post Visual acuity , IOP at post--op visitsop visits
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M. Tayseer (2008)
Nursing ManagementNursing Management
Assess patient Assess patient¶¶s distance/near visual acuity s distance/near visual acuity
Assess visual acuity in nonoperative ey e Assess visual acuity in nonoperative ey e
A
ssess psy chosocial impact of disability A
ssess psy chosocial impact of disability Assess ability to care f or self w ith decreased Assess ability to care f or self w ith decreased
visual acuity visual acuity
Prevention: Sunglasses, av oid unnecessary Prevention: Sunglasses, av oid unnecessary
radiation, take antioxidants, (vitamins C and E )radiation, take antioxidants, (vitamins C and E ) ± ± g ood nutritiong ood nutrition
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M. Tayseer (2008)
MedicationsMedications
PrePre--op meds: dark irises, more medop meds: dark irises, more med
Photophobia commonPhotophobia common ± ± w ear dark glasses w ear dark glasses
Transient stinging/burning Transient stinging/burning
Contraindicated w ith narrow Contraindicated w ith narrow--angle glaucomaangle glaucoma
My dratics cardio vascular effectsMy dratics cardio vascular effects
Use punctual occlusionUse punctual occlusion
Inf orm re lack depth perception ( Inf orm re lack depth perception (2424 hrs)hrs) Notif y MD if pain intenseNotif y MD if pain intense ± ± may signal hemorrhage,may signal hemorrhage,
infection or incr. IOPinfection or incr. IOP
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M. Tayseer (2008)
R etinal DetachmentR etinal Detachment
Separation of sensory retina and undelry ing pigmentSeparation of sensory retina and undelry ing pigmentepitheliumepithelium
Fluid accumulate bet w een theFluid accumulate bet w een the 22 lay erslay ers
Increased w ith aphakiaIncreased w ith aphakia Causes blindness!!Causes blindness!! Caused by retinal break (tears or holes)Caused by retinal break (tears or holes) holes spontaneous; tears w ith aging holes spontaneous; tears w ith aging
Sx of photopsia (light flashes); floaters, and aSx of photopsia (light flashes); floaters, and a
³³cobw ebcobw eb
´́
³³hairnethairnet´́ or ring in visual fieldor ring in visual field Curtain comes across visionCurtain comes across vision Ultrasound to dx if opthalmoscope or slit lamp notUltrasound to dx if opthalmoscope or slit lamp not
definitivedefinitive
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M. Tayseer (2008)
GlaucomaGlaucoma
Group of disorders:Group of disorders:
Increased IOPIncreased IOP
Optic nerve atrophy Optic nerve atrophy
Peripheral Visual LossPeripheral Visual Loss
Congenital or primary diseaseCongenital or primary diseaseIOP regulated by f ormation/reabsorption of aqueous humorIOP regulated by f ormation/reabsorption of aqueous humor
Glaucoma R/T balance or imbalanceGlaucoma R/T balance or imbalance
Can damage optic nerve atrophy /blindnessCan damage optic nerve atrophy /blindness
22ndnd
leading cause of blindness inU
S andleading cause of blindness inU
S and leading cause inleading cause in A frican A mericans A frican A mericans 50% una w are they have it50% una w are they have it
Incidence w ith age 1:50 w hites 1:10 African AmericanIncidence w ith age 1:50 w hites 1:10 African American
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M. Tayseer (2008)
Normal IOP isNormal IOP is 1010--2121mm Hg mm Hg
PO AG PO AG ± ± primary openprimary open--angleangle 9090%% -- outflow is decr inoutflow is decr intrabecular net work trabecular net work
P ACG P ACG ± ± Primary anglePrimary angle--closure; closure; 1010% mechanism is angle% mechanism is angleclosure:closure:
partial dilated states can causepartial dilated states can cause
drug drug --induced my driasisinduced my driasis al w ay s check ingredients OTC medsal w ay s check ingredients OTC meds
Teach NOT to take my driatics Teach NOT to take my driatics
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M. Tayseer (2008)
Otitis MediaOtitis Media
A CU TE A CU TE ± ± Most common problem of middleMost common problem of middle childhood disease assoc w ith colds, allergies, sorechildhood disease assoc w ith colds, allergies, sore
throats, blockage eustachian tubethroats, blockage eustachian tube E
arlier theE
arlier the 11stst
episode, > risk subsequentepisode, > risk subsequentRisk Risk ± ± young, congenital, immune deficiencies, exposureyoung, congenital, immune deficiencies, exposureto cig smoke, family hx, recent URI, males/allerg y to cig smoke, family hx, recent URI, males/allerg y
MedsMeds ± ± amoxicillin f oramoxicillin f or 1010 day s is the drug of choiceday s is the drug of choice ± ±surgery : my ring otomy w ith short or long surgery : my ring otomy w ith short or long --term useterm use ± ±prompt rx prevents perf oration ty mpanic membraneprompt rx prevents perf oration ty mpanic membrane Antihistamines in aduts Antihistamines in aduts
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M. Tayseer (2008)
Chronic Otitis MediaChronic Otitis Media
Untreated or repeated attacks of acuteUntreated or repeated attacks of acute
More common in those w ho have has childrenMore common in those w ho have has children
Middle ear and air cells of mastoidMiddle ear and air cells of mastoid
ChronicChronic ± ± purulent, mucoid or serous discharge w ith hearing purulent, mucoid or serous discharge w ith hearing
loss and ear pain, nausea, dizzinessloss and ear pain, nausea, dizziness Ossicle destruction leads to hearing lossOssicle destruction leads to hearing loss
Also ty mpanic membrane perf or fluids ( pain) Also ty mpanic membrane perf or fluids ( pain)
DX DX ± ± sinus X sinus X --ray s, MRI, CT scan of temporalray s, MRI, CT scan of temporalbonebone««««««««««««can show a cholesteatomacan show a cholesteatoma
Antibiotic ear gtts + acetic acid Antibiotic ear gtts + acetic acid Parenteral antibiotics if a recurrenceParenteral antibiotics if a recurrence
Surgery : reconstruction (ty mpanoplasty )Surgery : reconstruction (ty mpanoplasty )