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Chapter 26 The Sensory System: Eye and Ear Jodi Olenginski MSN, RN Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. Theory Objectives Identify ways in which nurses can help patients preserve their sight and hearing. Identify signs and symptoms of eye problems. Discuss tests and examinations used to diagnose eye and ear disorders. Perform nursing activities associated with assessing the eye and ear. Utilize the nursing process for patients with disorders of the eye or ear. Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 1 Clinical Practice Objectives Provide teaching for a patient who is to undergo tests for a vision problem. Perform focused assessments for disorders of the eyes and ears. Assist visually impaired patients to find resources to maximize their vision. Instruct a spouse in ways to effectively communicate with a hearing-impaired partner. Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 2 The Eyes - - - Structures of the eye Eyeball Sclera-White part of eye Cornea( part of wall of eyeball)-refracts light rays to the lens Choroid (Part of middle layer, highly vascular) Ciliary body- (middle layer produces aqueous humor). Helps change eye shape for near and far vision Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 3 EYE STRUCTURES Iris- Colored portion of eye. Contain muscles that constrict an dilate the pupil to regulate the entrance of light. Biconvex- transparent lens. Divides interior of eyeball into two chambers. The anterior chamber is filled with aqueous humor. The posterior chamber contain vitreous humor Retina- Inner coat of the eyeball contains several layers. The layer with rods and cones as receptor for light images and color. Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 4 Optic nerve- carries messages from nerve cells in the retina to the brain. Optic disc- formed by the axons of the ganglion cells of the retina Macula lutea-yellow spot that allows for visual detail Eyelids, conjunctiva, eyelashes Lacrimal glands(upper outer area above eye). Lacrimal ducts carry tears Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 5 FUNCTIONS ORBIT-protections eyeball EYELASHES- Trap foreign particles EYELIDS – Protect eye and distribute moisture Sebaceous glands- lubricate lids Blinking-stimulate lacrimal gland to produce tears Lacrimal gland-secrete tears that moisten, lubricate and cleanse surface of eye Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 6 Functions Continued Tears-contain an enzyme that destroy bacteria and prevent infection Transparent cornea- allows light to hit the lens. Assists with bending of light rays(refraction) Choroid- brown pigment absorb excess light Ciliary process-secrete aqueous humor that help maintain the shape of the anterior chamber. The amount of the aqueous humor determines the internal pressure of the eye Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 7 Functions cont Retina’s rods and cones are photoreceptors for light and color Optic nerve- conducts nerve impulses from retina to the brain Optic disc-when pressures increase the disc appears swollen or choked (Iincreased intracranial pressure ICP) Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 8 AGING Fat and elasticity decrease-sunken eyes Arcus senilis-opaque ring outlining the cornea caused by fatty deposits Cornea flattens and becomes irregular causing astigmatism..blurred vision Sclera may develop a yellowish tinge or bluish Lens loses water and hardens-Cataracts form Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 9 AGING Con’t Ability of iris to dilate decreases(causes difficulty going from bright to dark) Ciliary muscle has less ability for the eye to accomodate., responsible for the gradual extension of distance from which an object can be read( presbyopia) Pupils become smaller-reduces ability to see in dim lighting Color discrimination decreases Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 10 Aging Con’t Moisture secretion decreases ( greater risk for irritation and infection- may lead to keratits ( inflammation of the cornea) which may compromise vision Ectropion- eversion of the lower eyelid Drooping of the upper lid- ptosis Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 11 Structures of the Eye Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 12 Visual Pathway Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 13 https://www.youtube.com/watch?v=gvozcv8p S3c Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 14 Arcus Senilis Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 15 Ectropion Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 16 Eye Disorders Causes-born blind..developed later in life, injury, diabetes, HTN, glaucoma, macular degeneration, AIDS Prevention Rest eyes when working on computer, TV etc Vitamin A-prevents night blindness, slow adaptation to darkness. Carotenoids are precursor to vitamin A (green leafy veggies, carrots, OJ, sweet potatoes etc) Lutein and zeaxanthin (antioxidants)- may prevent Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 17 Eye care cataracts…found in yellow fruits and veg., red and purple fruits and greens, kale, turnips greens, corn Purulent discharge or excessive tearing may warrant a Dr visit Prevent injury-protective wear, disgard make up See a Dr. once in 20s,and twice in 30s unless problem occurs. After 65, every 2 years Discard makeup every 6 months Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 18 Danger Signals of Eye Disease Persistent redness of the eye Continuing pain or discomfort about the eye, especially following injury Disturbance of vision Colored light flashes or feeling a curtain has been pulled over field of vision may signal retinal detachment Crossing of the eyes, especially in children Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 19 Danger Signals of Eye Disease (cont.) Growths on the eye or eyelids or opacities visible in the normally transparent portion of the eye Continuing discharge, crusting, or tearing of the eyes Pupil irregularities, either unequal size of the two pupils or distorted shape Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 20 Visual Loss Retinopathy associated with diabetes mellitus and hypertension Diabetic retinopathy and open-angle glaucoma among Latinos Visual screening and check-up Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 21 The Tono-Pen Used to Check Intraocular Pressure Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 22 Slit-Lamp Ocular Examination Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 23 Examination of the Eye with an Ophthalmoscope Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 24 Assessment (Data Collection) History-taking and systemic disorders(history of DM, HTN, AIDS, Neuro muscular disorders Medications with ocular side effects- digitalis, corticosteroids, Indocin Family history Physical examination Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 25 Abnormalities of Lid Position Entropion Ectropion Ptosis OTHER ABNORMALITIES Exopthalmos Xanthelasma Photophobia Inability to raise eyebrow-facial nerve damage Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 26 Xanthelasma Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 27 Exopthalmos Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 28 Expected Outcomes The patient will Compensate for decreased visual acuity and not suffer sensory deprivation Not experience injury Verbalize decreased fear as treatment begins to help condition Seek assistance with home maintenance within 7 days Explore other means of diversion than reading and watching television Demonstrate proper instillation of eye drops and will verbalize the schedule for the eye drops Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 29 Nursing Interventions for the Visually Impaired Patient When communicating with these patients, remember that the person has a vision impairment; he is not deaf Prevention of accidents Pity is neither expected nor appreciated by the visually impaired Most patients prefer to feed themselves, if at all possible If a guide dog is present, don’t interfere with it or pet it, as it is working Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 30 Audience Response Question 1 Which nursing action(s) demonstrate(s) appropriate care of a visually impaired patient? (Select all that apply.) 1. Introduces self prior to touching 2. Speaks slowly with a loud voice 3. Keeps the door ajar 4. Ensures ready access to the call button for assistance 5. Assists with feeding using the clock method Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 31 The Ears Structures of the ear Pinna-fleshy external ear Auditory meatus-extends from pinna to tympanic membrane. Lined with hair ad glands that secrete cerumen( earwax) Middle ear contains auditory bones and opens to eustachian tube. The bones are malleus(hammer), incus (anvil), and stapes (stirrup) Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 32 Structures con’t Malleus attaches to tympanic membrane Incus links malleus and stapes Tympanic membrane separates middle and external ear Eustachian tube connects middle ear with the throat Inner ear-consists of vestibule, semi-circular canal and cochlea Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 33 Con’t Cochlea contains the organ of Corti which is composed of sound receptors Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 34 Structures of the Ear Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 35 How is sound produced? http://www.youtube.com/watch?v=XDgL-t38wik Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 36 Hearing Loss Sensorineural hearing loss- acoustic nerve Conductive hearing loss Causes and prevention Noise-induced hearing impairment Amplified music exposure Medications (vancomycin, furosemide, aspirin, Ibuprofen Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 37 Common Causes of Conductive Hearing Loss Obstruction by impacted cerumen Infection with labyrinthitis Otosclerosis (abnormal bone growth in middle ear) genetic, measles, stress fracture Trauma and scarring of the tympanic membrane Congenital malformation of the outer or middle ear Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 38 Common Causes of Sensorineural Hearing Loss Presbycusis( age related hearing loss) Heredity with congenital loss Ototoxic drugs Loud noise exposure Tumor (acoustic neuroma) Ménière’s disease Severe infection such as measles, mumps, meningitis Rubella in utero Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 39 Dangers of Ototoxic Drugs Assess frequently when receiving a potentially ototoxic drug Signs of ototoxicity: ringing in the ears, subtle changes in hearing ability, and difficulty in hearing Teach importance of immediate reporting of symptoms Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 40 Diagnostic Tests and Examinations Visual examination Tuning fork tests Weber test and Rinne test Test for nystagmus- involuntary jerking of eye. May indicate tumor, inner ear problem or paralysis of eye muscle Romberg test –equilibrium . Positive test may reveal problem with inner ear or cerebellum Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 41 Examination of the Ear with an Otoscope Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 42 Irrigating the External Ear Canal Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 43 General Goals for the Patient with Problems of the Ear or Hearing Promote knowledge to protect hearing Prevent infection and injury Promote effective communication Promote coping with hearing loss Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 44 Communicating with the Hearing-Impaired Person If the person uses a hearing aid, encourage its use and see that it is situated, turned on, and adjusted before beginning speaking Be certain you have the person’s attention before beginning speaking Sit facing the person with the light on your face rather than from behind you Ask permission to turn down the volume or turn off the television or radio Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 45 Communicating with the Hearing-Impaired Person (cont.) The best distance for speaking to a hearingimpaired person is 2½ to 4 feet. Place yourself on eye level with the person. Do not speak directly into the person’s ear as this prevents the person from obtaining visual cues while you are speaking Do not smile, chew gum, or cover the mouth while speaking Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 46 Communicating with the Hearing-Impaired Person (cont.) Use short, simple sentences. If the patient does not appear to understand or responds inappropriately, state the message again using different words. Try to limit each sentence to one subject and one verb Give the person time to respond to questions Ask for oral or written feedback to make certain your message is understood Avoid using the intercom system as it may distort sound Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 47 When a Hearing Aid Does Not Work Check that the switch is “on” Examine the ear mold for attached wax or dirt; clean the sound hole Check the battery to see that it is inserted correctly Check the connection between the ear mold and the receiver Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 48 When a Hearing Aid Does Not Work (cont.) Replace the battery. Batteries last an average of 12 to 14 days depending on type of aid Check placement of the ear mold in the ear; it should fit snugly Adjust the volume If all else fails, take the hearing aid to an authorized service center for repair Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 49 Cleaning the Hearing Aid Turn the hearing aid off Wash the ear mold with mild soap and warm water; do not submerge in water Use a pipe cleaner or toothpick to gently cleanse the opening or short tube that fits into the ear Dry the mold completely before turning on the aid or before reattaching it to the hearing aid (if it is separate) Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 50 Common Problems of Patients with Ear Disorders Hearing impairment Dizziness and vertigo, may accompany nausea and loss of balance Tinnitus –ringing in the ears Rehabilitation for hearing loss Lip reading (speech reading) Sign language Hearing aids Cochlear implant Hearing-assistive devices Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 51 Cochlear Implant Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 52 Audience Response Question 2 When communicating with a hearing-impaired patient, the nurse must consider which strategy(ies)? (Select all that apply.) 1. Sit at eye level facing the patient. 2. Chew gum. 3. Enunciate clearly. 4. Speak directly into the patient’s ear. 5. Use simple sentences. Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 53 Community Care Public education on the dangers of loud noise and music Encourage thorough evaluation of hearing Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc. 54
