Chapter 25 The Sensory System: Eye and Ear - PowerPoint Presentation

Slide1

Chapter 25The Sensory System: Eye and Ear

Medical-Surgical Nursing: Concepts & Practice3rd edition

Copyright © 2017, Elsevier Inc. All rights reserved.

Slide2

Structures of the eyeFunctions of the eye structuresChanges associated with aging

2

The Eyes

Slide3

Structures of the Eye

3

Slide4

Visual Pathway

4

Slide5

Muscles of the Eye

Extrinsic (skeletal) musclesSuperior rectusInferior rectusMedial rectusLateral rectusSuperior obliqueInferior oblique

5

Slide6

Muscles of the Eye (Cont.)

Intrinsic (smooth) musclesCiliaryIris, circular musclesIris, radial muscles

6

Slide7

Arcus Senilis

7

From Swartz M: Textbook of physical diagnosis: history and examination, ed. 6, Philadelphia, 2009, Saunders.

Slide8

Ectropion

8

From Albert DM, Jakobiec FA: Principles and practice of ophthalmology, vol. 3, Philadelphia, 1994, Saunders.

Slide9

Eye Disorders

CausesPreventionBasic eye careVitamins and antioxidants“Dry eyes” and “replacement tears”Eye injury

9

Slide10

Danger Signals of Eye Disease

Persistent redness of the eyeContinuing pain or discomfort about the eye, especially after injuryDisturbance of visionColored light flashesCrossing of the eyes, especially in children

10

Slide11

Danger Signals of Eye Disease (Cont.)

Growths on the eye or eyelids or opacities visible in the normally transparent portion of the eyeContinuing discharge, crusting, or tearing of the eyesPupil irregularities, either unequal size of the two pupils or distorted shape

11

Slide12

Visual Loss

Retinopathy associated with diabetes mellitus and hypertensionDiabetic retinopathy and open-angle glaucoma among LatinosVisual screening and check-up

12

Slide13

The Tono-Pen Used to Check Intraocular Pressure

13

Slide14

Slit-Lamp Ocular Examination

14

Slide15

Examination of the Eye with an Ophthalmoscope

15

Slide16

1

Slide17

1

Slide18

Assessment (Data Collection)

History taking and systemic disordersPhysical examination

18

Slide19

EntropionEctropionPtosis

19

Abnormalities of Eyelid Position

Slide20

Xanthelasma

20

From Bolognia JL, Schaffer JV, Duncan KO, Ko CJ: Dermatology essentials, St. Louis, 2014, Saunders.

Slide21

Expected Outcomes

The patient willCompensate for decreased visual acuity and not experience 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.

21

Slide22

Nursing Interventions for the Visually Impaired Patient

When communicating with these patients, remember that the person has a vision impairment; the person is not deaf.Prevention of accidentsPity is neither expected nor appreciated by visually impaired people.Most patients prefer to feed themselves, if at all possible.If a guide dog is present, don’t interfere with it or pet it because it is working.

22

Slide23

The Ears

Structures of the earFunctions of the ear structuresChanges associated with aging

23

Slide24

Structures of the Ear

24

Slide25

Hearing Loss

Sensorineural hearing lossConductive hearing lossCauses and preventionNoise-induced hearing impairmentAmplified music exposureMedications and older adults

25

Slide26

Common Causes of Conductive Hearing Loss

Obstruction by impacted cerumenInfection with labyrinthitisOtosclerosisTrauma and scarring of the tympanic membraneCongenital malformation of the outer or middle ear

26

Slide27

Common Causes of Sensorineural Hearing Loss

PresbycusisHeredity with congenital lossOtotoxic drugsLoud noise exposureTumor (acoustic neuroma)Ménière’s diseaseSevere infection such as measles, mumps, meningitisRubella in utero

27

Slide28

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 hearingTeach importance of immediate reporting of symptoms.

28

Slide29

Diagnostic Tests and Examinations

Visual examinationTuning fork testsWeber test and Rinne testTest for nystagmusRomberg test

29

Slide30

Examination of the Ear with an Otoscope

30

From Jarvis C: Physical examination and health assessment, ed. 6, St. Louis, 2012, Saunders.

Slide31

Irrigating the External Ear Canal

31

Slide32

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.

32

Slide33

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.

33

Slide34

Communicating with the Hearing-Impaired Person (Cont.)

The best distance for speaking to a hearing-impaired person is 2½ to 4 feet. Place yourself at eye level with the person. Do not speak directly into the person’s ear because this prevents the person from obtaining visual cues while you are speaking.Do not smile, chew gum, or cover your mouth while speaking.

34

Slide35

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 because it may distort sound.

35

Slide36

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.

36

Slide37

When a Hearing Aid Does Not Work (Cont.)

Replace the battery. Batteries last an average of 12 to 14 days depending on the type of hearing 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.

37

Slide38

Cleaning the Hearing Aid

Turn off the hearing aid.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).

38

Slide39

Common Problems of Patients with Ear Disorders

Hearing impairmentDizziness and vertigoTinnitusRehabilitation for hearing lossLip reading (speech reading)Sign languageHearing aidsCochlear implantHearing-assistive devices

39

Slide40

Cochlear Implant

40

Slide41

Community Care

Public education on the dangers of loud noise and musicEncourage thorough evaluation of hearing

41