copyright © 2010 wolters kluwer health | lippincott williams & wilkins timby/smith:...

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/21 Pg 595

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/21 Pg 595

S-54 Chapter 41: Introduction to the Sensory System By: P.K. Williams, RN


23 Words to Know*** 02/21 Pg 59523 Words to Know*** 02/21 Pg 595

• Accommodation Audiometry

• Caloric stimulation test Central vision

• Conductive hearing loss Conjunctivitis

• Decibels Elelctronystagmography

• Near point Nystagmus

• Ophthalmoscopy Otoscope

• Proptosis Ptosis

• Refraction Rinne Test

• Romberg Test Sensorineural hearing loss

• Tonometry Tuning fork

• Visual acuity Visual field examination

• Weber test


Unit 10 Chpt 41 Learning Objectives 03/21 Pg 595 Unit 10 Chpt 41 Learning Objectives 03/21 Pg 595

On completion of this chapter, you will be able to:

01. Describe the anatomy and physiology of the eyes.

02. Discuss tests that are used for visual screening.

03. Identify questions to ask during an eye assessment.

04. Describe diagnostic studies for eye function

05. Explain the anatomy and physiology of the ears.

06. Describe methods for assessing the ear and hearing acuity.

07. Describe specific diagnostic tests for ear function.


Anatomy, Physiology of the Eye 04/21 Pg 595 Anatomy, Physiology of the Eye 04/21 Pg 595

• Extraocular Structures***

– Eyelids, eyelashes, tears: Protect the eye

– Canthus: Where eyelids meet; Usually horizontal; Down syndrome; Epicanthal fold

– Blinking: Clears dust, particles from eye surface

– Eyelids: Adjust amount of light entering eyes; Distribute tears; Multiple glands; Conjunctiva; Caruncle; Lacrimal apparatus

– Tears: Water, Sodium chloride, lysozyme [antibacteria

enyzemel]***


Anatomy, Physiology of the Eye*** 04/19 Pg 595 Anatomy, Physiology of the Eye*** 04/19 Pg 595

Figure 41-1 External

structures of the eye and position of the lacrimal

structures


Intraocular Structures*** 06/00 Pg 596 Intraocular Structures*** 06/00 Pg 596

• Three Layers

– Sclera (White of the eye)

• Protects structures within the eye

• Connects to cornea, anterior chamber, pupil

– Uvea (Vascular coat of the eye)

• Choroid; Iris; Pupil; Aqueous humor; Vitrous humor

– Retina

• Rods and cones; Macula


The Eye*** Fig:41-2 06/21 Pg 597 The Eye*** Fig:41-2 06/21 Pg 597

Figure 41-2 Three-dimensional cross-section of the eye


Visual Function*** Fig: 41-3 08/21 Pg 597/596 Visual Function*** Fig: 41-3 08/21 Pg 597/596

• Light Nerve signals: Interpreted in cerebral cortex

• Refraction;RETINA = Rods [dim light dark colors], Cones [ bright light colors] Optic nerve; Accommodation

• Near point; Cataract: Opaque lens, blurred, cloudy images

Figure 41-3 A normal opthalmoscopic picture. The fundus or back of the eye as seen through an ophthamoscope. The optic disc, with its radiating vasculature, is easily distinguished from the macula lutea.


Nursing Assessment*** 09/21 Pg 597 Nursing Assessment*** 09/21 Pg 597

• Client History

– Allergy; Vision changes; Discomfort; Corrective lenses

– Eye medications; Eye trauma, disease, surgery

– Family history of eye disease

• Physical Assessment

– Symmetry [13% Pop USA= unequal pupils]

– Inflammation; Exudate = [drainage]

– Pupil constriction


Eye Assessment*** 10/19 Pg 597 Eye Assessment*** 10/19 Pg 597

• Visual Screening Tests

– Snellen eye chart: Visual acuity

– Jaeger chart; Rosenbaum Pocket Vision Screener: Near vision

– Ishihara polychromatic plates: Color vision

• Extraocular Muscle Function

– Corneal light reflex test: Eye alignment

– Cover-uncover test: Extraocular muscle function

– Positions test: Eye muscle strength, cranial nerve function


Not in Text 11/20Not in Text 11/20


Snelling Eye Chart*** Not in Text 11/21 Snelling Eye Chart*** Not in Text 11/21


Diagnostic Studies *** 13/21 Pg 600 Diagnostic Studies *** 13/21 Pg 600

• Ophthalmoscopy: Examination of fundus***

• Retinoscopy: Focusing power of each eye***

• Tonometry: Intraocular pressure***

– Normal IOP: 10 to 21 mm Hg***

• Visual Field Examination

– Peripheral vision; Gaps

– Visual field change associations: Glaucoma; Stroke; Brain tumor; Retinal detachment

• Color Vision Testing: Color differentiation ability


Diagnostic Studies *** 14/21 Pg 600Diagnostic Studies *** 14/21 Pg 600

• Amsler Grid: Macular problems

• Slit-lamp Examination: Magnifies eye surface

– Identifies: Corneal abrasions; Iritis; Cataracts; Conjunctivitis

• Retinal Angiography: Vascular changes, blood flow

• Ultrasonography: Used when posterior of eye difficult to visualize

• Retinal Imaging: High-resolution; Pupil dilation unnecessary


Nursing Management 15/21 Pg 601Nursing Management 15/21 Pg 601

• Client Education

– Maintenance, preservation of eye function

• Obtain an Accurate Baseline

• Client Assessment for Further Action


Anatomy and Physiology of the Ear 16/21 Pg 601Anatomy and Physiology of the Ear 16/21 Pg 601

• Subdivisions of the Ear: Outer; Middle; Inner***

– Outer ear (Auricle)***

• Pinna; External acoustic meatus; Tympanic membrane

– Middle ear***

• Eustachian tubes; Malleus; Incus; Stapes

– Inner ear (Labyrinth)***

• Cochlea (hearing); Semicircular canals (balance); Vestibulocochlear nerve (Cranial nerve VIII; Organ of Corti


Subdivisions of the Ear *** 17/21 Pg 602Subdivisions of the Ear *** 17/21 Pg 602

Figure 41-8Diagram of the ear, showing the external, middle, and

internal subdivisions.


Ear Assessment*** 18/21 Pg 602 Ear Assessment*** 18/21 Pg 602

• Basic Auditory Acuity Tests

– Whisper test: Gross auditory acuity

• Otoscopic Examination: External acoustic canal, tympanic membrane inspection

• Tuning Fork Tests

– Conductive or sensorineural hearing loss

– Rinne test; Weber test

• Romberg Test: Ability to sustain balance


Diagnostic Studies 19/21 Pg 600Diagnostic Studies 19/21 Pg 600

• Audiometry: Precise measurement of hearing acuity; Measured in decibels (dB)

– Lowest perceptible sound perceived: 20 dB

– Painful sound level: 120 dB

• Caloric Stimulation Test Nystagmus

– Measures vestibular reflexes of inner ear

• Electronystagmography: Vestibular function

– Used in conjunction with caloric stimulation test

– Measures duration, velocity of eye movements during nystagmus


Nursing Management 20/21 Pg 605 Nursing Management 20/21 Pg 605

• Client Assessment: Ear structure; Hearing function***

– Screening in healthcare settings

– Baseline for further testing, referral

– Client education: Maintenance of hearing function and testing


End of Presentation: 21/21 Time to NCLEX

BY: P.K. Williams, RN [email protected]

copyright © 2010 wolters kluwer health | lippincott williams & wilkins timby/smith:...

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