Nursing Care of Patients With Sensorineural Disorders

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



M. Tayseer (2008)

The special Senses The special Senses

Sight.Sight.

Hearing.Hearing. SmellSmell

Taste. Taste.

Balance.Balance.



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



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



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)



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



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



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



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



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



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



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



M. Tayseer (2008)

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



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



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



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



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



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



M. Tayseer (2008)

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 ́́ ) )



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



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



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



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



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



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



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



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 )

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Nursing Care of Patients With Sensorineural Disorders

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