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NC3-Sensory Impairment


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diviation in ocular alignment
Amblyopia, or lazy eye, is a disorder of the eye that is characterized by poor or blurry vision in an eye that is otherwise physically healthy and normal. The problem is caused by either no transmission or poor transmission of the visual image to the brain for a sustained period of dysfunction or disuse during early childhood.
Hirchberg Test
It is performed by shining a light in the persons eyes and observing where the light reflects off of the corneas. In a person with normal ocular alignment the light lands on the centre of both corneas. For an abnormal result, based on where the light lands on the cornea, the examiner can detect if there is an exotropia (abnormal eye is turned out), esotropia (abnormal eye is turned in), hypertropia (abnormal eye higher than the normal one) or hypotropia (abnormal eye is lower than the normal one).
epicanthal folds
excess folds of skin that extend from the roof of the nose to the inner termination of the eyebrow and that partially or completely overlap the inner canthus of the eye, may give a false impression of malalignment
Visually evoked potentials
A visual evoked potential (VEP) is an evoked potential caused by sensory stimulation of a subject's visual field. Commonly-used visual stimuli are flashing lights, or checkerboards on a video screen that flicker between black on white to white on black (invert contrast).

Visual evoked potentials are very useful in detecting blindness in patients that cannot communicate, such as babies or non-human animals.
color blindness (confusion of grey with pink and blue with greeen
confusion with gray with pale purple or green
suffocation: suffocation as a result of physical blockage of the airway or inhalation of toxic gases, causing a lack of oxygen and unconsciousness
Conductive hearing loss
(middle-ear hearing loss) results from interference of transmission of sound to the middle ear
Sensorineural hearing loss
Sensorineural hearing loss is a type of hearing loss in which the root cause lies in the vestibulocochlear nerve (Cranial nerve VIII), the inner ear, or central processing centers of the brain.
Mixed conductive-sensorineural hearing loss
Interference with transmission of sound in the middle ear and along neural pathways- recurrent otitis media
central auditory imperception-organic type
reception of auditory stimuli along the central pathways and expression of the message into meaningful communication
the inability to interpret sound correctly
difficulty in processing details or discrimination around sounds
the inability to express ideas in any form either writing or verbally
decibel (dB)
a unit of loudness
Evidence of auditory stimuli
startel reflex, head turning, eye blinking, and cessation of body movement.
one sign of sensorineural hearing loss is
difficulty articulating
mild conductive hearing loss may manifest
by child speaking in a loud monotone voice, may speak clearly
most common cause of hearing loss
otitis media
Otitis media
Otitis media is an inflammation of the middle ear segment of the ear. It is one of the two conditions that are commonly thought of as ear infections, the other being otitis externa. Otitis media is very common, and includes a whole range of medical conditions; all of which involve inflammation of the ear drum (tympanic membrane), & are usually assoc. /c a buildup of fluid in the space behind the ear drum (middle ear space).
Type of hearing loss acquired from rubella
sendorineural hearing loss
Type of hearing loss from exposure to noise pollution
sensorineural hearing loss
School vision
aka partially sighted- acuity between 20/70 and 20/200
Legal blindness
visual acuity 20/200 and or a visual field of 20 degrees or less in the better eye
Causes of visual impairment
herpes, chlamydia, gonocochi, rubella, syphilis, toxoplasmosis, retinopathy of prematurity, trauma, postnatal infections (meningitis and disorders such as sickle cell disease. juvenile rheumatoid arthritis, tay-sachs disease albinism and retinoblastoma.
Refractive errors
most common type of visual disorders, means bending of light rays as they pass through the lens of the eye
Normal eye reaction to light compared to refractive disorders
light rays enter the lens and fall directly on the retina. In refractive disorders the light rays either fall in front the retina (myopia) or beyond it (hyperopia)
Myopia/nearsightedness, is a refractive defect of the eye in which collimated light produces image focus in front of the retina when accommodation is relaxed.
Those with myopia typically can see nearby objects clearly but distant objects appear blurred.
Hyperopia, also known as hypermetropia or colloquially as farsightedness (or, rarely, longsightedness), is a defect of vision caused by an imperfection in the eye (often when the eyeball is too short or when the lens cannot become round enough), causing inability to focus on near objects, & in extreme cases causing a sufferer to be unable to focus on objects at any distance. As an object moves towards the eye, the eye must increase its power to keep the image on the retina. If the power of the cornea & lens is insufficient, as in hypermetropia, the image will appear blurred.
self-stimulatory activities, such as rocking, finger flicking, or arm twirling
cat's eye reflex
sign of retinoblastoma
treatment of retinoblastoma when there is no hope for useful vision
enucliation - removal of the affected eye - tx of choice
A savant is a learned person, well versed in literature or science, often with an exceptional skill in a specialized field of learning. The term is also commonly used as an abbreviation of autistic savant, formerly "idiot savant". The word is a loanword from the French language.
General objective in tx of Autism
promote positive reinforcement, increase social awareness of others, teach verabl communication skills, and decrease unacceptable behavior
Ways to deal with a Autistic child
decrease stimulation- private room, avoid extraneous auditory and visual distractions, and encouraging the parents to bring in possessions the child is attached to, minimal holding or eye contact, introduce slowly to new situations
Acute Otitis media follows
upper respiratory infection
Bacteria that causes (AOM) Acute otitis media
streptococcus pneumoniae, haemophilus influenzae and moraxella catarrhalis
Symtoms of Acute Otitis media
acute ear pain, fever and a bulging yellow or red typanic membrane.
Symtoms of Acute Otitis media with effusion
rhinitis, cough or diarrhea
Treatment of choice for otitis media
oral amoxicillin in high doses
surgical incision of the eardrum to alleviate the severe pain of AOM
Nursing objectives for the child with AOM
1. relive pain, 2. facilitate drainage when possible, 3. prevent complications or recurrence, 4. educate family in the care of the child,5. provide emotional suport to the child and family
cause pupiliary constriction
the ability to focus and refocus
rods and cones
are long, narrow cells shaped like rods or cones, rods are mainly responsible for night vision or vision in low light, cones provide the best vision for bright light, color vision or fine detail
optic nerve aka
Cranial nerve II (CN II)
physiologic blind spot in the eye
optic disc/optic nerve head
Right Eye
Left eye
both eyes
digitalis toxicity with the eye
may cause color vision deficit
macular degeneration and color
macular degeneration -central vision --difficulty identifying colors because central vision identifies color
growth of abnormal new blood vessels in aged-related macular degeneration
measures IOP
visualizes the angle of the anterior chambers to identiy abnormalities in appearance and measurements
Color fundus photography
used to detect and document retinal lesions
Flourescein angiography
evaluates clinically significant macular edema, documents macular capillary nonperfusion and identifies retinal and choroidal neovascularization (abnormal growth of new vessels)
normal vision
direct visibility of lesions in the globe or orbit
retinitis pigmentosa
night blindness
intraocular pressure (IOP)
Intraocular pressure (IOP) is the fluid pressure inside the eye. It may become elevated due to anatomical problems, inflammation of the eye, genetic factors, as a side-effect from medication, or during exercise
medications causing pupiliary dilation
Characteristics of cataracts
Painless, blurry vision
double vision
bullous keratopathy
formation of blisters that cause pain and discomfort on rupturing
Persistent edema of the cornea leads to
bullous keratopathy
Aphakia is the absence of the lens of the eye, due to surgical removal, perforating wound or ulcer, or congenital anomaly; causes a loss of accommodation, hyperopia, and a deep anterior chamber. Complications include detachment of the vitreous or retina, and glaucoma.
condition characterized by conical protuberance of the cornea with progressive thinning or protrusion and irregular astigmatism
corneal transplantation or corneal grafting
Refractive surgeries
cosmetic, elective procedures performed to reshape corneal tissue and correct refractive errors so that eye glasses or contact lens are no longer needed.
Rhegnomatogenous detachment
most common form of retinal detachment, - a hole or tear develops in the sensory retina, allowing some of the liquid vitreous to seep through the sensory retina and detach
Clinical manifestation of retinal detachment
pt may report the sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing lights, or the sudden onset of a great number of floaters. No c/o pain
aged macular degeneration
yellowish spots called drusen
abnormal blood vessel formation
downward displacement of the eyeball
Management of soft tissue damage that does not threaten vision
Cold compresses used early, then warm compresses later
corneal abrasion with contacts
pt experiences severe pain and photophobia
ocular pain on exposure to light
Treatment for chemical burns
irrigation with normal saline or tap water immediately
ocular trauma from foreign body
no attempt should be made to remove the foreign material, or apply pressure or a patch
splash injuries are irrigated with
normal saline
Caution in topical eye drops and corneal abrasions
topical anesthetic eye drops are not given to a pt. for repeated use /p corneal injury because their effects mask further damage, delay healing, and can lead to permanent corneal scarring.
hemorrhagic chemosis
edema of the conjunctiva
hemorrhage within the chamber
MRI is contraindicated in most DX of eye from trauma or foreign bodies because
most foreign bodies are metallic and magnetic
inflammation of the whole eye
Treatment for benign lesions of the eye lid
no treatment unless vision is affected
malignant tumor in children
S & Sx of Rhabdomyosarcoma
sudden painless proptosis of one eye followed by lid swelling, conjunctival chemosis and impairment of ocular motility.
Common site of metastasis of rhabdomyosarcoma
the surgical removal of the intraocular contents through an incision or opening in the cornea or sclera
is the removal of the eyelids, the eye and various amts. of orbital contents
What are the effects of loosing and eye
depth perception is lost
swelling of the optic disc due to increase IOP
The ear is the sensory organ with dual functions
hearing and balance
auricle aka
tympanic membrane
aka eardrum
middle ear bones
malleus, incus and stapes (transmission of sound)
organ of hearing
organ of balance
semicircular canal
organ of corti
end organ of hearing- transforms mechanical energy into neural acivity and separates sounds into different frequencies
proprioceptive system
body balance is maintained by the cooperation of the muscles and joints of the body
a healthy tympanic membrane looks a color of
pearly grey
how does the weber test work
the weber test uses bone conduction to let lateralization of sound, tapping it on the examiner's knee or hand , placed on the pts head or forehead, a person with normal hearing will hear the sound equally in both ears or describe the sound as centered in the middle of the head, with conductive hearing loss, the pt will hear the sound better in the affected ear, in sensorinueral hearing loss the sound is heard well in the better-hearing ear
drugs that cause hearing loss
aspirin, aminoglycosides, quinine sulfate
Contraindications for irrigation when removing foreign objects
foreign vegetable bodies and insects tend to swell, this irrigation is contraindicated. mineral oil can remove an insect
Primary cause of acute otitis media
Streptococcus pheumoniae, haemophilus inluenzae, moraxella catarrhalis
ingrowth of the skin of the external layer of the erdrum into the middle ear( causes conductve or mixed hearing loss)
Preventing infection when med in placed in ear canal
cotton with petroleum jelly to prevent water contamination
Promoting wound healing in the ear
no heavy lifting, straiing, exertion and nose blowing for 2-3 wks /p surgery
result from formation of new spongy bone, especially around the oval window, with resulting fixation of the stapes, sound is prevented because the stapes cannot vibrate
Menieres disease
abnormal inner ear fluid balance
Clinical manifestations of Menieres disease
tinnitus or a roaring sound, feeling of pressure or fullness in the ear, episodic incapacitating vertigo (most troublesome) accompanied by N/V
Diet therapy with menieres disease
Low sodium diet (sodium controls fluid balance in our bodies) since this disease is abnormal inner ear fluid balance
inflammation of the inner ear- viral or bacterial
Clinical manifestations of labyrinthitis
sudden onset of incapacitating vertigo, /c N/V, various degrees of hearing loss and possibly tinnitus
Acoustic neuroma
slow-growing, benign tumor of cranial nerve III
Diagnostic finding of Acoustic neuroma
unilateral tinitus and hearing loss with or without vertigo or balance disturbance
function of the nervous system
to control all motor, sensory, autonomic, cognitive and behaviral activities
The basic functional unit of the brain is
the neuron, composed of a cell body, a dendrite and an axon
branch-type structure with synapses for receiving electrochemical messages
long profection that carries impulses from the cell body
Temporal lobe
auditory receptive areas, provides integration of somatization, visual and auditory areas
Parietal lobe
sensory lobe, analyzes sensory information , relays the interpretation of this info. to the thalamus and cortical areas, gives awareness of the body in space as well as orientation in space ans patial realations
responsible for visual interpretation
basal ganglia
masses of nuclei located deep in the cerebral hemispheres taht are responsible for control of fine motor motor movements including those of the hands and lower extremities
all memory, sensation and pain impulses pass through this section
involved in olfactory reflexes and emotional response to odors, plays an important role in endocrine sys. it regulates the pituitary secretion of hormones that influence metabolism, reporduction, stress response and urine production. Works with the pituitary to maintain fluid balance, temp., vasodilation and vasocaonstriction
Which site is the hunger center in the brain
the hypothalamus- controls appetite
responsible for coordination of movements, fine movement, balance, position sense, and integration of sensory input
Circle of Willis
The circle of Willis (also called the cerebral arterial circle or arterial circle of Willis) is a circle of arteries that supply the brain
autonomic nervous system
regulates the activities of internal organs such as the heart, lungs, blood vessels, digestive organs and glands.(maintaining homeostasis)
controls visceral functions
Sympathetic nervous system
fight or flight
manifestations that are of a neurological nature
pain, seizures, dizziness, visual disturbances, weakness, abnormal sensation
assessing cerebral function
mental status, intellectual function, thought content, emotional status, perception, language ability, impact on lifestyle
inability to interpret or recognize objects seen through the special senses
Romberg Test
Screen test for balance. Pt stands with feet together, hands at side, eyes closed for 20-30 seconds. Swaying or off balance is a positive Romberg test
incoordination of vlountary muscle action
Abnormal Reflexes - sign of
central nervous system disease
repeated uncontrollable movement of a muscle
corneal reflexes are absent in
CVA pts and coma pts
Gag reflex is absent in pts
who have had CVA
How is tactile sensation assessed
assessed by lightly touching a cotton wisp to corresponding areas on each side of the body. Sensitivity is compared with that of distal parts
Diseases that can be diagnosed through the eye
AIDS, CVD, muscular and endocrine disorders, hematologic and neurologic diseases
Topical anesthetics for the eye
proparacaine HCl (Ophthaine, Ophthetic and tetracaine HCl (Pontocaine)
infection of meibomian glands of the eylids that may produce cysts, causing blocage of the ducts
inflammation of structures of the inner eye
local i nfection of eye lash follicles and glands on lid margins
corneal inflammation
infection of vascular layer of the eye
Cholinergic agents are aka
Treatment for Glaucoma (open angle glaucoma)
Miotics/cholinergic agents- used to lower the IOP, increasing blood flow to the retina and ddecreasing retinal damage and loss of vision
Action of miotics
Miotics cause a contraction of the ciliary muscle and widening of trabecular meshwork
herbs contraindicated with Glaucoma
golden seal
herbs and opththalmic surgery
generally are discontinued
How to prevent systemic absorption of miotics
gently apply pressure to the lacrimal duct (passage that carries tear into the nose)
Side effects of miotics
HA, eye pain, decreased vision, brow pain, and less frequently, hyperemia of the conjunctiva
Systemic side effects of miotics
nausea, vomiting, diarrhea, frequent urination, precipitation of asthmatic attacks, increased salivation, diaphoresis, muscle weakness, and respiratory difficulty.
Toxicity of Miotics
vertigo, bradycardia, tremors, hypotension, syncope, cardiac dysththmias, and seizures
Drug used for toxicity of mitotics
Contraindications of Cholinergic (Pilocarpine)
retinal detachment, adhesions between the iris and lesn, and acute ocular infections, Caution for clients with asthma, HTN, corneal abrasion, hyperthyroidism, CVD, Urinary tract obstruction, GI obstruction, uler, prkinsonism and bracycardia
Beta adrenergic on the eye
derease the production of aqueous humor
Carbonic Anhydrase Inhibitor
interferes with production of carbonic acid, leads to decreased aqueous humor formation and decreased IOP. Open angle glaucoma
Side effects of Carbonic Anhydrase Inhibitor
lethargy, anorexia, drowsiness, praesthesia, depression, polyuria, nausea, vomiting, hypokalemia, renal calculi, photosensitivity
Examples of Carbonic Anhydrase Inhibitors
Diamox, Trusopt, Neptazine, brinzolamide, Daranide,
Example of Osmotic drugs
glycerin, Ismotic, Mannitol, urea
Use of Osmotics
generally used preoperatively and postoperativelyd to decrease vitreous humor volume and so reducing IOP
side effects of osmotics
HA, nausea, vomiting and diarrhea, disorientation resulting from electrolyte imbalance
Use of midriatics
dilate the pupils
paralyze the muscles of accommodation
Side effects of Midriatics
headache, brow pain, allergic reaction and worsening of narrow-angle glaucoma
Caution of midriatics
pts with cardiac dysrhythmias, and cerebral atherosclerosis, BPH, DM, Parkinsonism
signs and symptoms to report with midriatics
blurred vision or loss of sight, difficult breathing, increased perspiration, or flush
SE of Cycloplegics
tachycardia, photophobia, dryness of the mouth edema, conjuctivitis and dermatitis
Symptoms of Atropine toxicity (cycloplegics)
dry mouth, blurred vision, photophobia, consipation, fever, tachycardia, confusion, hallucinations, delirium and coma
Treament for toxicity of Atroprine (cycloplegics)
How to prevent myopia when instilling miotics
myopia is minimized by inserting the disk in the upper conjuctival sac at bed time

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