Sensory

Glaucoma Ocular conditions characterized by optic nerve damage Patho Increased ocular pressure (IOP) damages the optic nerve and nerve fiber layer Patho Aqueous humor flows between the iris and the lens, nourishing the cornea and lens, flows out the anterior chamber and draining through the spongy trabecular meshwork into the canal of Schlemm Risk factors Family history Thin cornea African American Older age Diabetes CVD Migraines Nearsighedness Eye Trauma Prolong use of corticosteriods Two theories: high IOP damages the retinol layer, and indirect ischemic theory that high IOP compresses microcirculation, resulting in cell injury and death

Glaucoma Classifications Open-angle: the outflow of aqueous humor is obstructed at the trabecular meshwork Closed-angle: aqueous humor encounters resistance to flow through the pupil Congenital Associated with other conditions

Glaucoma Assessment: decrease or loss in peripheral vision, blurred vision, halos around lights, difficulty focusing or adjusting in low light. Diagnostic testing: tonometry to measure IOP/inspection of the optic nerve, central visual field testing. Management: Medication: systemic and topical to decrease IOP (pg 1856 table 63-5) Cholinergics (pilocarpine): increase aqueous outflow by affecting ciliary muscle contraction and pupil constriction Beta blockers (timolol): decrease aqueous production Prostaglandin analogues (latanoprost): increase uveoscleral outflow Surgery: laser trabeculoplasty (laser burns the inner surface of the trabecular meshwork to open up the spaces and widen canal Education Cholinergics are called miotics: cause pupillary constriction

CAtaracts Opacity or cloudiness of lens Patho Assessment Management Nuclear: genetic component, myopia Cortical: sunlight Posterior subcapsular: prolonged corticosteriod use, diabetes, ocular damage Assessment Painless, blurry vision, dimmer surroundings Decrease visual acuity--Snellen chart Management Surgery Education (page 1860 chart 63-9) Visual acuity does not always have a direct correlation to the degree of cataracts There is no medical management

Macular degeneration Tiny, yellowish drusen spots located in the macualar Dry: outer layers of the retina slowly break down Wet: proliferation of abnormal blood vessels growing under the retina, vessels leak fluid elevating the retina Assessment Central vision is affected Intervention Amsler grid: monitor for sudden onset or distortion of vision Most common cause of visual impairment in people older than 65 Most people have the “dry” type Amsler grid—tests for worsening of macular degeneration

Amsler Grid Patients should look at grid one eye at a time, several times a week, wearing their corrective lenses (for near vision)—lines should not look distorted—changes should be shared with eye doc

Hearing loss Deafness: partial or complete loss of the ability to hear Conductive hearing loss: the transmission of sound by air to the inner is ear is interrupted, from an external ear disorder (impacted cerumen), middle ear disorders (otitis media or otosclerosis) Senorineural hearing loss: damage to the cochlea or vestibulocochlear nerve Early signs: tinnitus, increasing inability to hear when in a group, turning the volume up Assessing: Speech Deterioration Fatigue Indifference Social withdrawal Insecurity False pride False pride—pretending to hear when they can’t What other behaviors might you see?

Hearing loss Risk Factors Nursing Management Family history of sensorineural impairment Congenital malformation Ototoxic medication Recurrent ear infections Bacterial meningitis Chronic exposure to loud noises Perforation of the tympanic membrane Nursing Management Screening/Assessing Communication Pg 1890 Chart 64-4 Screening—subjective questions: hearing loss in the past? Now? Does family think you have loss?