1. Sensory

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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?

9. 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?