1. 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

2. 23 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

3. 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.

4. 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]***

5. Anatomy, Physiology of the Eye*** 04/19 Pg 595
Figure External structures of the eye and position of the lacrimal structures

6. 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

7. Figure 41-2 Three-dimensional cross-section of the eye
The Eye*** Fig: /21 Pg 597
Figure 41-2 Three-dimensional cross-section of the eye

8. 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.

9. 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

10. 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

11. Not in Text /20

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

13. 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

14. Diagnostic 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

15. Nursing Management 15/21 Pg 601
Client Education
Maintenance, preservation of eye function
Obtain an Accurate Baseline
Client Assessment for Further Action

16. Anatomy 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

17. Subdivisions of the Ear *** 17/21 Pg 602
Figure 41-8
Diagram of the ear, showing the external, middle, and internal subdivisions.

18. 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

19. Diagnostic 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

20. 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

21. End of Presentation: 21/21 Time to NCLEX
BY: P.K. Williams, RN