1. Chapter 13 Care of the Patient with a Sensory Disorder
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, Mosby, Inc.

2. Care of the Patient with a Sensory Disorder
The sensory system constantly gathers information through millions of receptors scattered throughout the body and delivers it to the brain
Five major senses:
taste
touch
smell
sight
hearing

3. Normal Aging
Crystalline lens of the eye harden and becomes too large for the eye muscle – loss of accommodation
The crystalline lens also loses some transparency and becomes more opaque – glare begins to be a problem
Pupil becomes smaller and decrease amount of light that reaches the retina – patient needs more light to read

4. Normal Aging (con’t)
Ear – loses ability to hear high frequencies and distinguish consonant sounds
Remaining senses have slight changes causing decreased reaction or threshold time – slower responses and diminished sensation

5. Laboratory and Diagnostic Examinations
After the normal Snellen’s test, additional eye test may be required
Amsler’s chart – detect defects of the macular area of the retina
Goldmann perimetry tests – detects and evaluates intraoccular pressure
Exophthalmometry – measures the degree of forward placement of the eye
Slit-lamp – examines the conjunctiva, lens, vitreous humor, iris, and cornea

6. Applanation Tonometry
(Figure 13-12)

7. Eye Disorders - Nursing Consideration
Initial consideration – review of following items:
Eye pain, pruritus, excessive tearing, floaters, light flashes, discharge, visual changes, or blind spots
History of allergies
Current medication, and side effects, for the eye disorder
Use of glasses or contact lenses
Adequacy of current eyewear prescription
Personal habits related to care of eyewear
Any previous eye injuries or surgeries

8. Disorders of the Eye
Blindness and near blindness – individuals with a maximum visual acuity of 20/200 with corrective eyewear and/or visual field sight capacity reduced by 20 degrees
Refractory errors – astigmatism, strabismus, myopia, and hyperopia
Inflammatory and infectious disorders
Myopia – elongation of the eyeball
Hyperopia – inability to see things at close range
Macular degeneration – slow, progressive loss of central and near vision

9. Other Disorders
Glaucoma – elevated pressure within an eye because of obstruction of the outflow of aqueous humor
Open-angle – common form of the disease that progresses slowly
Closed-angle – occurs when sudden blockage occurs
Treatment - Medications and surgery

10. Surgery of the Eye Trauma to the eye can result in need for surgery
Enucleation – surgical removal of the eyeball
Corneal Transplants – implantation of donor cornea
Retinal detachment – retina separates from the choroid in the posterior area of the eye – cryosurgery or scleral buckling are usual treatment
Vitrectomy – removal of excess vitreous fluid caused by hemorrhage

11. Ear Disorders – Nursing Considerations
After general assessment, additional information would include the following:
Occurrence of ear drainage, tinnitus, vertigo, wax buildup, pressures, pain, and pruritus
Behavioral clues indicating hearing loss
History of medications used for ear disorders
Current medications and side effects
Speech pattern abnormalities
Use of assistive hearing device
Home remedies that cause ear trauma

12. Disorders of the Ear
Inflammatory and infectious – external otitis, otitis media, and labyrinthitis
Obstructions of the ear – excessive secretions of cerumen or foreign bodies
Noninfectious disorders
otosclerosis (chronic progressive deafness)
meniere’s – inner ear problem causing vertigo and tinnitus

13. The Inner Ear
(Figure 13-4)

14. Surgery of the Ear
Tympanoplasty – designed to restore or improve hearing with conductive hearing loss
Myringotomy – surgical incision of the eardrum to relieve pressure and purulent exudate

15. Nursing Diagnoses Health maintenance, ineffective Anxiety
Self-care deficit
Fear
Environmental interpretation syndrome, impaired
Risk for injury
Home maintenance, impaired
Social interaction, impaired
Loneliness, risk for
Sensory perception, disturbed
Social isolation