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Concept: Sensory Perception Exemplars Revised July 2015 EYE DISORDERS Reduced Vision Visual acuity of 20/200 or less with corrective lenses = legal blindness Reduced visual acuity may be in one or both eyes Causes of Reduced Vision Refractory errors Cataracts* Glaucoma* Diabetic retinopathy Macular degeneration* Eye infection Eye injury* Tumors Signs and Symptoms of Reduced Vision Frequent headaches Reports of blurred or double vision Closes one eye to read Trips over or bumps into furniture Poor depth perception Inability to discriminate between similar colors/ shapes No PERRLA Reduced Vision Interventions include: Communication regarding use of adaptive items Safety in familiar settings Ambulation assisted with care Self-care and independence promoted Support for the difficulty of adapting to loss of sight Interventions to Maintain Safety with Reduced Vision Increase amount of light without glare Utilize bright colors Remove hazards Throw rugs Electric cords Coffee table Clear path to bathroom • Orient to surroundings Interventions to Assist in Adapting to Reduced Vision Large print books and handouts Audio books Magnifying glass Talking devices (alarm clocks) Large key pad phone Hand held call bell Orient to food location on tray Color coded or raised label med bottles Communicating with the Visually Impaired Use normal voice tones Knock, introduce self Describe the environment Don’t move anything without permission Announce your movements Read for the patient Therapeutic communication Ambulating with the Visually Impaired Offer arm Hold elbow in close Cane or laser Community Resources National Federation for the Blind Chicago Lighthouse for the Blind American Foundation for the Blind Blind/ Visual Impairments website Blindness Resource Center AER Online Association of Education and Rehabilitation for the Visually Impaired Cataracts Cataracts Clouding and blurring of the lens distort the image and color projected onto the retina. As cataract matures, opacity makes it difficult to see the retina. Visual acuity is reduced. No pain or eye redness is associated with age-related cataracts. One or both eyes Vision with Cataracts Vision with Cataracts Cataract Risk Factors Aging Heredity Eye trauma Diabetes mellitus Chronic steroid use Sun exposure Cigarrete smoking Cataract Treatment Ambulatory surgery Pre-op teaching Local anesthesia, sedative Home 1 hour after surgery Multiple eye drops TID x 2-4 weeks Eye assessment Cataract Surgery Cataract: Postoperative Care Eye is unpatched (usually). Eye shield. Discharge usually occurs within 1 hr with dark glasses. Instill antibiotic-steroid eye drops. Mild itching is normal. Pain indicates a complication. Reduce IOP (usually ordered). Prevent infection. Assess for bleeding. Cataract Surgery Discharge Teaching Report to surgeon—sharp, sudden pain in the eye, bleeding or yellow or green discharge, lid swelling, decreased vision, or flashes of light or floating shapes. Avoid activities that might increase IOP. Review procedure for use of eye drops. Follow up appointment with surgeon, usually in 48 hours. Activities that Increase IOP Bending over Lifting objects over 10 lb. Coughing, sneezing, blowing nose Constipation, straining Vomiting Sexual intercourse Tight collars Glaucoma Decrease fluid drainage or increased fluid production Group of ocular diseases resulting in increased IOP Disturbance of the optic nerve Primary open-angle glaucoma Angle-closure glaucoma Glaucoma Risk Factors for Glaucoma Aging Heredity African American race Diabetes mellitus Infection Tumors Primary Open Angle Glaucoma Clinical Manifestations Generally no symptoms Elevated IOP (> 21 mm Hg) Loss of peripheral vision Decreased accommodation Usually affects both eyes Untreated = blindness Vision with Glaucoma Diagnostic Tests Tonometry Measures IOP (normal 10-21 mm Hg) Gonioscopy Determines the drainage angle of the anterior chamber of the eye Opthalmoscopy Visual Field Perimetry Optic Disc Photographs Optic Nerve Imaging Used at regular intervals to assess for loss of optic nerve fibers Tonometry Glaucoma Drug Therapy Reduce production or increase absorption of aqueous humor Prostaglandin analogs Alpha-adrenergic agonists Beta- blockers Cholinergic agonists (miotics: constrict the pupil Carbonic anhydrase inhibitors Patient Teaching: Administration of Eye Drops Don’t skip doses If more than one medication, wait 5-15 minutes between doses Punctal occlusion Glaucoma Surgical Treatment Glaucoma Surgery Laser or conventional Ambulatory surgery Post operative care IOP checked by surgeon 1-2hr Eye patch or shield Position on back or non-operative side Monitor for severe pain, N/V Eliminate activities that increase IOP Glaucoma Surgery S&S Postoperative Complications Acute eye pain Decreased vision Vital sign changes Nausea and vomiting Retinal Disorders Macular degeneration* Retinal hole Retinal tear Retinal detachment Diabetic retinopathy Macular Degeneration Risk Factors Aging Hypertension Smoking Family history UV light exposure Light colored eyes Macular Degeneration The macula—the area of central vision— deteriorates. Degeneration can be atrophic age-related (dry) or exudative (wet). Rod and cone photoreceptors die. Central vision declines; patient reports mild blurring, distortion or a blind spot. Vision with Macular Degeneration Macular Degeneration Treatment Control of underlying causes (smoking, HTN) Vitamins (C, E, beta carotene, zinc and others) Statins Pegaptanib (Macugen) eye injections Laser surgery Eye Injury/ Trauma Eye trauma- the leading cause of blindness in children and young adults. Treatment of Eye Injuries Splash injuries- irrigate Foreign bodies- cover and seek treatment EAR DISORDERS Hearing Loss One of the most common physical handicaps in North America. 2 Types Conductive Sensorineural Anatomy of Hearing Loss Causes of Conductive Hearing Loss Inflammatory process Tympanic membrane perforation Obstruction of the external or middle ear by cerumen or foreign objects Otosclerosis Causes of Sensorineural Hearing Loss Loud noises Aging Ototoxic drugs: Antibiotics (gentamycin, amikacin, vancomycin) Diuretics (furosemide) NSAIDS (aspirin) Chemo (cisplatin) Causes of Sensorineural Hearing Loss Meniere’s Disease Other diseases: Atherosclerosis, HTN, fever, DM Ear Surgery Acoustic Neuroma Treatment of Hearing Loss Early detection Drug therapy Assistive devices: Hearing aids Cochlear implants Tips for Hearing Aids Start at the lowest setting and gradually increase Wear for short periods in beginning Amplifies all noise, background noise Clean earmold regularly Turn off and remove battery when not in use Carry extra batteries Cochlear Implant Used with sensorineural hearing loss Electrodes near inner ear Computer device external ear 50% hearing improvement Cochlear Implant Communicating with the Hearing Impaired Be sure they can see your lips during conversation Use good lighting Get the patient’s attention prior to speaking. Move closer to hearing ear Speak clearly and slowly Don’t shout Minimize distracting noises Community Resources ADARA American Deafness and Rehabilitation Association o RID o Registry of Interpreters for the Deaf o Soft TTY o [email protected] o NAD oNational Association for the Deaf Other Sensory Disorders: PERIPHERAL NEUROPATHIES Peripheral Neuropathies Risk factors: Diabetes, impaired perfusion, smoking Decreased tactile sense Increased risk for burns, foot injury, falls.