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Sensory Impairments
Lisa Flatt, RN, MSN, CHPN
Be able to:
• Assess vision, hearing, taste, smell, touch
and balance
• Identify the way to reorient to person,
place, time and situation
• Define components of sensory dysfunction
assessment
• State nursing care of patients with
sensory dysfunction
Definitions to know
• See Page 111
Eyes and Ears
• Most impact
• Proprioception (posture, equilibrium movement) –
is maintained by ears and eyes
• Eyes and ears send messages to cerebellum in
relationship to coordination & perception and
provide feedback for movements of the body in
space (think of a baby’s head wobble – not related
to the neck muscles)
Parts is Parts -- EYES
• Eye parts
• Outer protection - sclera, cornea, iris, ciliary body
• Inner area - retina
• Alterations of parts
– Presbyopia, hyperopia, myopia, astigmatism,
macular degeneration, cataracts, glaucoma,
conjunctivitis, corneal abrasions, detached
retina; retinopathy
Parts is Parts - EARS
• Ear Parts
– External ear – auricle auditory canal, tympanic membrane
– Internal ear – eustachian tuve, semicircular canan,
acoustic nerve
• Alterations of Parts
– Otitis media, otitis external, cholesteatoma,
otosclerosis, masses, cerumen imopaction, prebycusis,
Meniere’’s disease, labyrinthitis, hearing loss (conductive
or sensorineural), tinnitus
Leading cause of
blindness worldwide?
• Name it conjunctivitis
• Why untreated
• Treatment – cheap eye drops
Clinically you will see:
• Neurovascular deficits- injury to
neurologic and vascular systems at
one time
– What may have happened bleeds, clots
– Disease states HTN, CVA, TIA
– Numbness, tingling is called neuropathy
And more….
• Signs of impaired vision are:
squinting, balance issues, moving
furniture is bad, glasses, headaches,
double vision, cloudy, hazy
And more…….
• Signs of impaired hearing are: what?,
looking at face, leaning, balance,
sounds, repeating stuff, loud talkers
Factors that influence,
Psychological
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Psychological- PTSD, depression
Sensory deprivation – lack of stimulation
Sensory overload – too much stimulation
Social isolation – no people interaction,
4000 facebook friends
• Paranoia – they want me, vulnerability,
weakness
More factors:
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Socioeconomic—can’t afford stuff
Environmental –train tracks, work
Chronic illness - no money
Medications – cannot afford
The Illustrious Nursing
Process the Eyes have it!
• Assessment
– PERRLA
– Eye movement
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• Visual fields – metric ophthalmoscopy – papilledema –
tonometry – noncontact tonometry – accommodation refraction
Slit Lamp exam
Color vision test
Amsler grid
Fluorescent angiography
Functional visual acuity (Snellen chart)
The Ears Have it!
• Hearing tests (audiometry,
tympanogram, functional hearing)
• Weber test
• Physical exam
• Platform posturography
• Sinusoidal harmonic acceleration
(rotary chair)
Analysis/Nursing
Diagnosis
Planning
Implementation
Evaluation