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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 • • • • 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: • • • • 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 – – – – – • 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