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Chapter041

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  • 1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 41: Introduction to the Sensory System Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. Anatomy, Physiology of the Eye • 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. Anatomy, Physiology of the Eye Figure 41-1 External structures of the eye and position of the lacrimal structures Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 4. Intraocular Structures • 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. The Eye Figure 41-2 Three-dimensional cross-section of the eye Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Visual Function • Light  Nerve signals: Interpreted in cerebral cortex • Refraction; Rods, cones  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. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 7. Nursing Assessment • Client History – Allergy; Vision changes; Discomfort; Corrective lenses – Eye medications; Eye trauma, disease, surgery – Family history of eye disease • Physical Assessment – Symmetry – Inflammation; Exudate – Pupil constriction Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 8. Eye Assessment • 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 9. Diagnostic Studies • 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 10. Diagnostic Studies • 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Nursing Management • Client Education – Maintenance, preservation of eye function • Obtain an Accurate Baseline • Client Assessment for Further Action Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. Anatomy and Physiology of the Ear • 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 13. Subdivisions of the Ear Figure 41-8 Diagram of the ear, showing the external, middle, and internal subdivisions. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 14. Ear Assessment • 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 15. Diagnostic Studies • 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 16. Nursing Management • Client Assessment: Ear structure; Hearing function – Screening in healthcare settings – Baseline for further testing, referral – Client education: Maintenance of hearing function and testing Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 17. End of Presentation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins