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Chronicity - 6

Sensory Impairments

QuestionAnswer
Conjunctiva Mucous membrane that provides a barrier to environment and nourishes the eye.
Sclera White of the eye.
Limbus The outermost edge of the iris where the conjuctiva meets the cornea.
Cornea Transparent domelike structure. The main refracting surface of the eye.
Anterior Chamber Behind the cornea, filled with clear aqueous humor which is produced by the ciliary body. Production is related to intraocular pressure. Normal pressure is 10-21 mm Hg.
Uvea Consists of the iris, the ciliary body, and the choroid.
Iris Colored part of the eye.
Pupil Space that dilates and constricts in response to light. Normally round. 20% have pupils that are slightly unequal.
Lens Directly behind the pupil.
Aqueous humor Anterior to the lens.
Vitreous humor Posterior to the lens. 2/3 of the eye volume. contained in the ocular fundus (largest chamber).
Retina Innermost surface of the ocular fundus. composed of 10 microscopic layers. Made of neural tissue. An extension of the optic nerve. Consists of the retinal pigment epithelium which functions to absorb light, and the sensory retina which has the cones/rods.
Rods Responsible for night vision/low light
Cones Responsible for bright light vision, color and fine detail.
Retinal Pathway Retina, optic nerve, optic chiasm, optic tracks, lateral geniculate bodies, optic radioations and visual cortex of the brain. CNS - 2nd cranial.
Diagnostic Evaluation of Visual Acuity Snellen Letter or E Eye Chart, Blackbird Preschool System, Denver etc.
Diagnostic Evaluation of Vision in Infants Light Perception test.
Diagnostic Evaluation of Near Vision Jaeger chart or Rosenbaum Pocket Vision Screener
Diagnostic Evaluation of color Vision Ishihara polychromatic plates and Hardy-Rand-Rittler.
Blindness BCVA of 20/400 to no light perception
Emmetropia Normal eyesight
Myopia Nearsighted
Hyperopia Farsighted
Astigmatism Irregular curve of cornea
Glaucoma Optic nerve damage r/t increased IOP. Leading cause of irreversible blindness in the world.
Open-angle Glaucoma Optic nerve damage, visual field defects. IOP>21mmHg. HA, ocular pain, halos. Tx: topical and oral agents to decrease IOP 20-50%, laser trabeculoplasty, glaucoma filtering surgery.
Angle-Closure Glaucoma Pupillary block. Obstruction in aqueous humor outflow d/t closure of angle.
Acute Angle-Closure Glaucoma Ocular Emergency. Pain, hyperemia, congestion. Associated with nausea, vomiting, bradycardia, and profuse sweating. Decreased CV acuity, severely increased IOP, corneal edema, pupil fixed, vertically oval.
Subacute Angle Closure Glaucoma Transient blurring, halos, temporal HA and/or pain, pupil may be semidilated. Tx - prophylactic peripheral laser iridotomy.
Chronic Angle-Closure Glaucoma Progression with significant visual field loss, IOP normal or increased.
Nursing Management of Acute Angle-Closure Glaucoma Limit sensory stimulation, such as loud noise, activity, and movement.
Cholinergic (Miotics - pilocarpine, carbachol) Increase aqueous outflow. S/E: Periorbital pain, blurry vision, difficulty seeing in the dark.
Adrenergic Agonists (dipivefrin, epinephrine) Decrease production of aqueous humor and increase outflow. S/E: Redness and burning, possible palpitations, increased BP. Teach punctual occlusion to limit systemic effects.
Adrenergic Agonists (dipivefrin, epinephrine) Decrease production of aqueous humor and increase outflow. S/E: Redness and burning, possible palpitations, increased BP. Teach punctual occlusion to limit systemic effects.
Alpha-Adrenergic Agonists Decrease aqueous humor production. S/E: redness, dry mouth and nasal.
Beta-blockers (betaxolol, timolol) Decrease aqueous humor production. S/E: bradycardia, exacerbation of pulmonary disease, hypotension. Contraindicated in pts with asthma, COPD, heart block, bradycardia. Teach punctual occlusion.
Alpha-Adrenergic Agonists Decrease aqueous humor production. S/E: redness, dry mouth and nasal.
Carbonic Anhydrase Inhibitors Decrease aqueous humor production. S/E: Serious. Anaphylaxis, electrolyte loss, depression, lethargy, GI upset, impotence, weight loss. Do not admin to pt with Sulfa allergies. Monitor electrolytes.
Prostaglandin Analogs Increase uveoscleral outflow. S/E: Darkening of the iris, conjuctival redness, rash.
Cataract A condition in which the lens of the eye becomes opaque. 70% of those aged 75 and up.
Nuclear Cataract Associated with myopia. Usually progresses slowly.
Cortical Cataract Anterior, posterior or equatorial cortex of lens. Progress at variable rate. Vision is worse in bright light and may be d/t high levels of sunlight exposure.
Posterior Subcapsular Cataract In front of the posterior capsule. Typically in younger people, may be associated with prolonged corticosteroid use, inflammation or trauma.
Surgical Management of Cataracts By intracapsular extraction or extracapsular extraction
Corneal Dystrophies Inherited as autosomal dominant traits/ present at about 20 years old. Corneal deposits.
Retinal Detachment Separation of the RPE from the sensory layer. Medical management: Pneumatic retinopexy. Surgical Management: cryosurgery, electrodiathermy, laser reattachment, and scleral buckling. Complete bed rest for several days with the head immobilized.
Macular Degeneration Most common cause of visual loss in over 60 yo.
Age related Dry Macular Degeneration 85-90% with AMD have dry or nonexudative type. Outer layers of retina slowly break down, gradual blurring of vision, no known treatment that can slow or cure this type.
Keratoconus Conical protuberance of cornea with progressive thinning on protrusion and irregular astigmatism. Hereditary with increased incidence in women, onset at puberty; bilateral.
Retinal Detachment Separation of the RPE from the sensory layer. Medical management: Pneumatic retinopexy. Surgical Management: cryosurgery, electrodiathermy, laser reattachment, and scleral buckling. Complete bed rest for several days with the head immobilized.
Macular Degeneration Most common cause of visual loss in over 60 yo.
Age related Dry Macular Degeneration 85-90% with AMD have dry or nonexudative type. Outer layers of retina slowly break down, gradual blurring of vision, no known treatment that can slow or cure this type.
Conjunctivitis Pink appearance. Most common causes include microbial infection, allergy, and irritating toxic stimuli.
Age Related Wet Macular Degeneration Exudative type. May have abrupt onset. C/O straight lines appearing crooked or letters in words appear broken up. Due to abnormal blood vessel growth under the retina - can leak fluid and blood. May be treated with laser. Use of Amsler grids.
Ocular Trauma Leading cause of blindness in children and young adult males due to occupational injury, sports, weapons, assault, war and motor vehicle accidents. Recommend use of glasses with shatter-resistant lenses or safety goggles.
Dry Eye Syndrome Keratoconjunctivitis Sicca. Related to lid surface and epithelial abnormalities r/t systemic diseases, infection or injury or medications
Conjunctivitis Pink appearance. Most common causes include microbial infection, allergy, and irritating toxic stimuli.
Hordeolum Sty. Acute infection of glands of the eyelid caused by Staph A. Warm compresses, incision and drainage may be indicated, topical antibiotic.
Chalazion Inflammation of the meibomian glands. Can appear as single or multiple granulomas in eyelids.
Blepharitis Inflammation of the eyelid margins. Staph or seborrheic.
Bacterial Keratitis Infection of the cornea by S aureus, Strep, and pseudomonas.
Herpes Simplex Keratitis Leading cause of corneal blindness in the USA
Uveitis Inflammation of the uveal tract - can affect the iris, ciliary body, or choroid. Nongranulomatous and granulomatuous. Wear dark glasses outdoors.
Orbital Cellulitis May be secondary to becterial, fungal or viral inflammations. Infection of sinus is most frequent case. Periorbital cellulitis to orbital cellulitis to subperiosteal abcess to orbital abcess to cavernous sinus thrombosis.
Benign Tumors Orbit - can develop from infancy and grow slowly or rapidly. Surgical excision. Eyelid - increase in frequency with age. Conjunctiva - Congenital conjuctival neva. Slightly elevated brown spot becomes pigmented during late childhood.
Malignant Tumors Orbit - Rhabdomyosarcoma - most common in children. Eyelid - Basal cell carcinoma, squamous cell carcinoma. Conjunctiva - Conjuctival carcinoma most often grows in exposed areas. Ocular melanoma - rare malignant choroidal tumor discovered on retinal exam.
Enucleation Surgical removal of the entire eye and part of the optic nerve.
Evisceration Removal of the intraocular contents thru incision in the cornea or sclera - optic nerve, sclera, extraocular muscles are left intact.
Exenteration Removal of the eyelids, eye, and some orbital content.
Diabetic Retinopathy Diabetes is leading cause of new cases of blindness in working-aged people.
Cytomegalovirus Retinitis 90% of AIDS pt have ocular lesions. 40% lose central vision by time of death.
Medication Administration 1-7% of ocular meds absorb. Corneal membrane barriers - epithelial, stromal, and endothelial layers are barriers to absorption.
Mydriatics Dilate the pupil
Cycloplegics Paralyze the iris sphincter. Contraindicated in narrow angle or shallow anterior chambers and pts taking MAOIs or tricyclic antidepressants.
Outer Ear Auricle and external auditory canal. Skin of the canal contains hair, sebaceous glands and ceruminous glands which make cerumen.
Middle Ear Air-filled cavity. Contains the tympanic membrane and ossicles. Eardrum protects the middle ear and conducts sound vibrations to the ossicles - magnified 22 times.
Inner Ear Cochlea, semicircular canals (balance), facial nerve (CN7), and vestibulocochlear nerve (CN8) All housed in bony labyrinth and bathed in fluid called perilymph.
Symptoms of Hearing Loss Speech deterioration, fatigue, indifference, social withdrawal, insecurity, indecision and procrastination, suspiciousness, false pride, loneliness and unhappiness, tendency to dominate a conversation.
Gerontologic Consideration About 50% of 75+ have hearing loss. Cerumen is harder and drier, posing a chance of impaction. Tympanic membrane atrophy or sclerotic, cells at the base of cochlea degenerate. Presbycusis is progressive hearing loss. Many take quinine for leg cramps.
Cerumen Impaction Otalgia is a sensation of fullness or pain in the ear. Removal is by gentle irrigation, agents to soften ear was include warmed glycerin, mineral oil, half-strength H2O2, suction, and instrumentation.
Foreign Objects Mineral oil is instilled into the ear to smother an insect. Solid objects are removed with a small forceps. Standard methods of removal are irrigation, suction, and instrumentation.
Otitis Externa Causes may include water in the ear, trauma, systemic conditions such as vitamin deficiency and endocrine disorders. Wear ear plugs to prevent trapping water in the ear.
Malignant External Otitis Rare. Temporal bone osteomyelitis.
Masses of the External Ear Exostoses - small hard bony protrusions, usually occur bilaterally. basal cell carcinomas.
Tympanic Membrane Perforation Caused by infection or trauma.
Otitis Media May have acute or chronic forms of either serous otitis media, also known as secretory or nonsuppurative otitis media, or the purulent or suppurative type.
Otosclerosis A hearing aid helps. If surgical treatment is selected, a stapedectomy is performed on the ear most affected.
Motion Sickness Disturbance of equilibrium caused by constant motion - OTC antihistamines.
Meniere's Disease Fluctuating, progressive sensorineural hearing loss, tinnitus or a roaring sound, feeling of pressure or fullness in ear, episodic incapacitating vertigo accompanied by nausea and vomiting. TX is low sodium diet, and meclizine.
Labyrinthitis Inflammation of the inner ear, bacterial or viral. Usually occurs as complication of otitis media. Sudden onset of incapacitating vertigo, nausea, and vomiting. TX is IV ABT, fluid replacement and Meclizine.
Vestibular Neuronitis Disorder of vestibular nerve. Severe vertigo with normal hearing. Caused by virus, vascular and demyelinating diseased and toxins. Many pts have had previous ear/nose/throat infection. Recovery without treatment.
Benign Proxyusmal Positional Vertigo Brief incapacitation vertigo with head position change. Place head back with affected ear turned down.
Ototoxicity Meds may have adverse effect on cochlea. At high doses, Aspirin toxicity may cause tinnitus. IV Aminoglycosides destroy hair cells in the organ of Corti. Long term IV ABT should have 2 week audiogram.
Acoustic Neuroma Slow growing benign tumor of CN8.
Thalamus Major receiving and transmitting center for afferent sensory nerves. Responsible for sense of movement and position and ability to recognize size/shape/quality of objects.
BCVA Best Corrected Visual Acuity
OD Ocular dexter. Right Eye
OS Ocular sinister. Left Eye
OU Ocular Uterque. Each Eye
UCVA un-corrected visual acuity.
Accommodation process where the eye adjusts for near distance such as reading by chnging the curvature of the lens to focus a clear image on the retina.
Anterior chamber Space in the eye bordered anteriorly by the cornea and posteriorly by the iris and pupil.
Aphakia Absence of the natural lens.
Astigmatism Regractive error where light rays are spread over a diffuse area rather than sharply focused on the retina; d/t differences in the curvature of the cornea and lens.
Chemosis Edema of the conjunctiva.
Color Vision Deficit Formerly called color blindness. Effects 8-10% of white males.
Cones Retinal photo-receptor celss essential for visual acuity and color recognition.
Diplopia Seeing one object as 2. Double vision.
Hyphema Blood in the anterior chamber.
Nystagmus Involuntary oscillation of the eyeball
Proptosis Downward displacement of the eyeball from an inflammatory condition of the orbit or mass in the orbital cavity.
Ptosis Drooping eyelid.
Refraction determination of the refractive errors of the eye and correction by lenses
rods retinal photo-receptors for bright and dim light.
romberg test test for balance and gait
scotoma blind or partially blind area in the visual field.
Strabismus Condition where there is deviation from perfect ocular alignment.
Sympathetic Ophthalmia Inflammatory condition created in the fellow eye by the affected eye w/o useful vision; condition may become chronic and result in blindness.
Created by: rjsnowrn