SPECIAL SENSES

— Eye and E Disds

 Red
cones - Central, Colored and Day vision → RGB: ____, Green

SPECIAL SENSES
■ ______ _____,
Blue
_____
○ Optic Disk
_____________ Blind Spot
- where optic nerve enters, exits; “_____________”
○ Macula Lutea
_____________ Forea Centralis - central vision → Deterioration →
→ _____________
Prepared by: Vinz Tomboc, RN Bjerrum
Dx: _____________ Tangent
Macular Degeneration → Test: _______________
Abnormal
■ Wet Exudative - more aggressive; Cause: ________
_____________ Vessel → leak
fluid, blood → damage → macula → vision loss
Non- aging
■ Dry exudative - more common, slower; Cause: _______
_____________ process → drusen
BASIC CONCEPTS OF THE EYE
(yellow deposits) → thinner macula → vision loss
● vitreos humor
_____________ - jelly-like substance maintaining posterior eye shape,
External Layer
transmits light to retina
● Orbit - bone surrounding, protecting the eye
______
● sclera
______ - fibrous, white part
Others
● corned - transparent outer layer
______
● conjuctiva
_____________ - lines the posterior surface of each eyelid

uveal tract ● Lacrimal Gland - produces tears

_____________
Middle Layer - “____________”

● ______
chorora - dark brown membrane preventing light to reflect internally;
SAFETY
for falls → Priority: ________
Nursing Diagnosis - Impaired Vision → Nx Dx: u/f
_________
contains vessels supplying nutrients to retina
injury
● Ciliary Body - secrete ______________
____________ ageous humor - maintains anterior eye shape → ↑
REFRACTIVE ERRORS
glaucoma
→ Dx: _________
○ lens - bend light to focus on retina →
Controls thickness of ______ Snellens Chart - tests visual acuity
Cataract
Opacity → Dx: _________
Order: Right
_____ > Left Both (RLB)
_____ > _____
Canal of Schlemm - where aqueous humor drains high
drainage ●
● _______________ → block → Glaucoma
● 20/20
Normal: _____
● Iris
______ - colored portion
=
Trabecular Meshwork
○ numerator
_____________ - physical distance from the chart
○ Pupil - controls amount of light entering
______ denominator
○ _____________ - Size, Reference point for normal vision
■ Myosis - constriction → ↓ light
________
20/200
● Legal Blindness: _____
■ Mydriasis
________ - dilation → ↑ light
○ Approach: Talk __ Touch
○ Safety
Ambulation: _______
Inner Layer
■ Assisted/Unassisted
● Retina
______ - sensory (visual receptive) layer of eye → separation → Dx: Retinal
____ detachment
■ first , one step ahead
Nurse: _________
○ Rods vs Cones kinds of receptors Cane
○ Device: _____
■ Rods
______ - peripheRal, daRk and Night vision
○ Dog
Guide: _____
○ Substitute
Compensate: _________ W/ Other senses
 Types of Glaucoma
Closed/Acute Open/Chronic

Cause
complete Obstruction partial obstruction
Refractive Errors - problems with bending of light rays
Onset sudden >
-

emergency slow , insiduous

Myopia Hyperopia Astigmatism Presbyopia
Pain painful painless
Cause long Short irregular shape aging ID "hall" "blurry
"
"tunnel I
loss of peripheral vision"
Sight near-sightedness far-sighted blurry (near, far) far-sighted less more
Common
Focus front back Front ,
back back
Miosis mydriasis
Refractive Management
Ability strong weak weak
● Rest
Activity: __________
Opening
↓ ↓

↓ ↓
Corrective
(t) cylindrical lens HOB Elevated (Semi-fowlers)
Lens
1-) , concave
,
Convex
soft toric
St) convex ● Position: __________ ↑ Outflow obstruction
,
● Quiet
Room: ______, Dark
_______
Surgical Lasik , it progresses
Mgt: LASIK ● Drugs
○ Miotic - constrict pupils → ↑ outflow → ↓ IOP
_________
■ Pilocarpine
Prototype: _________
GLAUCOMA ○ Beta blockers - ↓ aqueous humor production → ↓ IOP
_________
Timolol * (DOC)
■ Prototype: _________
4 intraocular pressure (IOP) =
Definition: disease resulting in __ aqueous humor ○ Diuretics
_________
↓ fluids
- ↓ aqueous humor production → ↓ IOP
↑
● 4 IOP → damage →
Overproduction, Inadequate drainage of Aqueous humor → __ ■ Acctazolamide - Carbonic Anhydrase Inhibitor
Prototype: ____________
permanent Blindness
optic nerve → _________ compress of anticholinergic
○ Atropine _________,
AVOID (ABC): ________, Benadryl Congentin → mydriasis →
_________
eye structure
obstruction → ↓ outflow → ↑ IOP 2 Dipenny
antihistamine
tramine Bentropine
Tonometry - measures IOP
○ Teaching: Meds taken for LIFE
_____________
● 10 21
IOP: ________ ● Surgery:
○ time taken
Document: ______________ ○ Time Highest: __________ morning ○ Peripheral Iridectomy
____________________ → create hole → iris → → ↑ outflow → ↓ IOP
● Types: ■ Used in: EMERGENCY
○ Trabeculesto my
______________ → create channel → conjunctival spaces → ↑ outflow
Non-contact Contact
→ ↓ IOP
Uses of air
puff cones

Anesthesia topical anesthesia

Accuracy less accurate more accurate

"painful" avoid
1 "
Health Teaching the
painless rubbing eye
= scratch the eye
RETINAL DETACHMENT ● Congenital
__________ - due to heredity
● Traumatic - due to injury
__________
Definition: Separation of retina from the epithelium ● Secondary
__________ - due to other conditions
↓ blood
supply >
Og supply ○ Diabetes Mellitus
#1 Cause: _____________
Accumulation of Fluid, Tumor → Separation of retinal layer from choroid
-

● >
-

→ Partial detachment → Untreated → Complete Detachment → Blindness provide blood in the reting
*

● Hallmark: "CurtainOver Visual field

____________
surgery
Management - __________ 101 = intraocular lens
damage
● Others: _________ light
Floaters (Bleeding), _________
flashes ● Intracapsular Extraction - remove → entire lens → capsule absent → NO IOL
____________________

● Ophthalmoscopy: implants → aphakic glasses aphasis

○ Cloudy
Vitreous: _______ ● Extracapsular Extraction - remove → cloudy parts → capsule intact → IOL implant
_____________________
Cloud
○ Hanging Gray
Retina: _____________ implants
○ IOL Vision: magnified
______ - “objects appear closer than they really are”
Management → r/f: _____

● CBR
Activity: _________ ● Phacoemulsification → crushing cataract → smaller pieces → flush with NSS
_________________

● covered
Eyes: _________ ● Iridectomy → removal of iris → prevents secondary glaucoma
____________

● lower most/dependent
Position: Retina → _____________ risk of angle closure

○ supine
Superior RD: ________
OTHER EYE DISORDERS, TESTS
○ sitting
Inferior RD: ________
○ opposite side lying
Inner Aspect RD: __________ Infectious
same side lying
○ Outer Aspect RD: __________ chalazion - internal stye; inflammation of meibomian gland
● _________
● Surgery: Hordeolum
● _________ - external stye; infection of eyelash follicle, eyelid margin
○ Scleral Buckling- splint → hold choroid, retina together → scar tissue
__________
or sebaceous gland
forms → reattachment
○ #1 cause: Staphylococcus
_________
○ Gas Bubble
__________ - holds retinal and choroidal in place → reattachment
● conjuctivitis - inflammation of conjunctiva; “_________”
_________ Pink eye cause : E Coli
.

■ Face Down (Prone)

Position: __________

Tumors
Retinoblastoma
CATARACT ● #1 Eye Tumor in Children: _____________
● Malignant Melanoma
#1 Eye Tumor in Adults: ______________
Definition: Opacity of the lens ● Enucleation
Management: ___________, Brachytherapy
_____________

● "Cloudy"
Blurry Vision
Hallmark: ________, _____________
● ↓ color perception
Early sign: ________________ Trauma

Gradual Hyphema - trauma → “blood in the eye” → resolves in ________

5 7
days
-

● Loss of vision: ________ ● ____________

○ Best
Activity: _____
Types: ○ Semi-fowlers /HOB elevated)
Position: _____

● senile
__________ - due to aging ○ Atropine → cycloplegia → relaxes eye muscles
Eye drops: _________
Mydriatic
● Penetrating Objects - object penetrates the eye Postoperative Nursing Interventions
○ Remove Object =
hemorrhage ● unaffected
Position: ___________
○ Immobilize
Priority: ___________ BEST
● Activity: _______
○ cover
________ Cup taped in place
→ ____ Miotic (eye drops
● Drugs: ________
○ Bend Over, Lie Down ● Wear Off → Teaching: _______
Burning Sensation → Anesthetic: ________
N
○ ASAP
See HCP _________ ●
N
“Something in the eye” → sutures → Teaching: _______
Flush with Water
● Eye Irritants: _______ ● Activities: ↓ heavy activities not more than 51bs (< 51bs)
○ Rubbing eyes
Diagnostic Tests common in : ○ Lifting head/hips flexion ↑10p
>
-

Ishihara * linked recessive

● ___________ - color vision → color blindness Male
○ Sudden/jerky head movement
● allergy iodine , shellfish
Fluorescein Angiography → Assess: __________ ○ N/V D
-
Slow
vomit in Open eyes
● Slit Lamp → Teach: "Bright Light"
___________ ○ Sneezing/Coughing open mouth
○ Bending, Stooping ↑ 10 p
○ Reading, Watching TV > for 1 week
EYE SURGERY
-

○ Straining at stool Valsalva > stool softener

-

Terms: ○ Heavy Lifting ↑ 10p

Bleeding
● Enucleation - removal of eyeball → requires artificial eye
___________
● Floater
Complication: ________, ________
Sharp Report HCP
pain → ↑ IOP, Bleeding → Action: __________
Exisceration - removal of eyeball, sclera retained ● Devices: ________,
eyepatch eye shield (Night) for 5-7 days
_________
● ___________
● Extenteration - removal of all orbital contents
___________

Preoperative Nursing Interventions

● Atropine → CI: _________

Eye Drops: ________ Glaucoma BASIC CONCEPTS OF THE EARS
○ Mydriasis - dilation of pupils → better exposure
____________
Basic Parts of the Ear
○ Cyclopegia - relaxation of ciliary muscles
____________ "Blurry Vision"
● Tympanic (Eardrum) →
External Ear: Pinna, External Auditory Canal, __________
○ S/E: ___________ Sunglasses
Photosensitivity→ Wear: __________ CONDUCTIVE
damage → hearing loss: _________
○ Administration:
In cus
Malleus ______, Stapes → damage →
lower lid ● Middle Ear (3 bony ossicles): _______, _______
■ Pull: __________
hearing loss: CONDUCTIVE
_________
■ lower conjuctival sac
Expose: __________________ Labyrinth
● VIII →
Inner Ear: Semicircular Canals, Cochlea, CN ___ damage → hearing
■ Tilt Head:Backwards
_______ → reach conjunctival sac easily
LOOK UP and focus loss: SENSORINEURAL
_________
■ Teaching: “__________________” - to prevent blinking Tube - allows for equalization of pressure within the ear;
● Eustachian
______________
■ Apply:gentle pressure to inner
___________ __________
canthus → prevents systemic A/E
athmospheric pressure
opens in middle ear
■ Dropper should touch the eye
● VIII
Cranial Nerve: ____
○ Balance, Equilibrium: ________ Vertigo
Vestibule → damage → Dx: _______

conductive
sensorineural
hearing loss
hearing
loss
 ○ Hearing: ________ Tinnitus
Cochlear → damage → Dx: _______

Diagnostic Tests MENIERE’S DISEASE "endolymphatic hydrops"

● Rinne vs Weber Test - uses tuning fork Definition: Accumulation of endolymphatic fluid in the inner ear

Rinne Test (Conduction) Weber Test (Lateralization) ● Overproduction, Decreased Reabsorption → ↑ endolymphatic fluid → ↑
pressure of inner ear → auditory, vestibular function loss → Meniere’s
Primarily Validates conductive hearing loss sensorineural hearing loss
VIII
Cranial Nerve
Triad (VTS):
None air > bone Midline ,
No Lateralization
1. V______ Falls safety
ertigo → r/f: _______ → Priority: _______
Sensorineural HL air > bone good ear -

innitus
2. T________
Conductive HL bone air bad ear >
-
conductive ensorineural HL
3. S___________
Remission
Exacerbation & ___________
● Chronic
Characteristic: ________, ____________
● Caloric Test (Oculovestibular Test) - elicits jerk nystagmus by applying water

○ cold Opposite _______-________”

COWS - “_______-________, Warm same jevisy movements ○ Debilitating
Acute Attack → ____________
of the
eyes
Management
HEARING LOSS ● Meclizine - Antihistamine
Shorten Attack: _________ Anti-vertigo - bonamine Or Anti-pert

● Acetazolamide - ↓ endolymph volume

Diuretics: ___________
Conductive vs Sensorineural Hearing Loss
● Nicotinic Acid
_________________ - vasodilatory effect Vitamin B3
-

Conductive HL Sensorineural HL - Ototoxic

din retir ● Antiemetic
____________ - nausea/vomiting metoclopramide
inner loop
Location Outer middle furosemide ● Sedative
____________ - calm the patient benzodiazepine
Speech
softy loudly aspirin ● drainage of
Surgery: ____________, Resection of vestibule
_____________________________, Labyrinth ectomy
___________
Hears best noisy environment endolymphatic removal of innerear
-

quiet Getamycin fluid

Nursing Interventions
Telephone hear , understand hear , NOT understand
Aminoglycoside ● Assisted
Ambulation: ________
● safely
Priority: ________
Treatable?
surgery irreversible Rest ● Slow
Moving Head: ________
● Activity: ________
#
hearing implant ● Fluid: ________
J

Device aids cochlear Non-stimulating

● Environment: ________
mixed
↓
● hearing
________
loss - combination of both ● Sodium: ________
● ____________
presbycosis - sensorineural HL due to aging ● Smoking, Alcohol, Caffeine, Watching Television
● high-pitch
1st Tone Lost: __________ nicotine
pressure
= Inner ear

Communicating with Hearing Loss

● Close
Distance: ________
● face pt
Talking: _________ .

● better
Side: ________
Low normal
● Tone of Voice: _________
,
● substitute W/ Other senses
Compensate: _________
● Gestures
Accompany Speech: _______
OTOSCLEROSIS

Definition: Formation of abnormal spongy bone within ossicles → fixation of

EAR SURGERY
stapes → ↓ sound transmission
bilateral
● Involvement: _________ Preoperative Nursing Interventions
Conductive
● Hearing Loss: _________
tract infection
● upper respiratory
Assess: __________
● Characteristics: _______, Over time
slow , grows
___________
● Shampoo
Hair: __________
● Sign: Schwartze's
_____________ - pink-reddish hue through the tympanic membrane
● Women
Patient Population: _________ normal; whitish/
Irrigation
Postoperative Nursing Interventions
grayish
● unaffected side
Position: ______________
Management Post-op
● Hearing initially worse → __________,
ede ma Ear packing → Teaching: ________
__________ N
● Surgery:
Assisted
● Initial Ambulation: __________
○ Stapedectomy
________ - removal of stapes → replacement w/ prosthesis; mainstay
● Activities:
○ Fenestration
___________ - create new window → stapes footplate → allow sound
○ Airplane for 1 week
waves → inner ears
○ Shampoo, Showering, Head wet withold for 1 week

○ Reading, Watching TV for 1 week

ACOUSTIC NEUROMA ○ Blowing, sneezing, coughing / Open mouth

○ Sudden head movements - Slow

Definition: Benign tumor of the CN ___
VIII → damage to adjacent cranial nerves
○ Riding Elevator forI week
●
facial movement) Cranial newve
hearing ___________________
Damage: ________,
VII)
○ Straining at stool (valsalva)
● Tinnitus Sensorineural HL
Hallmark: ________ → __________ ○ Cotton Swab at risk for impacted cerumen
Q tip
● Resection
Management: ____________ Craniotomy
via _________ ● Complications
○ Facial Nerve Paralysis - damage to facial nerve (Bells Palsy)
■ Unilateral facial
Assess: _____________ paraly sis
OTHER EAR CONDITIONS,
○ Meningitis - due to bacterial contamination of inner ear fluid
Parrafin Ear Drops
-

● Hydrogen Peroxide ________________,

Impacted Cerumen → Tx: _______________, Olive Oil ______________
■ Stiffneck
Fever
Assess: _______, Headache
_______, __________
● Ear Irrigation: FeS H
○ Body temp
Temperature: _________
○ Lateral Flow
Direct Flow: _____________ ↓ perforation
→ Tympanic Membrane → _________
Vegetable seeds “If you have a dream, fight for it”
○ Contraindication: ____________
● Otitis Media
____________ - infection of middle ear "Otalgia" earache Lady Gaga
○ My ringotomy - create hole → tympanic membrane →
Surgical Mgt: __________
Grommet
device: _______
■ Teaching: Falls out on its
_____________ YES
, as long
Swimming: _____________
Own after 6-12 as there is

months
earplugs