SPECIAL SENSES

by: Prof Lorelie Pomentil

10. Macula – area of the retina responsible for central

EYES vision
● Located at the center of the retina
● Rest of the retina - peripheral vision
* Photoreceptors cells
11. Cons – receptors for Daylight/Bright vision (iNcreased
Light)
12. Rods –receptors for Dim/ Night (Decreased light)

3 Layers of the Eye

----------------------------------------------
● Eyes has 3 layers
a. Sclera — outer & toughest layer; colored white
○ Retina - innermost
b. Choroid — middle layer; brown because it is highly
○ Choroid
vasculated; bleeds heavily when injured
○ Sclera - outermost
c. Retina — innermost layer; visual receptive layer where
images are converted into nerve impulses → CN2: OPTIC
NERVE → OCCIPITAL LOBE
- contains the photoreceptor cells & macula

ASSESSMENT

VISUAL ACUITY
----------------------------------------------
● ability to distinguish details based on a given
distance

Snellen Chart
1. Client is asked to stand
at a distance of 20 feet
away from the chart
ANATOMY AND PHYSIOLOGY
2. Over eye at a time: R →
L → Both
1. Cornea — transparent dome like structure attracts light
3. Result:
to enter the eyes
Normal vision: 20/20
● ❌ ❌
● Light - 1st req to vision
light = vision
2. Iris – gives color to the eyes; also helps in pupil
Legal Blindness: 20/200

Ex. Reads 20/70 is interpreted as client can read at

constriction
a distance of 20ft what a person with normal vision
3. Pupil – constricts & dilates based on illumination (light)
can read at 70 ft
● Inc light - constriction; protection mechanism
● Dec light - dilation; adaptive mechanism
COLOR VISION TEST
4. Lens – refraction or accomodation: adjustment of the
----------------------------------------------
lens depending on how far/near or big/small is a subject
Color Blindness — Ishihara Plate
5. Vitreous Humor – a jelly like structure found inside the
eye; it maintains normal shape of the eye; Sphere
How to use the test?
6. Aqueous Humor – liquid; maintains normal pressure of
1. Room should be
the eyes: 10-21 mmHg
adequately lit by daylight.
7. Conjunctiva – clear membrane that protects the eye;
2. The plates are held 75cm
covers the inside of eyelid & sclera (white of the eye)
from the subject
8. Ciliary Body – produces the fluid in the eye: Aqueous
3. The numerals which are
humor
seen on the plates are
9. Canal of schlemm – collect aq. Humor the from the
stated
anterior chamber of the eyeball & deliver it to the veins of
4. Each answer should be
the eyeball
given in 3 seconds.
● Trabecular meshwork - dito dumaan before canals
schlemm

PROF AD CRUZ, RN 2023 1

 SPECIAL SENSES
SPECIAL SENSES
Prof Pomentil

Analysis of Result: 14 Plate AMSLER GRID

1. 10 or more plates are read normally - Normal ----------------------------------------------
2. Only 7 or less plates are read normal - Deficient ● Test for Macular Degeneration
3. 0 plates are read normal - Total Color Blindness ○ Macula since may central fixation point

FLUORESCEIN ANGIOGRAPHY
----------------------------------------------

Graphy - viewing;
Angio - blood vessel; 1. Hold the chart 12-14 in. away
Fluorescein - Contrast 2. Cover one eye & focus on the central fixation point
agent is used ● Since the other compensate when the one eye is
abnormal

● Used to evaluate clinically significant conditions Report of the px:

particularly: NEOVASCULARIZATION Squares look faded
○ zation - formation; neo - new/abn Lines look wavy
○ Formation of new and abnormal blood
vessels
EYE DISORDERS
How:
1. fluorescein dye is injected (usually into antecubital vein)
2. Over a 10-minute period, serial black and white photos of
retinal vasculature is taken detecting neovascularization REFRACTIVE ERRORS

Side Effects: Systemic side effects

1. Skin — gold tone
2. Urine — deep yellow
* expected at least 24 hours after procedure

Nursing Action:
1. Inc fluid - to promote excretion
2. Px education- regarding side effect to prevent anxieties FINDINGS HYPEROPIA MYOPIA ASTIGMATISM
SIGHT Farsighted Nearsighted Blurry both
TONOMETRY D = clear D = blurry D & N vision
---------------------------------------------- N = blurry N = clear
● Measures inc IOP
SHAPE OF Short: Beyond/ Long: In front/ Irregular shape
● Detects glaucoma EYEBALL Behind Retina In short of
Retina
1. Contact
● W/ topical anesthesia CURVATURE Too much
OF THE curvature
● flattened cone in contact
CORNEA
to cornea and amount of pressure needed to
flatten cornea is measured REFRACTIVE Weak Strong Abn shape
● Instruct: Avoid rubbing the eye - to prevent ABILITY/ LENS
scratching cornea CORRECTIVE Positive Negative Soft Toric lens
LENS
2. No Contact SHAPE OF Convex - Concave Cylinder
● No anesthetic LENS makapal gitna
● Puff of air is directed into the cornea to indent the
cornea
● Less accurate than contact tonometry

Nursing Action:
Note the time of the day the test was done
1. IOP Fluctuates all throughout the day
2. IOP Normally & slightly increase in the morning

PROF AD CRUZ, RN 2023 2

 SPECIAL SENSES
SPECIAL SENSES
Prof Pomentil

Open- angle Glaucoma Angle-closure Glaucoma

• Partial block of the • Blocked angle caused by

trabecular meshwork the iris
• Painless • Painful
• Slow changes in vision • Emergency
• Tunnel vision • Blurred vision
Normal Eye - the cornea and lens focus light ray on the - Loss of peripheral • Halos around light
retina vision

Astigmatism - 2 different points: front of and beyond the

retina
3 anatomical problem
1. Too much curvature of cornea
2. Irregular shape of eyeball
3. Abn shape of lens
MEDICATIONS

1. Meds that dec. production of Aqueous Humor:

● Alpha agonists
• Concave lens
● Alpha2-adrenergic agonists
• Lens too weak
● Carbonic anhydrase inhibitor
• Too much curvature of cornea
● Beta blockers
• Eyeball too long
• Irregular shaped eyeball
2. Prostaglandin analogs - inc aq humor outflow
• Positive lens
● Open glaucoma
• Cylindrical lens
• Lens too strong
3. Miotics - pupil constriction: lifetime
• Negative lens
● Eyedrops - maintenance for close glaucoma
• Eyeball too short
•Near sighted
*Mydriatics - pupil dilation
•Distorted vision
• Convex lens
SURGERY
• Cylindrical lens
• Concave lens
1. Laser Trabeculoplasty (repair) — Open Angle Glaucoma
• Far sighted
- Laser beam is applied to the inner surface of the
• Soft toric lens
trabecular meshwork to open the intertrabecular
spaces
GLAUCOMA
2. Laser Iridotomy (making of an opening) — Close Angle
● An eye disorder characterized by an INC OP → Glaucoma
Damage to Retina, Optic Nerve (important part of - An opening is made in the iris to eliminate the
the eyes) pupillary block
● = Visual loss is irreversible
● Lifetime loss 3. Filtering Procedure — creation of an opening in the trab
meshwork
Pathophysiology: ● Trabeculectomy - remove part of the meshwork
● Drainage Implants - tubes implanted to shunt AH
to the conjunctival space

• Emergency
• Partial block of the trabecular meshwork
• Blurred vision

PROF AD CRUZ, RN 2023 3

 SPECIAL SENSES
SPECIAL SENSES
Prof Pomentil

2. Post op
• Slow changes in vision
● Report: SEVERE EYE PAIN & FLOATERS
• Ocular erythema - redness of the skin of
○ Severe pain — Inc IOP
the eyelid
○ Floaters — Bleeding
• Tunnel vision
○ Immediately Report to HCP
• Painless
● Eye patch — Day
• Halos around light
● Metal Shield — Night
• Blocked angle caused by the iris
● Sunglasses — out
● Keep it dry — prevent infxn
● Position:
CATARACT
○ Semi fowler's - prevent inc pressure
● Lens opacity/ cloudiness ○ Side lying - Unaffected
○ Opaque - light is not able to pass through
○ Due to Chemical changes in the protein of
the lens

CLASSIFICATIONS:
+ • Avoid eye straining
1. Senile — ass w/ aging
- • Rub the eye when itchy
2. Traumatic — ass w/ injury
+ • Avoid rapid movements
3. Congenital — occurs at birth
- • Lift objects heavier than 5lbs (2.25 kg)
4. Secondary — occurs ff other systemic or eye disease
- inc in intra abdominal pressure →
inc intrathoracic pressure →
MANIFESTATIONS:
intracranial → IOP
Early Signs: - pharmacological muna nigagamit
1. Blurred vision
2. Low color perception
-

+
⬆️
• Low fiber diet — Low fecal vol →
constipation → straining = IAP
• Avoid bending
- • Report itching and mild discomfort
Late Signs:
- • Coughing
1. Diplopia (double vision)
- • Place in supine position
2. Dec visual acuity
- • Turn to operative side
3. White pupil

SURGERY
RETINAL DETACHMENT
1. Intracapsular Cataract Extraction — removal of the
cataract
2. Extracapsular Cataract Extraction — removal of the
cataract w/o capsule
3. Phacoemulsification — breaking of the lens → using
ultrasonic vibrations → microsuction
4. Lens Replacement
● IOL implants - implant made of polyethyl
methacrylate
CAUSES:
● Aphakic eyeglasses - objects are 25% magnified
1. Fluid accumulation (Rhegmatogenous)
making them appear closer than they are; risk for
- naghiwalay sensory retina at RPE
injury
Two innermost layer of the retina:
● Contact lens - can provide almost normal vision
a. Sensory retina (where rods and cons are)
but high risk for infection
b. RPE/Retinal pigment epithelium
NURSING RESPONSIBILITIES
2. Tumor (Traction Retinal)
- humiwalay buong layer ng retina sa choroid due to
1. Preop
tumor
● Anticoagulants — withhold → 1-4 weeks
● Mydriatics — to have clear & unobstructed view of
MANIFESTATIONS:
eye structures
a. Flashes of lights
○ Give 4 doses every 10 mins → 1 hour
b. Floaters or black spots — sign of Bleeding
prior surgery

PROF AD CRUZ, RN 2023 4

 SPECIAL SENSES
SPECIAL SENSES
Prof Pomentil

c. Increased in blurred vision ● Clusters of debris / waste materials

d. CURTAIN LIKE VISION — Pathognomonic Sign 2. Wet - Choroidal neovascularization → leaking fluid &
e. Painless but EMERGENCY blood → elevates the retina affecting the macula → loss of
CV

MANAGEMENT

1. Photodynamic Therapy — Verteporfin Injection - Inject

via IV → Photosensitive (absorb light) → heat energy →
destroy abn blood vessels

MANAGEMENT Systemic effect: Risk for sunburn = Sunburn Management

● Sunglasses
*Prevent further detachment* ● Long sleeves
1. Bed rest ● Wide brimmed hat
2. Avoid eye stress ● Avoid going outdoors for 5 days
3. Avoid jerky head movement

4. Surgery
• Drainage of fluid/Removal of tumor
• Curtain vision
• Tunnel Vision
• Cryosurgery - cold probe applied to sclera → stimulate
• Loss of central vision
inflammatory response → adhesion
• Blurring of vision
• Halo around lights
• Diathermy - heat through the sclera → inflammatory
• Floaters
response → adhesion
• Loss of peripheral vision
• Drusen
• Laser therapy- stimulate inflammatory response and
• Flashes of lights
sealing of tears
• Painful
• Opacity of lens
• Scleral Buckling - to hold the choroid and retina together
with splint until scar tissue forms closing the tear

EARS

5. Postop
• HEMORRHAGE — floaters
• IOP — severe eye pain
• Position — as prescribed
•Deep breathing —
•Minimize eye stress
- Sunglasses - out
- Eye patch - day
- Metal shield - night
HEARING DISORDERS
MACULAR DEGENERATION
● loss of central vision HEARING LOSS
Conductive hearing loss caused by something that stops
Types:
sounds from getting through the outer or middle ear:
1. Dry - Age related → development of Drusen → locate at
presence of obstruction (otosclerosis or otitis media)
macula → loss of CV

PROF AD CRUZ, RN 2023 5

 SPECIAL SENSES
SPECIAL SENSES
Prof Pomentil

Sensorineural hearing loss, problems in the inner ear; MANAGEMENT

resulting from damage to the cochlear or vestibulocochlear
nerve (neuron HL) - CN8
- NO NEURON
✅
✅ • Get the attention of client before talking
• Using written words if the client can see, read, and

TUNING FORK TESTS ❌

write - compensation

❌ • Talk directly to the client's ear

RINNE’S TEST ✅ • Talking in a crowded room

• Moving close to the client and speaking slowly and
Compares Air conduction to Bone conduction
● Distance 2 inches from the opening of the ear ❌
clearly

✅ • Talking in high volume and at a high pitch

Normal: AC > BC
Conductive HL: BC > AC
Sensorineural HL: AC > BC (kaya need magwebber)
✅•• Rephrasing sentences and repeating information
Validating with the client the understanding of
statements made by asking the client to repeat what was

WEBER TEST ✅
said
• Using sign language, which combines speech with
Normal: tone is heard equally in both ears
Conductive HL: poor ear ❌
hand movements that signify letters, words, or phrases
• Exaggerate the movement of your lips when talking -
Sensorineural HL: good ear
✅
insulting
• Using flashing lights that are activated by ringing of the
telephone or doorbell

OTOSCLEROSIS
● Formation of new bones in the ossicles (middle
ear)
● Can lead to conductive hearing loss
● New bones can cause Abn. BV that can be seen in
the Eardrum: Color Pink → Schwartze’s Sign - abn
blood vessels

Example: SURGERY

Stapedectomy with Fenestration - prosthesis

● Improvement of hearing after 6 weeks
● Gelfoam ear pack - reduce bleeding
● Assist with ambulation
● Assess for facial nerve damage
● Avoid showering and getting the wound wet
● Avoid increase in pressure - avoid blowing of the
TYPES
nose
○ Otitis media -
1. Conductive — obstruction
❌
2. Sensorineural —inner ear; CN 8
3. Mixed — CHL + SHL MENIERE’S SYNDROME (ENDOLYMPHATIC HYDROPS)
4. Central — problem temporal lobe
● Dilation of the endolymphatic system by
overproduction or decreased reabsorption of
endolymphatic fluid. → inc pressure → CN8
○ Almost the same with glaucoma

PROF AD CRUZ, RN 2023 6

 SPECIAL SENSES
SPECIAL SENSES
Prof Pomentil

● Can cause damage in Vestibulocochlear

○ Vestibulo- balance
○ Cochlear - hearing
○ Prone: Vertigo, Tinnitus, Hearing loss

Characterized by: TRIAD

1. Vertigo
2. Tinnitus
3. Hearing loss

MANAGEMENT

✅
❌ • Safety — 1st priority!!

✅
✅
• Let the client ambulate
• Quiet environment. - due to tinnitus

❌
❌
• Instruct the client to move the head slowly
• Initiate high sodium and high fluid intake.

❌ • Expose clients to flickering lights.

• Administer nicotinic acid for vasoconstriction. — VIT B

✅
→ vasodilation → drainage

✅ • Avoid antihistamines — due to inflammation

• Administer antiemetics — vertigo → nausea and

✅
vomiting = prevent increase of pressure
• Administer tranquilizers and sedatives — provides calm

❌• Diuretics are contraindicated. — promote fluid loss

& rest

PROF AD CRUZ, RN 2023 7