Human Senses - Complete the worksheet.doc

8/21/2019 Human Senses - Complete the worksheet.doc

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SENSES – VISUAL – THE EYE

The eye

Complete the missing words:

1. The eyeball consists of three layers, the

a. ___________________________ - fibrous coat that supports the eye

i. ___________________________ - tough, white connective tissue, located

anteriorly and posteriorly

ii. ___________________________ - transparent tissue through which light enters

the eye, located anteriorly

b. The middle layer of the eye consist of three parts

i. ___________________________ - a dark brown membrane located between the

sclera the retina, it lines most of the sclera is attached to the retina but can

easily detach from the sclera and contains blood vessels that nourishes the retina

ii. ___________________________ - connects the choroid with the iris, secretes

a!ueous humor that helps give the eye its shape

iii. ___________________________ - the colored portion of the eye, e"tension of the

ciliary body, located in front of the lens and it has a central opening called the pupil

c. The inner layer of the eye also known as the ___________________________ is a thin

dedicate structure in which the fibers of the ___________________________ are

distributed and e"tremely sensitive to ___________________________.

#. $%&'() *$ T+

. /&*&) +&0*

- Clear, watery fluid fills anterior posterior

chamber

- produced by the ciliary processes, the fluid

drains in the Canal of )clemm

- serves as refracting medium provides

nutrients to lens cornea

- contributes to maintenance of '*2


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3. 4'T*&) +&0*

- Clear, gelatinous56ell-like material that fill the

posterior cavity of the eye

- 0aintains the form shape of the eye

- 2rovides additional physical support to the

ye

7. 0&)C%)

. '8T'8)'C 0&)C%):

a. '')

b. C'%' 3*(

3. 9T'8)'C

a. $*& )T'+T CT&) 0&)C%

- superior, inferior, lateral medial

b. T;* *3%'/& 0&)C%)

- superior inferior

nerve of sight?

3. C8'% 84 4


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- Trigeminal >opthalmic?

C. 0*T* 84 > C8 ''', C8 '4, C8 4'?

- oculomotor, trochlear, abducens

)8)* 2T+; $* 4')'*8

the *( C*8 receptors, which are sensitive to light initiate nerve impulse messages which w5c

travel over the optic nerves

*2T'C C+')0 is the crossing point for fibers from the medial halves of the retinae

that in *2T'C C+')0, the optic nerve fibers from the medial halves of the retinae cross to the

opposite side of the brain while from the lateral halves or the retinae remain uncrossed

Thus fibers from the right half of each eye carry impulses to the brain@s right occipital lobe, and fibers

from the left half of each eye carry impulses to the left occipital lobe.

$rom the *2T'C C+')0, the optic nerves continue, as optic tracts, to the cerebrum.

;ithin the brain, visual impulses are interpreted as light

$%9) *$ T+

%'+T $%9

- pupil becomes smaller when light is flashed in

the eye

3. CC*0*(T'*8 $%9

- pupil becomes smaller when gaAe is shifted

from distant to near ob6ect

2+)'*%* *$ 3'8*C&% 4')'*8

C*848C *$ 4')&% 9)

-coordinated movement of # eyes toward fi"ation of same near point

3. &%T'*8 *$ 2&2'% )'B


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-regulating amount of light entering eyes by

changing pupil siAes

C. $CT'*8 *$ %'+T )

- rays are refracted or bent as they pass thru

varying densities

(. CC*00*(T'*8

a. near vision- ciliary muscle contract, lens

bulges 5conve"

b. distant vision- ciliary muscle rela"es, lens

flattens

))))08T *$ 4')'*8

4')&% C&'T T)T

- measures the client@s distance near vision

)8%%8 C+T

- simple tool to record visual acuity

- the client stands # ft from the chart covers 1

eye and uses the

other eye to read the line that appears more

clearly

- this procedure is repeated for the other eye

- the findings are recorded as a comparison

between what the client can read at # ft and

the no. of feet normally re!uired by an individual to read the same line

902%: #5=

- The client is able to read at # ft from the chart

what a healthy eye can read at = ft

C*8$*8TT'*8% T)T


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- 2erformed to e"amine visual fields or peripheral

vision

- The e"aminer the client sit facing each other

- The test assumes that the e"aminer has normal

peripheral vision

9T*C&% 0&)C% $&8CT'*8

- tests muscle function of the eyes

- tests D cardinal positions of gaAe

1. Client@s right >lateral position?

#. &pward right >temporal position?

7. (own right

lateral position?

=. &pward left >temporal position?

D. (own left

- client holds head still asked to move eyes

follow a small ob6ect

- the e"aminer looks for any parallel movements

of the eye or for

8)T0&)

- an involuntary rhythmic rapid twitching of

the eyeballs

))))08T *$ 4')'*8

C*%* 4')'*8 T)T

- Tests for color vision which involve picking nos. or letters out of a

comple" colorful picture

')+'+ C+T


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- consists of nos. that are composed of colored dots located within a circle

of colored dots

- client is asked to read the nos. on the chart

- each eye is tested separately

- the test is sensitive for the diagnosis of

red5green blindness but not

effective for the detection of the discrimination

of blue

2&2'%)

- 8ormal: round of e!ual siAe

- 'ncreasing light causes pupillary constriction

(ecreasing light causes pupillary dilation

- the client is asked to look straight ahead while

the e"aminer !uickly

brings a beam of light > penlight? in from the side

directs it onto the side

- C*8)8)&% )2*8)

('8*)T'C T)T) $* T+

1. $%&*)C'8 8'*2+

- detailed imaging recording of ocular circulation by

a series of photographs after administration of the

dye

2-*2 8&)'8 C

ssess for allergies previous reactions to dyes


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*btain informed consent

mydriatic medication is instilled in the eye 1 hr. before the test

The dye is in6ected into the vein of the client@s arm

'nform client that the dye may cause the skin to appear yellow for several hrs. after the test this is

gradually eliminated through the urine

The client may e"perience 84, sneeAing, paresthesia of the tongue or pain at the in6ection site

'f hives appear, oral or '0 antihistamines such as (iphenhydramine

>3enadryl? are given as prescribed.

2*)T-*2 8&)'8 C

ncourage rest.

ncourage oral fluids.

emind the client that the yellow skin appearance will disappear

'nstruct the client that the urine will appear bright green until the dye is e"creted

'nstruct the client to avoid direct sunlight for a few hrs after the test.

'nstruct the client that the photophobia will continue until pupil siAe returns to normal

#. C*02&T( T*0*2+

- a beam of "-ray scans the skull orbits of the eye

- a cross-sectional image is formed by the use of a

computer

- contrast material is not usually administered

8&)'8 C

8o special client preparation or follow-up care re!uired

'nstruct the client that he or she will be positioned in a confined space need to keep the head still

during the procedure.

7. )%'T %02

- allows e"amination of the anterior ocular structures

under microscopic magnification


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- the client leans on a chin rest to stabiliAe the head

while a narrow beam of light is aimed so that it

illuminates only a narrow

segment of the eye.

8&)'8 C

"plain the procedure to the client.

dvise the client about the brightness of the light the need to look forward at the point over the

e"aminer@s ear


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ach eye is anesthetiAed.

The client is asked to stare forward at a point above the e"aminer@s ear

flattened cone is brought in contact with the cornea

The amount of pressure needed to flatten the cone is measured

The client is instructed to avoid rubbing the eye following the e"amination if the eye has been

anesthetiAed

- the potential for scratching the cornea e"ists

*2T+%0'C 0('CT'*8)

2)02T+*%T'C (&)

- used pre-op or for eye e"aminations to produce mydriasis

- C5' in clients with glaucoma because of the risk of increased '*2

- 0ydriatics are C5' in cardiac dysrhythmias cerebral atherosclerosis should be used with

caution in the elderly in clients with prostatic hypertrophy, (0 or parkinsonism

0('T'C), CC%*2%'C 8T'C+*%'8'C medications

0('T'C)

- dilate the pupils >mydriasis?

CC%*2%'

- rela" the ciliary muscles

8T'C+*%'8'C)

- block responses of the sphincter muscle in the ciliary body, producing mydriasis

".

tropine sulfate >'sopto-tropine, *cu-Tropine, tropair, tropisol?

)copolamine hydrobromide >'sopto-+yoscine?

Cyclopentolate hydrochloride >Cyclogyl, F-2entolate, 2entolair?

+omotropine hydrobromide >'sopto +omatrine, F-+omatropine,


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)pectro-+omatrine?

Tropicamide >0ydriacyl, '-2icamide, Tropicacyl?

2henylephrine hydrochloride >F-(ilate, (ilatair, 0ydfrin, *cu-2hrin?

8&)'8 )2*8)'3'%'T')

0onitor for allergic reactions

ssess for risk of in6ury

ssess for constipation urinary retention

'nstruct the client that a burning sensation may occur on installation

'nstruct the client not to drive or operate machine for #< hrs after installation of the medication

unless otherwise directed by the physician

'nstruct the client to wear sunglasses until the effects of the medication wear off

'nstruct to notify 0( if blurring of vision, loss of sight, difficulty in breathing, sweating or flushing occurs

'nstruct the client to report eye pain to the physician

2)02T+*0'0T'C

. *&2 ': 0'*T'C C+*%'8'C (&) - - reduce '*2 by mimicking the action of

acetylcholine

- act directly on the myoneural 6unction produce strong contractions of the iris > miosis? ciliary

body musculature > accommodation?

3. *&2 '': C+*%'8)T) '8+'3'T*)

- reduce '*2 by inhibiting the action of cholinesterase

- action of this drug is difficult to reverse

0'*T'C)

- reduce '*2 by constricting the pupil contracting the

ciliary muscle, thereby increasing the blood flow to

the retina decreasing retinal damage loss of

vision

- open the anterior chamber angle increase the


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outflow of a!ueous humor

- used for chronic open-angle glaucoma or acute

chronic closed-angle glaucoma

- used to achieve miosis during eye surgery

- C5' in clients with retinal detachment, adhesions

between the iris lens, or inflammatory diseases

- used with caution in clients with asthma,

hypertension, corneal abrasion,hyperthyroidism,

coronary vascular disease, urinary tract obstruction,

' obstruction, ulcer disease, parkinsonism, or

bradycardia

".

cethylcholine Cl >0iochol?

Carbachol >0iostat?

2ilocarpine +Cl >'sopto Carpine, 2ilocar?

2ilocarpine nitrate >2ilofrin, %i!uifilm, 2ilagan?

chothiophate iodide >2hospholine iodide?

(emecarium bromide >+umorsol?

'soflurophate >$loropryl?

8&)'8 C

ssess 45) risk of in6ury

ssess the client for the degree of diminished vision

0onitor for postural hypotension instruct the client to change positions slowly

ssess breath sounds for rales rhonchi

cholinergic meds cause bronchospasms

increased bronchial secretions

0aintain oral hygiene due to increased salivation


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+ave tropine sulfate available as antidote for 2ilocarpine

'nstruct the client not to stop the meds suddenly

'nstruct to avoid activities such as driving while vision is impaired

'nstruct clients with glaucoma to read labels on *TC meds to avoid tropine-like meds

tropine increase '*2

3T-(8'C 3%*CF'8 0('CT'*8)

- '*2 by decreasing sympathetic impulses decreasing

a!ueous humor production w5o affecting

accommodation or pupil siAe

- &sed to treat chronic open-angle glaucoma

- C5' in the client with asthma

9.

3eta"olol +Cl >3etoptic?

Carteolol +Cl >*cupress?

%evobunolol +Cl >3etagan?

0etipranolol >*ptipranolol?

Timolol maleate >Timoptic?

8&)'8 C

0onitor 45) before administering medication esp. 32 2

'f the pulse is below D or if systolic 32 is below G mm +g, withhold the medication contact 0(

0onitor for shortness of breath and '*


'nstruct the client to notify 0( if shortness of breath occurs

'nstruct not to (5C medication abruptly

'nstruct to change positions slowly to avoid orthostatic hypotension

'nstruct to avoid haAardous activities


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'nstruct to avoid *TC meds without the 0(@s approval

(8'C 0('CT'*8)

- (ecrease the production of a!ueous humor lead

to a decrease in '*2

- &sed to treat glaucoma

(8'C 0('CT'*8)

praclonidine +Cl >'opidine?

3rimonidine tartrate >lphagen?

(ipivefrin +Cl >2ropine?

pinephrine borate >pinal, ppy?

pinephrine +Cl >pifrin, laucon?

C3*8'C 8+() 0('CT'*8)

- 'nterfere with the production of carbonic acid

which leads to decreased a!ueous humor

formation decreased '*2

- &sed for long-term treatment of open-angle

glaucoma

- C5' in the client allergic to sulfonamides

9.

CTB*%0'( > ('0*9?

('C+%*2+8+0'( >(8'(, *T*%?

T+*9B*%0'( >C(), T+0'(?

0T+B*%0'( >82TB8?

8&)'8 C

0onitor 45)

ssess visual acuity


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0onitor '*

0onitor weight

0aintain oral hygiene

0onitor for lethargy, anore"ia, drowsiness, polyuria, 854

0onitor electrolytes for hypokalemia

'ncrease fluid intake unless C5'

dvise the client to avoid prolonged e"posure to sunlight

ncourage the client to use artificial tears for dry eyes

'nstruct not to (5C the medication abruptly

'nstruct to avoid haAardous activities while vision impaired

*)0*T'C 0('CT'*8)

- %ower '*2

- &sed in emergency treatment of acute closed-

angle glaucoma

- &sed pre-op post-op to decrease vitreous humor

volume

902%)

lycerin >lyrol, *smoglyn?

0annitol >*smitrol?

&rea >&reaphil?

8&)'8 C

ssess 45), visual acuity risk for in6ury

0onitor weight and '*

0onitor electrolytes

'ncrease fluid intake unless C5'


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0onitor for changes in level of orientation

%&3'C8T)

- eplace tears or add moisture to the eyes

- 0oisten contact lenses or an artificial eye

- 2rotect the eyes during surgery or diagnostic

procedures

- &sed for keratitis, during anesthesia or in a

disorder that results in unconsciousness or

decreased blinking

902%)

+ydro"ypropyl methylcellulose >%acril, 'sopto 2lain?

2etroleum-based ointment >rtificial Tears, %i!uifilm Tears?

8&)'8 C

'nform the client that burning may occur on installation

3e alert to allergic responses to the preservatives in the lubricants

T*2'C% 8)T+T'C) $* T+

- 2roduce corneal anesthesia

- &sed for anesthesia for eye e"aminations, surgery,

or to remove foreign bodies from the eye

902%)

2roparacaine +Cl >*phthaine, *pthenic?

Tetracaine +Cl >2ontocaine?

8&)'8 C


8ote that the medications should not be given to the client for home use are not to be self-

administered by the client


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8ote that the blink refle" is temporarily lost that the corneal epithelium needs to be protected

2rovide an eye patch to protect the eye from in6ury until the corneal refle" returns

8T'-'8$CT'4 0('CT'*8)

8T'3CT'%

Chloramphenicol >Chloromycetin, Chloroptic?

Ciproflo"acin hydrochloride >Cipro?

rythromycin >'lotycin?

entamicin sulfate >aramycin, enoptic?

8orflo"acin >Chibro"in?

Tobramycin >8ebcin, Tobre"?

)ilver nitrate 1H

8T'$&8%

8atamycin >8atacyn *pthalmic?

8T'4'%

'do"uridine >+erple"-%i!uifilm?

Trifluridine >4iroptic?

4idarabine >4ira- *pthalmic?

8&)'8 C


'nstruct the client in how to apply the eye medication

'nstruct the client to continue treatment as "

'nstruct the client to wash hands thoroughly fre!uently

dvise the client that if improvement does not occur, notify the 0(

8T'-'8$%00T* 0('CT'*8)

902%)

(e"amethasone >0a"ide"?


17/70


(iclofenac >4oltaren?

$lurbiprofen 8a >*cufen?

)uprofen >2rofenal?

Fetorolac tromethamine >cular?

2rednisone acetate >2redforte, conopred?

2rednisolone 8a phosphate >F-2red, 'nflamase?

ima"olone >4e"ol?

(')*() *$ T+

%%% 3%'8(

- a person is legally blind if the best visual acuity with

corrective lenses in the better eye is #5# or less or

a visual field of # degrees or less in the better eye

8&)'8 C

;hen speaking to a client who has limited sight or blind, the nurse uses a normal tone of voice

lert the client when approaching

*rient the client to the environment

&se a focal point provide further orientation to the environment from the focal point

llow the client to touch ob6ects in the room

&se the clock placement of foods on the meal tray to orient the client

2romote independence as much as possible

2rovide radios, T4s, clocks that give the time orally or provide a 3raille watch.

;hen ambulating, allow the client to grasp the nurse@s arm at the elbow

'nstruct the client to remain one step behind the nurse when ambulating


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'nstruct the client in the use of the cane used for the blind client, which is differentiated from other

canes by its straight shape white color with red tip

'nstruct the client that the cane is held in the dominant hand several inches off the floor

'nstruct the client that the cane sweeps the ground where the client@s foot will be placed ne"t to

determine the presence of obstacles

1. CTCT)

- an opacity of the lens that distorts the image

pro6ected onto the retina that can progress to

blindness

- intervention is indicated when visual acuity has been

reduced to a level that the client finds to be

unacceptable or adversely affecting lifestyle

C&))

ging process >)enile cataracts?

'nherited >Congenital cataracts?

'n6ury >Traumatic cataracts?

Can occur as a result of another eye disease >)econdary cataracts?

))))08T

*pa!ue or cloudy white pupil

radual loss of vision

3lurred vision

(ecreased color perception

4ision that is better in dim light with pupil dilation

2hotophobia

bsence of red refle"

0('C% 0808T

- surgical removal of the lens, one eye at a time

- a lens implantation may be performed at the time


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of surgical procedure

9TC2)&% 9TCT'*8

- the lens is lifted out w5o removing the lens capsule

- may be performed with 2hacoemulsion

2+C*0&%)'$'CT'*8

- the lens is broken up by ultrasonic vibrations

e"tracted

'8TC2)&% 9TCT'*8

- the lens is removed within its capsule through as

small incision

2-*2 8&)'8 C

'nstruct measures to prevent or decrease '*2

dminister pre-op eye medications including mydriatics cycloplegics as prescribed

2*)T-*2 8&)'8 C

levate the head of the bed 7-


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Cataract glasses act as magnifying glasses replace central vision only

Cataract glasses magnify, ob6ects appear closer therefore teach client to 6udge distance climb

stairs carefully

Contact lenses provide sharp visual acuity but de"terity is needed to insert them

Contact the 0( for any decrease in vision, severe eye pain or increase in eye discharge

#. %&C*0

- increased '*2 as a result of inade!uate drainage of

a!ueous humor from the canal of )chlemm or over

production of a!ueous humor

- the condition damages the optic nerve can result

in blindness

T2)

. C&T I a rapid onset of '*2 J =-K- mm +g

C%*)(-8%58*; 8% %&C*0

- results from obstruction to outflow to

a!ueous humor

3. C+*8'C I a slow progressive, gradual onset of '*2J7-= mm+g

C%*)(-8% %&C*0

- follows an untreated attack of acute close-angled

glaucoma

*28-8% %&C*0

- results from an overproduction or obstruction to

the outflow of a!ueous humor


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))))08T

2rogressive loss of peripheral vision followed by a loss of central vision

levated '*2 >8ormal pressure is 1-#1 mm +g?

4ision worsening in the evening with difficulty

ad6usting to dark rooms

3lurred vision

+alos around white lights

$rontal headaches

2hotophobia

'ncreased lacrimation

2rogressive loss of central vision

8&)'8 C $* C&T %&C*0

Treat as medical emergency

dminister medications as prescribed to lower '*2

2repare the client for peripheral iridectomy

- allows a!ueous humor to flow from the posterior

to anterior chamber

8&)'8 C $* C+*8'C %&C*0


22/70


'nstruct the client the importance of medications

a. 0'*T'C): to constrict the pupils

b. C3*8'C 8+() '8+'3'T*): to decrease

the production of a!ueous humor

c. 3T-3%*CF): to decrease the production of

a!ueous humor '*2

'nstruct the client the need for life-long medication use

'nstruct the client to wear a 0edic-lert bracelet

'nstruct the client to avoid anti-cholinergic medications

'nstruct the client to report eye pain, halos around eyes changes of vision to the physician

'nstruct the client that when ma"imal medical therapy has failed to halt the progression of visual field

loss optic nerve damage,

surgery will be recommended

2repare the client for T3C&%*2%)T as prescribed

to facilitate a!ueous humor drainage

2repare client for T3C&%CT*0 as prescribed

- allows drainage of a!ueous humor into the

con6uctival spaces by the creation of an opening

7. T'8% (TC+08T

- occurs when the layers of the retina separate because

of accumulation of fluid between them

- also occurs when both retinal layers elevate away

from the choroid as a result of a tumor

T2)

2T'% T'8% (TC+08T

- becomes complete if left untreated

C*02%T T'8% (TC+08T


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- when detachment is complete, blindness may occur

))))08T

$lashes of light

$loaters

'ncrease in blurred vision

)ense of curtain being drawn

%oss of a portion of the visual field

'00('T 8&)'8 C

2rovide bedrest

Cover both eyes with patches to prevent further detachment

)peak to the client before approaching

2osition the client@s head as prescribed

2rotect the client from in6ury

void 6erky head movements

0inimiAe eye stress

2repare the client for surgical procedure as prescribed

0('C% 0808T

- draining fluid from the subretinal space so that the

retina can return to the normal position

)%'8 T'8% 3F) 3 C*)&

- a cold probe applied to the sclera to stimulate an

inflammatory response leading to adhesions

('T+0

- the use of electrode needle heat through the

sclera to stimulate an inflammatory response

leading to adhesions

%) T+2

- to stimulate an inflammatory response to seal small


24/70


retinal tears before the detachment occurs

)C%% 3&CF%'8

- to hold the choroid retina together with a splint

until scar tissue forms closing the tear

'8)T'*8 *$ ) * )'%'C*8 *'%

- to encourage attachment because these agents

have a specific gravity less than vitreous or air can

float against the retina

2*)T-*2 8&)'8 C

0aintain eye patches bilaterally as prescribed

0onitor hemorrhage as prescribed

2revent 84 and monitor for restlessness which can cause hemorrhage

0onitor for sudden, sharp eye pain >notify the 0( stat?

ncourage (3 but avoid coughing

2rovide bed rest for 1-# days as prescribed

'f gas has been inserted, position as prescribed on the abdomen turn the head so unaffected eye isdown

dminister eye medications as prescribed

ssist client with (%

void sudden head movements or anything that increases '*2

'nstruct the client to limit reading for 7-= weeks

'nstruct client to avoid s!uinting, straining constipation, lifting heavy ob6ects

bending from the waist

'nstruct the client to wear dark glasses during the day an eye patch at night

ncourage follow-up care because of the danger of recurrence or occurrence in the other eye


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- a condition in which the eyes are not aligned

because of lack of muscle coordination of the

e"traocular muscles

- most often results from muscle imbalance or

paralysis of e"traocular muscles, but may also result

from conditions such as brain tumor, myasthenia

gravis or infection

- normal in young infant but should not be present

after about age < months

))))08T

mblyopia if not treated early

2ermanent loss of vision if not treated early

%oss of binocular vision

'mpairment of depth perception

$re!uent headaches

)!uints or tilts head to see

8&)'8 C

Corrective lenses as indicated

'nstruct the parents regarding patching >occlusion therapy? of the LgoodM eye > to strengthen the weak

eye?

2repare for botulinum to"in >3oto"? in6ection into the eye muscle

- produces temporary paralysis

- allows muscles opposite the paralyAed muscle

to strengthen the eye

'nform the parents that the in6ection of botulinum to"in wears off in about # months if successful,

correction occurs

2repare for surgery to realign the weak muscles as " if nonsurgical interventions are unsuccessful

'nstruct the need for follow-up visits


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=. C*8N&8CT'4'T')

- also known as L2'8F M

- inflammation of the con6unctiva

- usually caused by allergy, infection, or trauma

T2)

3CT'% * 4'% C*8N&8CT'4'T')

- e"tremely contagious

C+%0('% C*8N&8CT'4'T')

- is rare in older children if diagnosed in a child who

is not se"ually active, the child should be assessed for

possible se"ual abuse

))))08T

'tching, burning or scratchy eyelids

edness

dema

(ischarge

8&)'8 C

'nstruct in infection control measures such as good handwashing not sharing towels washcloths

dminister antibiotic or antiviral eye drops or ointment as " if infection is present

dminister antihistamines as " if an allergy is present

'nstruct the parents that the child should be kept home from school or day care until antibiotic eye

drops have been administered for #< hrs

'nstruct in the use of cool compresses to lessen irritation in wearing dark glasses for photophobia

'nstruct the child to avoid rubbing the eye to prevent in6ury

(5C use of contact lenses to obtain new lenses to eliminate the chance of re-infection

'nstruct the adolescent that eye make-up should be discarded replaced


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28/70


)

9T8%

- mbedded in the temporal bone bilaterally at the

level of the eyes

- "tends from the auricle through the e"ternal canal

to the tympanic membrane or eardrum

- 'ncludes the mastoid process, a bony ridge located

over the temporal bone

. &'C% >2'88?

- *uter pro6ection of ear composed of cartilage

covered by skin

- collects sound waves

3. 9T8% &('T* C8%

- %ined with skin

- lands secrete cerumen >wa"?

- provides protection

- transmits sound waves to tympanic membrane

C. T028'C 0038 >(&0?

- %ocated at the end of the e"ternal canal

- 4ibrates in response to sound transmit vibrations

to middle ear

0'((%

- Consists of the medial side of the tympanic

membrane

- The tympanic membrane is a thick transparent sheet

of tissue that provides a barrier between the


29/70


e"ternal ear the middle ear

- The middle ear is protected from the inner ear by

the round the oval window membranes

- The eustachian tube opens into the middle ear

allows for e!ualiAation of pressure on both sides of

the tympanic membrane

. *))'C%)

- Contains 7 small bones: 0alleus >+ammer? 'ncus >nvil?

)tapes >)tirrup?

- *ssicles are set in motion by sound waves from

malleus to the footplate of the stapes in the oval

window

3. &)TC+'8 T&3

- Connects nasopharyn" middle ear

- !ualiAes pressure on both sides of eardrum

'88

- Contains the semi-circular canals, the cochlea the

distal end of the Eth cranial nerve

- 0aintains sense of balance e!uilibrium

. )0'-C'C&% C8%)

- Contains fluid hair cells connected to sensory

nerve fibers of the vestibular portion of Eth

cranial nerve

3. C*C+%

- )piral-shaped organ of hearing

- Connects organ of Corti, receptor and organ for


30/70


hearing

- Transmits sound waves from the oval window

initiates nerve impulses carried by cranial nerve

4''' >acoustic branch? to brain > temporal lobe of

cerebrum?

C. Eth C8'% 84

1. C*C+% 38C+

- transmits neuro-impulses from the cochlea to the

brain where it is interpreted as sound

#. 4)T'3&% 38C+

- maintains balance e!uilibrium

+'8 /&'%'3'&0

The e"ternal ear conducts sound waves to the middle ear

The middle ear also called the tympanic cavity conducts sound waves to the inner ear

The middle ear is filled with air which is kept at atmospheric pressure by the opening of the ustachiantube

The inner ear contains sensory receptors for sound fore!uilibrium

The receptors in the inner ear transmit sound waves changes in body position to the nerve impulses

))))08T *$ T+

*T*)C*2'C 90

&'(%'8)

- the speculum is never blindly introduced into the

e"ternal canal because of the risk of perforating

the tympanic membrane

- tilt the head slightly away hold the otoscope

upside down as if it were a large pen


31/70


- this permits the e"aminer@s hand to lie against the

head for support

- pull the pinna up back to straighten the e"ternal

canal in an adult

- visualiAe the e"ternal canal while slowly inserting

the speculum

8*0% $'8('8) *$ T+ 9T8% C8%

2ink intact without lesions

+as various amounts of cerumen fine little hairs

8*0% $'8('8) *$ T+ T028'C 0038

The tympanic membrane should be intact without perforations free from lesions

The tympanic membrane is transparent, opa!ue, pearly gray slightly concave

&('T* ))))08T

)ound is transmitted by air conduction bone conduction

ir is #-7" longer than bone conduction

CT*') *$ +'8 %*))

C*8(&CT'4 +'8 %*))

- due to any physical obstruction to the transmission

of sound waves

)8)*'8&% +'8 %*))

- due to a defect in the organ of hearing, in the Eth

cranial nerve, or in the brain itself

0'9( C*8(&CT'4, )8)*'8&% +'8 %*))

- results in profound hearing loss

4*'C T)T


32/70


sk the client to block one e"ternal canal

The e"aminer stands 1-# ft away !uickly whispers a statement

The client is asked to repeat the whispered statement

ach ear is tested separately

;TC+ T)T

ticking watch is used to test the high-fre!uency sounds

The e"aminer holds a ticking watch about = inches from each ear asks the client if the ticking is

heard.

T&8'8 $*F T)T)

. ;3 T&8'8 $*F T)T

C*8(&CT'4 +'8 %*)) I the sound is heard in affected ear

)8)*'8&% +'8 %*))I sound heard in the unaffected ear

3. '88 T&8'8 $*F T)T

8*0% )&%T: >O? '88 T)T5 CJ3C

C*8(&CT'4 +'8 %*))

'f the client is unable to hear the sound through the ear in front of the pinna, >-? '88 T)T5 CP3C

4)T'3&% ))))08T *$ T+

T)T $* $%%'8

The e"aminer asks the client to stand with the feet together arms hanging loosely at the sides

eyes closed

The client normally remains erect with slight swaying

38*0% )&%T: >O? *03 )'8

- presence of significant swaying

T)T $* 2)T 2*'8T'8

8*0% T)T )2*8):

- The client can easily return to the point of


33/70


reference

$'8('8)

The client with vestibular function problem lacks a normal sense of position sense and is unable to

return to the e"tended fingers to the point of reference, the fingers instead either goes to the right or left

of the reference point

B 8)T0&) 4%&T'*8

"amine the client@s eyes as they look straight ahead, 7 degrees to each side, upward downward

$'8('8)

- ny spontaneous nystagmus is a >O? result

- 38*0% $'8('8

- a constant involuntary cyclic movement of the

eyeball in any direction represents a problem with

the vestibular system

+%%2'F 08&4

ssesses for positional vertigo or induced diAAiness

The client assumes a supine position

The head is rotated to one side for 1 minute

$'8('8)

>O? test result is presence of nystagmus after =-1 sec

- 38*0% $'8('8

- a constant involuntary cyclic movement of the

eyeball in any direction represents a problem with

the vestibular system

('8*)T'C T)T) $* T+

T*0*2+

- may be performed with or without contrast

medium


34/70


- assesses the mastoid, middle ear inner ear

structures

- multiple "-rays of the head are done

8&)'8 C

ll 6ewelry are removed

%ead eye shields are used to cover the cornea to diminish the radiation dose to the eyes

The client must remain still in a supine position

8o follow-up care is re!uired

&('*0T

- measures hearing acuity

- uses # types: 2& T*8 &('*0T )2C+

&('*0T

- after testing, audiogram patterns are depicted on a

graph to determine the type level of hearing loss

2& T*8 &('*0T

- used to identify problems with hearing, speech,

music other sounds in the environment

)2C+ &('*0T

- the client@s ability to hear spoken words is measured

8&)'8 C

'nform the client regarding the procedure

'nstruct the client to identify the sounds as they are heard

%CT*8)T0*2+

- evaluates spontaneous nystagmus


35/70


- used to distinguish between normal nystagmus

either medication-induced nystagmus or

nystagmus caused by a lesion in the central or

peripheral vestibular pathway

- records changing electrical fields with movement

of the eye, as monitored by electrodes placed on

the skin around the eye

C%*'C T)T >3'-T+0% T)T?

- evaluate diAAiness

- 8ystagmus, 854 or ata"ia

- indicate a pathological condition of the labyrinth

system, whereas a decreased response may

indicate that the vestibular system is affected

8&)'8 C

;arm water causes a greater response than cold water

;arm water caloric testing >irrigation? precedes cool water caloric testing >irrigation?

The character duration of the eye movements are measured

The client must assume a supine position with eyes closed head elevated to 7 degrees

fter the procedure, the client begins taking clear fluids slowly cautiously because 8 4 may occur

ssistance with ambulation may also be necessary following the procedure

*T'C 0('CT'*8)

(0'8')T'8 (*2)

(&%T

2ull the pinna up back to straighten the e"ternal canal to instill ear drops

C+'%(

2ull the pinna down back for infants children younger than 7 years of age


36/70


2ull the pinna up back for children for children more than 7 years

''T'*8 *$ T+

'rrigation of the ear needs to be prescribed by 0(

nsure that there is direct visualiAation of the tympanic membrane

;arm irrigating solution to 1Q $

- solutions not close to the client@s body temp

will cause ear in6ury, nausea vertigo

'rrigation must be done gently to avoid damage to the eardrum

;hen irrigating, don@t direct irrigating solution directly toward the eardrum

'f perforation of the eardrum is suspected, irrigation is not done

0('CT'*8) T+T $$CT +'8

8T'3'*T'C)

mikacin >mikin?

Chloramphenicol

- Chloromycetin

- Chloroptic

- *phthoclor

rythromycin

- -0ycin

- C

- ry-Tab

- 2C (ispertabs

- 'lotycin

entamicin >aramycin?

)treptomycin sulfate

>)treptomycin?

Tobramycin sulfate >8ebcin?


37/70


4ancomycin >4ancocin?

('&T'C)

cetaAolamide >(iamo"?

$urosemide >%asi"?

thacrynic acid >decrine?

*T+)

Cisplatin >2latinol, 2latinol-/?

8itrogen mustard

/uinine >/uinamn?

/uinidine

- Cardio!uin

- /uinaglute

- /uinde"

8T'-'8$CT'4 0('CT'*8)

902%)

mo"icillin >mo"il?

mpicillin trihydrate >2olycillin?

Cefaclor >Ceclor?

Clindamycin +Cl >Cleocin?

Trimethoprim >T02? )ulfametha"aAole >)0B?

- 3actrim, Cotrim, )eptra

rythromycin >'lotycin, -0ycin?

2enicillin 4 potassium >2en 4?

%oracarbef >%orabid?

Clarithromycin >3ia"in?

2olymy"in 3 sulfate >erosporin?

Tetracycline +Cl >chromycin?


38/70


cetic acid and luminum acetate >*tic (omeboro?

8T'-+')T0'8) (C*8)T8T)

- 2roduce vasoconstriction

- )timulate the receptors of the respiratory mucosa

- educe respiratory tissue hyperemia edema to

open obstructed eustachian tubes

- &sed for acute otitis media

)'( $$CT)

(rowsiness

3lurred vision

(ry mucous membranes

8&)'8 C

'nform the client that drowsiness, blurred vision, dry mouth may occur

'nstruct the client to increase fluid intake unless C5' to suck on hard candy to alleviate dry mouth

'nstruct the client to avoid haAardous activities if drowsiness occurs

902%)

Tripolidine pseudoephedrine >ctifed?

8aphaAoline +Cl >llerest, lbalon?

Chlorpheniramine >Chlor-Trimeton, Teldrin?

3rompheniramine >3romphen, (imetane?

Terfenadine >)eldane?

Clemastine >Tavist?

CetiriAine >Byrtec?

stemiAole >+ismanal?


39/70


%*C% 8)T+T'C)

0('CT'*8 :

3enAocaine >mericaine *ticR Tympagesic?

)'( $$CT)

llergic reaction

'rritation

8&)'8 C

0onitor for effectiveness if used for pain relief

ssess for irritation or allergic reaction

C&0'8*%T'C 0('CT'*8)

902%)

Carbamide pero"ide >(ebro"?

3oric acid >ar-(ry?

8&)'8 C

'nstruct the client not to use drops more often than prescribed

0oisten a cotton plug with medication before insertion

Feep the container tightly closed away from moisture

void touching the ear with the dropper

7 minutes after installation, gently irrigate the ear as " with warm water using a rubber bulb ear

syringe

'rrigation may be done with hydrogen pero"ide sol@n as "

$or chronic cerumen impaction, 1-# gtts of mineral oil will soften the wa"

'nstruct the client to notify 0( if redness, pain or swelling persists

(')*() *$ T+


40/70


1. C*8(&CT'4 +'8 %*))

- occurs when sound waves are blocked to the inner ear

fibers because of e"ternal ear or middle ear disorders

- disorders can often be corrected with no damage to

hearing, or minimal permanent hearing loss

C&))

ny inflammatory process or obstruction of the e"ternal or middle ear

Tumors

*tosclerosis

build-up of scar tissue on the ossicles from previous middle ear surgery

#. )8)*'8&% +'8 %*))

- a pathological process of the inner ear or of sensory

fibers that lead to the cerebral corte"

C&))

(amage to the inner ear structures

(amage to the cranial nerve 4'''

2rolonged e"posure to loud noise

0edications, trauma, infections, surgery

'nherited disorders

0etabolic circulatory disorders

0eniere@s syndrome

(iabetes mellitus

0y"edema

7. 0'9( +'8 %*))

- also known as conductive-sensorineural hearing loss


41/70


- client has both sensorineural conductive hearing

loss

)'8) *$ +'8 %*)) : 8%

$re!uently asking people to repeat statements

)training to hear

Turning head or leaning forward to favor one ear

)houting in conversations

inging in the ears

$ailing to respond when not looking in the direction of the sound

nswering !uestions incorrectly

aising the volume of the television or radio

voiding large groups

3etter understanding of speech when in small groups

;ithdrawing from social interactions

$C'%'TT'8 C*00&8'CT'*8

&se of written words

2rovision of light in the room

etting the attention of the client before you begin to speak

$acing the client when speaking

Talking in a room without distracting noises

0oving close to the client speaking slowly

clearly

Feeping hands other ob6ects away from the mouth when talking to the client

Talking in lower tones, because shouting is not helpful

ephrasing sentences repeating information

4alidating


42/70


eading lips

&sing sign language

&sing telephone amplifiers

$acing lights that are activated by ringing of the telephone or doorbell

)pecially trained dogs that help the client to be aware of sound to alert the client of potential

dangers

C*C+% '02%8TT'*8

- used for sensorineural hearing loss

- a small computer converts sound waves into

electrical impulses

- electrodes are placed by the internal ear with a

computer device attached to the e"ternal ear

- electronic impulses directly stimulate nerve fibers

+'8 '()

- used for the client with conductive hearing loss

- can help the client with sensorineural loss,

although it is not as effective

- a difficulty that e"ists in its use is the amplification

of background noise as well as voices

C%'8T (&CT'*8: +'8 '(

ncourage to begin using the hearing aid slowly to develop an ad6ustment to the service

d6ust the volume to a minimal hearing level to prevent feedback s!ueaking

Teach the client to concentrate on the sounds that are to be heard to filter out background noise

'nstruct the client to clean ear mold with mild soap water

void e"cessive wetting of the hearing aid, and try to keep the hearing aid dry

Clean the ear cannula of the hearing aid with a toothpick or pipe cleaner

Turn off the hearing aid remove the battery when not in use

Feep e"tra batteries on hand


43/70


Feep the hearing aid in a safe place

2revent hair sprays, oils, or other hair face products from coming into contact with the receiver of the

hearing aid


44/70


infection

- the skin becomes red, swollen, tender to touch

on movement

- the e"cessive swelling of the canal lead to

conductive

hearing loss due to obstruction

- more common in children termed as L);'00@)

M

- occurs more often in hot, humid environments

))))08T

2ain

'tching

2lugged feeling in the ear

edness edema

"udate

+earing loss

8&)'8 C

pply heat locally for # minutes 7" a day

ncourage rest to assist in reducing pain

dminister analgesics such as aspirin or acetaminophen >Tylenol? for the pain as prescribed

'nstruct the client that the ears should be kept clean dry

'nstruct the client to use earplugs for swimming

'nstruct the client that cotton-tipped applicators should not be used to dry ear because their use can

lead to trauma to the canal

'nstruct the client that irritating agents such as hair products or headphones should be discontinued


45/70


D. *T'T') 0('

- infection of the middle ear occurring as a result of a

blocked eustachian tube, which prevents drainage

- a common complication of an acute respiratory

infection

))))08T

$ever

'rritability, restlessness loss of appetite

olling of head from side to side

2ulling on or rubbing the ear

arache or pain

)igns of hearing loss

2urulent ear drainage

ed, opa!ue, bulging or retracting tympanic membrane

8&)'8 C

ncourage oral fluids

Teach the parents to feed infants in an upright position

'nstruct the child to avoid chewing during the acute period

- chewing increases the pain

2rovide local heat have the child lie with affected ear down

'nstruct the parents in the appropriate procedure to clean drainage from the ear with sterile cotton

swabs

'nstruct in the administer of analgesics or antipyretics such as cetaminophen >Tylenol? to decrease

fever pain

'nstruct the parents in the administration of prescribed antibiotics, emphasiAing that the 1-1< day

period is necessary to eradicate positive organisms

'nstruct the parents that screening for hearing loss may be necessary

0'8*T*0

- temporary incision of tympanic membrane to

decompress the membrane and promote drainage


46/70


of effusion

- insertion of tympanoplasty tubes in the middle ear

to e!ualiAe pressure keep the ears dry

2*)T-*2 8&)'8 C

Feep the ears dry

arplugs should be worn during bathing, shampooing swimming

(iving submerging under water are C5'

Client education post myringotomy

void strenuous e"ercise

void rapid head movements, bouncing or bending

void straining on bowel movement

void drinking through a straw

void traveling by air

void forceful coughing

void contact with persons with colds

void washing hair, showering or getting the head wet for a week as "

'nstruct the client that if she5he needs to blow the nose, blow one side at a time with wide mouth open

'nstruct the client to keep ears dry by keeping a ball of cotton coated with petroleum 6elly in the ear

to change cotton ball daily

'nstruct the client to report e"cessive ear drainage to the physician

K. C+*8'C *T'T') 0('

- a chronic infective, inflammatory, or allergic

response involving the structure of the middle ear

- surgical treatment is necessary to restore hearing

- the type of surgery can vary include a simple

reconstruction of the tympanic membrane, a


47/70


myringotomy, or replacement of the ossicles

within the middle ear

T028*2%)T

- a reconstruction of the middle ear may be

attempted to improve conductive hearing loss

2-*2 8&)'8 C

dminister antibiotic ear drops as "

Clear the ear of debris as " irrigate ear with a solution of e!ual parts of vinegar sterile +#*as "

'nstruct to avoid persons with &T'

'nstruct client to obtain ade!uate rest, eat a balanced diet drink ade!uate fluids

'nstruct in (3 coughing but forceful coughing avoided.

- increases pressure in the middle ear esp. post-op

2*)T-*2 8&)'8 C

'nform client that initial hearing after surgery is diminished hearing will improve after the ear canal

packing is removed

Feep dressing clean dry

Feep client flat with operative ear up for at least 1# hours

dminister antibiotics as "

'nstruct the client that he5she may return to work in appro"imately 7 weeks post-op

E. *T*)C%*)')

- disease of the labyrinthine capsule of the middle

ear that results in a bony overgrowth of the tissue

surrounding the ossicles

- causes the dev@t of irregular areas of new bone

formation causes fi"ation of the bones

- stapes fi"ation leads to C*8(&CT'4 +'8

%*))


48/70


- if it involves inner ear, )8)*'8&% +'8

%*))

))))08T

)lowly progressing conductive hearing loss

3ilateral hearing loss

ringing or roaring type of constant tinnitus

%oud sounds heard in the ear when chewing

2inkish discoloration >)C+;TB@) )'8? of the tympanic membrane

- indicates vascular changes in the ear

>-? inne test

;eber test shows lateraliAation of the sound to the ear with the most conductive hearing loss

- it is not uncommon to have bilateral

involvement, although hearing loss may be

worse in one ear

- nonsurgical intervention promotes the

improvement of hearing through amplification

- surgical intervention involves removal of the

bony growth that is causing the hearing loss

- a 2T'% )T2(CT*0 or C*02%T

)T2(CT*0 ;'T+ 2*)T+)')

>$8)TT'*8? may be surgically performed

$8)TT'*8

- removal of the stapes with a small hole drilled in

the footplate a prosthesis is connected

between the incus footplate

- sounds cause the prosthesis to vibrate in the


49/70


same manner as the stapes

C*02%'CT'*8):

Complete hearing loss

2rolonged vertigo

'nfection

$acial nerve damage

2-*2 8&)'8 C

'nstruct the client in measures to prevent middle ear or e"ternal ear infections

'nstruct the client to avoid e"cessive nose blowing

'nstruct not to clean the ear canal with cotton-tipped applicators

'nstruct the client to remove the hearing aid # weeks before surgery to ensure the integration of local

tissue

2*)T-*2 8&)'8 C

'nform the client that hearing is initially worse after the surgical procedure no noticeable

improvement in hearing may occur for as long as D weeks

'nform the client that the elfoam ear packing interferes with hearing but is used to decrease bleeding

ssist with ambulating during the first 1-# days after surgery

2rovide side rails when the client is in bed

dminister antibiotics antivertiginous pain meds as "

ssess for facial nerve damage, weakness, changes in taste sensation, vertigo, nausea vomiting

'nstruct to move head slowly when changing positions

'nstruct to avoid showering getting the head wound wet

'nstruct to refrain from using small ob6ects to clean the e"ternal ear canal

'nstruct to avoid rapid, e"treme changes in pressure caused by !uick head movements,

sneeAing,nose blowing, straining changes in altitude

'nstruct to avoid changes in the middle ear pressure

- it could dislodge the graft prosthesis

08'@) )8(*0


50/70


- a syndrome also called 8(*%02+T'C +(*2)

>- refers to dilation of the endolympathic system by

either overproduction or decreased reabsorption of

endolymphatic fluid?

- characteriAed by tinnitus, unilateral sensorineural

hearing loss, vertigo

- symptoms occur in attacks last for several days,

the client becomes totally incapacitated

- initial hearing loss is reversible, but as the

fre!uency of attacks continues, hearing loss

becomes permanent

- repeated damage to the cochlea caused by

increased fluid pressure leads to the permanent

hearing loss

C&))

ny factor that increases endolymphatic secretion in the labyrinth

4iral bacterial infections

llergic reactions

3iochemical disturbances

4ascular disturbances producing changes in the microcirculation in the labyrinth

))))08T

$eelings of fullness in the ear

Tinnitus, as a continuous low-pitched roar or humming sound - is present most of the time but

worsens 6ust before during severe attacks

+earing loss is worse during an attack

4ertigo

- periods of whirling which might cause the client

to fall to the ground


51/70


- sometimes so intense that even when lying down,

the client holds the bed or ground in an attempt

to prevent the whirling

8ausea vomiting

8ystagmus

)evere headaches

8*8-)&'C% 0808T

2reventing in6ury during vertigo attacks

2roviding bed rest in a !uiet environment

2rovide assistance with walking

'nstruct the client to move the head slowly

- to prevent worsening of vertigo

'nitiate 8a fluid restrictions as "

'nstruct to avoid smoking

dminister 8icotinic acid >8iacin? as "

- promote vasodilating effect

dminister antihistamines as "

- reduce the production of histamine

inflammation

dminister antiemetics as "

dminister tran!uiliAers sedatives as "

- to calm client allow rest, control the vertigo,

84

)&'C% 0808T

- performed when medical therapy is ineffective

the functional level of the client has decreased

significantly


52/70


8(*%02+T'C ('8 '8)T'*8 *$ T+ )+&8T

- may be performed early in the course of the disease

to assist with the drainage of e"cess fluids

)CT'*8 *$ T+ 4)T'3&% 84

%3'8T+CT*0

- removal of the labyrinth may be performed

2*)T-*2 8&)'8 C

ssess packing dressing on the ear

)peak to the client on the side of the unaffected ear

2erform neurological assessments

0aintain side rails

ssist with ambulating

ncourage the use of bedside commode

dminister antivertiginous antiemetic medications as "

C&08 $*'8 3*(')

C&085 ;9

- the most common cause of impacted canals

$*'8 3*(')

- can include vegetables, beads, pencil erasers

insects

))))08T

)ensation of fullness in the ear with or without hearing loss

2ain, itching or bleeding

C&08

8&)'8 C

emoval of the wa" by irrigation is a slow process

'rrigation is C5' in clients with a h" of tympanic membrane perforation


53/70


To soften cerumen, add 7 gtts of glycerin to the ear S hs 7 gtts of hydrogen pero"ide 3'(

fter several days the ear is irrigated

-=-K ml of solution is the ma"imal amount a client can tolerate during an irrigation sitting

$*'8 3*(')

8&)'8 C

'f the foreign matter is vegetable, irrigation is used with care

'nsects are killed before removal unless they can be coa"ed out by flashlight or a humming noise

0ineral oil or alcohol is instilled to suffocate the insect which is then removed with ear forceps

&se small ear forceps to remove the ob6ect avoid pushing the ob6ect farther into the canal

damaging the tympanic membrane

C

2*TCT'*8

2rotecting and Caring $or our ars

The ears are delicate and irreplaceable instruments.

*nce hearing is damaged, it often cant be restored.

)o give your ears U and your hearing U the same level of care and attention as you do other vital parts

of your body.

eneral 8ursing Care Tips

+ave your ears and hearing checked periodically

Fnow the warning signs of hearing loss

)ee a medical professional right away if you:

in6ure your ears,

e"perience ear pain, or

notice changes in your ears or sense of hearing

;arning )igns of +earing %oss


54/70


(ifficulty hearing conversations, especially in the presence of background noise

$re!uently asking others to repeat what they@ve said

0isunderstanding what people say

(ifficulty hearing on the telephone

e!uiring the T4 or radio volume to be louder than others in the room prefer

$eeling that people are mumbling when they are talking

(ifficulty hearing certain environmental sounds, such as birds chirping

greeing or nodding your head during conversations when you@re not sure what@s been said

emoving yourself from conversations because it@s too difficult to hear

eading lips so you can try to follow what people are saying

)training to hear or keep up with conversations

Tinnitus

2reventing +earing %oss

void loud or prolonged e"posure to noise.

;hen you cant avoid noise, wear ear protection.

'f your ears produce e"cessive earwa", have your ears cleaned periodically by a health care

professional. >(o not use cotton swabs, as you will lodge more earwa" even deeper into the ear canal

than the small amount of wa" you will remove.?

void ototo"ic drugs. 'f taking one already, talk with your doctor and see if theres a less-ototo"ic

alternative.

)tay healthy and be mindful of risk factors, such as hypertension.

8oise

void e"posure to loud noise.

best action: get rid of the noise or leave the noisy area.

$ollow this simple rule of thumb: if you need to shout to be heard over noise, its potentially damaging

;hen you can@t avoid noise, always wear ear protection >earplugs or earmuffs?

3e aware that repeated or prolonged e"posure to lower noise levels may cause hearing damage


55/70


2rotect the ears of children who are too young to know the dangers that noise can pose

Cleaning of ars

Clean ears with e"tra care.

;ipe the outer ear with a washcloth or tissue.

8ever put anything into your ear that@s smaller than an adult finger covered with a washcloth.

&sing cotton swabs or other small ob6ect may damage the sensitive structures of your inner ear

arwa" is usually removed by the ear@s own cleaning mechanism.

'f there is build-up of e"cess earwa", have it removed by a physician or medical professional.

'llness and 0edications

educe the risk of ear infections by treating upper respiratory tract infections promptly

)ome illnesses and medical conditions can affect hearing.

'f e"periencing sudden hearing loss or persistent noise in your ears or head >tinnitus?, have it seen by a

health care provider5physician right away

'llness and 0edications

3e aware that certain medications are ototo"ic and may damage your hearing.

Take medications only as directed, and refer to you health care provider5physician immediately if you

e"perience unusual symptoms

)top smoking.

)ome studies have found that adults who smoke are more likely to develop hearing loss than

nonsmokers.

)moking can also aggravate e"isting conditions, such as tinnitus

3lowing of the nose

study conducted by a team of researchers from the &niversity of 4irginia and the &niversity of arhus

in (enmark, revealed that blowing your nose may actually cause mucus to be propelled back into the

sinus cavities.


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lso, blowing the nose creates a huge amount of pressure in the nose -- over seven times more

pressure than is produced by sneeAing or coughing.

2roper blowing of the nose

3low your nose gently.

3lowing too hard creates even more pressure that can force infectious mucus into your ears and

sinuses.

void the Vboth-nostrils-openV blow. 'nstead ...

2ress a finger over one nostril.

ently blow the nose into a paper tissue thru the one open nostril.

)witch your finger to close the opposite nostril, and repeat.


(rink plenty of fluids.

0akes it easier for mucus to be removed by blowing gently.

3lowing your nose after taking a steamy shower can also help.


&se paper tissues rather than cloth handkerchiefs.

used handkerchief is a breeding ground for germs -- and when you reuse it youre spreading those

germs around your face and hands.


*nly use a paper tissue once, then throw it away.

0inimiAes the risk of putting germs back onto your face and hands.

;ash your hands when youre finished,

0icrobes from your nose and tissue will be transferred to your fingers while you blow.

2revents spread of germs to other people or back to yourself.

ar "amination

'ncludes an assessment of:

+earing, and


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appearance of the ear

ar "amination

ar "amination

+istory

%ook for classic symptoms of ear disease: deafness, tinnitus, discharge >otorrhia?, pain >otalgia?, and

vertigo

2revious ear surgery, or head in6ury

$amily history of deafness

)ystemic disease >for e"ample stroke, multiple sclerosis, cardiovascular disease?

*toto"ic drugs >antibiotics: gentamicin?, diuretics, cytoto"ics?

"posure to noise >pneumatic drill or shooting, for e"ample?

+istory of atopy and allergy in children

ar "amination

'nspecting the "ternal ar

'nspect the e"ternal ear before e"amination with an otoscope5auriscope.

)wab any discharge, and remove any wa".

'nspecting the "ternal ar

%ook for obvious signs of abnormality:

)iAe and shape of pinna

"tra cartilage tags5pre-auricular sinuses or pits

)igns of trauma to pinna

)uspicious skin lesions on the pinna including neoplasia

)kin conditions of the pinna and e"ternal canal

'nfection5inflammation of e"ternal ear canal with discharge

)igns5scars of previous surgery


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2%2T'*8 *$ T+ 9T8%

ently pull on the pinna to test for pain >'f painful this may suggest e"ternal ear disease?.

2alpate for any lymph nodes >e.g. The parotid or postauricular nodes W this may also be suggestive of

e"ternal ear disease?

'8)2CT'*8 *$ T+ 9T8% &('T* 0T&)

"amine the Xgood ear@ first. ;ith prior warning to the patient, gently pull the pinna upwards and

outwards >(irectly down and back in children?.

'nspecting the ar Canal and ar (rum

)lowly insert the otoscope5auriscope, looking at the skin of the canal while entering.

Check skin for normality or signs of inflammation.

'nspecting the ar Canal and ar (rum

%ook for wa" or other obstructions >e.g. foreign bodies U tips of cotton budsY?

ar wa"

'nspecting the Tympanic 0embrane

0ove the otoscope in order to see several different views of the drum.

8ormal tympanic membrane should appear pearly grey, concave, roughly circular >W1cm indiameter?.

'nspecting the Tympanic 0embrane

1Ittic >pars flaccida?

#I %ateral process of malleus

7I+andle of malleus


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%ook for signs of perforation.

2erforation of ear drum

ar "amination

)lowly retract the otoscope5auriscope from the ear.

Change the speculum on the otoscope5auriscope and e"amine the other ear.

$inally document what was seen in both ears, the condition of the tympanic membrane and the

e"ternal auditory meatus

3asic hearing tests

(etailed hearing tests are usually performed in audiology clinics.

patient with normal hearing should hear e!ually as well in both ears.

Tuning fork tests: ;eber test and inne test

$ree field voice testing >whisper from


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inne Test

'nterpretation of results is as follows:

'f the sound is now heard, the inne test is positive, meaning that air conduction is better than bone

conduction and there is:

- no hearing loss- perceptive hearing loss.

Conductive hearing loss may be diagnosed if the test is negative >i.e. bone conduction is better than air

conduction?

inne Test

inne Test

The whispered voice test

+as the advantage of not needing any e!uipment.

2atients are told that they will be asked to repeat three numbers.

The e"aminer stands out of view of the patient >to prevent lip reading? while covering one of the

patients ears and rubbing the e"ternal auditory meatus with a gentle circular motion.

This serves to mask sound input from the non-test ear.

The e"aminer then fully e"hales >which reduces voice volume? and standing .K= m >arms length? from

the ear being tested whispers 7 numbers.

't is very important to pay attention to the loudness of the whispering.

$ailure to repeat =H or more of the numbers on two trials is considered a fail and suggests a 7 d3O

hearing loss.

;hispered voice test

)tand 1-# feet behind client so they can not read your lips.

#? 'nstruct client to place one finger on tragus of left ear to obscure sound.

7? ;hisper word with # distinct syllables towards clients right ear.


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%ight enters the eye thru a small hole called the pupil and is focused on the retina, which is like a

camera film.

'ris >colored ring of the eye? controls the amount of light entering the eyeR closes when light is bright

and opens when light is dim.

)clera: the tough white sheet that covers the outside of the eye

The ye

ye also has a focusing lens, which focuses images from different distances on the retina.

The ye

Ciliary muscles in ciliary body control the focusing of lens automatically.

'mage formed on the retina is transmitted to brain by optic nerve.

The image is finally perceived by brain.

Three %ayers

of the yeball

)clera: outer fibrous layer, helps keep the shape of the eye

Choroid: middle blood rich layer supplying nutrition to the eye structures

etina: inner colored >pigmented? nerve layer of the eye.

ye Care 2ractitioners

ye Care 2ractitioners

*phthalmologist

a medical doctor who specialiAes in eye care.

*ptometrist

optometric doctor trained to provide refractive correction and diagnose5treat common issues.

*phthalmic medical practitioner

)imilar to an optometrist >in the &F?.

*culist

*lder term for either an ophthalmologist or optometrist.

*cularist


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specialiAes in the fabrication and fitting of ocular prostheses for people who have lost eyes due to

trauma or illness.

*ptician

also called *ptical (ispenser

specialiAes in the fabrication and fitting of

spectacles. 2rescription for the spectacles must

be supplied by an ophthalmologist or

optometrist.

*rthoptist

specialiAes in ocular motility, which is the movement of the eye controlled by the e"traocular muscles.

4ision therapist

work with patients that re!uire therapy, such as low vision patients.

*phthalmic medical personnel

popularly called V*02V

is a collective term for allied health personnel in ophthalmology.

often used to refer to non-specialiAed personnel >unlike ocularists or opticians?.

(anger signs of 4isual (isorders for referral

loss or distortion of central vision, or marked difference of acuity between eyes

sudden loss of peripheral vision

flashes of light or floaters >ischemia?, sudden cobweb or stringy floaters >detachment?

curtain across eyes >ischemia?

halos about lights >glaucoma?


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intermittent dimming of vision

strabismus

cornea J 11 mm in newborn >congenital glaucoma?

red eye with ed ye (anger )igns

ed ye (anger )igns

blurred vision >keratitis, glaucoma, 'ritis?

ciliary flush - perilimbal con6unctival in6ection >'ritis?

corneal opacification or epithelial disruption >bacterial keratitis?

abnormal pupil: nonreactive, small5irregular. >glaucoma, iridocyclitis, 'ritis?

proptosis

'ritis

2roptosis

lso called "ophthalmos

forward displacement of the eye in the orbit.

caused by swelling of the soft tissues or bones of the orbit.

Causes:

inflammation, infection and tumor, hyperthyroidism

C*8T'8&( :ed ye (anger )igns

increased intraocular pressure

colored halos >acute angle-closure glaucoma?

pain >glaucoma, 'ritis, bacterial keratitis?

u@s sign: sharp pain in covered >red? eye when uncovered eye is illuminated >'ritis?

photophobia >iridocyclitis, 'ritis?

Feratitis

laucoma

ye +ealth 2romotion


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8utrition

nsure proper intake of nutrients necessary for optimum vision health in the daily diet

nsure intake of different vitamins, minerals, and herbal supplements

shown by research as essential for good vision health and the prevention of potentially blinding vision

conditions

4itamin

absolutely essential for eye and vision health.

re!uired by the retina for its proper functions

recommended for those with poor night vision

+elps eyes ad6ust to light changes

0oistens the eyes, which can enhance visual acuity

has been shown to prevent the forming of cataracts

helps prevent blindness from macular degeneration

)ources: sweet potatoes, carrots, mangoes, spinach, and cantaloupe, yellow s!uash.

4itamin C

- n antio"idant

%inked to the prevention of cataracts

*ne study has shown that taking 7 to D mg supplemental vitamin C reduced cataract risk by K

percent, delay of macular degeneration, and eye pressure reduction in glaucoma patients.

)ources: orange 6uice, citrus fruits and broccoli, cauliflower, cabbage, and strawberries.

4itamin

&se as an antio"idant

+elps protect against cataracts and age-related macular degeneration.

clinical study has showed that taking vitamin can cut the risk of developing cataracts in half.


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nother study also showed that the combination of vitamins C and had a protective effect against &4

rays.

)ources: wheat germ, dark green leafy vegetables >such as spinach?, sweet potatoes, avocado,

asparagus

Binc

*ur eyes actually contain the greatest concentration of Ainc in our body.

an essential element re!uired for the conversion of beta-carotene into vitamin .

)ources: *ysters, red meat and poultry

Chromium

plays a large role in muscle contraction including eye muscles

low levels of chromium are a ma6or risk factor for increased intraocular pressure

)ources: beef, liver, eggs, chicken, oysters, wheat germ, green peppers, broccoli, apples, bananas,

and spinach.

lutathione

n amino acid that protects the tissues surrounding the lens of the eyes

+elps prevent cataracts, glaucoma, retinal disease, and diabetic blindness.

)ources: garlic, eggs, asparagus, and onions, watermelon, asparagus, and grapefruits.

%utein and Aea"anthin

ccumulate within the retina and imbue a yellow pigment that helps protect the eye

2rotects photoreceptors of the retina from light damage

ct like sunglass filters to protect the eye

%ower the risk of cataracts and macular degeneration

re also antio"idants

)ources: dark, leafy greens , corn, oranges, papaya and s!uash.

inkgo 3iloba


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'ncreases blood flow to the retina.

Can slow retinal deterioration which results in an increase of visual acuity.

2revention of ye 'n6ury

2rotect your eyes from the sun.

&ltraviolet radiation can harm your eyes.

&se a wide-brim hat and &4-absorbing eyewear to protect your eyes from harmful effects of the sun.

yewear should provide GG to 1 percent of &4- and &4-3 protection.


egular eyeglasses do not provide enough safety protection.

2rotect your eyes with proper safety glasses.

'n6uries can be prevented if proper eye protection is used at home, in the workplace and playing sports.

&se appropriate lighting.

2roper lighting can help improve safety at home and prevent eye in6uries.


Feep your children safe.

2ay special attention to where sharp items are placed.

'tems such as cosmetics, kitchen utensils and desk supplies can cause eye damage.

void flying or pro6ectile toys and any with sharp points and dangerous edges.

4isit eye doctor

>ophthalmologist? regularly.

ecommended regular eye e"am at least every # years.

arly detection of problems is key to treatment and prevention.

)pecific 2revention of ye 'n6ury

t home or outside:


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;ash your hands after using household chemicals.

;ear chemical safety goggles when using haAardous solvents and detergents, and do not mi" cleaning

agents around or near a child.


t home or outside:

Turn spray noAAles away from your face and the faces of others.

ead and follow directions when opening bottle-tops >such as wine, carbonated beverages?.

ead and follow directions when playing games and operating e!uipment.


t home or outside:

2rovide lights and handrails to improve safety on stairs.

Feep paints, pesticides and fertiliAers properly stored in a secure area.

3e sure to wear recommended protective goggles, helmets, and safety gear during the appropriate

activities.

&se guards on all power e!uipment.

2rotect eyes from the sun with either by a wind-brimmed hat or by wearing ultraviolet >&4?-protective

sunglasses

8ever look directly at the sun >especially during an eclipse?.


t play:

ecommended protective eyewear should be worn during the appropriate sports and recreational

activities.

helmet with a polycarbonate face mask or wire shield should be worn during the appropriate sports.

$ireworks should be handled with care and only be used by adults.

ppropriate protective eyewear should be worn during sporting and recreational activities.

2rotective eyewear should be worn when using lawnmowers, as debris may be pro6ected into the air.


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t school, it is important to wear protective eye wear when performing science or lab e"periments.

2revention of ye )train

0ost common symptoms of eye strain, which may be attributed to prolonged computer screen or tv

viewing.

)ymptoms may include:

red, watery, irritated eyes

tired, aching, or heavy eyelids

problems with focusing

muscle spasms of the eye or eye lid

headache

backache

)ymptoms of eye strain are often relieved by:

resting the eyes

changing the work environment

wearing the proper glasses.

&sing proper lighting when using a computer

2revention of ye )train when &sing a Computer

2osition the video display terminal >4(T? slightly further away than where you normally hold reading

material.

2osition the top of the 4(T screen at or slightly below eye level.

2lace all reference material as close to the screen as possible to minimiAe head and eye movements

and focusing changes.

0inimiAe lighting reflections and glare.

Feep the 4(T screen clean and dust-free.

)chedule periodic rest breaks to avoid eye fatigue.

Feep the eyes lubricated >by blinking? to prevent them from drying out.

Feep the 4(T screen in proper focus.

Consult ophthalmologist


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some individuals who normally do not need glasses may need corrective lenses for computer work.


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Human Senses - Complete the worksheet.doc