Chronicity- sensory

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kinesthetic stimuli

provides awareness of the position and movements of th persons body parts

stereognosis

awareness of objects size, shape, nd texture based on touch alone

reticular activating system

component in the brain stem a persons arousal mechansm is mediated by

sensoristasis

describes when a person is at optimal state of arousal

somnolence

expeiencing extreme drowsiness but responds to stimuli

presthesias

abnormal sensations such as burning or prickling

sensory deprivation

decrease in or lack of meaningful stimuli, balance in RAS disturbed and is unable to maintain normal stimulation of the cerebral cortex, person becomes more aware of remaining stimuli and perceives them in a distorted manner

SX of sensory deprivation

impaired memory with difficult concentrating, crying, excessive sleeping, annoyance over small matters, apathy, emotional lability

sensory overload

experiencing so many stimuli that they are unable to process or manage them d/t inability to disregard stimuli, increase in quality or quantity of internal or external stimuli

hair cells

modified epithelial cells of ear that are sensitive to movement and vibration

outer ear

consists of external auditory canal and pinna

external auditory canal

air filled passage that extends from the external environment to the tympanic membrane

auricle

visible shell like projection that surrounds the opening of the auditory canal

middle ear

consists of round and oval windows, auditory ossicles, eustachian tube. air filled chamber between tympanic membrane and round and oval windows

round and oval windows

membrane covered openings that lead to the inner ear

malleus

attached to the tympanic membrane

stapes

attached to the oval window

incus

connects the tympanic membrane andthe oval window

eustachian tube

connects the midle ear cavity to the pharnyx, hels equalize pressure within the ear whenever the air pressure in the environment changes

inner ear

consists of cochlea, semicircular canals, cochlear nerve, vestibular nerve

cochlea

organ of sound transduction, coiled tubular structure resembling a snails shell that is flled with a fluid called perilymph

semicircular canal

critical in maintenance of balance and equilibrium

cochlear nerve

carries impulses related to sound, connects the stuctures of the inner ear to the brain

vestibular nerve

carries impulses related to balance connects the structures of the inner ear to the brain

bone conduction

sound vibrations are transmitted through the skull directly to the inner ear

air conduction

tympanic membrane sends the sound vibrations throughthe auditory ossicles and into the cochlea via the oval window

organ of corti

converts the movement of hair cells into an electrical impulse that is sent to the brain

conductive hearing loss

results from interference in the transmission of sound through the middle ear caused b disease (otitis media) or impacted cerumen

sensorineural hearing loss

damage to structures of inner ear caused by either actions or acquired conditions (kernicterus, ototoxic drugs, excessive noise) perceptive deafness

mixed hearing loss

results from interference with the transmission of sound in the middle ear as well as along neural pathways caused by recurrent otitis media

functional hearing loss

nonorganic unrlated to detectable structural changes in personbs hearing mechanical usually accompanied by emotinal problems (psychogenic)

deaf

person whose hearing precludes the ability to successfully process linguistic info through hearing (with or without hearin aids)

hard of hearing

person who generally with use of hearing aid has enough residual hearing to be able to process linguistic info through audition

atrophy or sclerosis of tympanic membrane

cause loss of ability to hear high freq sounds followed by inability to hear sounds in mid and low frequencies in time

presbycusis

form of sensoineural hearing loss, hair cells in inner ear begin to degenerate after age 50

presbystasis or presbyvertigo

balance disorder of aging

ototoxic meds

aspirin, loop diuretics, aminoglycosides

otalgia

sensation of fullness or pain in the ear with or without hearing loss caused by cerumen impaction. tx- remova by irrigation, suction, or instrumentation. instillation of warm glycerin or mineral oil for 30 minutes before removal

presence of foreign bodies

objects placed in ear by children or adults cleaning ears sx- no discomfor to severe pain and decreased hearing. tx- irrigation, suction and instrumentation (insects can swell with water so mineral oil is used)

external otitis

inflammation in the external auditory canal caused by bacterial (staph) or fungus (aspergillus) caused by water (swimers ear), trauma to skin of ear canal, vit def, endocrine disorders. tx- reduce swelling and discomfort and eradicting the infection, analgesics for 48-96 hours, antibiotics if fever, cotton ball with petroleum to prevent water from entering

malignant external otitis (temporal bone osteomyelitis)

rare serious condition, occ fatal, infection of external auditory canal surrounding tissue and base of the skull. caused by pseudomonas aeroginosa (organism involved with diabetic pts) tx- control diabetes, antibiotics IV, agressive local wound care

masses and malignancies of external ear (Exostoses)

small bony protrusions in lower posterior portion of the ear canal usually in both ears. tx- removal

squamous cell carcinoma of pinna

can spread through temporal lobe causing facial nerve paralysis and hearing loss if untreated

gaping earring punctures

result from wearing earrings for long time, after an infection, or a reaction to impurities in an earring, needs surgically corrected

tympanic membrane perforation

usually occur as result of trauma such as skull fx, explosive injury, or severe blow to the ear, foreign object, or infection. causes pressure in the middle ear to exceed atmospheric pressure. tx- most heal spontaneously, some may take several months protect ear from water, Tympanoplasty

tympanoplasty

surgical procedure to close a perforation and improve healing placing tissue acoss the perforation to allow healing, reestablish middle ear function, prevents recurrent infections, improve hearing

otorrhea or rhinorrhea

cerebrospinal fluid clear watery drainage from ear or nose, complication with head injury or temporal bone fx.

otitis media

inflammation of the middle ear

acute otitis media (AOM)

rapid and short onset of sx lasting 3-6 weeks, freq in children 6 months-2 years caused by strep pneeumoniae, haemophilus influenzae, and moraxella catarrhalis usually enter after eustachian tube dysfunction caused by obstruction related to URI, or sinusitis or allergic reactions. risk factors- secondhand smoke, feeding postions, less common in breast feed babies d/t IgA

SX of AOM

purulent exudates result in conductive hearing loss, pain, fever, red bulging tympanic membrane, external auditory canal appears normal

TX of AOM

antibiotics (Ceftriaxone (Rochephin)- single dose if vomiting or family not compliant) dilute with lidocaine to decrease pain or EMLA cream 1 1/2 hours prior to injection, amoxicillin (10 days), Myringotomy,or ventilating or pressure equalizing tubes

myringotomy

tympanic membrane is numbed, incision is made to drain purulent or serous fluid and relieve pressure painless 15 min procedure

Otitis media with effusion (OME)

inflammation of the middle ear in which a collection of fluid is present, occurs d/t negative pressure in middle ear caused by euschasian tube obstruction, mostly children (if adults underlying cause must be found- nasopharyngeal cancer?) common in people after barotraumas (scuba diving or airplane descent)

SX of OME

hearing loss, fullness in ear, sensatio og congestin, pooping or crackling nosises as eustachian tube attempts to open

TX of OME

not tx with meds unless infection, myringotomy if hearing loss, corticosteroids to decrease edema in barotraumas, valsalva maneuver

valsalva maneuver

open eustachan tube by increasing nasopharyngeal pressure

chronic otitis media with effusion

middle ear effusion that persists beyond 3 months causing irreversible tissue pathology and persistant perforations of the tympanic membrane, can cause mastoid infections but is are d/y antibiotics. dx- otoscopic exam reveals perforation, cholesteatoma, audiometric tests show conductive or mixed hearing loss

cholesteatoma

ingrowth of the skin of the external later of the eardrum into the middle ear, skin forms a sac that can be attached to structures of the middle ear and mastoid, sac is filled with degenerated skin and sebaceous materials, if left untreated it will enlarge causing damage to the facial nerve and horizontal canal and destruction of surrounding structures

TX of chronic otitis media with effusion

instillation of antibiotic drops or app of antibiotic powder into the ear canal, systemic antibiotics used if acute infection, tympanoplasty, ossiculoplasty, mastoidectomy

ossiculoplasty

surgical reconstruction of the middle ear, teflon and hydroxyapatite are used to reconnect ossicles, therby reestablishing the sound conduction mechanism

mastoidectomy

goal is to remove the cholesteatoma, gain assess to diseased structures and create a healthy dry ear by reconstructng the ossicles under general anesthesia

otosclerosis

throught to occur d/t formation of new abnormal spongy bone esp around the oval window, with resulting fixation of the stapes (stapes cannot vibrate so sound cannot be carried and conducted from malleous and incus to the inner ear), risks- women, pregnancy, hereditary sx- conductive or mixed hearing loss.

TX of otosclerosis

fluroide tx thought to mature spongy bone, hearing aid mayalso help, stapedectomy, stapedotomy

DX of otosclerosis

testing reveals bone conduction is better than air conduction and audiogram condirms hearing loss esp in low freq.

stapedectomy

involves removing stapes superstructure and part of the footplate and inserting a tissue graft and suitable prosthesis

stapedotomy

removal of small part of the stapes footplate

vertigo

misconception of motion of either the person or the surroundings, spinning sensation, or feel like objects are moving around them

ataxia

failure of muscle coordination and may be present in people with vestibular disease

nystagmus

invluntary rhythmic movement of the eyes, ocular problem associated with vestibular dysfunction (can be horizontal, vertical, rotary)

meniere's disease

abnormal inner ear fluid balance d/t malabsorption in the endolymphatic sac endolymphatic hydrops (dilation in endolymphatic space develops) either increased pressure or rupture of inner ear occur, risks- 20-60, genetic

etiology of meniere's disease

abnormal blood flow to labyrinth, electrolyte imablance within labyrinth fluids, allergic reactions, autimmune disease, impairment of micorvascular of inner ear d/t abnormal high levels of metabolites

SX of Meniere's disease

triad of sx including episodic incapacitating vertigo, tinnitus, and fluctuating sensorineural hearing loss, fullness or pressure in ear. dx- normal except cranial nerve VIII, weber test lateralize to ear opposite of hearing loss

TX of Meniere's diseas

low na diet, diuretic therapy, antihistamines (antivert-to suppress vestibular system), tranquilizers (valium- help acute edisodes of vertigo), antiemetics (phenergan control N/V, vertigo, surgery for vertigo attacks- endolymphatic sac decompression, middle and inner ear perfusion, intraotoligc catherters, labyrinthectom, vesticular nerve section

labyrinhitis

inflammation of the inner ear that can be either bacterial (comp of otitis media) or viral (caused by mumps, rubella, etc affects hearing and balance. sx- sdden incapacitating vertigo, N/V, tinnitus, hearing loss, first episode is the worst. tx- antibiotic, antivert, antiemtic

ceruminolytics

cerumenex (expensive and no more effective than hydrogen peroxide)

fibrous tunic

near the back of the eyeball it takes the form of the sclera and is continuous with the dura mater of the brain, near the fron of the eye the sclera takes the form of the cornea

vacular tunic

posteriorly forms the choroid (pigmented layer containing blood vessels) ad anteriorly- ciliary body (ring of tissue that supports the lens

Iris

attaches the ciliary body to the lens creating anopening called the pupil which allow light that has penetrated the cornea to pass through the lens

retina

consists of two layers, outer pigmented layer of epithelial cells and inner layer that contain photoreceptors (rods and cones) and several layers of interneurons that carry out the first stages of neural integration of visual info

anterior hollow segment of eye

filled with aqueous humor which is secreted by the cliary body and reabsorbed into the sclera which helps pressurize the eyeball

posterior segment of the eye

filled with gelatinous vitreous humor

fovea centralis

light ras coming from each point in the visul world must be bent so that they are gathered at a single point in the plane of the retina, most bending is accomplished by cornea but it is limited in ability to accomodate for distance which is accomplished by the lens

distance vision

ciliary body pulls the lens into flat shape

near vision

muscles of ciliary body contract relieving tension and allowing the lens to assume a rounded shape

emmetropia

absense of refractive errors

myopia

nearsightedness, light rays from distance objects are focused anterior to the retina

presbyopia (hyperopia)

farsightedness, light rays fromdistant objects are focused behind the retina

astigmatism

irregularity in the curve of the cornea that distorts the visual image, light rays are spread over diffuse area rather than sharply focused on the retina

low vision

in addition to corrective lenses, other devices are needed defined as best corrected visual acuity (BCVA) of 10/70 to20/200

blindness

impaired vision ranging from a BCVA of 20/400 to no light perception

legal blindness

BCVA that does not exceed 20/200 in his better eye or if he has a visual field diameter of 20 degrees or less

glaucoma

characteized by increased intraocular pressure (IOP) d/t reabsoprtion of intraocular fluid becomes less efficient with age. caused by congestion of aqueous humor, can lead to optic nerve damage. leading cause of blindness sx- blurred vsion, halos, problems focusing,diff adjusting in low lighting, loss of peripheral vision, headache, aching around eyes. tx- no cure beta blockers topically to prevent more damage or laser surgery (intense heat create an opening in anterior camber of pts eye to facilitate aqueous humor outflow

cataracts

begin in 5th decades, exposure to UV rays with cross linkage of collagen cretes a rigid thickened lens. eye is opaque or cloudy, 3rd most common cause of preventable blindness. sx- painless blurring, dim surroundings, tx- surgery one eye at a time

macular degeneration (AMD)

chronic degeneration disorder resulting from pathological changes in the pigmentation of the retina, painless decrease in central vision that occurs over days, weeks, or months. tiny yellow spots called drusen beneath retina causing wide range of vision loss

SX of macular degeneration

visual blurring, distortion, central vision loss, decreased ablility to distiguish colots

dry AMD

85% of affected individuals, oute areas of retina slowly break down, first notice when trying to read, drusen appear in center of retina- blurred vision occurs, if drusen outside of this area usually no sx

wet AMD

retinal changes occur abruptly, complain that straight lines appear crooked or broen result from proliferation of abnormal blood vessels growing under the retina within the choroid, vessels break and leak fluid (laser tx may - affect eye)

amsler grids

used with clients to monitor for sudden occurences of visual distortion and macular degeneration (lines look wavy or faded). consists of geometricalgrid of identical squares with a central fixation point, client stares at grid and otes any distortion of the squares.

DX of cataracts

snellen visual acuity test, ophthalmoscopy, slit lamp biomicroscopic exam

retinal detachment

separation of the retinal pigment epithelium (RPE) from the sensory layer

rhegmatogenous detachment

most common, hole or tear develops in sensory retina allowing vitreous humor to seep through the sensory retina and detach it from RPE. caused by high myopia, aphakia (absense of natural lens), after cataract surgery and trauma

traction detachment

result of tension or a pulling force d/t scar tissue from conditions like diabetic retinopathy, vitreous hemorrhage, or retinopathy of prematurity

exudative detachment

results from production of serous fluid under the retina. macular degeneration often causes it

SX of retinal detachment

sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing light, or sudden onset of a great number of floaters, no pain

DX of retinal detachment

dilated fundus exam using a direct and indirect ophthalmoscope and goldman three mirroe evaluation

goldman three mirror exam

ophthamologist must find and document all retinal breaks, fibrous bands that are causing traction and all degenerative changes

TX of rhegmatogenous detachment

surgery to reattch sensory retina to RPE

TX of traction detachment

vitrectmy

vitrectomy

ocular procedure surgeon diects preretinal membrane under direct visualization whileretina is stabilized by intraoperative vitreous substitute, combined with scleral buckling to repair retinal breaks

TX of exudative

vitrectomy and laser photocoagulation and use of growth factors

Post Op complication of vitrectomy

increased IOP, endophthalmitis (inflammation of internal structure of the eye) additional retinal detachment, development of cataracts and loss of eye turgor

retinal vascular disorders

occlusion of retinal artery or vein from HTN, venous stasis, cardiac valvular disease, atherosclerosis sx- decreased visual acuity ranging from mild blurring to ability to detect only close motion dx- ophthalmoscopy shows optic dism swelling, benous dilation retinal hemorrhages, and cotton wool spots

ocular trauma

if chemical burn irrigation with NS or plain tap water must be performed immediately

corneal abrasion

d/t contacts. tx- epithelial cells of cornea are tc with antibiotic ointment and a pressure patch to immobilize eyelid (anesthic eyedrops)

Hordeolum

infection of sebaceous gland in the eyelid margin (sty) sx- red raised area of eyelid

chalazion

inflammation of a sebaceous gland in the eyelid sx- appears swollen nontender, raised area may be red tx- warm moist compresses and massage can help drain, if chronic surgery

blepharitis

inflammation of the lid margins and lash follicles sx- red irritated margins, burning, itching, mucus crusting scaling of lid margins tx- antibiotic ointment, avoid cosmetics

seborrheic blepharitis

tx with antiseborrheic shampoo or baby shampoo

keratitis

inflammation or infection of the cornea, can lead to corneal ulcers and permanent vision loss, can be bacterial, viral, or fungal and prolonged exposure to air caused by inability to close eyelids. risk factors- connective tissue disorders, rheumatoid arthritis sx- pain, tearing, photophobia, blurred vision tx- antimicrobial therapy

conjunctivitis (pinkeye)

inflammation or infection caused by bacteria, viruses, fungi, allergens, most common ocular disease sx- foreign body sensation, scratching, burning, itching, photophobia risk factors- chlamydia trachomatis, neisseria gonorrthoeae, herpes simplex virus during birth, nasolacrimal duct obstruction dx- cultures

mydriatics

potentiate alpha adrenergic sympathetic effects that result in relaxation of ciliary muscles, causes dilation

cycloplegics

paralyze the iris spincter, used in combo to achieve maximum dilation needed during surgery and retinal exams effects lasts 2hrs to several ays, need sunglasses and ride home se- dizziness, ataxia, confusion, hallucination, increased bp contraindicated by pts taking tricyclic antidepressants or mao inhibitors and glients with glaucoma or shallow anterior chambers

miotics

cause pupillary constriction and are used to tx glaucoma, increase outflow of aqueous humor by affecting ciliary muscles and pupil constriction se- periorbital pain, blurred vision, diff seeing at night

allergy meds

used to tx allergic conjunctivitis

ocular irrigting solutions

used on external corneal surface to regain normal pH, cleanse the external lids, inflate the eyeball intraoperatively or irrigate the corneal surface to eliminate debris, chemical burns. contraindicated- corneal perfusion

strabismus

eye deviates from the point of fixation, weak eye becomes lazy and the brain suppresses the image produced by that eye, if not dx by 4-6 years amblyopoa (type of blindness) occurs

acoustic trauma

refers to hearing loss caused by a single exposure to extremely intense noise

Vitamin A

factor in eyes ability to adapt to light and darkness, causing night blindness if deficient.

weber tests

used to laterization of sound, tuning fork that has been tapped is placed on clietns forehead, client is asked to indicate if they hear right, left or middle

rinne test

used to differentiate between conductive and sensorineural hearing loss. tuning fork is held 2 inches from opening of ear canal (to test air conduction) and then aganst mastoid bone (test bone conduction) normally sound conduction through air is heard longer than sound conduction through bone

audiometry

most important dx tool, client wears earphone and signals when they hear tone

tympanogram

measures middle ear muscle reflex to sound stimulation and compliance of the tympanic membranes done by changing pressure in a sealed air canal

auditory brain stem response

electrods are placed on clients forehead, and acoustic stimuli (usually clicking sounds) are made in the ear, can determine at which level a client hears and if problems with nerve pathway (tumors)

snellen chart

composed of series of progressively smaller rows of letters, tests distance viewing 20/20 see line from 20 ft away. 20/200 can see object from 20 feet away that a normal person cen see from 200 ft away

external eye exam

ptosis (drooping of syslids), lid retraction , reactivity to light, tilt (may indicate cranial nerve palsy), nystagmus (oscillating eye movement)

direct ophthalmoscopy

enables the examiner to bring the cornea, lens and retina into docus in sequential order. room is darkened and client focuses on a taget with both eyes open. loos for intraretina hemorrhages, lipid deposits, exudates,microaneurysms (small red dots, drusens (yellow in color with indistanct edges)

indirect ophthalmoscopy

uses a light source afixed to a pair of binoculars which are mounted on examiners head. used in conjuction with a 20-diopter lens and allows the examiner to see larger but unmagnified areas of the retina

slit lamp exam

useds a binocular microscope mounted on a table that enables the examiner to view the eye with magnification of 10-40x. cataracts can be evaluated by hanging the angle of light

ishihara polychromatic plates

color vision test, bound together in a book with doys of primary and secondary colors

tonometry

evaluates the clients intraocular pressure by determining the amount of force necessary to indent or flatten a small anterior area of the eyeball, noninvasive and painless. topical anesthetic is used in lowed conjunctival sac before measurements taken

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