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140 terms

Chronicity- sensory

STUDY
PLAY
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