Chapter 13
Care of the Patient with a Sensory
Disorder
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
Care of the Patient with a Sensory
Disorder


The sensory system constantly gathers
information through millions of receptors
scattered throughout the body and delivers it
to the brain
Five major senses:
– taste
– touch
– smell
– sight
– hearing
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
Normal Aging



Crystalline lens of the eye harden and
becomes too large for the eye muscle – loss
of accommodation
The crystalline lens also loses some
transparency and becomes more opaque –
glare begins to be a problem
Pupil becomes smaller and decrease amount
of light that reaches the retina – patient
needs more light to read
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
Normal Aging (con’t)


Ear – loses ability to hear high frequencies
and distinguish consonant sounds
Remaining senses have slight changes
causing decreased reaction or threshold time
– slower responses and diminished sensation
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
Laboratory and Diagnostic
Examinations

After the normal Snellen’s test, additional eye
test may be required
– Amsler’s chart – detect defects of the
macular area of the retina
– Goldmann perimetry tests – detects and
evaluates intraoccular pressure
– Exophthalmometry – measures the degree
of forward placement of the eye
– Slit-lamp – examines the conjunctiva, lens,
vitreous humor, iris, and cornea
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
Applanation Tonometry
(Figure 13-12)
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
Eye Disorders - Nursing
Consideration

Initial consideration – review of following items:
– Eye pain, pruritus, excessive tearing, floaters, light
flashes, discharge, visual changes, or blind spots
– History of allergies
– Current medication, and side effects, for the eye
disorder
– Use of glasses or contact lenses
– Adequacy of current eyewear prescription
– Personal habits related to care of eyewear
– Any previous eye injuries or surgeries
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
Disorders of the Eye


Blindness and near blindness – individuals with a
maximum visual acuity of 20/200 with corrective
eyewear and/or visual field sight capacity reduced by
20 degrees
Refractory errors – astigmatism, strabismus,
myopia, and hyperopia

Inflammatory and infectious disorders

Myopia – elongation of the eyeball

Hyperopia – inability to see things at close range

Macular degeneration – slow, progressive loss of
central and near vision
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
Other Disorders

Glaucoma – elevated pressure within an
eye because of obstruction of the outflow of
aqueous humor
– Open-angle – common form of the disease
that progresses slowly
– Closed-angle – occurs when sudden
blockage occurs
– Treatment - Medications and surgery
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
Surgery of the Eye

Trauma to the eye can result in need for
surgery
– Enucleation – surgical removal of the eyeball
– Corneal Transplants – implantation of
donor cornea
– Retinal detachment – retina separates from
the choroid in the posterior area of the eye –
cryosurgery or scleral buckling are usual
treatment
– Vitrectomy – removal of excess vitreous fluid
caused by hemorrhage
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
Ear Disorders – Nursing
Considerations

After general assessment, additional
information would include the following:
– Occurrence of ear drainage, tinnitus, vertigo,
wax buildup, pressures, pain, and pruritus
– Behavioral clues indicating hearing loss
– History of medications used for ear disorders
– Current medications and side effects
– Speech pattern abnormalities
– Use of assistive hearing device
– Home remedies that cause ear trauma
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
Disorders of the Ear



Inflammatory and infectious – external
otitis, otitis media, and labyrinthitis
Obstructions of the ear – excessive
secretions of cerumen or foreign bodies
Noninfectious disorders
– otosclerosis (chronic progressive deafness)
– meniere’s – inner ear problem causing
vertigo and tinnitus
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
The Inner Ear
(Figure 13-4)
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
Surgery of the Ear


Tympanoplasty – designed to restore or
improve hearing with conductive hearing loss
Myringotomy – surgical incision of the
eardrum to relieve pressure and purulent
exudate
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.
Nursing Diagnoses

Health maintenance,
ineffective

Anxiety

Self-care deficit





Fear

Environmental
interpretation
syndrome, impaired


Home maintenance,
impaired
Social interaction,
impaired
Loneliness, risk for
Sensory perception,
disturbed
Social isolation
Risk for injury
Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.