Assessment & Problems
of
Visual and Auditory Systems
Chapter 20
&
Chapter 21
N3
Professor Jondea Orr
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Visual System
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2
Structures and Functions
Visual System
• Structures and functions of vision
 __________structures
 ___________structures
 Light is ________through structures of
the eye, refracted to fall on______, and
perceived as an ______in______
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Structures and Functions
Visual System
• Structures and functions of vision
 Eyeball
 _______and ________
 Uveal tract
 ___________
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Structures and Functions
Visual System
(From Newell FW: Ophthalmology: principles and concepts, ed 7, St Louis, 1992, Mosby)
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Structures and Functions
Visual System
• Structures and functions of vision
 Refractive media
 Cornea
 __________humor
 Lens
 ____________
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Structures and Functions
Visual System
• Structures and functions of vision
 Refraction
 Refractive errors
 __________
 __________
 __________
 __________
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Structures and Functions
Visual System
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Structures and Functions
Visual System
• External structures and functions
 Eyebrows
 Eyelids
 Eyelashes
 Serve as a physical ______ primarily for
__________ of eyeball or globe
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Structures and Functions
Visual System
• External structures and functions
 Medial and lateral canthi
 Cranial nerves (__________)
 Conjunctiva
 Tears
 Sclera
 “________” of the eye
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Structures and Functions
Visual System
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Structures and Functions
Visual System
(From Liu GT, Volpe NJ, Galetta SL: Neuro-Ophthalmology: diagnosis and management, ed 2, Philadelphia, 2010, Saunders)
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Pupil Response
Structures and Functions
Visual System
• Internal structures and functions
 Lens
 ________ light rays to focus on retina
 Ciliary body
 Changes ______ of lens and secretes
aqueous humor
 Choroid
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Structures and Functions
Visual System
• Internal structures and functions
 Retina
 Forms the _______ nerve
 _________ regenerate as it is composed
primarily of neurons
 __________ images brain can understand
as vision
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Retinal Detachment
•
•
•
•
Etiology and pathophysiology
Clinical manifestations
Diagnostic studies
Collaborative care
• _______ therapy
•
•
•
•
Laser photocoagulation and cryopexy
Scleral buckling
Intraocular procedures: pneumatic retinopexy
Postoperative considerations in scleral buckling and
intraocular procedures
16
Scleral Buckling
17
Structures and Functions
Visual System
• Internal structures and functions
 Retina
 Photoreceptor cells: rods and cones
 _____provide vision in dim light
 _____ receptive to color in bright light
 Macula – ______ visual field
 Fovea centralis - provides _______ vision
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Gerontologic Considerations
Effects of Aging on Visual System
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Assessment of Visual System
• Subjective Data
 Important health information
• Past health history
• Ocular information such as visual tests,
family history, and head or eye trauma
• Nonocular health problems such as
systemic, cardiac, or pulmonary diseases
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Assessment of Visual System
• Subjective Data
 Important health information
• Medications including OTC, eye drops,
herbal therapies, or dietary supplements
• Surgery or other procedures, including
brain surgery or laser treatments
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Assessment of Visual System
• Subjective Data
• Functional health patterns
• Health perception–health management
pattern
• ________perception of problem
• Ability to perform ____ ______
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Assessment of Visual System
• Subjective Data
• Functional health patterns
• Health perception–health management
pattern
• Safety
• Allergies
• Hereditary diseases and ______ ______
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Assessment of Visual System
• Subjective Data
• Functional health patterns
• Nutritional-metabolic pattern
• Elimination pattern
• Activity-exercise pattern
• Sleep-rest pattern
• Cognitive-perceptual pattern
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Assessment of Visual System
• Subjective Data
• Functional health patterns
• Self-perception–self-concept pattern
• Role-relationship pattern
• Sexuality–reproductive pattern
• Coping–stress tolerance pattern
• Value-belief pattern
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Case Study
(©Digital Vision/Photodisc/Thinkstock)
• A.O., a 74-year male, comes into the
clinic for an eye and ear exam.
What are some reasons you may want
to involve his wife and how would you
go about it?
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Assessment of Visual System
• Objective Data
 Physical examination
 May be as brief as _______ visual acuity or
in-depth and require special training
 Always based on what is appropriate and
necessary for specific patient
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Assessment of Visual System
• Objective Data
 Physical examination
• Initial observation
• Assessing functional status
 Visual _______
 Assess right eye first, then left
 _________ eye chart
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Jaeger Chart
Right
Jaeger Chart
Jaeger Chart
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Snellen Chart
Assessment of Visual System
• Objective Data
 Physical examination
• Assessing functional status
 Visual acuity
 _______ eye chart
 Alternative methods
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Case Study
(©DigitalVision/Photodisc/Thinkstock)
• A.O. looks tired and his eyes are
sunken.
What should you ask?
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Assessment of Visual System
• Objective Data
 Physical examination
• Assessing functional status
 _________ muscle functions
 Corneal ______ reflex
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Assessment of Visual System
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Assessment of Visual System
• Objective Data
 Physical examination
• Assessing functional status (cont.)
 Pupil function
 _____
 Anisocoria
 Unequal pupil size
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Assessment of Visual System
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Assessment of Visual System
_____ Lamp
Assessment of Visual System
• Objective Data
 Physical examination
• Assessing structures
 Eyebrows, eyelashes, and eyelids
 Conjunctiva and sclera
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Assessment of Visual System
• Objective Data
 Physical examination
• Assessing structures
 Cornea
 Iris
 _____ and _____ nerve
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Assessment of Visual System
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Age-Related
Macular Degeneration
 Etiology and pathophysiology
• Retinal aging
• Genetic
• Exposure to UV
• Smoking
• Light colored eyes
 Clinical manifestations
• ________ and darkened vision
• _______ spots
• _______vision
 Collaborative care
• Lutein may help decrease risk
• Photodynamic therapy
40
Macular Degeneration
41
Assessment of Visual System
• Objective Data
 Special assessment techniques
• Color vision
• ________ Color Test
• Stereopsis
• Used for judging ___________
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Ptosis
43
Hordeolum
44
Conjunctivitis
45
Strabismus
Corneal Abrasion
Diagnostic Studies
Visual System
• Diagnostic studies to obtain
objective data
• Refractometry
• Ultrasound
• Fluorescein angiography
• ________ grid test
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Diagnostic Studies
Visual System
• ________ grid test
A, Normal grid. B, Abnormal grid as seen by person with macular degeneration.
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Diabetic Retinopathy
Case Study
(©Digital Vision/Photodisc/Thinkstock)
• You notice A.O. has two different
colored socks on
1. Is this important?
2. Why or why not?
3. What do you say to him
about his socks?
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Eye Trauma
• Trauma
• Blunt injury
• Penetrating Injury
• Burn-Chemical injury
• Thermal Injury
• Foreign Bodies
52
Questions
53
Auditory System
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54
Structures and Functions
Auditory System
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Structures and Functions
Auditory System
• Middle ear
• Eustachian tube
• Three small bones
• ________
• ________
• ________ or ossicles
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Structures and Functions
Auditory System
• Inner ear
 Functional organs for ______ and
______
 Cochlea
 Organ of Corti
 Three semicircular canals and vestibule
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Structures and Functions
Auditory System
 Transmission of _______
 _____ conduction
 _____ conduction
 Conductive and sensorineural
hearing loss
 Hearing, balance, and equilibrium
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Rinne Tuning Fork Test
On mastoid bone
Next to ear
Weber Tuning Fork Test
Gerontologic Considerations
Effects of Aging on Auditory System
• Presbycusis
• _______ _____ as a result of aging
• Many sources
• Tinnitus
• Prevalence expected to rise as life
span increases
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HEARING LOSS
• Tinnitus
• Perception of noise without an actual source of sound
• “______ __ ____ ____” May be first symptom of
hearing loss
• Most commonly caused by noise
• More than ____ drugs cause tinnitus
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Assessment of Auditory System
• Subjective Data
 Important health information
• Auditory and _________ problems may be
difficult to differentiate
• Vertigo
• Dizziness
• Nystagmus
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Rotary Chair Test for
Vestibular Function
Assessment of Auditory System
• Subjective Data
 Important health information
• Past health history of childhood illnesses
• Problems of organs adjacent to ear
• ___________ medications
• Surgery of ear or other treatments
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Assessment of Auditory System
• Subjective Data
• Functional health patterns
• Health perception–health management
pattern
• Nutritional-metabolic pattern
• Elimination pattern
• Activity-exercise pattern
• Sleep-rest pattern
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Assessment of Auditory System
• Subjective Data
• Functional health patterns
• Cognitive-perceptual pattern
• Self-perception–self-concept pattern
• Role-relationship pattern
• Sexuality-reproductive pattern
• Coping–stress tolerance pattern
• Value-belief pattern
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Assessment of Auditory System
• Objective Data
 Physical examination
 Observe for __________adjustments
indicating hearing difficulties
 Hearing loss may be ______ or undetected
until moderate losses have occurred
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Causes of Hearing Loss
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NURSING MANAGEMENT
HEARING LOSS AND DEAFNESS
• Assistive devices and techniques
• ________ aids
• Fit by a specialist
• Provide amplification, sound lateralization,
speech discrimination
• Require a motivated, capable user for optimum
success
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Types of Hearing Aids
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Case Study
(©Digital Vision/Photodisc/Thinkstock)
• You notice that when you are
talking to A.O., he frequently
interrupts.
What do you think this could mean?
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Case Study
1. What are some verbal aids you can
use to communicate with a hearingimpaired person?
2. What are some nonverbal aids you
can use to communicate with a
hearing-impaired person?
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Assessment of Auditory System
• Objective Data
 Physical examination
• External ear
• Symmetry or deformity
• External auditory canal and tympanum
• ___________ examination
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Assessment of Auditory System
Normal tympanic membrane
(Jarvis C: Physical examination and health assessment, ed 7, St Louis, 2015, Elsevier.)
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Normal Eardrum
Otitis Media
78
Acute Otitis Media
 Symptoms:
 _____, fever, HA,
reduced hearing
 Etiology:
 virus or bacteria
 Collaborative care:
 Antibiotic
Amoxicillin
 Myringotomy:
 incision to release
pressure/exudate
Chronic Otitis Media
• Symptoms:
• ___ ______; but has
nausea, dizziness, hearing
loss
• Etiology:
• Untreated or repeated
infections
• Mastoid bone may be
involved
• Collaborative care:
• Antibiotics
• Surgery
Acute Otitis Media
Diagnostic Studies
Auditory System
• Tests for hearing acuity
 Audiometry
• Effective screening tool
• Uses tones to establish hearing
thresholds
• ______measures tone _________
• ______ measures __________
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Diagnostic Studies
Auditory System
• ____________
Case Study
(©Digital Vision/Photodisc/Thinkstock)
• Further studies indicate A.O. would
benefit from a hearing aid, but he
refuses.
• His wife is very interested in him
getting a hearing aid.
What should you do?
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Meniere’s Disease
A state of hearing loss characterized by:
• ________
• ________
• ________
fluctuating
hearing loss
83
NCLEX Question
A patient complains of partial loss of vision on the
right side. The nurse should perform which
assessment?
a. Administer the Snellen test
b. Perform the confrontation test
c. Examine the pupil response to accommodation
d. Use tonometry to evaluate intraocular pressures
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NCLEX Question
Which finding would indicate to the nurse that the
patient has weakness of the extraocular nerves?
a. Limited field of vision
b. Sluggish pupillary reflex
c. Conjugate eye movement
d. Irregular corneal light reflex
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NCLEX Question
The nurse is caring for a patient who has hearing loss.
What equipment should the nurse obtain to assess
whether the patient’s hearing loss is sensorineural or
conductive?
a. Otoscope
b. Tuning fork
c. Audiometer
d. Ticking watch
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NCLEX Question
The patient complains of severe pain when the outer
ear is touched. What does the nurse suspect?
a. A blocked eustachian tube
b. Inflammation of the ear canal
c. A ruptured tympanic membrane
d. An infection of the mastoid bone
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NCLEX Question
A patient complains of dizziness when
bending over and of nausea and dizziness
associated with physical activities. The
nurse will plan to teach the patient about:
A. tympanometry
B. rotary chair testing
C. pure-tone audiometry
D. bone-conduction testing
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NCLEX QUESTION
A patient presents at the urgent care clinic with
complaints of right ear pain. Which of the
following should be included in physical
assessment? (SELECT ALL THAT APPLY)
1. VS with pulse
2. Inspection of the oral pharynx
3. Manipulation of the ear pinna
4. Palpation of the cervical lymph nodes
5. Inspection of the ear canal and tympanic
membrane
Questions