Class Notes Sensory Preception

SENSORY PERCEPTION Ability to receive sensory input, and through various physiologic processes in the body, translate the stimulus or data into meaningful information. Exemplars: Glaucoma Patho: loss of peripheral vision increase IOP (intra-ocular pressure) - pressure compresses retinal blood vessels/photoreceptors resulting in poorly oxygenated photoreceptors/nerve fibers - ischemic & die Risk: Primary: age/heredity/central retinal vein occlusion Associated: DM/HTN, severe myopia, retinal detachment Secondary: Uveitis, iritis, neovascular disorders, trauma, ocular tumors, degenerative disease, eye surgery S/S: slow vision loss blurred vision distorted vision eye pain headache halo’s around lights nausea/vomiting eye redness Diagnosis: Electroretinopathy gonioscopy Tonometry laser imaging of retina & optic nerve Education: TX: drug therapy (eye drops) – reduce I&O to prevent further damage. Does not “fix” impaired vision. Prostglandins - decrease IOP by dilating blood vessels – drains aq. Humor Fluid faster Adrenergic agonist /beta-adrenergic blockers – decrease IOP by limiting production of aq. Humor & dilating pupils. Cholinergic agonist – decrease IOP, decrease aq humor, makes more room Carbonic – directly / strongly decrease aq humor Surgery: Trabeculoplasty – fixes old channel Trabeculoectomy – makes new channel *if fails – shunt may be placed Education: use schedule - Punctual wait 5-10 minutes if more than 1 medication hand washing Keep clean eye dropper DO NOT TOUCH TIP TO EYE Meds: timolol – beta blocker… when teaching patient, they need to put finger in corner of eye to keep drops from getting into corner as it will cause HR to go low – because they absorb systemically Latanoprost (Xalatan) NCLEX QUESTION: The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would the nurse include in the plan of care? Decrease fluid intake to control the IOP Avoid overuse of eyes Decrease the amount of salt in the diet Eye medications will need to be administered lifelong Cataracts Patho/risk: lens opacity that distorts the image age related trauma exposure to toxins other disease & disorders: diabetes, hypoparathyroidism, etc s/s: blurred vision decreased color perception double vision difficulty w/ ADL’S lens is cloudy pupil is blueish white Diagnosis: eye chart brightness acuity testing use ophthalmoscope: describe & observe density by size, shape and location TX/Education Corrected by surgery Phacoemulsification: sound waves breaking the ions -> removed by suction Pre-Op: eyedrops that dilate pupils vasoconstrict & paralyze pupil Post-Op: antibiotic & steroid ointments, wear dark glasses, avoid bright lights, antibiotic eyedrops 2-4 weeks. Normal abnormal Discomfort pain Blood shot purulent drainage Slightly swollen eyelids After surgery – patient should have some improvement in vision, if vision gets worth, something is wrong and need to notify DR. Family to assist in planning. Be careful for ocular pressure, eye drop schedule adherence, daily eye exams, keep patient safe NCLEX QUESTION A male patient just had a cataract operation without a lens implant. In discharge teaching, the nurse will instruct the clients wife to: feed him soft foods for several days to prevent facial movement keep the eye dressing on for one week have her husband remain in bed for 3 days allow him to walk upstairs only with assistance Peripheral neuropathy Patho/risk A condition that develops as a result of damage to the peripheral nervous system. Can be inherited or acquired through disease process or trauma No known cause – idiopathic Acquired d/t: physical injury (trauma) Repetitive stress “entrapment neuropathies (compression injury) Diseases or disorders – metabolic and endocrine disorders “diabetic mellitus” Autoimmune diseases (sjogren’s syndrome, lupus, rheumatoid arthritis) Kidney disorders Cancers Neuromas Infections Exposure to toxins Signs and symptoms Burning numbness in extremities nocturnal leg pain Decrease sensation of touch sensitive to pain Poor balance chronic pain Acute pain Types: Guillain Barre Carpel tunnel syndrome Diagnostics test of muscle strength evaluate ability to sense touch, temp, vibration, body position nerve conduction velocity (NCV) electromyography (EMG) – fine needle inserted into muscle MRI Skin and nerve biopsy Examination of cerebrospinal fluid Blood test (vitamin deficiencies, liver/renal damage) TX/Education Check shoes prior to wearing Monitor blood sugar Wear soft loose cotton socks and padded shoes Quit smoking, exercise, good nutrition, avoid excessive alcohol Check temp of water prior to bathing Assess feet daily Gabapentin (Neurontin) Physical therapy / surgery Plasma exchange and IV immune globulin TENS transcutaneous electrical nerve stimulation NCLEX QUESTION: A patient with DMII has been admitted to the ed/surg unit with redness and swelling of his LLE. The healthcare provider has ordered imaging studies of the lower extremities. What other nursing orders can be expected? (select all that apply) blood glucose checks ACHS BP checks every hour Pt permitted to ambulate barefoot Monitor temperature/pulse of lower limbs Monitor pain in big toe of left foot Eye injuries: trauma & corneal ulcers Patho/Risk: scrape/scratch burns contact lens use foreign body contact malnutrition (dry eye) emergency – no blood supply bacterial or fungal infection cancer therapy S/S: decreased vision secretions cloudy vision hazy cornea photophobia Diagnostic Tests Microbial culture/ corneal scraping Fluorescein staining No MRI if you think metal is in eye visual field tests Treatment & education Gloves to be worn eye drops q 1 hr for 1st 24 hours Anti-infective therapy started immediately to decrease vision loss Wash hands do not treat unaffected eye No contact lens Steroids decrease inflammation No make-up Ocular irrigation Eye patch may be used after removal Ice packs to reduce swelling Discard all contact lens solution & make up Medications Gentamycin (antibiotic) Prednisolone acetate (steroid) Amphotericin B (antifungal) Eye drops every hour w/in 1st 24 hours to prevent infection – so patient doesn’t lose vision. Patient will even need to wake up to instill eye drops. NCLEX QUESTION: The client sustains a contusion of the eye ball following a traumatic injury with a blunt object. What intervention should be initiated immediately? Apply ice to the affected eye Irrigate with cool water Notify HCP Accompany patient to E.D. Macular degeneration age related – happens because you get old PATHO/RISK: gradual blockage of retinal capillaries -> retinal cells To become ischemic/necrotic RISK FACTORS: HTN, diabetes, hereditary, poor diet, smoking, low vit e & carotene S/S: loss of center vision, initial symptoms, mild blurring/distortion Diagnosis: fluroscien angiography- looking for leaking vessels or new vessels Asmler grid – looks like checkerboard – if lines are wavy, they could have macular degeneration TX/Education: dietary therapy slows progression, there is no cure. Vit E, B12, lutein Safety is a big issue – the patient will get to the point they can’t drive, increase risk for fall precautions RETINAL DETACHMENT Like a curtain coming over your eye. If it happens 1 time you have a greater chance it will happen again because it is weakened. You want to get reattached as soon as possible, because you can lose your vision.