Sensory Perception: Visual Impairment

Question 1

What questions should a nurse ask a patient to assess for visual impairment?

Answer 1

1. How would you rate your vision (excellent, good, fair, or poor)? Describe any recent changes in your vision
2. Do you wear eyeglasses or contact lenses?
3. Do you have any difficulty seeing near or far objects or difficulty seeing at night?
4. When did you last visit an eye doctor?

Question 2

What comorbidities put someone at risk for vision impairment?

Answer 2

DM, Heart problems, breathing problems, hypertension, joint problems, and stroke

Question 3

How would a pt’s visual acuity be assessed?

Answer 3

Use a Snellen chart or other reading material such as a newspaper, and visual fields, using picture charts for those with limited reading or language proficiency.

Question 4

What resources should be available to a person with a visual deficit?

Answer 4

1. eyeglasses of the right prescription, clean and in good repair
2. Adequate room lighting, including night-lights
3. Sunglasses or shades on windows to reduce glare
4. Bright contrasting colors in the environment
5. magnifying glass
6. Phone dialer with large numbers
7. Clock with large numbers or auditory device
8. Color code or texture code on stoves, washer, medicine containers, and so on.
9. Colored or raised rims on dishes
10. Reading material with large print
11. Braille or recorded books; podcasts
12. seeing-eye dog

Question 5

What is important to remember when communicating with someone who has a visual deficit?

Answer 5

1. Always announce your presence when entering the patient’s room and identify yourself by name
2. Stay in the patient’s field of vision if the patient has a partial vision loss
3. speak in a warm and pleasant tone of voice. Some people tend to speak louder than necessary when talking to someone who is blind.
4. Always explain what you are about to do before touching the individual
5. Explain the sounds in the environment
6. Indicate when the conversation has ended and when you are leaving the room

Question 6

How would a nurse educate on having a safe environment for someone with visual impairment?

Answer 6

1. keep an uncluttered environment with plenty of lighting
2. clear pathways (chairs pushed under tables, things put away); furniture should not be rearranged without orienting the patient
3. Organized self-care articles within reach
4. call lights and assistive devices within easy reach

Question 7

What surgeries can be done to help with visual impairments?

Answer 7

1. cataract surgery
2. glaucoma surgery
3. laser eye surgery to correct myopia, hyperopia, astigmatism, and other disorders
4. corneal transplant surgery
5. surgery to repair detached retinas
6. eye muscle surgery to correct strabismus

Question 8

What are the risk factors for cataracts?

Answer 8

1. Age
2. genetics
3. environmental factors: sunlight
4. Cigarette smoking and heavy alcohol consumption
5. Eye trauma
6. DM
7. Drugs (corticosteroids, lovastatin, phenytoin, chlorpromazine, busulfan)

Question 9

What medications can cause problems with vision?

Answer 9

1. antihistamines
2. antihypertensives
3. miotic eye drops
4. Antiseizure meds (eye pain)

Question 10

What is the difference between open-angle and closed-angle glaucoma?

Answer 10

open-angle glaucoma: the anterior chamber angle between the iris and cornea is normal
Closed-angle glaucoma: narrowing of the anterior chamber angle occurs because of corneal flattening or bulging of the iris into the anterior chamber.

Question 11

What are the types of otitis?

Answer 11

1. Otitis externa: Inflammation of the ear canal
2. Otitis interna (labyrinthitis): Inflammation of the inner ear
3. Otitis media: Inflammation of the middle ear

Question 12

What is otitis externa most likely referred to?

Answer 12

Swimmer’s ear

Question 13

What is otitis media most commonly referred to?

Answer 13

An ear infection

Question 14

What most often precedes the development of otitis media?

Answer 14

An upper respiratory infection or allergies

Question 15

What are the three types of otitis media?

Answer 15

1. serous otitis media
2. Acute otitis media
3. Chronic otitis media

Question 16

What is serous otitis media?

Answer 16

Occurs when obstruction of the eustachian tube is prolonged, impairing equalization of air pressure in the middle ear. The resulting negative pressure in the middle ear causes sterile serous fluid to move from the capillaries into space, a process that is known as middle ear effusion

Question 17

What is acute otitis media?

Answer 17

Acute otitis media typically follows an upper respiratory infection. Edema of the eustachian tube impairs drainage of the middle ear, causing mucus and serous fluid to accumulate. This fluid is an excellent environment for the growth of bacteria, which may enter from the oronasopharynx via the eustachian tube.

Question 18

What is chronic otitis media?

Answer 18

Involves permanent perforation of the tympanic membrane, with or without recurrent pus formation. It usually is the result of recurrent acute otitis media and eustachian tube dysfunction, but it may also result from trauma or other diseases.

Question 19

What are the clinical manifestations of serous otitis media?

Answer 19

In adults typically includes decreased hearing in the affected ear and complaints of “snapping” or “popping” in the ear.
The tympanic membrane demonstrates decreased mobility and may appear retracted or bulging.

Question 20

What are the clinical manifestations of acute otitis media?

Answer 20

Mild to severe pain in the affected ear, elevated temperature, diminished hearing, dizziness, vertigo, and tinnitus.
Pus within the mastoid air cells often causes mastoid tenderness.
tympanic membrane often appears red and inflamed or dull and bulging.

Question 21

What are the treatments for acute otitis media?

Answer 21

1. ear pain: local anesthetic, local herbal pain products, or systemic acetaminophen or ibuprofen
2. If the patient’s condition for 48-72 hours, treatment with a course of antibiotics

Question 22

What are the diagnostic tests for otitis media

Answer 22

1. impendence audiometry
2. CBC
3. Tympanocentesis or myringotomy
4. Spectral gradient acoustic reflectometry
5. Culture and sensitivity tests
6. Audiologic testing

Question 23

What type of drugs are used for pharmacologic therapy for otitis media?

Answer 23

1. antibiotics

2. Analgesics, antipyretics, antihistamines, and the local application of heat may relieve symptoms

Question 24

What type of surgery could be done to relieve otitis media?

Answer 24

myringotomy or tympanocentesis to relieve excess pressure in the middle ear and prevent spontaneous rupture of the eardrum.

Question 25

What is a tympanocentesis?

Answer 25

The healthcare provider inserts a 20-gauge spinal needle through the inferior portion of the tympanic membrane, allowing aspiration of fluid and pus from the middle ear to relieve pressure and, if necessary, to obtain a specimen for culture.

Question 26

What should nurses teach parents to help reduce the risk of otitis media?

Answer 26

1. infants in an upright position and not to put children to bed with a bottle 2. breastfeeding appears to be protective against otitis media 3. Pacifier use can alter the dental structure and promote eustachian tube dysfunction, and it also allows reflux of nasopharyngeal secretions into the middle ear from sucking 4. recurrent otitis media is common with children of parents who smoke and children who attend child care centers.

Question 27

What type of vaccination beginning at 2 months of age has proved to reduce the incidence of diseases like otitis media?

Answer 27

Haemophilus influenzae type B vaccine

Question 28

What are the interventions for Otitis media?

Answer 28

1. assess the severity, quality, and location of the pain 2. encourage the patient to use mild analgesics like ibuprofen or acetaminophen for pain and fever 3. advise the patient to apply heat to the affected side unless contraindicated. 4. Instruct the patient to promptly report to the primary care provider 5. Instruct the patient to avoid air travel, rapid changes in elevation, or driving 6. Instruct the patient to promptly report to the primary care provider 7. Elevate the head of the bed to decrease pressure on the middle ear when the patient is in bed