Chapter 51 Sensory System Function, Assessment, and Therapeutic Measures Vision and Hearing

Answers CHAPTER 51 SENSORY SYSTEM FUNCTION, ASSESSMENT, AND THERAPEUTIC MEASURES: VISION AND HEARING AUDIO CASE STUDY Selena and Sensory Care 1. Knock before entering. Always state who you are and what you are doing. 2. One of the most simple and effective ways to improve vision for older adults is to make sure their eyeglasses are clean. Clean glasses can improve safety by preventing falls or ingestion of a harmful substance. 3. Deafness or decreased hearing acuity is one of the main reasons that older adults withdraw from social activities. Selena wanted to prevent that from occurring. 4. Instruct the patient to tilt the head backward and look up toward the ceiling. Hold the medication bottle in one hand and use the other hand to pull the lower eyelid down and out to form a pocket. Then use the patient’s forehead to steady your hand and release an eye drop into the pocket. Avoid touching the tip of the dropper to anything to keep from contaminating it. Have the patient close the eye and apply gentle pressure with a tissue over the tear duct for at least 2 minutes, which is the amount of time it takes for the eye drop to be absorbed to keep the medication from being absorbed systemically and causing potentially serious side effects. STRUCTURES OF THE EYE 1 2 Chapter 51 Answers STRUCTURES OF THE EAR VISION Accommodation 1. (A) 2. (D) 3. (F) 4. (B) 5. (G) 6. (C) 7. (E) Definition: Adjustment of the eye for distance to focus the image on the retina by changing lens curvature. HEARING 1. (A) 2. (E) 3. (C) 4. (F) 5. (B) 6. (G) 7. (H) 8. (D) 9. (I) Ptosis Definition: Drooping of the upper eyelid as a result of paralysis. Arcus senilis Definition: Opaque white ring around the periphery of the cornea in aged persons from deposits of fat. Ophthalmologist Definition: Physician trained to diagnose and treat eye conditions and diseases. Optometrist VOCABULARY Nystagmus Definition: Doctor of optometry who diagnoses and treats certain eye conditions and diseases. Definition: Constant involuntary cyclical eyeball movement. Optician Tropia Definition: Deviation of the eye away from the visual axis. Definition: Makes prescribed corrective lenses. Chapter 51 Answers 3 DIAGNOSTIC TESTS Assessment Test Purpose of Test Normal Test Results Snellen chart Visual fields Cardinal fields of gaze Accommodation Visual acuity Peripheral vision Extraocular movement Pupillary response to near and far distance Rinne Differentiate between conductive and sensorineural hearing loss Hearing acuity Balance/vestibular function Right eye (OD) 20/20, left eye (OS) 20/20 Equal to health care provider’s Follows in all fields without nystagmus Eyes turn inward and pupils constrict when focusing on a near object Air conduction greater than bone conduction Weber Romberg CRITICAL THINKING 1. Eye strain from computer use. 2. The nurse should ask the positioning of Ms. Litley’s computer and the lighting of the office. 3. Position the center of the computer screen 4 to 5 inches below eye level and the screen 20 to 28 inches from the eyes. Glare should be reduced by situating the computer screen away from windows and lights. She should blink frequently to prevent dry eyes. She should rest her eyes every 20 minutes by looking 20 feet away for 20 seconds. She should also take a break every 2 hours for 15 minutes. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (4) is correct. Symmetrical eye muscle strength keeps the eyes in the same position, and the light is reflected in exactly the same place. (1) is incorrect. (2) defines accommodation. (3) defines the pupils’ reaction to light. 2. (1) is correct. Visual fields test peripheral vision. (2, 3, 4) are incorrect because near vision is tested with a handheld chart or by reading a book, distance vision is tested with a Snellen chart, and central vision is tested with an Amsler grid. 3. (3) is correct. Ototoxic is ear toxicity. (1) is incorrect. Otoplasty is ear repair. (2) is incorrect. Otalgia is ear pain. (4) is incorrect. Tinnitus is ringing in the ears. 4. (4) is correct. The whisper voice test could be used for initial screening. (1) is for balance. (2) examines the tympanic membrane. (3) assesses the reflex that controls balance. 5. (1) is correct. Otorrhea is ear drainage. (2) is incorrect. Otalgia is ear pain. (3) is incorrect. Ototoxic is toxic to the ear. (4) is incorrect. Tinnitus is ringing in the ears. Heard equally Able to maintain standing position without loss of balance 6. (3) is correct. Presbycusis is loss of high-pitched sounds due to aging. (1) is incorrect. Otoplasty is ear repair. (2) is incorrect. Otalgia is ear pain. (4) is incorrect. Tinnitus is ringing in the ears. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 7. (2) is correct. The first distance recorded when conducting the Snellen test is the distance from which the patient can clearly see the alphabetical line on the chart. The second distance recorded is the distance from which a person with normal vision can see the same alphabetical line. (1, 3) are incorrect. (4) is incorrect because normal vision is 20/20. 8. (3) is correct. PERRLA refers to P = pupils, E = equal, R = round, R = reactive, L = to light, and A = accommodation. (1, 2) are incorrect. (4) is correct documentation because PERRLA is the expected finding. 9. (1, 2, 4, 5) are correct. Glaucoma, cataracts, macular degeneration, and esotropia can all cause visual disturbances. (3) is incorrect. Arcus senilis, although a physical eye finding, does not cause visual problems. (6) is incorrect. Presbycusis is related to hearing loss, not visual changes. 10. (2) is correct. Air conduction is heard longer than bone conduction. (1) indicates the normal findings of a Weber test. (3, 4) indicate abnormal findings. 11. (4, 5, 6) are correct. Patients with hearing loss sometimes speak unusually loud or soft, turn toward the speaker to hear better or lip read, and withdraw from social situations. (1, 2, 3) indicate that the patient is hearing well enough to communicate. 12. (4) is correct. Seeing halos around lights would be an important visual finding. (1, 2, 3) are incorrect. 4 Chapter 51 Answers 13. (1) is correct. Darwin tubercle is a normal finding at any age. (2, 3, 4) are incorrect. 14. The area where the nurse should apply pressure after administration of the eye drops is the punctum (tear duct).