concept of perception
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TRANSCRIPT
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Christopher R. Bañez, RN, RM, US – RN, MSNc
Concept of
Perception
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Assessment of
Vision &Diagnostic Procedure
s
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Measures distance and near vision
Maintain 20 feet distance
Snellen’s Chart
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Examines the visual fields or peripheral vision
Instructions: Facing each other (examiner and the
patient) Examiner- cover his/her right eye Patient- covers his/her left eye The test assumes that the examiner
has a normal peripheral vision
Confrontational
Test
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Six cardinal positions of gaze. Client holds head still and is
asked to move eyes and to follow a small object.
Extraocular Muscle Function
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Ishihara Polychromatic plate: Consists of numbers
that are composed of colored dots.
Client is asked to read using each eye.
Assesses red or green blindness
Color Vision
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Normal pupil: P-upil E-qual R-ound R-eactive L-ight reacting A-ccommodation
Pupil
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Sclera Normal color is dull white Yellow sclera indicates a problemCornea Normal cornea is transparent,
smooth, shiny, and bright Cloudy areas or specks indicates
an eye accident or injury
Sclera and
Cornea
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Hand held device Darken the roomThe examiner: Uses right hand and right eye to
examine the right eye of the patient
Uses left hand and left eye to examine the left eye of the patient
Ophthalmoscop
y
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Ophthalmoscop
y
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Series of photographs after the administration of a dye.
MEM RY CANDY Assess for allergy. Administer mydriatic 1 hour before the test. Prepare IM antihistamines. Encourage fluid intake after the procedure. Expect photophobia.
Fluorescein
Angiography
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A cross sectional image is formed by the use of a computer
The patient will be positioned in a confined space
Computed Tomograp
hy
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The client lean on a chin rest to stabilize the head
Advise the client about the brightness of the light
Slit Lamp
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Topical dye is instilled into the conjunctival sac
The eye is viewed through a blue filter
Instruct the client to blink the eye after the dye has been applied
Bright green color- indicates non-intact corneal epithelium
Corneal Staining
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Measures IOPNon-Contact tonometry Use of air puff to flatten the corneaContact tonometry Use of anesthesia Instruct the patient not to rub the eye
after the procedure
Tonometry
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Tonometry
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Disorders of
the Eye
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20/200 visual acuity.
MEM RY CANDY
Alert the patient Allow the client to touch the environment Clock placement of food Dependence of the patient avoided Dominant hand – cane is placed Environmental safety is priority
Legally Blind
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Conjunctivitis
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Complete or Partial Opacity of the lens
Causes: Congenital Ageing Nutritional deficiency Trauma Secondary
Cataract
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Common Clinical Manifestations: Absence of red reflex Blurring of vision Color blindness Decrease visual acuity
Painless Opaque/milky white
Cataract
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Cataract
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MEM RY CANDYC
ATARACTS
are to prevent increased IOPpply eye patchesurn patient on back/unoperative sidedminister mydriaticsaise side railsssist with ambulationyclopegicsimingafety is priority!
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Increase IOP due to OVERPRODUCTION of Aqueous Humor
or OBSTRUCTION in the flow of Aqueous Humor
Glaucoma
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Risk factors: Familial tendency Age Myopia Secondary diseases
Glaucoma
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Common Clinical Manifestations: Loss of peripheral vision Elevated IOP Halos around white lights Frontal Headache Tunnel vision
Glaucoma
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Lifelong medication use: Beta blockers Anhydrase inhibitors Hyperosmotics Miotics
Avoid: Anticholinergics Benadryl Cogentin
Pharmacotherapy first followed by surgical approach
Prevent increase in IOP
MEM RY CANDY
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Tear and separation of retinal layer due to vitreous pull.
Causes: Tractional Exudative Rhegmatogenous
Retinal Detachme
nt
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Common Clinical Manifestations:
Retinal Detachme
ntFV
lashes of lightloatersalling curtaineil–like
image
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MEM RY CANDY
BEDS
ed rest
ye patches on OU
iscourage jerky head movements
cleral buckling
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Retinal Detachme
nt
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A deterioration of the macula, the area of central vision, commonly caused by:
Ageing
Common Clinical Manifestations:
Blurring of vision
Central vision affected
Macular Degenerat
ion
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Macular Degenerat
ion
Maximize remaining vision toMaintain independence
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Ear Assessme
nt and Diagnostic Procedure
s
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MEM RY CANDY Pen hold position Pink – normal color of the external canal Pearly gray and slightly concave – normal
Tympanic membrane Pull the pinna:
A CD HUp and back IL LT Down and
back
Otoscopic Examinati
on
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Weber’s test Place the vibrating fork stem in the:
Middle of the client’s forehead. Midline of the forehead. Upper lip over the teeth .
Normal: tone is heard equally in OU. CHL: tone is heard in the affected ear. SHL: tone is heard in the unaffected
ear.
Tuning Fork Test
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Rinne’s test Compares:
Air conduction: place the vibrating tuning fork 2 inches away from opening of the ear.
Bone conduction: place the vibrating tuning fork against the mastoid bone.
Normal: air conduction is better than bone conduction – positive Rinne’s test.
CHL: tone is louder behind the ear – negative Rinne’s test.
SHL: the test is of no value in determining SHL
Tuning Fork Test
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Romberg’s Sign
MEM RY CANDY Stand with feet together.
Arms hanging loosely at the side.
Close eyes.
Mild swaying is normal.
Obvious swaying is a positive Romberg’s sign.
Test for Falling
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Disorders of the
Ear
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Infective inflammatory or allergic response involving the auricle
Swimmer’s ear Common Clinical Manifestations:
Pain
Itching
Plugged feeling in the ear
Exudate, edema
Redness
External Otitis
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MEM RY CANDYA
SAKA
NALGESIC
TEROID
NTIBIOTICeep it dry, no to cotton tipped applicator
lways use earplugs when swimming
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Infective, inflammatory or allergic response involving the structure of the middle ear as a result of blocked Eustachian tube.
Risk factors: Upper RTI. Common in infant and children.
Otitis Media
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Common Clinical Manifestations:
Fever and loss of appetite.
Irritability, rolling of head from side to side.
Red, bulging tympanic membrane.
Earache, ear drainage.
Otitis Media
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Medical and Nursing Management: Analgesic and Antibiotic. Local heat application affected ear down. Upright position when feeding. Fluid intake increased.Myringotomy – equalizes pressure and maintains aeration. Keep the ears dry. Earplugs during swimming, shampooing and
bathing. No to diving and submerging under water.
Otitis Media
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Due to untreated or inadequately treated acute or chronic otitis media.
Common Clinical Manifestations:
Swelling behind the ear
Unrelieved by myringotomy
Low grade fever
A reddened, dull, thick, immobile tympanic membrane with or without perforation
Tender or enlarged post auricular lymph nodes
Mastoiditis
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MEM RY CANDY
MIDO
astoidectomy with tympanoplasty
njury due to dizziness – watch out
ressing change 24 hours post opperative side up
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Bony overgrowth of the tissue surrounding the ossicles.
This results to stapes fixation leading to Conductive Hearing Loss.
Causes: Unknown. Familial tendency. Common Clinical Manifestations: Schwartze’s sign. Weber’s test to the affected ear. Aringing or roaring type of tinnitus. Negative Rinne’s test.
Otosclerosis
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MEM RY CANDY
FAPAS
enestration
void excessive nose blowing and the use of cotton tipped applicatorrevent middle or external ear infectionssist with ambulation
afety is priority!
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Also called ENDOLYMPHATIC HYDROPSCauses: Bacterial. Allergy. Viral. Any factor that increases endolymphatic
secretion.
Miniere’s
Disease
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Classic triad of symptoms: VERTIGO TINNITUS SENSORINEURAL HEARING LOSS
Severe headache
Nausea and vomiting
Nystagmus
Miniere’s
Disease
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SAFETY – priority DIET – low sodium PHARMACOTHERAPY – 3 As: Antihistamine, Antivertigo,
Antiemetics plus niacin. SURGERY – vestibular nerve
resection.
Miniere’s
Disease