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SENSORY SYSTEM &
NEUROLOGICAL FUNCTIONS

   Dr. James M. Alo, BSN ,RN, MAN, MAP PHD
                                      ,
Sensory & Perception Fxns
2

    ¨   Sensory System




                         Part of the nervous system



                                                      drjAlo
SENSORY SYSTEM
3


    ¨   Responsible for processing sensory information
        ¤ Senses are physiological capacities of organisms that
          provide data for perception.
          n Physiology     is the science of the function of living systems.
            This includes how organisms, organ systems, organs, cells,
            and bio-molecules carry out the chemical or physical
            functions that exist in a living system.
          n Perception (from the Latin perceptio, percipio) is the process
            of attaining awareness or understanding of the environment
            by organizing and interpreting sensory information.All
            perception involves signals in the nervous system, which in
            turn result from physical stimulation of the sense organs.

                                               drjAlo
4


    ¨   VISION  involves light striking the retinas of the eyes,
        smell is mediated by odor molecules and hearing
        involves pressure waves.
        ¤ Perception  is not the passive receipt of these signals,
          but can be shaped by learning, memory and
          expectation.
        ¤ Perception depends on complex functions of the nervous
          system, but subjectively seems mostly effortless because
          this processing happens outside conscious awareness.


                                         drjAlo
5


    ¨   The senses and their operation, classification, and
        theory are overlapping topics studied by a variety of
        fields, most notably neuroscience, cognitive
        psychology (or cognitive science), and philosophy of
        perception. The nervous system has a specific sensory
        system or organ, dedicated to each sense.
    ¨   Senses are transducers from the physical world to
        the realm of the mind


                                       drjAlo
6


    ¨   Human beings have a multitude of senses.
        ¤ Sight (ophthalmoception),
        ¤ hearing (audioception),
        ¤ taste (gustaoception),
        ¤ smell (olfacoception or olfacception), and
        ¤ touch (tactioception) are the five traditionally recognized
          and the only senses proven to to be existent in humans.
    ¨   Some believe in other senses, including temperature
        (thermoception), kinesthetic sense (proprioception), pain
        (nociception), balance (equilibrioception) and
        acceleration (kinesthesioception)
                                             drjAlo
Sensory system consists of
7


    ¨   Sensory receptors
        ¤ is a sensory nerve ending that responds to a
          stimulus in the internal or external environment of
          an organism. In response to stimuli the sensory
          receptor initiates
          n   sensory transduction by creating graded potentials or
              action potentials in the same cell or in an adjacent one.




                                               drjAlo
8


    ¨   Transduction is the conversion of a stimulus from
        one form to another
        ¤ graded  potential, is the transmembrane potential
          difference of a sensory receptor




                Transmembrane receptor:E=extracellular space;
                I=intracellular space; P=plasma membrane
                                                  drjAlo
Transduction
9




    Stimulus




               Receptor potential
               (Generator potential)


                                                Action potential


                                       drjAlo
Action Potentials



                 +30




     Threshold   - 55


 Resting          -70
 Membrane
 Potential

                        Stimulus
                                   Receptor potential
10                                   drjAlo
Coding of sensory stimuli
11


     ¨   Stimulus strength is coded as the frequency of AP

     ¨   Higher the stimulus more frequent are the APs

     ¨   Amplitude of AP is constant




                                       drjAlo
Action
     potentials




     Receptor
     potentials




     Stimulus




12                drjAlo
Sensory coding
13

¨    A receptor must convey the type       ¨   It must send information about
     of information it is sending à            the location and receptive field,
     the kind of receptor activated            characteristic of the receptor
     determined the signal
     recognition by the brain

¨    It must convey the intensity of the
     stimulus à the stronger the
     signals, the more frequent will
     be the APs




                                                  drjAlo
Transduction in different receptors
14


     ¨   Different receptors have different ion channels

     ¨   Their opening causes receptor potential




                                       drjAlo
15   drjAlo
NEURAL PATHWAYS and parts of the
16
     brain
     ¨   Involved in sensory perception.
         ¤ neural  pathway, neural tract, or neural face,
           connects one part of the nervous system with
           another and usually consists of bundles of
           elongated, myelin-insulated neurons, known
           collectively as white matter. Neural pathways serve
           to connect relatively distant areas of the brain or
           nervous system, compared to the local
           communication of grey matter.

                                        drjAlo
Sensory pathway
17


     ¨   Once a receptor is stimulated

     ¨   impulse travels through a particular pathway

     ¨   known as sensory pathway or ascending pathway

     ¨   up to the brain


                                         drjAlo
Sensory pathway                               Sensory area
                                                    in the brain
18




                                                          Ascending
                                                          Sensory pathway


                                           Central Connections

                                        Sensory nerve
Touch stimulus

                             Receptor


                 Sensory
                  modality

                                                 drjAlo
Receptors
19


     ¨   Receptor cells are specific cells that are sensitive to
         different forms of energy from the environment

     ¨   These cells contain membrane receptors coupled to
         ion channels

     ¨   They transform the stimulus into electrical signals



                                          drjAlo
HUMAN SENSORY RECEPTORS
20
     Classifications:
     ¨   Chemosensor – TRANSDUCES a chemical signal into
         an action potential



     ¨   Nociceptor - responds to potentially damaging
         stimuli by sending nerve signals to the spinal cord
         and brain



                                        drjAlo
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     ¨   Mechanoreceptor – RESPONDS to mechanical
         pressure or distortion. Transform displacement or
         mechanical force into action potentials.




                                       drjAlo
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     ¨   Photoreceptor - specialized type of neuron found in
         the retina that is capable of phototransduction.




                                       drjAlo
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     ¨   Thermoreceptor - is a sensory receptor, or more
         accurately the receptive portion of a sensory
         neuron, that codes absolute and relative changes in
         temperature




                                       drjAlo
Two ascending pathways
24


     ¨   Dorsal column - medial lemniscus pathway
            fast pathway

     ¨   Spinothalamic pathway
             slow pathway




These two pathways come together at the level of thalamus


                                                    drjAlo
Posterior (dorsal)

     Dorsal root ganglion

            Dorsal root
                                     Dorsal columns


                            Dorsal horn

                                                                 Spinothalamic
                                                                 tracts




                                   Anterior (ventral)

25                                                      drjAlo
Spinothalamic pathway
     Dorsal column pathway




                                               Lateral
                                               Spinothalamic
                                               tract




                             Anterior
                             Spinothalamic
                             tract


26                             drjAlo
Dorsal column pathway         Spinothalamic pathway
27

 ¨   touch: fine degree       ¨   Pain
 ¨   highly localised touch   ¨   Thermal sensations
     sensations               ¨   Crude touch & pressure
                              ¨   crude localising sensations
 ¨   vibratory sensations
                              ¨   tickle & itch
 ¨   sensations signalling    ¨   sexual sensations
     movement
 ¨   position sense
 ¨   pressure: fine degree


                                     drjAlo
3rd
     thalamocortical tracts                                 order
                                                            neuron
          internal capsule

                                      thalamus
                                                            2nd
                                  Medial lemniscus          order
                                                            neuron
                              Dorsal column nuclei
                              (cuneate & gracile nucleus)

                                                            1st
       Dorsal column                                        order
                                                            neuron




28                                              drjAlo
dorsal column - medial lemniscus pathway
29


     ¨   after entering the spinal cord
         ¤ lateral branch: participates in spinal cord reflexes

         ¤ medial branch: turns upwards

     ¨   forms the dorsal columns
     ¨   spatial orientation:
         ¤ medial: lower parts of the body

         ¤ lateral: upper part of the body




                                         drjAlo
dorsal column - medial lemniscus pathway
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     ¨ synapse in the dorsal column nuclei
        ¤ nucleus cuneatus & nucleus gracilus
     ¨ 2nd order neuron cross over to the opposite
       side and ascends upwards as medial
       lemniscus
     ¨ as this travels along the brain stem fibres
       from head and neck are joined (trigeminal)
     ¨ ends in the thalamus (ventrobasal complex)

        ¤ ventral posterolateral nuclei

                                  drjAlo
dorsal column - medial lemniscus pathway
31

     ¨   spatial orientation in the thalamus
         ¤ medial: upper part of the body
         ¤ lateral: lower part of the body




                                     drjAlo
3rd
     thalamocortical tracts                     order
                                                neuron
          internal capsule

                              thalamus



                                                2nd
                              Spinothalamic     order
                              tracts            neuron




                                                 1st
                                                 order
                                                 neuron
32                                     drjAlo
spinothalamic pathway
33


     ¨   after entering the spinal cord
         ¤   synapse in the dorsal horn
     ¨   cross over to the opposite side
     ¨   divide in to two tracts
         ¤   lateral spinothalamic tract:
             n   pain and temperature
         ¤   anterior spinothalamic tract
             n   crude touch




                                            drjAlo
spinothalamic pathway
34

     ¨   spatial orientation
         ¤ medial: upper part of the body
         ¤ lateral: lower part of the body




                                             drjAlo
Spinothalamic pathway
     Dorsal column pathway




                                               Lateral
                                               Spinothalamic
                                               tract




                             Anterior
                             Spinothalamic
                             tract


35                             drjAlo
STIMULUS
36


     ¨   Sensory systems code for four aspects of a stimulus;
         ¤   type (modality)
             n Receptors are sensitive to certain types of stimuli (for
              example, different mechanoreceptors respond best to
              different kinds of touch stimuli, like sharp or blunt objects).
         ¤ Intensity
             n Receptorssend impulses in certain patterns to send
              information about the intensity of a stimulus (for example,
              how loud a sound is)



                                                  drjAlo
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     ¤ Location
       n gives the brain information about the location of the stimulus
         (for example, stimulating a mechanoreceptor in a finger will
         send information to the brain about that finger)
     ¤ Duration
       n The  duration of the stimulus (how long it lasts) is conveyed by
         firing patterns of receptors. These impulses are transmitted
         to the brain through afferent neurons.
     ¤ Arrival time of a sound pulse and phase differences of
       continuous sound are used for localization of sound
       sources.
                                            drjAlo
38   drjAlo
MODALITY
39


     ¨   A stimulus modality (sensory modality) is a
         type of physical phenomenon that can be
         sensed.
           nExamples are temperature, taste, sound,
             and pressure. The type of sensory receptor
             activated by a stimulus plays the primary
             role in coding the stimulus modality.


                                    drjAlo
Structure of human sensory system
40




                           drjAlo
Typical myellinated vertebrate
41
     motorneuron




                            drjAlo
I. Anatomy/Physiology
42


     A.    Neuron- highly specialized for the processing and
           transmission of cellular signals


          1.        Basic component of the nervous sy.
          2.        Composed of cell body, axon & dendrites
               a.    Cell body = center of metabolism
               b.    Axon =long fibers > conduct impulses away from the cell
                     body; usually 1 axon for each cell body
               c.    Dendrites = short, unsheathed fibers> receive nerve
                     impulses> transmit to cell body
                                                    drjAlo
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     3. Myelin sheath – covering that protects nerve fiber>
        facilitates> speed of impulse conductor
          a. Axon & dendrite – may/may not have myelin
                sheath




         b.   Most axons leaving the CNS – heavily myelinated
              w/ schwann cells
         c.   Gaps in myelin sheath – termed Nodes of Ranvier
                                         drjAlo
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     4. Primary fxn – transmission of nerve impulses
         a.   Afferent (sensory) n. – transmit impulses from
              peripheral receptors } CNS



         b.   Efferent (motor) n. – conduct impulses from CNS
         c.   Action potentials travel along axons} end of
              nerve fiber }impulse is transmitted across
              junction bet. nerve cells (synapse) }chemical
              interaction
                                        drjAlo
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     5. Neuroglia – glial cells
         a.   Provide support,
         b.   Nourishment and
         c.   Protection for neurons




                                       drjAlo
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     B. PNS } contains cranial
        nerves, spinal nerves,
        autonomic nervous
        system(unconscious
        reflexes), sympathetic
        division (accelerates
        activity), &
        parasympathetic
        division(slows body
        processes).
                                 drjAlo
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     C. CNS contains:
       1.   Cerebrum – divided into: left right hemisphere}
            longitudinal fissure




                                         drjAlo
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     a. Frontal lobes
         n Precentral   gyrus – contralateral movement; face, arm, leg,
           trunk
         n Broca’s area – dominant hemisphere } respon.> formation of
           words
         n Supplementary motor area – contralateral head & eye
           turning
         n Prefrontal area- personality, initiative
         n Paracentral lobule- contralateral inhibition of bladder &
           bowel


                                              drjAlo
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     b. Parietal lobes
       ¤ Postcentralgyrus – body sensations; temp, touch,
         pressure, pain }from opposite side of the body
       ¤ Dominant parietal lobe- wernickes’ speech area,
         auditory & visual aspects> comprehensions are
         integrated
             n   Responsible for skills { handle numbers & calculations
       ¤ Nondominant  parietal lobe- concept of body image &
         awareness of external envi{ ability to construct shapes


                                                   drjAlo
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     c. Occipital lobes – visual center; comprehension of
        written word
     d. Temporal lobes
       ¤ Dominant   hearing of language; taste, smell
       ¤ Memory

       ¤ Wernicke’s   speech area – recognition of language




                                         drjAlo
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     2. Basal ganglia – reg & integr skeletal voluntary &
        autonomic motor activity originating in cerebral cortex
     3. Diencephalon – connects the cerebrum & brain stem;
        contains several small structures, the most important of
        w/c are the thalamus & hypothalamus
       a. Thalamus – relay station for discrimination of sensation
         }received from periphery>several nuclei in the thalamus,
         each w/ specific fxns} such as: integration of sensory stimuli
         necessary for abstract thinking & reasoning, vision, hearing;
         relay station for fibers going to limbic system

                                            drjAlo
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     ¤ Hypothalamus- responsible for maintaining
      momeostasis} thru the secretion of hormones & central
      control of ANS
       n Controls vital fxn: water balance, BP, sleep, appetite, temp
       n Affects some emotional responses ] pleasure/fear
       n Control center for pituitary fxn
       n Affects both divisions of the ANS




                                           drjAlo
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     c. Limbic system –responsible for controlling various
        functions in the body. Structures of this system
        include the hippocampus, hypothalamus, and
        thalamus
       ¤ Fig.




                                       drjAlo
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     4. Brain stem- contains; midbrain, pons & medulla
       oblangata, extending from the cerebral
       hemispheres to the foramen magnum @ the base of
       the skull
       a.   Contains nuclei- 5,6,7,8th Cnerves & ascending
            sensory & descending motor tracts
       b.   Contains vital center- respiratory, vasomotor &
            cardiac fxn
       c.   Reticular formation – relays sensory of info; controls
            vasomotor/respiratory activity
                                           drjAlo
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     5. Ventricular system & CSF – supports & cushions
       CNS
       ¤ Removes metabolic wastes
       ¤ Compensatory mechanisms for ICVolume/pressure

       ¤ Produces 55 cc/d of CSF; 130-150cc amt ave in sy




                                      drjAlo
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     6. Cranial meninges
       ¤ Dura mater – dense, fibrous, outermost layer serves as
         periosteum for Cnerves
       ¤ Arachnoid mater
           n Delicate, avascular membrane lying under dura
           n Surrounds brain loosely
           n Subarachnoid space contains; CSF, arteries & veins
           n Contains arachnoid granulations that enable CSF } pass from
             subarachnoid space>venous system
       ¤   Pia mater
           n Most delicate inner meningeal layer
           n Barrier system

                                                   drjAlo
57


     7. Cerebellum – control of: muscle motion, balance,
       coordination; trunk mobility & equilibrium
       ¤ Spinal   cord – communications link bet CNS & PNS
         n Ascending    pathways ] transmit
            n   Sensory information
         n Descending    pathways] relay
            n   Motor instrtuctions




                                              drjAlo
HUMAN SENSORY SYSTEM
58


     ¨   The Human sensory system consists of the following
         sub-systems:
         ¤   Visual system consists of the photoreceptor cells, optic nerve, and
             V1.
         ¤   Auditory system
         ¤   Somatosensory system consists of the receptors, transmitters
             (pathways) leading to S1, and S1 that experiences the sensations
             labelled as touch or pressure, temperature (warm or cold), pain
             (including itch and tickle), and the sensations of muscle movement
             and joint position including posture, movement, and facial
             expression (collectively also called proprioception).
         ¤   Gustatory system
         ¤   Olfactory system


                                                   drjAlo
I. ANATOMY OF THE EYE
59


     ¨   A. three layers
         ¤ Sclera –fibrous outer coat
         ¤ Choroid – middle vascular coat
         ¤ Retina – inner nerve coat

     ¨   B. Lens
         ¤ Lies behind pupil & iris
         ¤ Held in position by suspensory ligament attached to the
           ciliary body
         ¤ Elastic qualities allow accommodation to focus image on
           the retina

                                            drjAlo
60


     ¨   C. Iris
         ¤ Colored portion of eye
         ¤ Attached around circumference by ciliary body

         ¤ Opening at center – pupil

         ¤ Controls the amt of light entering eye

     ¨   D. retina
         1.        Innermost lining
         2.        Contains rods & cons
              a.     Rods fxns w/ colorless, twilight vision
              b.     Cones fxns w/ perception of color & bright, daylight vision

                                                       drjAlo
61


     c. Optic disk
         1) Point of entrance of nerve & bld vessels
         2) Blind spot
         3) Most prominent structure visible on the fundus (retina
             lining of the back of the eye)
             a) Excessive pallor signals optic atrophy, a partial
                  or complete destruction of the optic nerve
             b) Excessive redness- papilledema inflamation

             c)   Papilledema – choked disks: severe form
               i.    Inflammation
               ii.   Passive congestion from ICP
                                          drjAlo
II. VISUAL FUNCTION
62


     ¨   A. Assessment (fig)
         ¤ Test
            n Tonometry –measures IOP
            n Visual fields – measurement of range of vision
              (perimetry)
            n Snellen test – visual acuity
                n Client preparation: recumbent/sitting position,
                  remove contact lenses, not to
                  squint/cough/hold breath during procedure

                                          drjAlo
63


     ¨   B. S/S of eye problem
         1.   Redness, pain & burning
         2.   Edema
         3.   #lacrimation & exudate
         4.   Headache
         5.   Nausea & vomiting
         6.   Squinting
         7.   Visual disturbances
         8.   Disorders of accommodation

                                           drjAlo
64


                    DISORDERS OF ACCOMMODATION
                   Types                    Nsg Considerations
     Myopia (nearsightedness) –       Corrective lenses
     light rays refract at a point in
     front of the retina
     Hyperopia (farsightedness) –     Corrective lenses
     light rays refract behind the
     retina
     Presbyopia with aging            Commonly occurs after age 35
     Astigmatism – uneven curvature Corrective lenses
     of cornea causing blurring of
     vision                                drjAlo
65


     ¨   C. Treatments
         1.        Eye irrigation method
              a.     Tilt head back toward the side of affected area
              b.     Allow irrigating fluid to flow from the inner to outer
                     canthus
              c.     Use a small bulb syringe/eye dropper to dispense fluid
              d.     Place a small basin close to head to collect excess
                     fluid/drainage




                                                   drjAlo
66


     ¤ 2.   Eyedrop instillation
       a.    Tilt head back toward the side of affected area
       b.    Allow irrigating fluid to flow from the inner to outer
             canthus
       c.    Use a small bulb syringe/eye dropper to dispense fluid
       d.    Place a small basin close to head to collect excess
             fluid/drainage




                                           drjAlo
67


     ¨   D. Nsg Mgt
         1.        Prevent eye injuries
              a.     Provide safe toys
              b.     Use of eye protectors when working w/ chemicals
              c.     Use of eye protectors during sports
              d.     Protect eyes from ultraviolet rays
              e.     Instruction for first aid




                                                  drjAlo
68


     ¤ 2.   Emergency Treatment
       n A.   Burns

            Types                         Nsg Considerations
            Chemical – acids, cleanser, Eye irrigation w/ copious
            insecticides                amts of H2O for 15-20min

            Radiation – sun, lightning,   Prevention- use of
            eclipses                      eyeshields

            Thermal – hot metals,         Use of goggles to protect
            liquids, occupational         the cornea, patching,
            hazards                       analgesics
                                            drjAlo
69


     ¨   B. EyeTrauma
            Types                            Nsg considertions
            Nonpenetrating- abrasions        Eye patch for
                                             24hrs
            Nonpenetrating- contusions       Cold compresses,
                                             analgesics
            Penetrating – pointed or         Cover w/ patch
            sharp objects

                                         drjAlo
III. Visual Function
70

     ¨   A. Assessment
         1.        Adjustment to vision loss depends upon:
              a.     Age of onset
              b.     Degree of suddenness
         2.        Principles of working w/ blind persons
              a.      Facilitate normal lifestyle patterns
                     a.    Adapted household eqpt
                     b.    Books/newspaper w/ large print for partially sighted
                     c.    Information > aids for the blind
                     d.    Braile, canes, guide dogs
                     e.    Facilitate dev patterns
                     f.    Enc social devt
                     g.    Provide for educ & employment
                                                         drjAlo
71


     ¨   3. Nsg Mgt for the blind px
         a.        Enhance communication
              a.     Address px by name
              b.     Always introduce self
              c.     State reason for being there
              d.     Inform px when leaving the room
         b.        Provide sense of safety/security
              a.     Explain procedures in detail
              b.     Keep furniture arrangement consistent, provide hand rail
              c.     Door should never be half open
              d.     Lightweight walking stick if walking alone

                                                    drjAlo
IV. SELECTED DISORDERS OF THE EYE
72


     ¨   A. DETACHED RETINA
         ¤ 1.   History
           n Flashes of light
           n Blurred or sooty vision
           n Sensation of particles moving in line of vision
           n Delineated of vision areas blank
           n Feeling of coating coming u & down
           n Loss of vision
           n Confusion/apprehension




                                                drjAlo
73


     ¨   2. Characteristics
         ¤ Separation    of the retina from choroid
         ¤ Cause
           n Trauma
           n Aging process
           n Diabetes
           n Tumors

         ¤ Medical    mgt
           n Sedatives & tranquilizers
           n Surgery- retina to adhere to choroid

                                             drjAlo
74


     ¨   3. Nsg Mgt
         ¤ Bedrest

         ¤ Affected   eye maybe patch- to decrease movement of
           eyes
         ¤ Specific positioning

         ¤ Hairwashing delayed for 1 wk

         ¤ Avoid strenuous activity for 3 mos




                                           drjAlo
75


     ¨   B. CATARACTS
         ¤ 1.   Hx
           n Objects appear distorted and blurred
           n Annoying glare
           n Pupil changes from black to gray to milky white




                                             drjAlo
76


     ¨   2. Assessment
         ¤ Partial/total  opacity of the normally transparent
           crystalline lens
         ¤ Cause
           n Congenital
           n Trauma
           n Aging process
           n Assoc w/ diabetes mellitus, intraocular surgery
           n Drugs- steroid therapy



                                              drjAlo
77


     ¤   Surgical Mgt – laser surgery
         n Extracapsular extraction – cut thru the anteriorcapsule to express
           the opaque lens material
         n Intracapsular extraction (method of choice) –entire removal of
           lens & capsule
         n Lens implantation
     ¤   Nsg Mgt
         n   Observe for post-operative complications
               n   Hemorrhage
               n   #IOP
               n   Slipped suture
               n   If lens implant, pupil should remain constricted; if aphakic, pupil
                   remains dilated

                                                        drjAlo
78


     n Avoid  straining /no heavy lifting
     n Bend from the knees only to pick up things
     n Instruct in instillation of eye drops/use of night shields
     n Protect from bright light
     n Adjustments needed if aphakic
     n Diversional activities




                                           drjAlo
79


     ¨   GLAUCOMA
         ¤ 1.   Assessment
           n Cloudy,  blurry vision
           n Artificial lights appear to have rainbows
           n Loss of vision
           n #decreased peripheral vision
           n Pain, headache
           n Nausea, vomiting
           n Tonometer readings exceed normal IOP (10-21mmhg)




                                          drjAlo
80


     ¨   2. Characteristics
         ¤ A. Abnormal #IOP leading to visual disability/blindness
           – obstruction of outflow of aqueous humor
         ¤ B. Types
           n Acute/close(narrow) – angle glaucoma; sudden onset
           n Chronic or open (wide) – angle glaucoma; most common

         ¤ C.   Causes
           n Close-angle  glaucoma – assoc w/ ocular d’s, trauma
           n Open-angle glaucoma – assoc w/ aging, heredity, retinal
             vein occlusion

                                            drjAlo
81


     ¤ D.   Tx
       n Meds – miotics, carbonic anhydrase inhibitors, oral glycerin
         & mannitol
       n Surgery – laser trabeculoplasty, standard glaucoma surgery

     ¤ Common    nsg diagnosis – sensory/ perceptual/visual
       alteration




                                          drjAlo
82


     ¨   Nsg Mgt
         ¤ Compliance w/ medical therapy
         ¤ Avoid tight clothing
         ¤ Reduce external stimuli
         ¤ Avoid heavy lifting, straining at stool
         ¤ Avoid use of mydriatics
         ¤ Educate public to 5 danger signs of glaucoma:
             n Brow arching
             n Blurry vision
             n Diminished peripheral vision
             n Headache or eye pain


                                              drjAlo
I. Anatomy & Physiology of EAR
83


     ¨   A. External Ear
         ¤ Pinna/auricle

         ¤ External acoustic meatus
         ¤ External auditory canal




                                      drjAlo
84


     ¨   B. Middle ear
         ¤ Located in temporal lobe
         ¤ Contains ossicles
           n Malleus
           n Incus
           n Stapes

         ¤ Eustachian  tube – connects middle ear to the throat &
           assist in equalizing pressure



                                           drjAlo
85


         ¤ Physiology   of sound
           n Sound  waves enter external auditory canal >tympanic
             membrane >vibrates, triggering ossicles(m,i,s) } transmitted
             to oval window to acoustic nerve and brain
     ¨   C. Inner ear
         ¤ Contains: vestibule, semicircular canals,
           cochlea(labyrinth) } movment of the sensory hair signals
           changes in position; aids in maintaining stable posture



                                               drjAlo
II. Alterations in Fxn
86


     ¨   A. Assessment
         ¤ S/S  } pain, fever, headache, discharge, altered growth
           & dev, personality changes (irritability, depression,
           suspiciousness, w/drawal
         ¤ Dx } Audiogram – quantitative(degree of loss), Tuning
           fork – qualitative (type of loss)
         ¤ Types:
           n Conductive   loss



                                          drjAlo
87


     ¤   Types:
         n   1. Conductive loss – disorder in auditorycanal, eardrum/ossicles
               n   Causes: infection, inflammation, foreign body, trauma
               n   Complications : meningitis resulting from initial infection
               n   Nsg Mgt: heat, antibiotics, ear drops/ointments/irrigation, surgery,
                   hearing aid
         n   2. perceptive(sensorineural loss) – due to disorder of organ of
             corti/auditory nerve
               n   Causes: congenital-maternal exposure to com’cable d’s, infection,
                   drug toxicity, trauma, labyrinth dsfxn(Meniere’s d’s
               n   Complications: vertigo, tinnitus, vomiting
               n   Mgt: meds, surgery, combined loss- conductive & sensorineural,
                   psychogenic loss-functional

                                                       drjAlo
88


     ¨   C. Nsg Mgt
         ¤ Ear irrigation
         ¤ Ear drop instillation

         ¤ Px undergoing surgery

         ¤ Discharge teaching – avoid getting water in ear, flying,
           drafts, crowds, exercise caution around people w/
           respiratory infections




                                           drjAlo
89


     ¨   III. Selected disorders
         ¤ A. Acute otitis media – infection of middle ear, cause:
           pathogenic organisms(bacteria/virus)
         ¤ B. Mastoiditis –inflammation

         ¤ C. meniere’s syndrome(endolymphatic hydrops) –
           dilation of the labyrinth, causes: trauma,
           intoxication,syphilis, otitis media, otosclerosis




                                           drjAlo
90


     ¨   Medical & Nsg Mgt
         ¤ Saltfree/neutral ash diet(furstenberg diet) – restrict
           h2o & salt intake
         ¤ Symptomatic treatment: antiemetics, histamines,
           vasodilators
         ¤ Px education: need to slow down body motion, self
           protection, occupational counseling




                                           drjAlo
SOMATIC SENSATION (TOUCH)
91


     ¨   somatosensory system
         ¤ isa diverse sensory system composed of the
           receptors and processing centres to produce the
           sensory modalities such as touch, temperature,
           proprioception (body position), and nociception
           (pain). The sensory receptors cover the skin and
           epithelia, skeletal muscles, bones and joints, internal
           organs, and the cardiovascular system.



                                           drjAlo
CORTICAL homunculus
92




                       drjAlo
Taste/GUSTATION
93



     ¨   Taste (also called smatch)
         ¤is one of the traditional five senses. It
          refers to the ability to detect the flavor
          of substances such as food, certain
          minerals, poisons



                                  drjAlo
94


     ¨   Taste buds




     ¨   Taste receptors




                           drjAlo
Smell/ OLFACTION
95


     ¨   Human olfactory system.
          ¨ 1: Olfactory bulb 2:

            Mitral cells 3: Bone 4:
            Nasal epithelium 5:
            Glomerulus (olfaction)
            6: Olfactory receptor
            cells


                                      drjAlo
THANK YOU.

All credibility, all good conscience, all evidence
       of truth come only from the senses.
                                 Friedrich Nietzsche




                             drjAlo
Understanding the Sensory System and Neurological Functions

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Understanding the Sensory System and Neurological Functions

  • 1. SENSORY SYSTEM & NEUROLOGICAL FUNCTIONS Dr. James M. Alo, BSN ,RN, MAN, MAP PHD ,
  • 2. Sensory & Perception Fxns 2 ¨ Sensory System Part of the nervous system drjAlo
  • 3. SENSORY SYSTEM 3 ¨ Responsible for processing sensory information ¤ Senses are physiological capacities of organisms that provide data for perception. n Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. n Perception (from the Latin perceptio, percipio) is the process of attaining awareness or understanding of the environment by organizing and interpreting sensory information.All perception involves signals in the nervous system, which in turn result from physical stimulation of the sense organs. drjAlo
  • 4. 4 ¨ VISION involves light striking the retinas of the eyes, smell is mediated by odor molecules and hearing involves pressure waves. ¤ Perception is not the passive receipt of these signals, but can be shaped by learning, memory and expectation. ¤ Perception depends on complex functions of the nervous system, but subjectively seems mostly effortless because this processing happens outside conscious awareness. drjAlo
  • 5. 5 ¨ The senses and their operation, classification, and theory are overlapping topics studied by a variety of fields, most notably neuroscience, cognitive psychology (or cognitive science), and philosophy of perception. The nervous system has a specific sensory system or organ, dedicated to each sense. ¨ Senses are transducers from the physical world to the realm of the mind drjAlo
  • 6. 6 ¨ Human beings have a multitude of senses. ¤ Sight (ophthalmoception), ¤ hearing (audioception), ¤ taste (gustaoception), ¤ smell (olfacoception or olfacception), and ¤ touch (tactioception) are the five traditionally recognized and the only senses proven to to be existent in humans. ¨ Some believe in other senses, including temperature (thermoception), kinesthetic sense (proprioception), pain (nociception), balance (equilibrioception) and acceleration (kinesthesioception) drjAlo
  • 7. Sensory system consists of 7 ¨ Sensory receptors ¤ is a sensory nerve ending that responds to a stimulus in the internal or external environment of an organism. In response to stimuli the sensory receptor initiates n sensory transduction by creating graded potentials or action potentials in the same cell or in an adjacent one. drjAlo
  • 8. 8 ¨ Transduction is the conversion of a stimulus from one form to another ¤ graded potential, is the transmembrane potential difference of a sensory receptor Transmembrane receptor:E=extracellular space; I=intracellular space; P=plasma membrane drjAlo
  • 9. Transduction 9 Stimulus Receptor potential (Generator potential) Action potential drjAlo
  • 10. Action Potentials +30 Threshold - 55 Resting -70 Membrane Potential Stimulus Receptor potential 10 drjAlo
  • 11. Coding of sensory stimuli 11 ¨ Stimulus strength is coded as the frequency of AP ¨ Higher the stimulus more frequent are the APs ¨ Amplitude of AP is constant drjAlo
  • 12. Action potentials Receptor potentials Stimulus 12 drjAlo
  • 13. Sensory coding 13 ¨ A receptor must convey the type ¨ It must send information about of information it is sending à the location and receptive field, the kind of receptor activated characteristic of the receptor determined the signal recognition by the brain ¨ It must convey the intensity of the stimulus à the stronger the signals, the more frequent will be the APs drjAlo
  • 14. Transduction in different receptors 14 ¨ Different receptors have different ion channels ¨ Their opening causes receptor potential drjAlo
  • 15. 15 drjAlo
  • 16. NEURAL PATHWAYS and parts of the 16 brain ¨ Involved in sensory perception. ¤ neural pathway, neural tract, or neural face, connects one part of the nervous system with another and usually consists of bundles of elongated, myelin-insulated neurons, known collectively as white matter. Neural pathways serve to connect relatively distant areas of the brain or nervous system, compared to the local communication of grey matter. drjAlo
  • 17. Sensory pathway 17 ¨ Once a receptor is stimulated ¨ impulse travels through a particular pathway ¨ known as sensory pathway or ascending pathway ¨ up to the brain drjAlo
  • 18. Sensory pathway Sensory area in the brain 18 Ascending Sensory pathway Central Connections Sensory nerve Touch stimulus Receptor Sensory modality drjAlo
  • 19. Receptors 19 ¨ Receptor cells are specific cells that are sensitive to different forms of energy from the environment ¨ These cells contain membrane receptors coupled to ion channels ¨ They transform the stimulus into electrical signals drjAlo
  • 20. HUMAN SENSORY RECEPTORS 20 Classifications: ¨ Chemosensor – TRANSDUCES a chemical signal into an action potential ¨ Nociceptor - responds to potentially damaging stimuli by sending nerve signals to the spinal cord and brain drjAlo
  • 21. 21 ¨ Mechanoreceptor – RESPONDS to mechanical pressure or distortion. Transform displacement or mechanical force into action potentials. drjAlo
  • 22. 22 ¨ Photoreceptor - specialized type of neuron found in the retina that is capable of phototransduction. drjAlo
  • 23. 23 ¨ Thermoreceptor - is a sensory receptor, or more accurately the receptive portion of a sensory neuron, that codes absolute and relative changes in temperature drjAlo
  • 24. Two ascending pathways 24 ¨ Dorsal column - medial lemniscus pathway fast pathway ¨ Spinothalamic pathway slow pathway These two pathways come together at the level of thalamus drjAlo
  • 25. Posterior (dorsal) Dorsal root ganglion Dorsal root Dorsal columns Dorsal horn Spinothalamic tracts Anterior (ventral) 25 drjAlo
  • 26. Spinothalamic pathway Dorsal column pathway Lateral Spinothalamic tract Anterior Spinothalamic tract 26 drjAlo
  • 27. Dorsal column pathway Spinothalamic pathway 27 ¨ touch: fine degree ¨ Pain ¨ highly localised touch ¨ Thermal sensations sensations ¨ Crude touch & pressure ¨ crude localising sensations ¨ vibratory sensations ¨ tickle & itch ¨ sensations signalling ¨ sexual sensations movement ¨ position sense ¨ pressure: fine degree drjAlo
  • 28. 3rd thalamocortical tracts order neuron internal capsule thalamus 2nd Medial lemniscus order neuron Dorsal column nuclei (cuneate & gracile nucleus) 1st Dorsal column order neuron 28 drjAlo
  • 29. dorsal column - medial lemniscus pathway 29 ¨ after entering the spinal cord ¤ lateral branch: participates in spinal cord reflexes ¤ medial branch: turns upwards ¨ forms the dorsal columns ¨ spatial orientation: ¤ medial: lower parts of the body ¤ lateral: upper part of the body drjAlo
  • 30. dorsal column - medial lemniscus pathway 30 ¨ synapse in the dorsal column nuclei ¤ nucleus cuneatus & nucleus gracilus ¨ 2nd order neuron cross over to the opposite side and ascends upwards as medial lemniscus ¨ as this travels along the brain stem fibres from head and neck are joined (trigeminal) ¨ ends in the thalamus (ventrobasal complex) ¤ ventral posterolateral nuclei drjAlo
  • 31. dorsal column - medial lemniscus pathway 31 ¨ spatial orientation in the thalamus ¤ medial: upper part of the body ¤ lateral: lower part of the body drjAlo
  • 32. 3rd thalamocortical tracts order neuron internal capsule thalamus 2nd Spinothalamic order tracts neuron 1st order neuron 32 drjAlo
  • 33. spinothalamic pathway 33 ¨ after entering the spinal cord ¤ synapse in the dorsal horn ¨ cross over to the opposite side ¨ divide in to two tracts ¤ lateral spinothalamic tract: n pain and temperature ¤ anterior spinothalamic tract n crude touch drjAlo
  • 34. spinothalamic pathway 34 ¨ spatial orientation ¤ medial: upper part of the body ¤ lateral: lower part of the body drjAlo
  • 35. Spinothalamic pathway Dorsal column pathway Lateral Spinothalamic tract Anterior Spinothalamic tract 35 drjAlo
  • 36. STIMULUS 36 ¨ Sensory systems code for four aspects of a stimulus; ¤ type (modality) n Receptors are sensitive to certain types of stimuli (for example, different mechanoreceptors respond best to different kinds of touch stimuli, like sharp or blunt objects). ¤ Intensity n Receptorssend impulses in certain patterns to send information about the intensity of a stimulus (for example, how loud a sound is) drjAlo
  • 37. 37 ¤ Location n gives the brain information about the location of the stimulus (for example, stimulating a mechanoreceptor in a finger will send information to the brain about that finger) ¤ Duration n The duration of the stimulus (how long it lasts) is conveyed by firing patterns of receptors. These impulses are transmitted to the brain through afferent neurons. ¤ Arrival time of a sound pulse and phase differences of continuous sound are used for localization of sound sources. drjAlo
  • 38. 38 drjAlo
  • 39. MODALITY 39 ¨ A stimulus modality (sensory modality) is a type of physical phenomenon that can be sensed. nExamples are temperature, taste, sound, and pressure. The type of sensory receptor activated by a stimulus plays the primary role in coding the stimulus modality. drjAlo
  • 40. Structure of human sensory system 40 drjAlo
  • 41. Typical myellinated vertebrate 41 motorneuron drjAlo
  • 42. I. Anatomy/Physiology 42 A. Neuron- highly specialized for the processing and transmission of cellular signals 1. Basic component of the nervous sy. 2. Composed of cell body, axon & dendrites a. Cell body = center of metabolism b. Axon =long fibers > conduct impulses away from the cell body; usually 1 axon for each cell body c. Dendrites = short, unsheathed fibers> receive nerve impulses> transmit to cell body drjAlo
  • 43. 43 3. Myelin sheath – covering that protects nerve fiber> facilitates> speed of impulse conductor a. Axon & dendrite – may/may not have myelin sheath b. Most axons leaving the CNS – heavily myelinated w/ schwann cells c. Gaps in myelin sheath – termed Nodes of Ranvier drjAlo
  • 44. 44 4. Primary fxn – transmission of nerve impulses a. Afferent (sensory) n. – transmit impulses from peripheral receptors } CNS b. Efferent (motor) n. – conduct impulses from CNS c. Action potentials travel along axons} end of nerve fiber }impulse is transmitted across junction bet. nerve cells (synapse) }chemical interaction drjAlo
  • 45. 45 5. Neuroglia – glial cells a. Provide support, b. Nourishment and c. Protection for neurons drjAlo
  • 46. 46 B. PNS } contains cranial nerves, spinal nerves, autonomic nervous system(unconscious reflexes), sympathetic division (accelerates activity), & parasympathetic division(slows body processes). drjAlo
  • 47. 47 C. CNS contains: 1. Cerebrum – divided into: left right hemisphere} longitudinal fissure drjAlo
  • 48. 48 a. Frontal lobes n Precentral gyrus – contralateral movement; face, arm, leg, trunk n Broca’s area – dominant hemisphere } respon.> formation of words n Supplementary motor area – contralateral head & eye turning n Prefrontal area- personality, initiative n Paracentral lobule- contralateral inhibition of bladder & bowel drjAlo
  • 49. 49 b. Parietal lobes ¤ Postcentralgyrus – body sensations; temp, touch, pressure, pain }from opposite side of the body ¤ Dominant parietal lobe- wernickes’ speech area, auditory & visual aspects> comprehensions are integrated n Responsible for skills { handle numbers & calculations ¤ Nondominant parietal lobe- concept of body image & awareness of external envi{ ability to construct shapes drjAlo
  • 50. 50 c. Occipital lobes – visual center; comprehension of written word d. Temporal lobes ¤ Dominant hearing of language; taste, smell ¤ Memory ¤ Wernicke’s speech area – recognition of language drjAlo
  • 51. 51 2. Basal ganglia – reg & integr skeletal voluntary & autonomic motor activity originating in cerebral cortex 3. Diencephalon – connects the cerebrum & brain stem; contains several small structures, the most important of w/c are the thalamus & hypothalamus a. Thalamus – relay station for discrimination of sensation }received from periphery>several nuclei in the thalamus, each w/ specific fxns} such as: integration of sensory stimuli necessary for abstract thinking & reasoning, vision, hearing; relay station for fibers going to limbic system drjAlo
  • 52. 52 ¤ Hypothalamus- responsible for maintaining momeostasis} thru the secretion of hormones & central control of ANS n Controls vital fxn: water balance, BP, sleep, appetite, temp n Affects some emotional responses ] pleasure/fear n Control center for pituitary fxn n Affects both divisions of the ANS drjAlo
  • 53. 53 c. Limbic system –responsible for controlling various functions in the body. Structures of this system include the hippocampus, hypothalamus, and thalamus ¤ Fig. drjAlo
  • 54. 54 4. Brain stem- contains; midbrain, pons & medulla oblangata, extending from the cerebral hemispheres to the foramen magnum @ the base of the skull a. Contains nuclei- 5,6,7,8th Cnerves & ascending sensory & descending motor tracts b. Contains vital center- respiratory, vasomotor & cardiac fxn c. Reticular formation – relays sensory of info; controls vasomotor/respiratory activity drjAlo
  • 55. 55 5. Ventricular system & CSF – supports & cushions CNS ¤ Removes metabolic wastes ¤ Compensatory mechanisms for ICVolume/pressure ¤ Produces 55 cc/d of CSF; 130-150cc amt ave in sy drjAlo
  • 56. 56 6. Cranial meninges ¤ Dura mater – dense, fibrous, outermost layer serves as periosteum for Cnerves ¤ Arachnoid mater n Delicate, avascular membrane lying under dura n Surrounds brain loosely n Subarachnoid space contains; CSF, arteries & veins n Contains arachnoid granulations that enable CSF } pass from subarachnoid space>venous system ¤ Pia mater n Most delicate inner meningeal layer n Barrier system drjAlo
  • 57. 57 7. Cerebellum – control of: muscle motion, balance, coordination; trunk mobility & equilibrium ¤ Spinal cord – communications link bet CNS & PNS n Ascending pathways ] transmit n Sensory information n Descending pathways] relay n Motor instrtuctions drjAlo
  • 58. HUMAN SENSORY SYSTEM 58 ¨ The Human sensory system consists of the following sub-systems: ¤ Visual system consists of the photoreceptor cells, optic nerve, and V1. ¤ Auditory system ¤ Somatosensory system consists of the receptors, transmitters (pathways) leading to S1, and S1 that experiences the sensations labelled as touch or pressure, temperature (warm or cold), pain (including itch and tickle), and the sensations of muscle movement and joint position including posture, movement, and facial expression (collectively also called proprioception). ¤ Gustatory system ¤ Olfactory system drjAlo
  • 59. I. ANATOMY OF THE EYE 59 ¨ A. three layers ¤ Sclera –fibrous outer coat ¤ Choroid – middle vascular coat ¤ Retina – inner nerve coat ¨ B. Lens ¤ Lies behind pupil & iris ¤ Held in position by suspensory ligament attached to the ciliary body ¤ Elastic qualities allow accommodation to focus image on the retina drjAlo
  • 60. 60 ¨ C. Iris ¤ Colored portion of eye ¤ Attached around circumference by ciliary body ¤ Opening at center – pupil ¤ Controls the amt of light entering eye ¨ D. retina 1. Innermost lining 2. Contains rods & cons a. Rods fxns w/ colorless, twilight vision b. Cones fxns w/ perception of color & bright, daylight vision drjAlo
  • 61. 61 c. Optic disk 1) Point of entrance of nerve & bld vessels 2) Blind spot 3) Most prominent structure visible on the fundus (retina lining of the back of the eye) a) Excessive pallor signals optic atrophy, a partial or complete destruction of the optic nerve b) Excessive redness- papilledema inflamation c) Papilledema – choked disks: severe form i. Inflammation ii. Passive congestion from ICP drjAlo
  • 62. II. VISUAL FUNCTION 62 ¨ A. Assessment (fig) ¤ Test n Tonometry –measures IOP n Visual fields – measurement of range of vision (perimetry) n Snellen test – visual acuity n Client preparation: recumbent/sitting position, remove contact lenses, not to squint/cough/hold breath during procedure drjAlo
  • 63. 63 ¨ B. S/S of eye problem 1. Redness, pain & burning 2. Edema 3. #lacrimation & exudate 4. Headache 5. Nausea & vomiting 6. Squinting 7. Visual disturbances 8. Disorders of accommodation drjAlo
  • 64. 64 DISORDERS OF ACCOMMODATION Types Nsg Considerations Myopia (nearsightedness) – Corrective lenses light rays refract at a point in front of the retina Hyperopia (farsightedness) – Corrective lenses light rays refract behind the retina Presbyopia with aging Commonly occurs after age 35 Astigmatism – uneven curvature Corrective lenses of cornea causing blurring of vision drjAlo
  • 65. 65 ¨ C. Treatments 1. Eye irrigation method a. Tilt head back toward the side of affected area b. Allow irrigating fluid to flow from the inner to outer canthus c. Use a small bulb syringe/eye dropper to dispense fluid d. Place a small basin close to head to collect excess fluid/drainage drjAlo
  • 66. 66 ¤ 2. Eyedrop instillation a. Tilt head back toward the side of affected area b. Allow irrigating fluid to flow from the inner to outer canthus c. Use a small bulb syringe/eye dropper to dispense fluid d. Place a small basin close to head to collect excess fluid/drainage drjAlo
  • 67. 67 ¨ D. Nsg Mgt 1. Prevent eye injuries a. Provide safe toys b. Use of eye protectors when working w/ chemicals c. Use of eye protectors during sports d. Protect eyes from ultraviolet rays e. Instruction for first aid drjAlo
  • 68. 68 ¤ 2. Emergency Treatment n A. Burns Types Nsg Considerations Chemical – acids, cleanser, Eye irrigation w/ copious insecticides amts of H2O for 15-20min Radiation – sun, lightning, Prevention- use of eclipses eyeshields Thermal – hot metals, Use of goggles to protect liquids, occupational the cornea, patching, hazards analgesics drjAlo
  • 69. 69 ¨ B. EyeTrauma Types Nsg considertions Nonpenetrating- abrasions Eye patch for 24hrs Nonpenetrating- contusions Cold compresses, analgesics Penetrating – pointed or Cover w/ patch sharp objects drjAlo
  • 70. III. Visual Function 70 ¨ A. Assessment 1. Adjustment to vision loss depends upon: a. Age of onset b. Degree of suddenness 2. Principles of working w/ blind persons a. Facilitate normal lifestyle patterns a. Adapted household eqpt b. Books/newspaper w/ large print for partially sighted c. Information > aids for the blind d. Braile, canes, guide dogs e. Facilitate dev patterns f. Enc social devt g. Provide for educ & employment drjAlo
  • 71. 71 ¨ 3. Nsg Mgt for the blind px a. Enhance communication a. Address px by name b. Always introduce self c. State reason for being there d. Inform px when leaving the room b. Provide sense of safety/security a. Explain procedures in detail b. Keep furniture arrangement consistent, provide hand rail c. Door should never be half open d. Lightweight walking stick if walking alone drjAlo
  • 72. IV. SELECTED DISORDERS OF THE EYE 72 ¨ A. DETACHED RETINA ¤ 1. History n Flashes of light n Blurred or sooty vision n Sensation of particles moving in line of vision n Delineated of vision areas blank n Feeling of coating coming u & down n Loss of vision n Confusion/apprehension drjAlo
  • 73. 73 ¨ 2. Characteristics ¤ Separation of the retina from choroid ¤ Cause n Trauma n Aging process n Diabetes n Tumors ¤ Medical mgt n Sedatives & tranquilizers n Surgery- retina to adhere to choroid drjAlo
  • 74. 74 ¨ 3. Nsg Mgt ¤ Bedrest ¤ Affected eye maybe patch- to decrease movement of eyes ¤ Specific positioning ¤ Hairwashing delayed for 1 wk ¤ Avoid strenuous activity for 3 mos drjAlo
  • 75. 75 ¨ B. CATARACTS ¤ 1. Hx n Objects appear distorted and blurred n Annoying glare n Pupil changes from black to gray to milky white drjAlo
  • 76. 76 ¨ 2. Assessment ¤ Partial/total opacity of the normally transparent crystalline lens ¤ Cause n Congenital n Trauma n Aging process n Assoc w/ diabetes mellitus, intraocular surgery n Drugs- steroid therapy drjAlo
  • 77. 77 ¤ Surgical Mgt – laser surgery n Extracapsular extraction – cut thru the anteriorcapsule to express the opaque lens material n Intracapsular extraction (method of choice) –entire removal of lens & capsule n Lens implantation ¤ Nsg Mgt n Observe for post-operative complications n Hemorrhage n #IOP n Slipped suture n If lens implant, pupil should remain constricted; if aphakic, pupil remains dilated drjAlo
  • 78. 78 n Avoid straining /no heavy lifting n Bend from the knees only to pick up things n Instruct in instillation of eye drops/use of night shields n Protect from bright light n Adjustments needed if aphakic n Diversional activities drjAlo
  • 79. 79 ¨ GLAUCOMA ¤ 1. Assessment n Cloudy, blurry vision n Artificial lights appear to have rainbows n Loss of vision n #decreased peripheral vision n Pain, headache n Nausea, vomiting n Tonometer readings exceed normal IOP (10-21mmhg) drjAlo
  • 80. 80 ¨ 2. Characteristics ¤ A. Abnormal #IOP leading to visual disability/blindness – obstruction of outflow of aqueous humor ¤ B. Types n Acute/close(narrow) – angle glaucoma; sudden onset n Chronic or open (wide) – angle glaucoma; most common ¤ C. Causes n Close-angle glaucoma – assoc w/ ocular d’s, trauma n Open-angle glaucoma – assoc w/ aging, heredity, retinal vein occlusion drjAlo
  • 81. 81 ¤ D. Tx n Meds – miotics, carbonic anhydrase inhibitors, oral glycerin & mannitol n Surgery – laser trabeculoplasty, standard glaucoma surgery ¤ Common nsg diagnosis – sensory/ perceptual/visual alteration drjAlo
  • 82. 82 ¨ Nsg Mgt ¤ Compliance w/ medical therapy ¤ Avoid tight clothing ¤ Reduce external stimuli ¤ Avoid heavy lifting, straining at stool ¤ Avoid use of mydriatics ¤ Educate public to 5 danger signs of glaucoma: n Brow arching n Blurry vision n Diminished peripheral vision n Headache or eye pain drjAlo
  • 83. I. Anatomy & Physiology of EAR 83 ¨ A. External Ear ¤ Pinna/auricle ¤ External acoustic meatus ¤ External auditory canal drjAlo
  • 84. 84 ¨ B. Middle ear ¤ Located in temporal lobe ¤ Contains ossicles n Malleus n Incus n Stapes ¤ Eustachian tube – connects middle ear to the throat & assist in equalizing pressure drjAlo
  • 85. 85 ¤ Physiology of sound n Sound waves enter external auditory canal >tympanic membrane >vibrates, triggering ossicles(m,i,s) } transmitted to oval window to acoustic nerve and brain ¨ C. Inner ear ¤ Contains: vestibule, semicircular canals, cochlea(labyrinth) } movment of the sensory hair signals changes in position; aids in maintaining stable posture drjAlo
  • 86. II. Alterations in Fxn 86 ¨ A. Assessment ¤ S/S } pain, fever, headache, discharge, altered growth & dev, personality changes (irritability, depression, suspiciousness, w/drawal ¤ Dx } Audiogram – quantitative(degree of loss), Tuning fork – qualitative (type of loss) ¤ Types: n Conductive loss drjAlo
  • 87. 87 ¤ Types: n 1. Conductive loss – disorder in auditorycanal, eardrum/ossicles n Causes: infection, inflammation, foreign body, trauma n Complications : meningitis resulting from initial infection n Nsg Mgt: heat, antibiotics, ear drops/ointments/irrigation, surgery, hearing aid n 2. perceptive(sensorineural loss) – due to disorder of organ of corti/auditory nerve n Causes: congenital-maternal exposure to com’cable d’s, infection, drug toxicity, trauma, labyrinth dsfxn(Meniere’s d’s n Complications: vertigo, tinnitus, vomiting n Mgt: meds, surgery, combined loss- conductive & sensorineural, psychogenic loss-functional drjAlo
  • 88. 88 ¨ C. Nsg Mgt ¤ Ear irrigation ¤ Ear drop instillation ¤ Px undergoing surgery ¤ Discharge teaching – avoid getting water in ear, flying, drafts, crowds, exercise caution around people w/ respiratory infections drjAlo
  • 89. 89 ¨ III. Selected disorders ¤ A. Acute otitis media – infection of middle ear, cause: pathogenic organisms(bacteria/virus) ¤ B. Mastoiditis –inflammation ¤ C. meniere’s syndrome(endolymphatic hydrops) – dilation of the labyrinth, causes: trauma, intoxication,syphilis, otitis media, otosclerosis drjAlo
  • 90. 90 ¨ Medical & Nsg Mgt ¤ Saltfree/neutral ash diet(furstenberg diet) – restrict h2o & salt intake ¤ Symptomatic treatment: antiemetics, histamines, vasodilators ¤ Px education: need to slow down body motion, self protection, occupational counseling drjAlo
  • 91. SOMATIC SENSATION (TOUCH) 91 ¨ somatosensory system ¤ isa diverse sensory system composed of the receptors and processing centres to produce the sensory modalities such as touch, temperature, proprioception (body position), and nociception (pain). The sensory receptors cover the skin and epithelia, skeletal muscles, bones and joints, internal organs, and the cardiovascular system. drjAlo
  • 93. Taste/GUSTATION 93 ¨ Taste (also called smatch) ¤is one of the traditional five senses. It refers to the ability to detect the flavor of substances such as food, certain minerals, poisons drjAlo
  • 94. 94 ¨ Taste buds ¨ Taste receptors drjAlo
  • 95. Smell/ OLFACTION 95 ¨ Human olfactory system. ¨ 1: Olfactory bulb 2: Mitral cells 3: Bone 4: Nasal epithelium 5: Glomerulus (olfaction) 6: Olfactory receptor cells drjAlo
  • 96. THANK YOU. All credibility, all good conscience, all evidence of truth come only from the senses. Friedrich Nietzsche drjAlo