Sensory Integumentary Alterations.docx

Alterations in Visual Function ============================== Normal flow of Aqueous Humor ============================ Ciliary body produces Aq humor. The Aq humor flows from the posterior chamber through the pupil into the anterior chamber. The aq humor exits the anterior chamber by passing thro...

Alterations in Visual Function ============================== Normal flow of Aqueous Humor ============================ Ciliary body produces Aq humor. The Aq humor flows from the posterior chamber through the pupil into the anterior chamber. The aq humor exits the anterior chamber by passing through the trabecular meshwork into the canal of Schlemm. Normal IOP is 13-22mm Hg ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Glaucoma ======== Overview -------- ### Backup of Ag fluid in the eye. Resulting in increased pressure. Compresses nerve cells. ### Damages the optic nerve. Causing loss of the visual field. 2-types of Glaucoma =================== Primary open-angle glaucoma --------------------------- ### Leading cause of blindness in the US. Early treatment could prevent 90% of cases. Leading cause of blindness in African Am and 3^rd^ among whites. ### Patho: #### Aq humor is unable to drain from canal due to obstruction. However, the canal has a normal opening ### Symptoms: #### Progressive loss of peripheral vision than central vision, painless, no symptoms until extensive optic nerve damage. Vision loss is irreversible. ### Risk factors #### Elevation of IOP, race, family history of POAG, advancing age. ### Screening #### High risk groups: q 2 yrs to age 45, annually. #### Others: q 4 yrs to age 45, q 2 years thereafter ### Treatment: #### Goal: prevent progression by reducing IOP. Facilitate aq humor outflow or decrease production #### Pharmacological treatment ##### Beta blockers, cholinergic agonists, adrenergic agonists, prostaglandins, and Carbonic Anhydrase inhibitors. (see drug charts) Angle-closure glaucoma ---------------------- ### Emergency condition, irreversible vision loss in 1-2 days. ### Patho: #### Angle is narrow, Iris maybe displaced and cover the trabecular meshwork. Rapid increase of Aq humor and IOP ### Symptoms #### Sudden onset severe eye pain, N & V, irreversible vision loss in 1-2 days ### Treatment #### Beta blockers, cholinergic agonists, CAIs, to control the attack followed by corrective surgery (laser iridotomy and iridectomy) ### Cataracts ========= Cloudy lens with loss of vision. Bilateral loss at different rates ------------------------------------------------------------------ Causes: Trauma to the eye, elevated glucose levels in Aq humor, irradiation to the lens, viruses, chemicals, infections, vitamin deficiencies, advancing age ------------------------------------------------------------------------------------------------------------------------------------------------------------ Symptoms: Grayish, pearly haze of the pupil, loss of vision ----------------------------------------------------------- Treatment: Surgical lens implant -------------------------------- #### Retinal detachment ================== Spontaneous separation of the retina from the epithelium layer -------------------------------------------------------------- Causes: Trauma, congenital malformations, metabolic disorders, vascular disease, intraocular inflammation, neoplasms, degenerative changes ------------------------------------------------------------------------------------------------------------------------------------------ Symptoms: Floaters, flashes of light, blurred black spots, painless sensation of curtain coming over eye -------------------------------------------------------------------------------------------------------- Treatment: Eye rest (bilateral patches), ocular surgery ------------------------------------------------------- Diabetic Retinopathy ==================== The most common eye disorder in diabetics. Caused by changes in blood vessels of the retina. Blood vessels swell and leak, abnormal new vessels grow on the surface, which hemorrhage. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Symptoms: Blurred central vision, cloudy or hazy vision of sudden onset, related to blood glucose levels. Floaters or flashers. Loss of vision. ----------------------------------------------------------------------------------------------------------------------------------------------- Treatment: Laser photocoagulation surgery to seal leaking blood vessels and destroy abnormal ones. -------------------------------------------------------------------------------------------------- Medications for the Treatment of Glaucoma ========================================= +-------------+-------------+-------------+-------------+-------------+ | Drug Class | Action | Use | Side | Nursing | | | | | Effects | Implication | | | | | | s | +-------------+-------------+-------------+-------------+-------------+ | Beta | Decrease | First line | Ocular | -Educate on | | Blockers | IOP by | treatment | stinging | symptoms. | | | decreasing | for | conjunctivi | | | Nonselectiv | production | open-angle | tis | -May need | | e: | of Aq. | glaucoma | | to use | | Timolol | humor | | blurred | artificial | | | | Used in | vision | tears. | | B~1~ | | combination | | | | selective: | | with other | photophobia | -Use | | | | medications | | caution | | Betaxolol | | for | dry eyes. | when | | ========= | | emergency | | driving at | | | | management | | night. | | | | of acute | | | | | | angle-closu | | -Wear | | | | re | | sunglasses | | | | glaucoma | | | | | | | | -Report | | | | | | sudden eye | | | | | | pain | | | | | | immediately | +-------------+-------------+-------------+-------------+-------------+ | Cholinergic | Stimulates | A first | Miosis | | | Agonists | cholinergic | line drug | | | | | receptors | for initial | blurred | | | Direct | in the eye | & | vision | | | Acting: | to produce: | maintenance | | | | Pilocarpine | 1) miosis | therapy of | retinal | | | | (constricti | open-angle | detachment | | | AChE | on), | glaucoma | | | | inhibitors: | and 2) | and | local | | | Physostigmi | contraction | emergency | irritation | | | ne | of the | treatment | | | | | ciliary | of acute | eye pain | | | | muscle. | angle-closu | | | | | | re | brow ache | | | | Indirectly | glaucoma. | | | | | lowers IOP | | Cataracts | | | | | Used for | | | | | Inhibits | POAG. | myopia | | | | Ach | | | | | | breakdown, | Reserved | | | | | promotes | for | | | | | accumulatio | patients | | | | | n | refractory | | | | | of Ach | to beta | | | | | producing | blockers, | | | | | miosis, and | pilocarpine | | | | | decreasing | , | | | | | IOP | epinephrine | | | +-------------+-------------+-------------+-------------+-------------+ | Adrenergic | Stimulates | Open-angle | Headache, | | | Agonists | alpha & | glaucoma | brow ache, | | | | beta | | blurred | | | Nonselectiv | adrenergic | Short-term | vision, | | | e: | receptors. | therapy of | ocular | | | | Decreases | open-angle | irritation, | | | Epinephrine | IOP by | glaucoma | mydriasis | | | | increasing | | which | | | Alpha~2~ | Aq humor | Pre-op | aggravates | | | Selective: | outflow. | laser | angle-closu | | | | | trabeculopl | re | | | Apraclonidi | Lowers IOP | asty | glaucoma. | | | ne | by reducing | or | Retina | | | | Aq humor | iridotomy | edema | | | | production | | | | | | | | Headache, | | | | | | dry mouth & | | | | | | nose, | | | | | | altered | | | | | | taste, | | | | | | conjunctivi | | | | | | tis, | | | | | | lid | | | | | | reactions, | | | | | | pruritus, | | | | | | tearing, | | | | | | blurred | | | | | | vision | | +-------------+-------------+-------------+-------------+-------------+ | Prostagland | Decreases | Open-angle | Irreversibl | | | ins | IOP by | glaucoma | e | | | | increasing | and ocular | heightened | | | Latanoprost | Aq humor | hypertensio | brown | | | =========== | outflow by | n | pigmentatio | | | | relaxing | | n | | | | ciliary | | to iris, | | | | muscle | | blurred | | | | | | vision, | | | | | | burning, | | | | | | stinging, | | | | | | conjunctiva | | | | | | l | | | | | | hyperemia, | | | | | | keratopathy | | +-------------+-------------+-------------+-------------+-------------+ | Carbonic | Decreases | Long-term | Malaise, | | | Anhydrase | IOP by | treatment | anorexia, | | | Inhibitors | decreasing | of | fatigue, | | | | Aq humor | open-angle | paresthesia | | | Systemic: | production | glaucoma. | , | | | Acetazolami | | Use when | acid-base | | | de | | refractory | disturbance | | | | | to beta | s, | | | Topical: | | blockers, | nephrolithi | | | Dorzolamide | | pilocarpine | asis | | | | | , | | | | | | epinephrine | Ocular | | | | | , | stinging, | | | | | cholinester | bitter | | | | | ase | taste, | | | | | inhibitors, | conjunctivi | | | | | topical | tis, | | | | | carbonic | lid | | | | | anhydrase | reactions, | | | | | inhibitors. | blurred | | | | | | vision, | | | | | Open-angle | tearing, | | | | | glaucoma | eye | | | | | and ocular | dryness, | | | | | hypertensio | photophobia | | | | | n | | | +-------------+-------------+-------------+-------------+-------------+ Medications for Diagnostic Procedures ===================================== +-------------+-------------+-------------+-------------+-------------+ | Anticholine | Cycloplegic | Refraction | Blurred | | | rgic | s: | measurement | vision, | | | Agents | paralyze | s | photophobia | | | | ciliary | | , | | | Atropine | muscle by | Intraocular | precipitate | | | ======== | blocking | exams | s | | | | muscarinic | | angle-closu | | | | receptors | Intraocular | re | | | | that | surgery | glaucoma, | | | | promote | | dry mouth, | | | | contraction | Anterior | constipatio | | | | of ciliary | uveitis | n, | | | | muscle | treatment | fever, | | | | | | tachycardia | | | | Mydriatics: | | , | | | | dilate the | | hallucinati | | | | pupil by | | ons, | | | | blocking | | delirium, | | | | muscarinic | | coma | | | | receptors | | | | | | that | | | | | | promote | | | | | | iris | | | | | | sphincter | | | | | | contraction | | | | +-------------+-------------+-------------+-------------+-------------+ | Adrenergic | Mydriatics: | Refraction | Precipitate | | | Agonist | dilate the | measurement | s | | | | pupil from | s | angle-closu | | | Phenylephri | stimulation | | re | | | ne | of | Intraocular | glaucoma, | | | =========== | alpha-adren | exams | "floater", | | | == | ergic | | ocular | | | | receptors | Intraocular | pain, | | | | on radial | surgery | corneal | | | | muscle of | | clouding, | | | | iris | Anterior | brow ache, | | | | | uveitis | HTN, | | | | | treatment | ventricular | | | | | | dysrhythmia | | | | | | s, | | | | | | cardiac | | | | | | arrest, | | | | | | sweating, | | | | | | blanching, | | | | | | tremors, | | | | | | agitation, | | | | | | confusion | | +-------------+-------------+-------------+-------------+-------------+ Alterations in Hearing Function =============================== 2-Types of Hearing Loss ======================= Conductive Hearing Loss ----------------------- ### Occurs when sound is not conducted efficiently through the outer ear canal to the middle ear. Usually involves a reduction in sound level, or the ability to hear faint sounds. Often corrected medically or surgically Causes: otitis media, perforated eardrum, benign tumors, impacted earwax (cerumen), foreign body, malformation of the outer ear, ear canal, or middle ear --------------------------------------------------------------------------------------------------------------------------------------------------------- Sensorineural Hearing Loss -------------------------- ### Occurs when there is damage to the inner ear (cochlea). Involves a reduction in sound level, ability to hear faint sounds, affects speech and understanding. Not corrected medically or surgically Causes: birth injury, ototoxic drugs, noise exposure, viruses, head trauma, aging, and tumors. ---------------------------------------------------------------------------------------------- Meniere's Disease ================= An inner ear disorder associated with excess fluid in the labyrinth. Typically, the attack is characterized by a combination of vertigo, tinnitus, and hearing loss lasting several hours. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ### Cause is unknown Treatment: low sodium diet, no caffeine, alcohol or tobacco, decrease stress. Diuretics, antiemetics, Antivert. --------------------------------------------------------------------------------------------------------------- Ototoxicity ("ear poisoning") ============================= due to drugs or chemicals that damage the inner ear or the vestibule-cochlear nerve, which sends balance and hearing information from the inner ear to the brain. Ototoxicity can result in temporary or permanent disturbances of hearing, balance, or both. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Ototoxic Drugs ============== **Aminoglycoside antibiotics** ------------------------------ ### gentamicin, streptomycin, kanamycin, tobramycin, neomycin, amikacin, netilmicin, dihydrostreptomycin, and ribostamycin. (permanent) **Anti-neoplastic** ------------------- ### Cisplatin and carboplatin (permanent) **Environmental chemicals** --------------------------- ### mercury, carbon disulfide, styrene, carbon monoxide, tin, lead (permanent) ### **Loop diuretics,** #### bumetanide (Bumex), furosemide (Lasix). (transient tinnitus) ### **Aspirin and quinine products.** (transient tinnitus) Infections ========== **Otitis externa** "Swimmer's ear" ---------------------------------- ### an infection of the ear canal from bacteria or fungi ### Symptoms: Primary symptom is ear pain, swelling of the canal, full feeling in ear, redness and swelling to outer ear, swollen lymph nodes, discharge from ear (clear-cloudy, yellow, pus-like. ### Treatment: wick, antibiotics, steroids Acute otitis media "middle-ear" ------------------------------- ### the presence of fluid, typically pus, in the middle ear, typically viral ### Symptoms: pain, redness of the eardrum, and possible fever. ### Treatment: Motrin, Tylenol for pain and fever. Antibiotics only for bacterial infections (rare) ### Alteration in Integumentary System Infectious Processes Viral infections Verrucae or Warts Verrucous papules usually less than 1 cm. Caused by human papillomaviruses (HPV) Herpes Simplex (HSV) Herpes Zoster (shingles) Fungal infections Candida Albicans (thrush, candidiasis) Tinea Infections Bacterial infections Impetigo Treatment: topical antibacterial cream Inflammatory Conditions Discoid Lupus Erythematosus (DLE) Seborrheic Dermatitis (Cradle cap) Psoriasis Pityriasis Rosea Acne Vulgaris Allergic Skin Responses Atopic Dermatitis (Eczema) Allergic & Irritant Contact Dermatitis Urticaria or Drug Eruptions Parasitic Infestations Scabies Lice Visible mites and nits, surface dwellers Ticks Burrow in the epidermis, carry bacteria and viruses Treatment: Ectoparasitic Dal drugs Carcinoma Basal cell carcinoma Squamous Cell Carcinoma **Malignant Melanomas (highly malignant)** Kaposi's sarcoma Topical & Dermatological Antiseptic & Disinfectant Astringents Emollients Cleansers or Baths Rubs/Liniments Corticosteroids/Glucocorticoids Protectives Keratolytic