July 20, 2023 • 15 mins
Are you ready to unravel the mysteries of Neurosensory conditions? It's a world where subtle signs like a halo around lights or a slight loss of peripheral vision can signify the onset of Glaucoma, a condition with potentially devastating impacts on vision. Join us as we embark on a deep exploration of Glaucoma, shedding light on everything from symptoms and diagnostic testing, to nursing considerations and treatments. We'll lend special focus to the proper administration of Pylocarpeen eye drops, a vital tool in the fight against this condition.
The journey doesn't end with Glaucoma; we also uncover the intricacies of Wet Macular Degeneration - a condition that can slowly blur your central vision. We'll walk you through the myriad of treatment options available, including laser therapy, ocular injections, and Vascular endothelial growth factor inhibitors. You'll learn how these treatments can slow down the progress of the disease and limit any potential damage. This adventure through neurosensory conditions is loaded with practical insights, whether you're preparing for your NCLEX or have a keen interest in the subject. Come along on this exciting journey of discovery and learning!
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Hey and welcome to Nursing with Dr Habeck.
Today I'm thinking aboutNeurosensory Just a quick
overview of visual disturbance,hearing disturbance and
neurological conditions.
I'm actually going to throwsome pediatric conditions in
today because this podcast isgoing out to my seniors this
semester as part of their reviewfor their NCLEX.
(00:26):
If you're a senior gettingready to study for your NCLEX,
welcome aboard.
If you're in nursing school andyou're looking for something to
help you understand the sensorydisturbances or neurological
conditions, welcome aboard Today.
Let's start with glaucoma.
Glaucoma is actually acondition that arises from a
(00:49):
decrease in the emptying of thefluid inside the eye and because
we continue to make more fluid,it's not emptying and so it
increases the pressure insidethe eye ball.
Typically, this is somethingthat is actually discovered
during a regular visual exam.
We don't really see a lot ofsymptoms of this in the early
(01:11):
stages.
The symptoms, of course, areincreased intraocular pressure
and increase in the pressureinside that eye.
An eye doctor, anophthalmologist or an
optometrist can discover wemight also see some trouble with
accommodation or the ability tofocus.
Remember, when you're testingaccommodation, you're testing if
(01:33):
the pupil constricts or expandswhen looking from near to far
or far to near objects.
Those are the early symptoms,the late symptoms.
If it hasn't been discoveredearly on, later we might see a
loss of peripheral vision, whichis one of the classic things
(01:54):
that you should associate withglaucoma.
The vision loss is in theperiphery of the vision.
They might see halos around thelights.
Now that doesn't mean if yousee halos around lights that you
have glaucoma.
You might have a stigmatism,like I do so, or you're wearing
glasses.
Halos around the lights,combined with increased
intraocular pressure, are thethings that we're thinking about
(02:17):
here.
So loss of peripheral vision,halos around lights, and then we
might have decreased visualacuity.
That is not correctable.
So the patient has glasses.
They're not working anymore.
They get new glasses.
Those aren't working anymore.
They're going to have thisvisual disturbance that they
just can't correct.
And finally, of course, when weincrease the pressure in there,
(02:39):
we might start to have eye pain.
We might have headaches andthat can actually get so bad
that they have nausea andvomiting, so have some of those
secondary symptoms of pain.
Now glaucoma is actually thesecond leading cause of
blindness in people over the ageof 80.
So keep in mind, glaucoma istreatable.
(03:00):
It is not curable.
And also we we can treat it,but we can't reverse any damage
that's already been done.
So if the patient has gotten tothe point where they have this
visual acuity problem or theirlost peripheral vision, we can't
get that back.
We can keep it from gettingworse.
(03:22):
How do we do that?
We do that with eye drops,pylocarpeen.
Pylocarpeen P, as in PaulI-L-O-C-A-R-P-I-N-E, is one of
the very common eye drops thatwe might give to this patient,
and what this does is itactually causes the pupil to
constrict and in thatconstriction that muscle
(03:45):
movement opens that Drain forthat aqueous humor and so
decreases the pressure insidethe eye.
And as long as we can keep thatpressure down, we can minimize
the damage or stop it fromgetting worse.
So pylocarpeen is pretty commonmedication.
Make sure that if you're givingyour patient pylocarpeen one,
you're using good administrationfor eye drops techniques, and
(04:09):
that would be, of course cleanyour hands, sanitizer,
handwashing, put on gloves,you're going to gently pull down
the lower lid and that dropwill go in that innercanthus
pocket.
After that have the patientpress gently on the corner of
their eye, near their nose, tokeep the medication in the eye
(04:32):
and from going into the Intothat drain and having some
systemic effects.
You can then have the patientjust dab their eye off
whatever's outside the eye andAfter that make sure they know
that may have some blurredvision for a couple of hours
afterwards.
Remember that this isconstricting that pupil so it's
going to interfere with theirability to accommodate and it's
(04:54):
going to interfere with theirability to adapt to dark light.
So dark light requires a widepupil and since we've had a
medication that's going to keepit constricted, they're going to
have some trouble with that.
So those are things you want tomake sure that you educate your
patient on.
We also want to make sure thatwe are aware of Diagnostic
(05:16):
testing.
So the diagnostic testing wemight see is a tonometer that's
going to measure thatintraocular pressure.
We might see an Electrictonometer which is actually used
to detect drainage of thataqueous humor and a goni on
gonioscopy Hopefully I said thatright that will allow direct
(05:38):
visualization of the lens.
Risk factors for this condition,of course, is a family history
of glaucoma, a family history ofdiabetes, history of previous
ocular problems, and then somemedications can actually Cause
glaucoma as a side effect.
Those are things likeantihistamines or anti-coloner
(05:58):
gix.
And then we have othermedications that can interact
and cause Glaucoma, other thingsthat you can do as a nurse.
You want to think about makingsure, if your patient is low
vision, that you always Announceyourself when you come in the
room.
You want to make sure that whenyour patient first is on your
unit or you're taking care ofthem, if you're in a new
(06:18):
Environment to the patient, thatyou orient them to the room,
show them how to use the calllight, walk them around if
they're able and it'sappropriate to show them where
the chair is, where the Closetis, where the bed is, where the
bathroom is, so that they knowwhere everything is.
Depending on their vision, youmay want to describe their plate
to them.
So when you take the tray in,tell them, using a clock face,
(06:43):
where everything is and what itis.
When you're giving themmedications, make sure that you
tell them how many pills you'regiving them so they know how
that they've gotten them all.
Make sure that you give them ahalf a glass of water to help
avoid spills.
And we want to make sure that wetalked to our patient about
avoiding anything that canincrease Interocular pressure.
(07:03):
So things that can increaseinterocular pressure are the
same things that increase intraabdominal pressure, any kind of
emotional upset Exertion.
So pushing heavy lifting likeshoveling those kinds of things,
coughing a lot, excessivesneezing can actually increase
interocular pressure so yourpatient gets a respiratory
(07:25):
infection.
They're going to want to seetheir provider Wearing any kind
of constrictive clothing on thetorso or the neck and then
straining.
So we don't want them to getconstipated.
We want to make sure that we'retalking to them about a good
amount of fiber.
Make sure that we're talking tothem about plenty of fluids,
ambulation if possible and youknow we can consult with the
(07:47):
provider on Stool softenersdocu-sate sodium is a good one,
or whatever the provider feelswould be appropriate for that
patient.
Older patients, of course, areat risk for constipation Because
they're older.
We've got to slow down in thatGI tract peristalsis.
You know that colon justabsorbs water at a set rate.
(08:08):
It doesn't have a oh, thetransit has slowed down, so I
need to slow down waterabsorption.
It doesn't have that.
So we need to make sure thatwe're aware of that.
Again, fiber fluid feet on thefloor, those three Fs that are
going to help our patient withconstipation Always identify
yourself when you walk in theroom.
Make sure the patient knows andresponds affirmatively before
(08:33):
you touch them.
Make sure that you always raisethe side rails for someone
who's newly sightless.
If your patient maybe hadsurgery to help with the
glaucoma, they may have eyepatches on and not be able to
see.
Just make sure you put thosetwo upper side rails up just to
help them out.
And we want to make sure thatwe are just being conscious of
(08:57):
our non-verbal body language.
If they're not able to see it,we need to make sure that we are
expressing ourselves verballyso that the patient can be aware
.
Next, let's talk about cataracts.
Cataracts are actually theleading cause of blindness in
the world, and it's actuallyvery easily corrected.
(09:18):
So there are a lot of groupsthat travel to third world
countries or other places wherepeople may not have access to
this kind of surgery.
It really doesn't take verylong.
It's a very minimally invasivesurgery.
It's actually typically done onan outpatient basis under local
anesthesia, and so I'm happy toknow that there are doctors who
(09:44):
are willing to go and helppeople with this surgery.
In fact, if you Google anorganization called C
International, like SEE, theyhave a fantastic film called
Second Sight about theorganization.
They are actually in 45different countries helping so
many people with cataracts beable to see again.
(10:06):
It's a very touching film and Ithink it really helps you
understand the impact that thishas on people's lives and the
fact that it's so easily fixed.
During the film, the doctorperforming the surgery, the
facility, actually loses powerand he continues.
So he can continue even thoughthey lose power.
(10:28):
So I think that's really helpsyou to understand that this is
really a very minimal surgeryand it makes such a huge impact
on people's lives.
I really hope that you'll taketime to watch the film.
It's available on YouTube.
Cataracts are the leading causeof blindness around the world.
Aging is actually the cause for95% of cataracts.
(10:49):
Scenile cataracts is whatthey're called.
There's also cataracts that canbe caused by systemic
conditions like diabetes.
A toxic substances can causecataracts.
They may be congenital, beingborn with them, and they also
can be caused by trauma.
So what does this look like tothe patient?
It's often blurred vision.
(11:09):
I know when we say cataracts,most people think about the
cloudy lens.
That's actually a pretty latesign.
So patients usually will noticeblurred vision.
Versus our glaucoma, where thepatient notices a decrease in
peripheral vision, cataractpatient may also experience a
decrease in their colorperception and photophobia is
(11:33):
something else that they mightsee as well.
Now, how do we treat this?
They usually treat itsurgically.
They remove the lens and a lotof times they use an intraocular
lens implant.
In my experience they can setthat lens up to help correct
vision.
The patient may go in withglasses, may not need glasses
afterwards not always guaranteedand if you're like me and
(11:56):
you've entered the stage ofprespioopia, you may still need
to use reading glasses.
Okay, the last vision problemthat we're going to talk about
is macular degeneration.
Macular degeneration is one ofthe leading causes of blindness
in those over 65.
Macular degeneration comes intwo different types a wet type
and a dry type.
(12:16):
The dry type is typicallyslower to progress, but it is
progressive.
The wet is usually a much moresudden onset.
This, the classic symptom formacular degeneration, is loss of
central vision.
So this patient will lose theability to focus on things right
in front of them A lot of thetime.
They'll end up using theirperipheral vision while they can
(12:38):
.
Things to know about this one.
Usually the doctor, the eyecare provider, will conduct an
ophthalmoscopy to assess thosegross macular changes and the
opacities.
Hemorrhaging that can happen.
Really, the management is juston trying to slow the
progression of vision loss and,of course, helping the patient
maximize whatever vision theyactually have left and their
(13:00):
quality of life.
We want to make sure thatdietary intake of lutein and
zeaxanthin are increased andthat central vision loss really
affects the ability to read,write, recognize safety hazards
and, of course, to drive.
It's going to have a big impacton that.
Our patients may want to havelarge print books, audio books,
(13:23):
public transportation or rely onfamily for transportation
around.
Our management for the wetmacular degeneration really is
just to slow down the processand see, you know, if some of
that fluid and blood that's inthere affecting that macula
would resorb, they might do somelaser therapy to seal those
leaking vessels.
(13:43):
That will actually limit thedamage.
And then they also do ocularinjections, so they actually do
shots into the eye Vascularendothelial growth factor
inhibitors.
Those are a couple ofmedications that will slow down
that development of new vessels.
That can be a problem with wettype of macular degeneration.
(14:04):
That's all I've got to sayabout the vision problems.
I'll record another one hereshortly about auditory and then
we'll move on to neurological.
Enjoy.
I'll see you again next time onNursing with Dr Havik.
Hey and welcome to Nursing with Dr Habeck.
Today I'm thinking aboutNeurosensory Just a quick
overview of visual disturbance,hearing disturbance and
neurological conditions.
I'm actually going to throwsome pediatric conditions in
today because this podcast isgoing out to my seniors this
semester as part of their reviewfor their NCLEX.
(00:26):
If you're a senior gettingready to study for your NCLEX,
welcome aboard.
If you're in nursing school andyou're looking for something to
help you understand the sensorydisturbances or neurological
conditions, welcome aboard Today.
Let's start with glaucoma.
Glaucoma is actually acondition that arises from a
(00:49):
decrease in the emptying of thefluid inside the eye and because
we continue to make more fluid,it's not emptying and so it
increases the pressure insidethe eye ball.
Typically, this is somethingthat is actually discovered
during a regular visual exam.
We don't really see a lot ofsymptoms of this in the early
(01:11):
stages.
The symptoms, of course, areincreased intraocular pressure
and increase in the pressureinside that eye.
An eye doctor, anophthalmologist or an
optometrist can discover wemight also see some trouble with
accommodation or the ability tofocus.
Remember, when you're testingaccommodation, you're testing if
(01:33):
the pupil constricts or expandswhen looking from near to far
or far to near objects.
Those are the early symptoms,the late symptoms.
If it hasn't been discoveredearly on, later we might see a
loss of peripheral vision, whichis one of the classic things
(01:54):
that you should associate withglaucoma.
The vision loss is in theperiphery of the vision.
They might see halos around thelights.
Now that doesn't mean if yousee halos around lights that you
have glaucoma.
You might have a stigmatism,like I do so, or you're wearing
glasses.
Halos around the lights,combined with increased
intraocular pressure, are thethings that we're thinking about
(02:17):
here.
So loss of peripheral vision,halos around lights, and then we
might have decreased visualacuity.
That is not correctable.
So the patient has glasses.
They're not working anymore.
They get new glasses.
Those aren't working anymore.
They're going to have thisvisual disturbance that they
just can't correct.
And finally, of course, when weincrease the pressure in there,
(02:39):
we might start to have eye pain.
We might have headaches andthat can actually get so bad
that they have nausea andvomiting, so have some of those
secondary symptoms of pain.
Now glaucoma is actually thesecond leading cause of
blindness in people over the ageof 80.
So keep in mind, glaucoma istreatable.
(03:00):
It is not curable.
And also we we can treat it,but we can't reverse any damage
that's already been done.
So if the patient has gotten tothe point where they have this
visual acuity problem or theirlost peripheral vision, we can't
get that back.
We can keep it from gettingworse.
(03:22):
How do we do that?
We do that with eye drops,pylocarpeen.
Pylocarpeen P, as in PaulI-L-O-C-A-R-P-I-N-E, is one of
the very common eye drops thatwe might give to this patient,
and what this does is itactually causes the pupil to
constrict and in thatconstriction that muscle
(03:45):
movement opens that Drain forthat aqueous humor and so
decreases the pressure insidethe eye.
And as long as we can keep thatpressure down, we can minimize
the damage or stop it fromgetting worse.
So pylocarpeen is pretty commonmedication.
Make sure that if you're givingyour patient pylocarpeen one,
you're using good administrationfor eye drops techniques, and
(04:09):
that would be, of course cleanyour hands, sanitizer,
handwashing, put on gloves,you're going to gently pull down
the lower lid and that dropwill go in that innercanthus
pocket.
After that have the patientpress gently on the corner of
their eye, near their nose, tokeep the medication in the eye
(04:32):
and from going into the Intothat drain and having some
systemic effects.
You can then have the patientjust dab their eye off
whatever's outside the eye andAfter that make sure they know
that may have some blurredvision for a couple of hours
afterwards.
Remember that this isconstricting that pupil so it's
going to interfere with theirability to accommodate and it's
(04:54):
going to interfere with theirability to adapt to dark light.
So dark light requires a widepupil and since we've had a
medication that's going to keepit constricted, they're going to
have some trouble with that.
So those are things you want tomake sure that you educate your
patient on.
We also want to make sure thatwe are aware of Diagnostic
(05:16):
testing.
So the diagnostic testing wemight see is a tonometer that's
going to measure thatintraocular pressure.
We might see an Electrictonometer which is actually used
to detect drainage of thataqueous humor and a goni on
gonioscopy Hopefully I said thatright that will allow direct
(05:38):
visualization of the lens.
Risk factors for this condition,of course, is a family history
of glaucoma, a family history ofdiabetes, history of previous
ocular problems, and then somemedications can actually Cause
glaucoma as a side effect.
Those are things likeantihistamines or anti-coloner
(05:58):
gix.
And then we have othermedications that can interact
and cause Glaucoma, other thingsthat you can do as a nurse.
You want to think about makingsure, if your patient is low
vision, that you always Announceyourself when you come in the
room.
You want to make sure that whenyour patient first is on your
unit or you're taking care ofthem, if you're in a new
(06:18):
Environment to the patient, thatyou orient them to the room,
show them how to use the calllight, walk them around if
they're able and it'sappropriate to show them where
the chair is, where the Closetis, where the bed is, where the
bathroom is, so that they knowwhere everything is.
Depending on their vision, youmay want to describe their plate
to them.
So when you take the tray in,tell them, using a clock face,
(06:43):
where everything is and what itis.
When you're giving themmedications, make sure that you
tell them how many pills you'regiving them so they know how
that they've gotten them all.
Make sure that you give them ahalf a glass of water to help
avoid spills.
And we want to make sure that wetalked to our patient about
avoiding anything that canincrease Interocular pressure.
(07:03):
So things that can increaseinterocular pressure are the
same things that increase intraabdominal pressure, any kind of
emotional upset Exertion.
So pushing heavy lifting likeshoveling those kinds of things,
coughing a lot, excessivesneezing can actually increase
interocular pressure so yourpatient gets a respiratory
(07:25):
infection.
They're going to want to seetheir provider Wearing any kind
of constrictive clothing on thetorso or the neck and then
straining.
So we don't want them to getconstipated.
We want to make sure that we'retalking to them about a good
amount of fiber.
Make sure that we're talking tothem about plenty of fluids,
ambulation if possible and youknow we can consult with the
(07:47):
provider on Stool softenersdocu-sate sodium is a good one,
or whatever the provider feelswould be appropriate for that
patient.
Older patients, of course, areat risk for constipation Because
they're older.
We've got to slow down in thatGI tract peristalsis.
You know that colon justabsorbs water at a set rate.
(08:08):
It doesn't have a oh, thetransit has slowed down, so I
need to slow down waterabsorption.
It doesn't have that.
So we need to make sure thatwe're aware of that.
Again, fiber fluid feet on thefloor, those three Fs that are
going to help our patient withconstipation Always identify
yourself when you walk in theroom.
Make sure the patient knows andresponds affirmatively before
(08:33):
you touch them.
Make sure that you always raisethe side rails for someone
who's newly sightless.
If your patient maybe hadsurgery to help with the
glaucoma, they may have eyepatches on and not be able to
see.
Just make sure you put thosetwo upper side rails up just to
help them out.
And we want to make sure thatwe are just being conscious of
(08:57):
our non-verbal body language.
If they're not able to see it,we need to make sure that we are
expressing ourselves verballyso that the patient can be aware
.
Next, let's talk about cataracts.
Cataracts are actually theleading cause of blindness in
the world, and it's actuallyvery easily corrected.
(09:18):
So there are a lot of groupsthat travel to third world
countries or other places wherepeople may not have access to
this kind of surgery.
It really doesn't take verylong.
It's a very minimally invasivesurgery.
It's actually typically done onan outpatient basis under local
anesthesia, and so I'm happy toknow that there are doctors who
(09:44):
are willing to go and helppeople with this surgery.
In fact, if you Google anorganization called C
International, like SEE, theyhave a fantastic film called
Second Sight about theorganization.
They are actually in 45different countries helping so
many people with cataracts beable to see again.
(10:06):
It's a very touching film and Ithink it really helps you
understand the impact that thishas on people's lives and the
fact that it's so easily fixed.
During the film, the doctorperforming the surgery, the
facility, actually loses powerand he continues.
So he can continue even thoughthey lose power.
(10:28):
So I think that's really helpsyou to understand that this is
really a very minimal surgeryand it makes such a huge impact
on people's lives.
I really hope that you'll taketime to watch the film.
It's available on YouTube.
Cataracts are the leading causeof blindness around the world.
Aging is actually the cause for95% of cataracts.
(10:49):
Scenile cataracts is whatthey're called.
There's also cataracts that canbe caused by systemic
conditions like diabetes.
A toxic substances can causecataracts.
They may be congenital, beingborn with them, and they also
can be caused by trauma.
So what does this look like tothe patient?
It's often blurred vision.
(11:09):
I know when we say cataracts,most people think about the
cloudy lens.
That's actually a pretty latesign.
So patients usually will noticeblurred vision.
Versus our glaucoma, where thepatient notices a decrease in
peripheral vision, cataractpatient may also experience a
decrease in their colorperception and photophobia is
(11:33):
something else that they mightsee as well.
Now, how do we treat this?
They usually treat itsurgically.
They remove the lens and a lotof times they use an intraocular
lens implant.
In my experience they can setthat lens up to help correct
vision.
The patient may go in withglasses, may not need glasses
afterwards not always guaranteedand if you're like me and
(11:56):
you've entered the stage ofprespioopia, you may still need
to use reading glasses.
Okay, the last vision problemthat we're going to talk about
is macular degeneration.
Macular degeneration is one ofthe leading causes of blindness
in those over 65.
Macular degeneration comes intwo different types a wet type
and a dry type.
(12:16):
The dry type is typicallyslower to progress, but it is
progressive.
The wet is usually a much moresudden onset.
This, the classic symptom formacular degeneration, is loss of
central vision.
So this patient will lose theability to focus on things right
in front of them A lot of thetime.
They'll end up using theirperipheral vision while they can
(12:38):
.
Things to know about this one.
Usually the doctor, the eyecare provider, will conduct an
ophthalmoscopy to assess thosegross macular changes and the
opacities.
Hemorrhaging that can happen.
Really, the management is juston trying to slow the
progression of vision loss and,of course, helping the patient
maximize whatever vision theyactually have left and their
(13:00):
quality of life.
We want to make sure thatdietary intake of lutein and
zeaxanthin are increased andthat central vision loss really
affects the ability to read,write, recognize safety hazards
and, of course, to drive.
It's going to have a big impacton that.
Our patients may want to havelarge print books, audio books,
(13:23):
public transportation or rely onfamily for transportation
around.
Our management for the wetmacular degeneration really is
just to slow down the processand see, you know, if some of
that fluid and blood that's inthere affecting that macula
would resorb, they might do somelaser therapy to seal those
leaking vessels.
(13:43):
That will actually limit thedamage.
And then they also do ocularinjections, so they actually do
shots into the eye Vascularendothelial growth factor
inhibitors.
Those are a couple ofmedications that will slow down
that development of new vessels.
That can be a problem with wettype of macular degeneration.
(14:04):
That's all I've got to sayabout the vision problems.
I'll record another one hereshortly about auditory and then
we'll move on to neurological.
Enjoy.
I'll see you again next time onNursing with Dr Havik.
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