Special Senses Medical Assisting Booth, Whicker, Wyman, Pugh, Thompson Third Edition
Special Senses PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-2 Learning Outcomes 35.1 Describe the anatomy of the nose and the function of each part. 35.2 Describe how smell sensations are created and interpreted. 35.3 Describe the anatomy of the tongue and the function of each part. 35.4 Describe how taste sensations are created and interpreted. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-3 Learning Outcomes (cont.) 35.5 Name the four primary taste sensations and the acknowledged fifth taste sensation. 35.6 Describe the anatomy of the eye and the function of each part, including the accessory structures and their functions. 35.7 Trace the visual pathway of through the eye and to the brain for interpretation. 35.8 Identify ways that patients can practice preventive eye care. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-4 Learning Outcomes (cont.) 35.9 State ways that vision changes with age. 35.10 List the medical professionals involved in diagnosis and treatment of visual disorders, including the roles that each play in patient care. 35.11 List treatments for eye visual disorders. 35.12 Describe the causes, signs and symptoms, and treatments of various diseases and conditions of the eye. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-5 Learning Outcomes (cont.) 35.13 Describe the anatomy of the ear and the function of each part. 35.14 Explain the role of the ear in maintaining equilibrium. 35.15 Explain how sounds travel through the ear and are interpreted in the brain. 35.16 State ways that hearing changes with age. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-6 Learning Outcomes (cont.) 35.17 List the types of hearing loss and how they differ. 35.18 Describe treatments for ear and hearing disorders. 35.19 Explain how patients can be educated about preventive ear care. 35.20 Describe the causes, signs and symptoms, and treatments of various disorders of the ear and hearing. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-7 Introduction Special senses Sensory receptors located in head Nose – smell Tongue – taste Eyes – vision Ears – hearing and equilibrium Touch is a generalized sense Stimulus nervous system brain response © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-8 Nose and Sense of Smell Olfactory receptors Chemoreceptors – respond to changes in chemical concentrations Chemicals must be dissolved in mucus Located in the olfactory organ © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-9 Nose and Sense of Smell (cont) Smell sensation Activation of smell receptors information sent to olfactory nerves that send the information along olfactory bulbs and tracts to different areas of the cerebrum; cerebrum interprets the information as a particular type of smell © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-10 Nose and Sense of Smell (cont.) Sensory Adaptation Chemical can stimulate receptors for limited time Receptors fatigue and stop responding to chemical No longer smell order © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-11 Apply Your Knowledge You notice an odor coming from a patient when you enter the exam room. Why would the patient not be able to smell it? ANSWER: After a few minutes, smell receptors undergo sensory adaptation and no longer respond to the chemical, and the patient can no longer smell the odor. Very Good! © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-12 Tongue and Sense of Taste Gustatory receptors – located on taste buds Taste buds Location Papillae of the tongue Roof of mouth } fewer than on tongue Walls of throat Tongue © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-13 Tongue and Sense of Taste (cont.) Taste cells and supporting structures On taste buds Supporting structures fill in space Taste cells Chemoreceptors Chemicals in food and drink must be dissolved in saliva to activate Tongue © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-14 Tongue and Sense of Taste (cont.) Taste sensation 4 primary Sweet – tip Sour – sides Salty – tip and sides Bitter – back Unami 5th basic taste Glutamic acid Spicy foods Activate pain receptors Interpreted by brain as “spicy” Tongue © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-15 Back © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-16 Tongue and Sense of Taste (cont.) Taste sensation Activation of taste cells Cranial nerves Gustatory cortex of cerebrum interprets information © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-17 Apply Your Knowledge What are the four primary taste sensations and where are their corresponding taste cells located? ANSWER: The four primary taste sensations are: Sweet – concentrated on the tip of the tongue Sour – concentrated on the sides of the tongue Salty – concentrated on the tip and sides of the tongue Bitter – concentrated on the back of the tongue © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-18 Eye and Sense of Sight Vision system Eyes Optic nerves Vision centers in the brain Accessory structures Eye Processes light to produce images Three layers Two chambers Specialized parts © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-19 Eye and Sense of Sight (cont.) Outer – sclera White of the eye Protects the eye Sense receptors Cornea Front of eye “Window” that allows light into eye Bends light as it enters Eye © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-20 Eye and Sense of Sight (cont.) Middle – choroid Contains blood vessels Iris Colored part of eye Muscle that contracts and relaxes to open or close pupil Regulates the amount of light that enters the eye Ciliary body Muscles Controls the shape of the lens Lens Posterior to iris Focuses light on retina Accommodation Eye © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-21 Eye and Sense of Sight (cont.) Inner – retina Visual receptors Cones Rods Sensitive to light Will function in dim light – “limited” night vision Do not provide sharp image or detect color Function in bright light Sensitive to color and provide sharp images Optic disc – optic nerve enters retina Eye © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-22 Eye and Sense of Sight (cont.) Chambers of the eye Anterior chamber Front of lens Filled with aqueous humor – nourishes and bathes anterior eye Posterior chamber Behind lens Contains vitreous humor – maintains shape of eyeball and holds retina in place Eye © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-23 Back © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-24 Eye and Sense of Sight: Visual Accessory Organs Eye orbits Eye sockets Form a protective shell around the eyes Eyebrows protect eyes Eyelids Skin, muscle, and connective tissue Blinking Prevents surface from drying out Keeps foreign material out of eye © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-25 Eye and Sense of Sight: Visual Accessory Organs (cont.) Conjunctivas Mucus membranes Line inner surfaces of eyelids Lacrimal apparatus Lacrimal glands Lateral edge of eyeballs Produce tears Nasolacrimal ducts Medial aspect of eyeballs Drain tears into nose © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-26 Eye and Sense of Sight: Visual Accessory Organs (cont.) Extrinsic eye muscles Six per eye move the eyeball Superiorly Inferiorly Laterally Medially © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-27 Eye and Sense of Sight: Visual Pathways Eye works like a camera Light enters the eye through the lens Refraction – cornea, lens, and fluids bend light to focus it on the retina Image upside down on retina Retina converts light to nerve impulse Image turned right-side up Optic nerve Optic chiasm Occipital lobe of cerebrum © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-28 Eye Safety and Protection 90% of eye injuries are preventable Eye safety practices Adequate lighting / handrails Pad or cushion sharp edges on furniture Toys should be age-appropriate Do not mix chemicals Proper protective wear Goggles Sports eye guards © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-29 Apply Your Knowledge Matching: ANSWER: ___ G Middle layer of eye H Eye sockets ___ ___ F Control shape of lens ___ D Outer layer of eye ___ B Anterior chamber A Tears ___ ___ I Bending of light ___ E Posterior chamber C Inner layer of eye ___ A. B. C. D. E. F. G. H. I. Lacrimal glands Aqueous humor Retina Sclera Vitreous humor Ciliary body Choroid Orbits Refraction Out of Sight! © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-30 The Aging Eye Eyelids may droop Quality and quantity of tears decrease Conjunctiva thins and eyes may become dryer Cornea yellows, fat deposits around it Brown spots on sclera Pupils become smaller Lens denser and more rigid Lens yellows Retinal changes – vision fuzzy Changes in ability of eye to adapt to light Impaired night vision Decreased peripheral vision; depth perception Floaters or flashes of light © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-31 Preventing Falls in the Elderly Falls can result in fractures of major bones Complications of falls can lead to death Prone to falling Vision problems Poor health Slower reflexes Equilibrium problems Medication Patient education Safety checklist Precautions © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-32 Apply Your Knowledge What vision changes can occur in the elderly patient? ANSWER: An elder patient may have difficulty seeing because of drooping eyelids. Focusing may be more difficult because less light enters the eye. He may have difficulty distinguishing colors due to yellowing of the lens. Vision may be fuzzy because of changes in the retina. Night vision can become impaired. The patient may see floaters or “sparks.” Nice job! © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-33 Vision Testing Professionals include Ophthalmologist – medical doctor who is an eye specialist Optometrist – provides vision screening and diagnostic testing Opticians – fills vision prescriptions for glasses and contacts © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-34 Vision Testing: Screening Tests Myopia – impairment of distance vision Eyeball is too long Light focuses anterior to retina Snellen chart Normal vision 20/20 Hyperopia – impairment of near vision Eyeball is shorter Light focused posterior to retina Test using a handheld chart with various sizes of print Presbyopia Impairment due to aging Loss of lens elasticity © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-35 Vision Testing: Screening Tests (cont.) Contrast sensitivity Distinguish shades of gray Testing PelliRobson contrast sensitivity chart Color vision May be inherited More common in males Tests Vistech Consultants vision contrast system Detect cataracts or retinal problems before sharpness is impaired Color-blindness Ishihara color system Richmond pseudoisochromatic color test Difficulties may indicate retinal or optic nerve disease © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-36 Apply Your Knowledge What is the difference between myopia and hyperopia and what is presbyopia? What effect does each have on vision? ANSWER: If the patient has myopia, the eyeball is elongated and light focuses in front of the retina. She will have difficulty seeing far away. If she has hyperopia, the eyeball is shorter than normal and light focuses behind the retina. With presbyopia, the lens loses elasticity due to aging, resulting in the inability to see things close up. Reyeght! © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-37 Treating Eye Problems Delicate organ – caution and sterile technique necessary Patient education on preventive care Administration Eye irrigation of medications Sterile solution Only ophthalmic medications Avoid touching dropper or ointment tube to the eye Purpose Remove foreign material Relieve discomfort © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-38 Common Diseases and Disorders Disorder / Disease Description Amblyopia Lazy eye; one eye is not used regularly; poor depth perception; often concurrent with strabismus Astigmatism Cornea or lens has abnormal shape; blurred images Opaque structures in lens prevent light from passing through; vision fuzzy Cataracts Conjunctivitis Pink eye; highly contagious bacterial infection © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-39 Common Diseases and Disorders (cont.) Disorder / Disease Description Dry eye syndrome Common problem; decreased production of oil in tears Entropion Inversion of lower eyelid Glaucoma Increase in intraocular pressure due to a buildup of aqueous humor in anterior chamber Hyperopia Farsightedness © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-40 Common Diseases and Disorders (cont.) Disorder / Disease Description Macular degeneration Progressive disease; inadequate blood supply to retina; most common cause of vision loss; affects people over 50 years Myopia Nearsightedness Nystagmus Rapid, involuntary eye movements © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-41 Common Diseases and Disorders (cont.) Disorder / Disease Description Prespyopia Loss of lens elasticity; develops with age Retinal detachment Layers of retina separate; medical emergency Strabismus Convergent Misalignment of eyes Crossed eyes; one or both eyes turn inward Wall eye; one or both eyes turn outward Divergent © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-42 Apply Your Knowledge It is okay to use any solution or medication in the eye? ANSWER: Only medications or solutions specifically designated for ophthalmic use may be used in the eyes. Medications not designated for the eye may be too concentrated or contain substances that can injure the eye. Solutions should be sterile and care must be taken not to contaminate the tip of the dropper or bottle. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-43 The Ear and the Senses of Hearing and Equilibrium: Structures External ear Auricle (pinna) External auditory canal Collects sound waves Guides sound wave to tympanic membrane Tympanic membrane Separates external canal and middle ear Vibrates when sound hits it Ear © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-44 The Ear and the Senses of Hearing and Equilibrium: Structures (cont.) Middle ear Ear ossicles Malleus Incus Stapes Ossicles vibrate in response to vibration of tympanic membrane Eustachian tube Connects middle ear to throat Equalizes pressure on eardrum Oval window Separates middle ear from inner ear Ear © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-45 The Ear and the Senses of Hearing and Equilibrium: Structures (cont.) Inner ear – labyrinth of communicating chambers Semicircular canals – detect balance of the body Vestibule – equilibrium Cochlea Hearing receptors Organ of Corti – organ of hearing Ear © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-47 The Ear and the Senses of Hearing and Equilibrium: Structures (cont.) Equilibrium Head movement causes fluid in semicircular canals and vestibule to move Equilibrium receptors transmit information along vestibular nerves to cerebrum Cerebrum determines if body needs to make adjustments © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-48 The Ear and the Senses of Hearing and Equilibrium: Hearing Process Sound waves collected Waves cause tympanic membrane to vibrate Ossicles amplify vibrations, which enter inner ear Movement of hairs lining cochlea trigger nerve impulses Impulses are transmitted by auditory nerve to the brain for interpretation © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-49 The Ear and the Senses of Hearing and Equilibrium: Hearing Process (cont.) Bone conduction Alternative pathway Bypasses external and middle ear directly to inner Useful in determining cause of hearing problem © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-50 Apply Your Knowledge Matching: ANSWER: ___ E Pinna A. Organ of Corti ___ C Malleus, incus, and stapes B. Cerumen ___ F Hearing receptors C. Ear ossicles ___ G Inner ear D. Tympanic membrane ___ A Organ of hearing E. Auricle ___ B Earwax F. Cochlea ___ D Eardrum G. Labyrinth ___ H Detect balance of body H. Semicircular canals © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-51 How to Recognize Hearing Problems in Children Guidelines Infants to 4 months 4 to 8 months Startled by loud noises Recognize mother’s voice Regularly follow sounds Babble at people 8 to 12 months Respond to the sound their name Respond to “no” © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-52 The Aging Ear External ear larger / earlobe longer Cerumen dryer and prone to impaction Ear canal narrower Eardrum shrinks and appears dull and gray Ossicles do not move as freely Semicircular canals less sensitive to changes in position – affects balance © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-53 Apply Your Knowledge What problem with the aging ear makes the elderly more prone to falls? ANSWER: The semicircular canals become less sensitive to change in position, which affects balance. This problem with equilibrium results in increased chance of falls in the elderly. Great Answer! © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-54 Hearing Loss Symptom of a disease, not a normal part of aging Conductive hearing loss Sensorineural hearing loss Interruption in transmission to inner ear Causes Obstruction of ear canal Infection of middle ear Reduced movement of stirrup Sound waves not perceived by brain as sound Causes Hereditary Repeated exposure to loud noises / viral infections Side effect of medication © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-55 Hearing Loss (cont.) Noise pollution – causes damage to sensitive cells in cochlea Working with the hearing-impaired patient Speak at a reasonable volume, in clear, low-pitched volumes Face the person; use hand gestures, if appropriate Do not overemphasize lip movements Have patient repeat message to verify understanding Treat hearing-impaired patients with patience and respect © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-56 Hearing and Diagnostic Tests Hearing tests Tuning forks – differentiate between types of loss Audiometer – measures hearing acuity Diagnostic testing Tympanometry Measures the ability of the eardrums to move Detects diseases and abnormalities of the middle ear © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-57 Apply Your Knowledge Identify the types of hearing loss based on the description below. What can be used to differentiate between the two? Answer: A tuning fork is a simple test to distinguish between types of hearing loss. Conductive hearing loss Interruption in transmission to inner ear Causes Obstruction of ear canal Infection of middle ear Reduced movement of stirrup Sensorineural hearing loss Bravo! Sound waves not perceived by brain as sound Causes Hereditary Repeated exposure to loud noises / viral infections Side effect of medication © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-58 Treating Ear and Hearing Problems Patient education Preventative ear care Administer ear medications Medications and Irrigation Relieve inflammation or irritation of canal Loosen and remove impacted cerumen or foreign body © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-59 Treating Ear and Hearing Problems (cont.) Hearing aids Obtaining a hearing aid Otologist – medical doctor specializing in health of ear Audiologist – evaluates and corrects hearing problems Other devices / strategies Amplifiers Closed-captioning Appliances that light up as well as ring Care and use Batteries Routine cleaning Keep dry and avoid hair sprays © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-60 Common Diseases and Disorders Disorder / Disease Description Cerumen impaction Build up of wax within external auditory canal Hearing loss Deafness Meniere’s disease Disturbance in equilibrium characterized by vertigo and tinnitus © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-61 Common Diseases and Disorders Disorder / Disease Description Otitis Otitis externa Otitis media Otitis interna Osteosclerosis Inflammation of the ear Swimmers’ ear Middle ear infection; common infection Labyrinthitis; inner ear infection Immobilization of the stapes; common cause of conductive hearing loss Presbycusis Hearing loss due to aging process © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-62 Apply Your Knowledge True or False: ANSWER: ___ F An audiologist is a physician that specializes in ear health. ___ F Otitis media is also called swimmers’ ear. otologist externa ___ T Presbycusis is hearing loss due to the aging process. ___ F Vertigo is ringing in the ears. Tinnitus ___ T Otitis interna is an inflammation of the labyrinth. ___ T Meniere’s disease is characterized by disturbances in equilibrium. ___ T Otosclerosis is the immobilization of the stapes. ___ F tinnitus is dizziness. Vertigo © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-63 In Summary Special senses detect changes in the environment Each works with the nervous system to enable the body to cope with environmental changes Medical assistant’s knowledge of senses Provide eye and ear care to patient Patient education Meet needs of children, elderly, and patients with impairments © 2009 The McGraw-Hill Companies, Inc. All rights reserved 35-64 End of Chapter Every closed eye is not sleeping, and every open eye is not seeing. ~ Bill Cosby © 2009 The McGraw-Hill Companies, Inc. All rights reserved
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