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Nursing 3 Test 3
Disorders of the Eye
| Question | Answer |
|---|---|
| cataract | clouding/opacification of lens of eye |
| types of cataracts | senile, congenital, acquired |
| health promotions for cataracts | sunglasses, avoid radiation exposure, good nutrition, take antixidant vitamins |
| pathophysiology of catarcts | lens ages; fibers and proteins change and degenerate |
| risk factors for senile cataracts | exposre to sunlight, smoking, and heavy ETOH use |
| manifestations of cataracts | impaired light transmissin through lens |
| manifestations of cataracts | increased glare and difficulty adjusting between light and dark environments/color hues. visual difficulty at night when pupil dilates |
| diagnosing cataracts by history and physical eye exam | mature cataract:pupil may appear gray/white instead of black |
| treatment for cataracts | nonsurgical:vision continues to deteriorate surgical:only cure:usually outpatient procedure |
| preop phase of cataract sx | address visual acuity of non surgical eye, assess pt's knowledge:disease process, tx options, psychosocial impact of visual alteration, possible preop antibiotic eyedrops, NPO 6-8hrs:admitted several hrs prior to OR |
| preop eye meds for cataract sx | pupil dilating eyedrops administered: photophobia...dim lights |
| mydiratic agent | contracts iris dilator muscle & stimulates sympathetic nervous system-monitor for tachycardia, increased BP, reflexive HR decreased: transient eye stinging/burning, need punctal occlusion |
| cycloplegic agent | blocks effect of acetylcholine on iris sphincter muscles:paralyzes accomodation |
| intraoperative phase of cataracts | extracapsular extraction(most common procedure) & intracapsular extraction |
| extracapsular extraction | most common procedure, anterior capsule opened & lens/cortex removed, posterior capsule left intact to support lens implant(new lens is attached to posterior capsule) |
| intracapsular extraction | entire lens/capsule removed |
| lens implant | after lens removal, eye can't focus light on retina and vision is seriously affected. a plexiglass lens is usually implanted behind the iris during surgery for light refraction/visual acuity |
| post op cataract sx | IV corticosteriods/antibiotics & eye ointments of same meds, usually eye patch & shield overnight; MD visits next day |
| post op phase of cataract sx | d/c when sedative agents have worn off, usually no pain, may experience sensation of eye scratchiness, usually antibiotics & corticosteroid eyedrops to decrease inflammatory response, mild OTC analgesic...NOT aspirin. |
| complications of cataract sx | IIP, hemorrhage, corneal edema, imflammation/infection, retinal detachment, lens displacement, loss of vitreous humor |
| vitreous humor | fluid that floats and bathes your eye(transparent semisolid fluid in the the posterior cavity btwn the lens and the retina) |
| cataract post op teaching | limit activites that increase IOP:bending,straining,BM,sexual activity,dont lift >5lbs,strenuous activity,no sleeping on op side,don't disturb eye dressing,falls safety(no depth perception w/eye patch),med instruction,f/u appts(4-5 visits over 6-8wks),new |
| eye drop precaution | never drop eye drops on the lens, drop into conjuctival site |
| cataract sx changes.... | pupillary response(more sluggish) |
| post op complications of cataract sx | s/s:eye pain,itching,redness,drainage,decreased visual acuity,other vision changes,h/a,nausea |
| teaching for complications of cataract sx | contact lens care PRN, resources:american society of cataract & lens refractive surgery |
| retinal detachment | the retina(sensory portion of eye) becomes separated from the pigmented vascular area |
| retinal detachment | a hole/tear in sensory retina allows liquid vitreous humor to seep through/detach it from the vascular area |
| risk factors for retinal detachment | #1 cause is eye trauma |
| clinical manifestations of retinal detachment | painless...a medical emergency progressing detachments:"shade/curtain" over vision of one eye, flashing lights |
| complete detachment of retina | central/peripheral vision loss |
| progressing detachment of retina | "shade/curtain" over vision of one eye, flashing lights |
| history of retinal detachment | usually spontaneous; external eye ok, evaluated by retinal specialist:long eye exam, uncomfortable, "looking directly into sun" |
| opthomologist | MD |
| optometrist | just gives basic eye exams |
| retinal detachment if not treated can lead to... | blindness |
| retinal detachment treatment goal | to bring retina & choroid back into contact & reestablish blood/nutrient supply to retina |
| retinal detachment tx | laser photocoagulation/cryotherapy cropexy, scleral buckling |
| laser photocoagulation/cryotherapy | used to "spot weld" |
| cryopexy | extreme cold appled with probe instrument |
| scleral buckling | sclera folded to bring the choroid into contact with the retina |
| priority nursing diagnosis for retinal detachment | ineffective tissue perfusion:retinal |
| health promotion for a pt with retinal detachment | teaching:activity restrictions,straining,eye shield, f/u care, |
| medications for pt with retinal detachment | pain, antibiotics/anti-inflammatory, dilating eye gtts, topical eye meds |
| glaucoma | a group of occular conditions resulting in optic nerve damage from increased intraoccular pressure(IOP) |
| IOP in glaucoma pt's is caused by... | congestion of aqueous humor in eye: imbalance btwn rate of production/absorption OR inflow>outflow(FLOW PROBLEM OR TOO MUCH AQUEOUS HUMOR) |
| glaucoma causes... | permanent vision loss if IOP remains elevated; no cure |
| glaucoma is the.... | leading cause of blindness among adults in U.S. prevalent >40 yrs old; affects 1 in 10 african americans |
| types of glaucoma | primary open-angle, primary angle-closure, secondary |
| primary open angle glaucoma | aqueous humor outflow decreased in trabecular meshwork;90% of cases (FLUIDS CAN FLOW BUT GET CONGESTED) |
| primary angle-closure glaucoma | outflow of aqueous humor blocked in trabecular network;10% of cases |
| primary angle-closure glaucoma can cause... | colored halos around eyes, blurred vision, ocular redness |
| possible acute attack of primary angle-closure glaucoma is r/t | pupil dilation:sudden excruciating pain in/around the eye with n/v |
| secondary glaucoma | associated with other conditions ie: developmental, corticosteroids, trauma, neoplasms |
| diagnosing glaucoma | medical and occular history: any s/s reported by patient?, eye exam:measure IOP, inspect optic nerve,check visual fields |
| Normal Intraoccular pressure(IOP) | 10-21 mm Hg |
| Significant findings for diagnosis of glaucoma | pallor of optic nerve, cupping of optic nerv disc:BV's bended excessively, scotomas |
| Goal of glaucoma tx | prevent optic nerve damage; lifelong therapy neccesary; cannot reverse present damage; control IOP within a normal range to prevent further damage |
| glaucoma management: medical | Beta-adrenergic Blockers, Alpha Adrenergic Agonists, Cholinergic Agents(Miotics), Hyperosmolar Agents, Carbonic Anahydrase Inhibitors |
| glaucoma management: surgical | laser trabeculoplasty, laser iridotomy, surgical trabecular meshwork fistula + antifibrosis agents for tx of angle-closure glaucoma |
| laser trabeculoplasty for glaucoma pt's | spaced burns to trabecular mesh in open-angle glaucoma when med tx not enough |
| laser iridotomy for glaucom pt's | an opening created in iris to eliminate block in agle-closure glaucoma |
| glaucoma health promotion | risk for disturbed sensory perception: address client by name & explain info clearly, visual aids, assis w/care,meals,mobility |
| glaucoma health promotion | risk for injury: traffic, clutter, ambulation, environmental adaptations |
| glaucoma health promotion | anxiety: assess verbal, nonverbal, and physical indicators |
| glaucoma health promotion | teaching/home care: meds: use/refills, national glaucoma foundation, environment, significant others, f/u care |
| miotics(cholinergics) | constrict the pupil and block the sympathetic nervous system input, which causes the pupil to dilate in low light. They also contract the ciliary muscle: both effects reduce intraocular pressure. Pilocarpine is the most widely used. |
| examples of miotics(cholinergics) | acetylcholine(miochol), carbachol(isopto carbachol), pilocarpine(isopto carpine,ocusert-pilo) |
| after adminstering miotic(cholinergics) drops... | have the client gently squeeze the lacrimal sac for 1-2 minutes to increase the local effect and decrease systemic absorption |
| adrenergic agonists(mydriatics) | epinephrine is a sympathomimetic drug acting to dilate teh pupil, reduce production of aqueous humor and increase its absorption, effectively reducing intraocular pressure in open angle glaucoma |
| The nurse is instructing a clent following cataract extraction surgery. She knows that the client requires further instruction when he said: | "I'll try to hold back any sneezes" |
| The client w/glaucoma tells the nurse that he doesn't feel as if he needs eye medication anymore. Which of the following responses by the nurse is the most accurate? | "Vision loss from glaucoma occurs gradually, and is permanent. Medication therapy helps to lower the pressure in your eyes and preserve your current level of vision". |
| The nurse notes a slight cloudy appearance to the lens of a 68 yr old clients eye. Which of the following questions should the nurse ask? | "Are you experiencing blurred vision or difficulty w/night driving?" |
| The nurse is reviewing medication data related to an eye drop that was ordered by the physician. The literature indicates that punctual occlusion is required when administering the eye med. The nurse understands that: | it prevents eye drop medication from entering the tear ducts and causing sytemic symptoms such as a drop in blood pressure |
| The nurse realizes that some rx'ed eye meds ex:Pilocarpines cause the pupil to constrict & pull the muscles away from the trabecular network & Schlemn's canal.The pupil contriction maynot correlate w/the pts needs in a particular lighting environment & re | blurred vision |
| The nurse is performing an admission assessment on a clent with a diagnosis of detached retina. Which of the following is associated with this eye disorder? | a shadow falling across the visual field(progressive detachment) |
| The client has just had extracapsular cataract extraction. He is reporting "mild aching eye pain". What type of analgesic is most appropriate for this client? | Acetaminophen |
| The client is scheduled for an extracapsular cataract extraction of the left eye. What should the nurse explain to the client about post op care? | He might experience some mild eye itching |
| Postoperative instruction for a client after cataract surgery would include which of the following? | The procedure for administering eye drops |
| The opthamologist prescribes Pilocarpine eye drops for a client w/open-angle glaucoma. In teaching about the effects of this medication, the nurse will most likely include which of the folling? The medication will... | constrict the pupils and may cause blurred vision |
| A client has an appt w/the opthamologist b/c of changes in his vision. A preliminary diagnosis of cataracts is made. When taking the clients hx, the nurse would expect him to report which of the following? | blurred vision and difficulty driving at night |
| A client is diagnosed w/open-angle glaucoma. Which of the following provides the best explanation of the pathophysiology of this type of glaucoma? | Pressure builds up in the eye vrom either overproduction of aqueous humor or obstruction of outflow |
| A detached retina can be a surgical emergency b/c blindness can result from: | seperation of the retina from the chorioid |
| The client who was diagnosed with chronic open-angle glaucoma has been prescribed the medication timolol maleate(Timoptic). The nurse monitors for which of the following adverse systemic responses to this drug? | Anxiety |
| The nurse who is administering ophthalmic meds to a client would do which of the following as correct procedure? | apply pressure to the canthus while administering the medication |
Created by:
jbittner
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