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Chapter 12
Unit 2: Nursing care of clients with neurosensory disorders
| Question | Answer |
|---|---|
| Disorders of the eye (Pg. 122) -Macular degeneration, cure? | Age-related macular degeneration (AMD) -Central loss of vision that effects the macula of the eye -No cure -#1 cause of vision loss over age of 60 |
| 2 types of AMD: | Dry & wet |
| Dry macular degeneration: | Most common -Gradual blockage in the retinal cap arteries= ischemic & necrotic macula |
| Wet macular degeneration: | Caused by new growth of BV's w thin walls allowing blood & fluid to leak from them |
| Risk factors for DMD: gender, ht, BP, diet | Female, short, hypertension, smoking, fam hx, diet lacking carotene & fit A |
| What age does WMD occur at? | Can at any age |
| S/s of AMD: (Pg. 123) | Lack of depth perception, distorted objects, blurry -loss of central vision, blindness |
| Dx procedures for AMD: Opthalmoscopy & visual acuity tests | Opthalmoscopy: scope examines back of eyeball (fundus) Snellen & rosenbaum eye charts |
| Educate client on AMD: -Diet | Foods high in antioxidants, carotene, vit E & B12 -need eye exams monthly, ADL care eventually |
| -Cataracts (Pg. 124) | Opacity in the lens of an eye that impairs vision |
| 3 types of cataracts: Subcapsular: | Begins at the back of the lens |
| A nuclear cataract: | Forms in the center (nucleus) of the lens |
| A cortical cataract: | Forms in the lens cortex & extends from the outside of the lens to the center |
| When is a good time for adults to get annual eye exams? | Over age of 40 |
| Cataracts can be prevented by what? | Wearing sunglasses outside Protective eyewear in hazardous areas |
| Risks of getting cataracts? | Older age, diabetes, heredity, smoking, eye trauma, sun, chronic corticosteroid use |
| S/S of cataracts: | Decreased visual acuity, blurred vision, diplopia (double vision), glare/light sensitivity, halo around lights -painless/progressive, visible opacity, absent red reflex |
| Dx for cataracts: | Exam of lens w opthalmoscope |
| Nursing: -Check visual acuity w/ ? -Lighting -Adaptive devices | Snellen chart -increase light -Magnifying glass, large prints, talking devices such as clocks |
| Meds for cataracts: -Cycloplegic mydriatic (Atropine 1% ophthalmic solution) | Prevents pupil constriction for prolonged periods of time & relaxes muscles in the eye -dilates the eye (good for preop & visualizing internal structures) -long duration & fast onset |
| How long does the atropine last? & s/e that is common | 7-14 days -Photosensitivity; wear sunglasses outside |
| What is an ophthalmologist? | Eye surgeon, can do cataract surgery |
| Surgical interventions for cataracts: | Removal of the lens -After being broken up by sound waves -Replacement or intraocular lens is inserted |
| Post op nursing care: | Prevent infection, meds, pain relief |
| What activities increase IOP? (limit these) | Bending at waist, sneezing, coughing, straining, head hyper flexion, restrictive clothing, sex |
| Indications of IOP or hemorrhage? | Nausea/vomit |
| Best vision after surgery is expected when? | 4-6 weeks after surgery |
| S/s of infection after surgery? -Drain, tears, light | Yellow/green drainage, increased redness/pain, reduced visual acuity, increased tear production, photophobia |
| Bleeding after surgery: | Complication |
| -Glaucoma (Pg. 127) | Disturbance of the functional or structural integrity of the optic nerve -IOP increased (d/t decreased fluid drainage or increased fluid secretion) |
| What is an expected IOP range? | 10-21 mm/Hg |
| 2 types of Glaucoma? | Open-angle & angle closure |
| What is open-angle glaucoma? | Most common -Refers to angle between iris & sclera -Aqueous humor outflow is decreased d/t blockage in the eye's drainage system = ^ IOP |
| What is angle closure glaucoma? | IOP rises suddenly, angle closes = ^ IOP |
| What is the leading cause of blindness? | Glaucoma |
| Early symptoms of Glaucoma? | Reduced vision & mild eye pain |
| Risk for Glaucoma? (Pg. 128) | Age, infection, tumors, DM, genetics, htn |
| S/s of open-angle glaucoma: | Headache, mild eye pain, loss of peripheral vision, decreased accommodation, ^ IOP |
| S/s of angle-closure? | Rapid onset of ^ IOP, decreased/blurred vision, halos around lights, not PERRLA, pain/nausea severe, photophobia |
| Dx for glaucoma: Visual assessments will show: | Decreased visual acuity & peripheral vision |
| Dx for glaucoma: Tonometry | Measures IOP (10-21) Elevated w glaucoma, especially angle-closure |
| Dx for glaucoma: Gonioscopy | Used to determine the drainage angle of the anterior chamber of the eyes |
| What is the priority intervention for tx glaucoma? | Medication therapy |
| Educating clients on eye drops? -How often, how long between drops, pressure | -Q12hr -One drop each eye 2x daily -Wait 10-15 mins between eye drops if >1 prescribed -Dont touch tip of bottle to eye, wash hands -Apply pressure by using the punctual occlusion technique |
| What is the punctual occlusion technique? (Pg. 129) | Place pressure on the inner corner of the eye |
| Meds for glaucoma: Pilocarpine (Isopto Carpine-opthalmic solution) | Miotic; contracts the pupil (better circulation of aqueous humor) -may cause blurred vision |
| Meds for glaucoma: Timolol (Timoptic) | Beta blocker; decrease IOP by reducing production |
| Meds for glaucoma: Acetazolamide (Diamox) oral med | Carbonic anhydrase inhibitor -does the same as timoptic -Ask about sulfa allergy -Good for preop |
| Meds for glaucoma: IV mannitol (Osmitrol) | Osmotic diuretic; used in emergencies! for angle-closure to quickly decrease IOP |
| Meds for glaucoma: Prednisolone acetate (Ocu-pred) | Ocular steroid to decrease inflammation |
| Glaucoma surgery: Laser trabeculectomy, iridotomy & placement of shunt | Improve the flow of aqueous humor by opening a channel out of the anterior chamber of the eye |
| Nursing care for Glaucoma surgery: -post-op IOP checks how often? | q1-2hr by the surgeon -same as cataract surgery precautions & care |
| Complication of Glaucoma? | Blindness; (undiagnosed/undertx) |
Created by:
mary.scott260!
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