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Chapter 12

Unit 2: Nursing care of clients with neurosensory disorders

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!