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Module 18.3 Sensory

Eye injuries

QuestionAnswer
What will damage an eye worse acid or alkaline substances? And why? Pg.1312 Alkaline. Because tiny particles of the chemical may remain in the conjunctival sac, causing progressive damage.
What substances can cause an eye injury? Pg.1312 Ammonia, products containing lye(oven or drain cleaners), acids from car batteries, External damage: burns by heat, radiation, explosion, chemical burns(most common)
What type of burn injures pose the greatest risk for thermal burns to the eye? Pg.1312 Explosions and flash burns
Ultraviolet light can cause what type of damage to the eye? Pg.1312 Can cause corneal damage ranging in severity from mild to extensive.
What are three types of Ultraviolet light burns? Pg.1312 snowblindness, welder’s arc burn or flash burn
What is a penetrating injury to the eye? Pg.1312 - the layers of the eye spontaneously re-approximate after entry of sharp-pointed object or small missile into the globe.
What is a perforating injury to the eye? Pg.1312 layers of the eye do not spontaneously re-approximate resulting in rupture of the globe and potential loss of ocular contents. A perforating eye involves an entrance and exit wound both of which are caused by the same source.
What are some concerns with a penetrating injury when assessing a client? Pg.1312 May be hidden because of tissue swelling, May be missed if client has other significant injuries, If eyelid is lacerated/puncture wound inspect eye tissue for damage
What are some signs of eye perforation? Pg.1312 pain, partial or complete loss of vision, possible bleeding or extrusion of eye contents
What is the most common cause of a blunt trauma to the eye? Pg.1312 Sports injury, struck by with a ball or contact sports
What are some alternative examples of blunt trauma to the eye? Pg. 1312 MVA, falls, physical assault
What are some examples of minor blunt trauma injuries? Pg.1312 lid ecchymosis (black eye), subconjunctival hemorrhage, hyphema, orbital blowout fracture
What is a subconjunctival hemorrhage? Pg.1312 Caused by a rupture of a blood vessel in the conjunctiva, appears as a bright area of erythema, no pain/treatment, reabsorbs in 2-3weeks
What is a hyphema? Pg.1312 bleeding into the anterior chamber of the eye, Client complains of eye pain, experiencing decreased visual acuity and seeing a reddish tint. Blood is visible in the anterior chamber.
What is enophthalmos? And when do you see it? Pg.1312 Eye appears sunken and has limited movement, Can occur after an orbital fracture
What happens to the eye during an orbital fracture? Pg.1312 Ethmoid bone on the orbital floor is the most likely site to be fractured. Orbital contents including fat, muscles, and the eye itself may herniate thru the fracture into the underlying maxillary sinus.
What happens when a retina detaches? Pg.1312 Separation of the retina or sensory portion of the eye from the choroid, the pigment vascular layer. It may occur after trauma but usually occurs spontaneously.
What are some risk factors related to retinal detachment? Pg.1312 Aging is a common risk factor, as are myopia, glaucoma, trauma, previous retinal detachment and aphakia, absence of the lens
Table. Focus on Diversity & Culture. Why are eye injuries among migrant farm workers underreported? Pg.1312 Most migrant workers don’t have jobs that provide worker’s compensation coverage. B/c of a limited number of clinics that serve this population, many injuries go both unreported and untreated
Table. Focus on Diversity & Culture. What type of exposures are the migrant farm workers at risk for? Pg.1312 chemicals, machinery, tools, and airborne soil and particulates.
Table. Clinical Manifestations and Therapies: Eye Injuries. What are the clinical manifestations for detached retina? Pg.1314 floaters: irregular dark lines or spots on the field of vision, flashes of light, blurred vision, progressive deterioration of vision, sensation of a curtain or veil being drawn across the field of vision, if macula is involved, loss of central vision
Table. Clinical Manifestations and Therapies: Eye Injuries. What are the clinical therapies for detached retina? Pg.1314 prompt treatment to preserve vision, proper positioning, cryotherapy, laser photocoagulation, scleral buckling and laser therapy
What are some Diagnostic tests you can do in clinic for a patient with an eye injury? Pg.1314 Visual acuity, Extraocular movements, Pupil reactivity &size (PERRLA), ophthalmoscope used to examine fundus for presence of red reflex
What is a slit lamp and what is it used for? Pg.1314 slit-lamp is a high-intensity light source combined with a low-power microscope can be focused to shine a blue light in a thin beam, used in conjunction with fluorescein stain, Fluorescein is orange/yellow in color appears if defect on the cornea
What other test can be done for the eye? Pg.1314 Facial x-rays & CT scan used to identify orbital fractures or foreign bodies in the globe. Ultrasonography used to detect a detached retina or vitreous hemorrhage
What treatments of the eye would not need surgical intervention? Pg.1314 corneal abrasion, subconjunctival hemorrhage or periorbital ecchymosis
What surgical interventions maybe necessary due to a severe chemical burn? Pg.1314 debridement, tissue grafting, or even corneal transplant
What is considered a medical emergency in order to preserve vision? Pg.1314 Retinal detachment is medical emergency; early diagnosis and treatment are important to preserve vision.
What are the three surgical treatments for retinal detachment? Pg. 1314 Cryotherapy, Scleral buckling, Pneumatic retinopexy
Describe Cryotherapy and how it is used to correct retinal detachment? Pg. 1314 uses a cooled probe or laser photocoagulation may be used to create an area of inflammation and adhesion to “weld” the layers together
Describe Scleral buckling and how it is used to correct retinal detachment? Pg. 1314 Scleral buckling during which an indentation or fold is surgically created in sclera to restore contact between retina and choroid. Contact is maintained with a local implant on the sclera or an encircling strap or buckle.
Describe Pneumatic retinopexy and how it is used to correct retinal detachment? Pg. 1314 air is injected into the vitreous cavity. Pt is positioned so air bubbles pushes the detached portion of the retina into contact with the choroid
What steps will the nurse take in order to protect the eye from further injury when penetration or perforation is suspected? Pg.1316 Do not place any pressure on the eye itself, cover gently with sterile gauze or eye pad, if object is embedded or sticking out of eye do not attempt to remove, object should be immobilized with metal eye shield, patch unaffected eye to decrease movement
What interventions and instruction would an RN offer to a client with a blunt trauma to the eye? Pg.1316 Intervention: best rest in Semi-fowler's position, use eye shield to prevent further damage, unaffected eye should be patched to reduce movement. Instruction: if healing has not occurred in 1-2weeks FU
How is a foreign body removed from the conjunctiva? Pg.1316 Irrigation, sterile cotton-tipped applicator, sterile needle, or other instrument
How do you position a client with a detached retina if an ophthalmologist is not readily available? Why might this position not be tolerated by some? Pg.1316 lay client flat with head midline. Position may not be tolerated by clients with cardiorespiratory diseases.
What are some appropriate Nursing diagnosis for a client with an eye injury? Pg.1316 Impaired tissue integrity: ocular, Acute pain, Anxiety, Ineffective tissue perfusion: retinal
During the implementation process how will the RN Reduce the risk for impaired vision? Pg.1316-1317 Assess vision with & w/o corrective lenses upon initial assessment, Inspect eye carefully, burn/foreign body present admin anesthetic drops, Remove any loose foreign bodies, rest/stabilize for severe injury
After an injury what topic would the RN discuss with the client & caregivers? Pg.1317 Prescribed meds & possible adverse effects, strategies to prevent further trauma, Application of eye pad/shield, Avoid activities that increase IOP, Importance of activity restriction
What are the interventions for retinal detachment? Pg.1317 Notify physician & ophthalmologist immediately, Lie pt flat & turn head to affected side, Maintain calm environment, Reassure pt in most cases detachments can be treated, explain the procedure thoroughly, Allow family/friends to remain with pt
During the evaluation phase for a client with an eye injury, what would be considered a successful resolution? Pg.1317 Client maintains optimal vision following injury, Experiences no loss of vision as result of preventable complications, Reports pain management to acceptable levels
Created by: Studying_Nurse