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Chapter48+49
Assessment of eyes and vision
| Question | Answer |
|---|---|
| Iris | Colored portion of eye |
| Sclera | White external layer of eye |
| Pupil | Center opening of the iris |
| Orbit | Bony socket of the skull that protects |
| Uvea | Middle layer; consist of Choroid, the ciliary body, and iris |
| What controls pupil size? | The muscles of the iris |
| The innermost layer of eye containing rods and cones... | Retina- Transmit impulses to optic nerve |
| Work at low light levels and provide peripheral vision... | Rods |
| Active at bright light levels and provide color and central vison... | Cones |
| Area at the inside back of eye; can be seen w/ophthalmoscope... | Optic Fundus |
| where optic nerve enters and exits | Optic Disk |
| "Blind Spot" bc contains no photoreceptor cells... | Optic Disk |
| Where vision is most acute... | Fovea Centralis |
| Connects the choroid with the iris; secretes aqueous humor... | Ciliary body |
| Light waves pass through these structures on the way to the retina... | Cornea, aqueous humor, lens, and vitreous humor |
| These structure are the eyes refracting media... | Cornea, aqueous humor, lens, and vitreous humor |
| Clear layer that forms the external coat on the front of the eyes... | Cornea |
| A clear watery fluid that fills the anterior and posterior chambers of the eye... | Aqueous humor |
| Drains through the canal of Schlemm into the blood to maintain a balanced intraocular pressure (IOP) (pressure w/in eye)... | Aqueous humor |
| Circular, convex structure that lies behind the iris and in front of the vitreous body... | Lens |
| This changes to focus on objects near or far | Lens |
| A lens that has lost its transparency | Cataract |
| This gel transmits light and maintains eye shape... | vitreous body |
| Gel in posterior segment of eye | vitreous humor |
| Fluid in the anterior segment of eye | aqueous humor |
| Pressure on blood vessels in eye is called... | glaucoma; can cause blindness |
| Where the 2 eyelids meet at the corner | Canthus |
| the mucous membranes of the eye | conjunctivae |
| Tears are produced by... | lacrimal gland; upper outer part of orbit |
| Tears drain from.. | punctum |
| A dim room... | peripheral vision kicks in proportion with in the retina. |
| Diffusion of fluids | doesn't excrete as well = dry eyes |
| Muscles coordinated eye movement ensures... | the retina of each eye receives image at same time. |
| The muscles around the eye are innervated by | Cranial nerves: oculomotor, trochlear, abducens |
| Nerve of sight... connecting the optic disk to the brain... | Optic nerve (CN II) |
| The perfect refraction of the eye | Emmetropia****** |
| the eye does not refract light enough (farsightedness) | Hyperopia******* |
| the eye overrefracts or overbends the light (nearsightedness) | Myopia******* |
| Refractive error caused by unevenly curved surfaces on or in the eye, especially cornea | Astigmatism******* |
| Important to know before examining patients eyes | If they have had any medication |
| Pupillary *constriction* | Miosis***** |
| Pupillary *dilation* | Mydrasis***** |
| Process of maintaining a clear visual image when the gaze is shifted to a near object | Accommodation****** |
| Lower eyelid relaxes and falls away from eye | ectropion |
| An opaque, bluish white ring within the outer edge of the cornea, caused by fat deposits | arcus senilis; does not affect vision |
| Age related: cornea | flattens, which blurs vison |
| What causes eye to develop yellowish tinge? | Fatty deposits ; aging process |
| Age related: sclera | The sclera's thinning ; bluish |
| Age related: Iris | difficulty adapting to dark ; decreased ability to dilate (so a small pupil) |
| Age related: Appearance of eye | appears "sunken"; doesn't indicate dehydration |
| Age related: Ocular muscles | Strength reduces; difficult to maintain upward gaze or single image. |
| Age related: Lens | Elasticity lost. *increasing the near point of vision (making near point of best vision farther away Lens hardens, compacts, forms cataracts |
| Age related: Pupil | smaller; harder to adapt to darkness |
| Age related: Color vision | Can't tell diff. btw greens, blues, violets |
| Age related: Tears | Production reduced = dry eyes, discomfort. AT RISK for corneal damage/ or infection |
| Age related: near point of vision | Presbyopia (40+) |
| Age related: IOP | Increases |
| Who should have exam yearly? | those with diabetes, hypertension, refraction error, adults 40+ |
| Retinal detachment is more common... | In men |
| Dry-eye more common in... | Women |
| Chronic exposure to UV light or infrared may cause | Photophobia, and cataract formation |
| Conditions affecting eyes list | Diabetes, hypertension, lupus, sarcoidosis, thyroid dysfunction, AIDS, cardiac disease, multiple sclerosis, pregnancy |
| Drugs affecting eyes list | Antihistamines, Decongestants, Antibiotics, Opioids, Anticholinergics, Cholinergic agonist, Sympathomimetics, Birth control, Chemo, corticosteriods, beta blockers, carboic anhydrase inhibitors |
| Drugs that increase IOP | Antihistamines, decongestants |
| Affects of eye drops: | pruritus (itching), foreign body sensation, redness, tearing, photophobia, cataracts/glaucoma |
| Eye dryness, keratomalacia (dry cornea), blindness | Vit. A deficiency |
| Helpful for retinal function: | lutein, beta carotene. Red orange green veg + fruit |
| Eye emergency symptoms | Sudden/persistent vision loss in 48 hours, trauma, foreign body in eye, sudden pain/redness |
| Inspection | look for head tilting, squinting. double vision = tilting, or closing one eye. |
| A protrusion of the eye | Exophthalmos |
| Sunken appearance of eye | Enopthalmos |
| Drooping of eyelids | Ptosis |
| Normal noticeable difference of pupils | anisocoria |
| Constriction of both pupils when light shown | consensual response |
| Pupils that fail to constrict | called nonreactive or fixed |
| Patients with near vision- eye test | rosenbaum or jaeger card, 14 in from face |
| Determine degree of peripheral vision | Visual field testing |
| Testing extraocular muscle function | Assessed using corneal light reflex and six cardinal positions of gaze. |
| An involuntary and rapid twitching of the eyeball | Nystagmus |
| Test for color vision | Ishihara chart (dots picture) |
| To diagnose infections: | Cultures+Smears of corneal or conjunctival swabs/scrapings (of inflamed area) |
| A passageway that extends completely around the eye that permits fluid to drain to maintain IOC | Canal of Schlemm |
| Major artery supplying the structures of the eye | Opthmalic artery and veins |
| Measures client's distance and near vision | visual acuity test |
| Examiner and the client sit facing each other | Confrontational test (visual field) |
| Near vision: diff reading w/out glasses | Use Rosenbaum/Jaeger card |
| Assessed using the corneal light reflex and 6 cardinal positions of gaze | Extraocular muscle function (3,4,5 nerves) |
| Determines alignment of eyes | Corneal light reflex |
| An involutary and rapid twitching of the eyeball | Nystagmus (normal for far lateral gaze) |
| Color vision tested | Ishihara chart |
| For diagnosing eye infection | Culture smear scraping |
| Detects tumor, look at bony structure/muscles, use of DYE (2sets axil+coronal image) | Computed Tomography (CT) |
| Replaces CT, looks at nerves, no metal | MRI |
| To diff. btw intraoclar tumor from hemmorrage. (esp in choroid layer) | Radioisotope Scanning |
| Diagnose trauma, tumor, protosis, DETACHMENTS, cloudy cornea/lens/lenght | Ultrasonography (high freq sound waves) |
| MAGNIFIES anterior eye Check for abnorm in cornea/lens/anterior vitreous humor/presence of cells in aqueous humor | Slit-Lamp Exam |
| For corneal trauma, or contacts, abrasions | Corneal staining |
| Measure IOP (40+, hx glaucoma- q 1/2 yrs) Standard for diagnosing glaucoma | Tonometry; quick, local anesthesia given |
| View inter/external structures. avoid w/confused. Fundus in dark room. Red reflex should be seen. | Ophthalmoscopy |
| Provides image of circulation (yellow/green skin pee) | Fluorescein angiography |
| Graphing retinas response to light. Check blood vessels for changes caused by drugs or diseases. *response of retina to light* | Electrorentiongraphy |
| Inflam. of eyelid edges, dry/burning/itchy/red/seborhea | Blepharitis |
| Inward eyelids, need surgery | ENtropion |
| Outward eyelids = tearing, sagging lower, need surgery | ECtropion |
| Stye, infection of sweat gland; caused by staphylococcus aureus/epidermidis, strep | hordeolum |
| Inflammation of a sebaceous gland on inside eyelid (painless swelling) | chalazion *not common* |
| Dry-eye syndrome | Keratoconjunctivitis sicca |
| Causes of dry-eye syndrome | Decreased tear production; antihistamines; beta-adrenergic blocking agents, or anticholinergic drugs |
| Diseases associated with dry-eye syndrome | rheumatoid arthritis, leukemia, sarcoidosis, and multiple sclerosis. INJURY to cranial nerve VII |
| small well-defined area- red under conjunctiva | hemorrhage, pain-less resolves 14 days |
| inflammation or infection from allergies or irritants | conjunctivitis; not contagious BACTERIAL conjunct. is contagioulos |
| Caused by staphylococcus aureus, haemophilus influenzae, or pseudomonas aeruginoa | pink eye |
| Bilateral scarring from conjunctivitis caused by chlamydia trachomatis | Trachoma; chief cause of blindness |
| As disease progresses, eyelid turns inward- eyelashs cuz damage | trachoma |
| Antibiotics used to treat | Trachoma |
| What places patients at greatest risk for visual disturbances? | Diabetes Mellitus, hyperglycemia |
| What can you expect to see in age-related older patients eyes? | Yellowing (fatty deposits) |
| A priority nursing intervention when providing care to an older patient with vision problems | Adequate, nonglare lighting in the room |
| Performing a psychosocial assessment of a patient who has recently experienced changes in vision, the nurse should: | Ask the patient how he feels about the changes in his vision and the effectiveness of his coping methods |
| What is an appropriate expected outcome for the patient who underwent an exam of the eye using fluorescein angiography? | Drinking fluids to eliminte the dye |
| If a patient has trouble seeing upper gaze... | Decreased muscle tone *normal in old |
| All problems with this structure reduce the refracting power of the cornea | Corneal |
| Drugs that dilates pupils *dont drive | Cyclopegic |
| Periphrial vision is positioned where? | Retina |
| If patient has dilated pupils make sure... | Adequate lighting where examination takes place AND know if they have had any medications prior to exam. Find out WHY before contacting doctor |
| Near point vision increases | Presbyopia |
| Double vision could be because | of orbit muscles in aging patients. DB is a problem |
| When objects are moved away the nose | Pupils dilate NORMAL |
| Problem following finger to nose... | Problem with medial rectus muscle, paralysis will set it |
| When objects moved toward from nose | Pupils constrict NORMAL |
| Muscles work to make sure what gets one vision | retina |
| What is an app. post outcome expected for the patient who has cataract removal | Mild, itching, bloodshot appearance |
| What is an appropriate intervention after a patient receives a corneal transplant? | Avoiding straining to have bowel movement. |
| Pat. reports hx of glaucoma. What question should be ask FIRST to collect surrounding data? | How does glaucoma affect your vision? |
| Avoid what medication if taking an MAOI (bipolar/antidepressants) | Alphagan (Brimonidine) |
| For a sharp image to be focused on retina, what must be transparent and intact? | Cornea |
| Degeneration of the cornea resulting in abnormal shape | keratoconus |
| irritation or infection of cornea | keratitis |
| Deposits in the cornea | dystrophies |
| Corneal transplant | Keratoplasty; patients eye numbed so cant move or see out |
| Give patient instructions regarding orthostatic hypo-tension when person is taking ... (stand up low BP) | a beta blocker |
| When drug goes systematic it will have what kind of effect on body? | BP drops, orthostatic hypotension (stand up low BP) |
| AGent that widens the iris (cyclopegics) patient cant... | dilate, can't drive, no accommodation to light |
| Treatment of chalazion | warm compresses for 15 minutes 4x a day; ophthalmic ointment. surgery optional |
| why would patient be put on aspirin before eye surgery? | so blood wont clot; commonly given |
| Treatment for keratonconjunctivitis sicca | DRY EYE SYNDROME : artifical tears, lubricating ointment, surgery. |
| Best way to assess for cataracts? | person have blurred vision, reduced color perception, lens becomes bleak |
| Treatment for conjunctival hemorrhage | Topical antibiotics, wear GLOVES, |
| Decreases interaocular pressure | Diamox |
| FOr eye pain, nauesa/vomitting/IOP/hemmoraging | Osmogyln (ORAL gylcerin) |
| Before patient has treatment for IOP what can you teach them to keep them from injury | DO NOT LIFT ANYTHING OVER THEIR HEAD! Take stool softener Avoid tight shirt colars/ties Avoid sneeze/cough |
| Post-Op Cataract surgery, dryness/crusty (creamy/white) drainage, what to do? | Normal. But pain, vision changes, tears, photophobia, yellow/green crust NOT NORMAL |
| Alphagan (brimonidine) is for what purpose | reduce IOP. (reduce aqueous humor produc.) avoid MAOI |
| Diamox (acetazolamide) | for secondary/chronic open angle glaucoma, diuretic that reduces IOP |
| Osmitrol (mannitol) | reduce IOP, diuretic, may be thirsty dry mouth |
| Betagan (Levobunolol) | Antiglaucoma, chronic open angle, cause bradycardia, bronchospasms, |
| Cyclopegics | block acetylcholine receptors. ATROPINE (to paralyze the ciliary muscle in order to determine the true refractive error of the lens |
| Beta blockers | used for glaucoma. Less aqueous humor is produced by ciliary bodies. fluid absorbed faster. Know if patient has lung problems, diabetics should check sugar more often, check pulse often. |
| Cholinergic drugs make pupils | smaller, reduce IOP, make more room btw iris and lens |
| Lopidine (Apraclonidine) | adrenergic agent, reduce aqueous humor, dilate pupil, lower IOP, KNOW IF PATIENT IS TAKING ANTIDEPRESSANTS FROM MAOI CLASS (NARDIL OR PARNATE) WEAR DARK GLASSES IN SUN. CONTACTS ABSORB DRUG. |
| reduced outflow of aqueous humor. Cant leave eye at same rate it is produced | Primary OPEN ANGLE glaucoma |
| Sudden onset and is an emergency | Primary ANGLE CLOSURE glaucoma |
| results from other problems w/in eye, such as trauma, ocular surgeries, iritis | Secondary Glaucoma |
| results from systemic disease ie diabetes, hypertension | Associated Glaucoma |
| Appearance of halos around lights | late manifestation of primary open angle glaucoma |
| Inflammation of the iris, ciliary body, choroid | Uveitis; aching Posterior- Retinitis |
| Drug used to treat uveitis | cycloplegic drugs or steroid drops |
| deterioration of the macula (area of central vision) | macular degeneration |
| gradual blockage of the retinal capillaries, allowing retinal cells in the macula to become ischemic and necrotic. rod and cons die | DRY macular degeneration, smokers |
| Growth of new blood vessels in the macula and leak blood and fluid | WET macular degeneration (blister) |
| Photosensitizer used | macular degen. |
| the separation of the retina from the epithelium | retinal detachment |
| signs/symp of retinal detachment | painless, sudden, photopsia (bright flashes), floating dark spots. |
| **Sensation of curtain being pulled*** | retinal detachment |
| Gas or oil placed in eye... | after retinal reattachment, place patient on abdomen. affected eye up for several days |
| Is nausea and pain normal after retinal reattachment? | yes; but an INCREASE should be contact doctor |
| Patient teaching after retinal attachment; | Avoid reading, writing, close work, sewing, rapid eye movement. |
| A condition in which retinal nerve cells degenerate and the pigmented cells of the retina grow and move into sensory areas of retina | Retinitis pigmentosa (nightblindness early symptom- in childhood |
| Cures far/near/astigmatism | LASIK |
| A hemorrhage in the anterior chamber | hyphema |
| patient care with hyphema | bedrest, semi fowlers, no sudden eye movement for 3-5 days, cycloplegic eyedrops. tv/reading restricted |
| Patient with abrasion is examined with | fluorescein |
| surgical eye removal | enucleation |
| 20/200 or widest diameter of visual field is less then 20 | Legally blind |
Created by:
NurseWendy
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