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Chapter48+49

Assessment of eyes and vision

QuestionAnswer
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