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) |