AC 2 Exam 3 Flashcards
What are some risk factors for cataracts?
Exposure to the sun and UVB rays
Long-term corticosteroid meds
Increased age
Smoking and alcohol
Obesity
DM, HLD, HTN
Trauma to the eye or hx of eye surgery
Caucasian race
What are some vision changes with cataracts?
Often bilateral, painless and slow onset of blurry vision
Sensitive to glare
Halos around objects
Loss of acuity
Reading and night driving difficulty
Decreased color perception
What’s the most common cause of adult CURABLE blindness?
Cataract
Cataract is characterized with
Clouding or opacity of lens due to structural changes in proteins, which leads to gradual loss of vision
Pre-op care for cataract surgery includes
NPO, void, measures to decrease IOP, eyedrops to dilate pupil, consents.
May clip eyelashes
Post-op care for cataract surgery includes
Measures to decrease IOP
Eyedrops to constrict pupil
Antibiotics
Anti-inflammatory
Minimum light
What’s the most important cataract post-op care?
Pressure management (IOP)
What are some complications following cataract surgery that require immediate physician notice?
Infection (drainage)
Wound dehiscence (poor IOP control)
Hemorrhage
Severe, acute, unrelieved pain
Uncontrolled, elevated IOP
Excessive tearing
Decline in visual acuity
Sparks, flashes, floaters
Excessive coughing
Why is IOP management so important following cataract surgery?
Because the incision site can burst. We don’t want that.
What are some measures to decrease IOP?
HOB at least 30, lying on back or unoperated side, monitor for N/V
How long do post-cataract surgery patients have to wear eye shield at night?
2-3 weeks
What is one medication that we need to give to eye surgery patients?
Stool softeners (no straining)
What is the leading cause of IRREVERSIBLE blindness?
Glaucoma
How are glaucoma and IOP related?
Increased IOP causes optic nerve damage, leading to glaucoma
What is the recommended schedule for glaucoma screening?
Screening should start at 40
What is glaucoma called a “thief in the night?”
Because there are no noticeable early symptoms
How is glaucoma diagnosed?
Measure IOP and visual acuity
What’s the relation between the aqueous outflow system and glaucoma?
The aqueous outflow system is obstructed, causing increased IOP, leading to optic nerve damage from all those pressure.
What are some ophthalmic medications used to treat glaucoma?
Beta blockers and cholinergics. They both control IOP.
What is the purpose of using ophthalmic agents for glaucoma?
To control IOP; we can’t treat/cure glaucoma, but can control IOP
How does beta blocker help decrease IOP in glaucoma?
It decreases production of aqueous humor, decreasing the IOP.
Patients with what condition should not use beta blockers?
Asthma and CHF. Beta blockers can also cause bradycardia
How does cholinergics help with glaucoma?
Ex. Pilocarpine; it constricts pupils, which opens canal and increases flow of aqueous fluid, decreasing IOP.
Why does glaucoma need to be diagnosed early?
Because it is irreversible. permanent blindness.
What needs to happen if a patient with glaucoma gets admitted to the hospital but forgets to bring their glaucoma medications at home?
We need to get those meds somehow to prevent them from going blind.
How long should we wait if the patient has more than one eye drop to be administered?
5 minutes
How can we prevent systemic absorption of eye drops?
Put punctal pressure
What does AMD/ARMD stand for?
Age-related macular degeneration
What causes macular degeneration?
Decreased blood supply, waste products, tissue atrophy, nutrition, and systemic disease
Why is the macula/retina the most important part of the eye?
Because it contains fovea where visual acuity is highest
What is the nutritional risk factor for ARMD?
Lack of dietary intake of antioxidants and zinc
What are some foods that are high in antioxidants?
Carrots, fruits, veggies, whole grains
What supplements should patients with ARMD take to delay progression? And how often?
Zinc oxide 80 mgm
Cupric oxide 2 mg
Beta carotene 15 mgm
Vitamin C 500 mgm
Vitamin E 400 IU
Divided doses twice a day
What are some symptoms of ARMD?
Blurred vision, center of vision dark, develop central loss of vision, glasses don’t help
What are some s/s of detached retina?
Sudden appearance of many floaters
Flashes of light in one or both eyes
Blurred vision
Gradually reduced peripheral vision
Curtain-like shadow over your visual field
What are some nursing cares for retina detachment patients?
Evaluate their functional ability; make sure they can do their ADLs and IADLs, read, drive, safety, prepare food, recreational and leisure activities, etc.
In what position should patients with gas bubble need to be in?
Face down so the bubble can hold the detached retina in place until it reattaches.
What are some drugs that can cause hearing loss?
Aminoglycoside antibiotics (-mycin)
Antineoplastics (chemo meds) (cisplatinum)
Loop diuretics (furosemide)
Propranolol (inderal)
ASA and NSAIDS
How should you communicate with an elder with hearing loss?
Speak clearly, slow, stand in front of them so they can read your lips. Make sure they have their hearing aids on if they have one.
What is the proper way to do hearing aid care?
Remove and clean at bedtime
Don’t use alcohol or harsh soaps
Use damp cotton pad/cloth with water/saline
Carefully remove cerumen
Disengage battery
Store in safe place
COPD includes what 3 diseases?
Emphysema, chronic bronchitis, asthma
What is the patho behind expiratory wheeze in asthma?
Due to inflammation and secretions, air is relatively easier to get in but hard to be out
What are the 4 categories of asthma?
Mild intermittent (symptoms < x2/week)
Mild persistent (> x2/week but not daily)
Moderate persistent (daily with exacerbations x2/week)
Severe persistent (continuous with frequent exacerbations that limit physical activity and QOL)
What is the goal of asthma symptom management in the sense of using the rescue inhaler?
Usage < 2/week
What are some nursing interventions for asthma?
Decrease risk of exposures, sit them up in high fowlers, O2 as ordered, monitor cardiac rate and rhythm during attack, maintain calm and reassuring demeanor, provide rest periods for older adult clients with dyspnea, encourage prompt medical attention for infections, encourage appropriate vaccinations
What is status asthmaticus?
A life-threatening episode of airway obstruction that is often unresponsive to common treatment
What are some s/s of status asthmaticus?
Extreme wheezing, labored breathing, use of accessory muscles, distended neck veins, risk for respiratory failure and cardiac arrest
What are some educational points for asthma patients?
Drink plenty of fluid (adequate hydration, thin secretion)
Take prednisone with food
Use anti-inflammatory med regularly to prevent asthma attacks
Use good mouth care (risk of infection and inhaled steroids)
Do not stop anti-inflammatory meds abruptly