Allergies, Vision loss

Question 1

Allergies drugs

Answer 1

Ocular meds, 
Inhalants
contactants
Ingestants
Injectants 

When asking a patient about allergies don’t only think about inhalants, contactant, ingetants, injectants
sometimes pt will characterized a side effect like an allergy, but never document on side effect with allergy because that drug will never been given to patient and any drug similar to that drug that was documented and inverterly may cause future medical care due to documenting improperly. Its important to document a side effect from the medication but don’t call it an allergy side effect might be GI upset, headache,

Question 2

Typical allergic responses

Answer 2

Itching
Skin rash
difficult breathing
Rapid/ weak pulse
Nausea/Vomiting

Question 3

Whats induction period

Answer 3

This is the period between the initial exposure agent that there eventually going to be allergic to and the time they had the allergic response during this induction period the body is making antibodies and at subsequent exposure it releases mast cells that break open and releases enzymes know as histamines which cause the allergic response this induction period can last minutes, hours, days , weeks, months or decades more information under pharmacy mast cell stabilizer

Question 4

Type of vision loss

Blurred VA due to refractive error

Answer 4

Blurred VA due to refractive error
Specific activity

There are types of vision loss it occurs due to refractive error, particular distance and specific activity

Question 5

Blurred VA due to organic disease

Answer 5

Usually all distances activities

Blurred vision is due to a disease usually occurs at all distances and all activities

Question 6

Loss of central vision

Answer 6

Va may be better in dim illumination
VA usually poor
Sudden onset: usually optic nerve or macula origin

Central vision loss pt may see better in dim illumination because the pupil dialates and they may be able to see around whatever central pathology is there the vision will still be poor

Question 7

Disorted vision

Answer 7

Macular disorders
high myopes or thick glasses
object may appear minimized and fuzzy with curved edges

Question 8

Night blindess

Answer 8

Can be symptom of RP or vitamin a deficiency

Night blindeness can be a symptom of retinitis pigmentosa which is present in one of 4000 people or vitamin A deficiency

Question 9

Transient Visual loss

Answer 9

one of both eyes
second to minutes
may be symptom of papilledema due to ICP, CAD, carotid insufficiency

Transisent visual loss can be a sign of swelling of optic nerve due to increase intracranial pressure, carotid artery increase intracranial pressure, carotid artery disease or carotid insufficiency always find out vision loss is one eye or both because that helps isolate the cause find out how long it last

Question 10

Inability to see to the left or right

Answer 10

Disability with daily tasks or ambulation
suspect neuro origin on apposite side of VF loss

If the pt cant see to the left or to the right suspect neurologic origin of the opposite side of the visual field loss

Question 11

Ascending Veil

Answer 11

Dark shadow arising from inferior VF
frequetnly sign of superior RD (retinal detachment)

Ascending veil is frequency a sign of superior retinal detachment

Question 12

Diplopia

Answer 12

Which eye or both?
Does it go away when you cover one eye or the other (monocular or binocular)

very important question to ask is monocular or binocular if you cover one eye or the other does the double vision go away, if the double vision goes away when covering one eye thats is Binocular Diplopia meaning they can see double when both eyes are open, it is cause by misalingment of the eyes, monocular diplopia is when pt covers one eye or the other and they still see double in the uncovered eye it usually cause by uncorrected refractor error or imperfection of the eye such as corneal opacification, cataract or monocular disorder.

Question 13

Are the images verticle, horizontal or oblique to one another,

Answer 13

ask if the images are verticle, horizontal on top of each other , oblique?

Question 14

Is it true double or an image and a ghost image?

Answer 14

ask the pt if the image is on top of another image, ghost image, ask if its a real double image they’re seeing

Question 15

Double Vision With glasses without glasses? or both?

Answer 15

ask if with glasses, without or both if the double vision goes away with glasses or thats not pathologic that uncorrected refractor error

Question 16

double vision at distance and at near

Answer 16

Find out if the double vision is at near distance or both.

Question 17

Headache

Answer 17

Where is it?
Do you ever wake up with it?
with or without glasses or both?
what tasks are you performing?
when you get them?
any visual disturbance?
nausea, vomiting?

Particular types of headaches depend on location always ask where headaches is located ask if they ever wake up with it if they wake up with headaches is not an ocular origin, is it with glasses or without glasses or both, any particular activity they’re performing when they get the headache, any visual disturbance, do they feel ok nausea or vomiting?

Question 18

Visual disturbance

Answer 18

Any appararant caused
Did you feel unusual before, during or after?
Is it one eye or both?
headache?
duration?
nausea, vomiting?

when pt has visual disturbance its important to ask patient if its one eye or both because if its both eyes its probably is not their eyes its their brain it its one eye its usually the eye

ask if they feel unusual before or during or after, do they get a headache anything in particular that triggers visual disturbances, how long does it last and if they have any nasuea or vomiting associated with visual disturbance.

Question 19

Trauma

7 questions

Answer 19

what did they hit?
did they have glasses on?
Loss of consciousness? LOC
Did they seek other medical care of have imaging done 
(ie, ct, MRI, )
change in vision
flashes or floaters
work or auto related?

When pt report when they have a trauma ask what they hit or if they had their glasses on did they seek any medical care did the have imaging studies done if so get a copy of report before doctor sees pt, did the pt loose consciousness, did they have any change in vision any floaters, or flashes did it happen at work or car accident

Question 20

Children

Answer 20

eyes drifting or turning?
Head tilt or turn?
Do you think s/he sees well?
How is s/he doing in school?
Who is the pediatrician?

When the child has vision complaints you want to find out if they had any head tilt or turn, have the parents notice any eye drifting or turning, do they seem to see well, how are they doing in school who is their pediatrician.