Ch 42 Flashcards
Emmetropia
Normal vision
Light rays are bent to focus images precisely on the retina
Myopia
Nearsightedness
People may hold things close to their eyes to see them well
Hyperopia
Farsightedness. People see objects far away better than objects that are close
Light doesn’t get to the retina in this condition
Myopia
Light goes beyond the retina in this condition
Hyperopia
Is associated with aging & results in difficulty with near vision
Presbyopia
A visual distortion caused by an irregularly shaped cornea
Astigmatism
People with ___ errors experience blurred vision. Some seek help for recurrent headaches caused by straining to see clearly
Refractive
Refractive errors are detected with the __ & __
Snellen & jaeger charts
___ usually are corrected with eyeglasses or contact lenses. The lenses bend light rays to compensate for the __
Refractive error x2
Definitions related to low vision refer to the ___
Best corrected visual acuity (BCVA)
Legal term for a BCVA of 20/200 or less even with corrective lenses
Blindness
___ is used to describe BCVA between 20/60 and 20/200 in the better eye with the use of glasses
Visually impaired
BCVA 20/400 to no light perception
Severe loss of visual field, also referred to as blind
___ can be congenital or caused by injury: a high fever that damages the optic nerve
Blindness
Diplopia
Double vision
Described as feeling gritty. There is tearing & the pt usually tries to relieve discomfort by squeezing eyelids closed to help control eye movement & reduce light from entering eye.
Eye trauma
During an eye injury, If the bony orbit is fractured, the eyes may appear __, and the pt has __
Asymmetrical
Diplopia (double vision)
Staining the surface with fluorescein dye identifies a minute foreign body or abrasion to the cornea
Diagnostic finding for eye trauma
Two types of ocular trauma that require quick responses
Chemical burns & foreign objects in the eye
Inflammation of the conjunctiva. Commonly called pinkeye because the inflammation of the subconjunctival blood vessels are more visible causing a reddish or pink appearance
Conjunctivitis
Results from a bacterial, viral or rickettsial infection and can affect one or both eyes
Conjunctivitis
In conjunctivitis the microorganism most often are introduced by ___ transmission, ___ with sources on the fingers, a contaminated face towel or washcloth
Air transmission
Direct contact
Untreated conjunctivitis, especially when caused by ___ and __ can lead to blindness
Neisseria gonorrhoeae
Chlamydia trachomatis
Clients may complain of photophobia in this condition
Conjunctivitis
In conjunctivitis a __ can identify the causative microorganism
C&S
Medical management for conjunctivitis
Warm soaks
Inflammation of the uveal tract, which consists of the iris, ciliary, body, and choroid
Uveitis
The causes of uveitis is not always identified, but one of the following may be the cause:
Eye injury or surgery
Infections or cancers such as lymphoma
Although the disorder occurs randomly, it is detected with some frequency among clients with juvenile RA, ankylosing spondylitis, TB and toxoplasmosis
Uveitis
Inflammation of the cornea
Keratitis
An erosion in the corneal tissue
Corneal ulcer
Treatment for keratitis and corneal ulcer is begun promptly to avoid ___
PERMANENT loss of vision
Keratitis is treated with ___, __ (drugs that dilate the pupil) and ___
Topical anesthetics
Mydriatics
Local and systemic antibiotics
Dark glasses are recommended to relieve photophobia. It is sometimes recommended that pts patch the effected eye
Keratitis
Treatment in the early stages of a __ is the same as for keratitis
Corneal ulcer
Inflammation of the lid margins, where eyelashes grow. It generally affects both eyes
Blepharitis
In blepharitis, the lid margins appear __. ___ cling to the eyelashes and are readily visible about the lids. __ may be missing. ___ may be present. __ eyelids
Inflamed
Patchy flakes
Eyelashes
Red swollen
Inflammation and infection of Zeis or Moll glands (types of oil glands at the edge of the eyelid)
Hordeolum (sty)
Sties are common in pts with
Diabetes because their glucose rich blood readily supports microbial growth
__ is the most common causative pathogen
Staph aureus
A sty appears as a __, __, ___, in the internal or external tissue of the eyelid
Tender
Swollen
Red pustule
Treatment of a sty includes __ of the area and a __. Severe cases require __ & __
Warm soaks
Topical antibiotics
Incision & drainage
The breakdown of or damage to the macula, the point in the retina where light rays converge for the most acute perception. Usually occurs in both eyes, but the vision in one eye tends to deteriorate more rapidly
Macular degeneration
Can’t see bullseye; they see peripheral
Macular degeneration
__ tends to affect older adults & is the leading cause of vision loss in clients older than 50
Age related macular disease (AMD)
__ does not have any treatment or cure
Dry AMD
When the macula becomes irreparably damaged, clients __
Compare their vision to a target in which the bulls eye are of the image is absent
In __ macular degeneration, the client experience distortion of vision, such as straight lines appearing wavy or letters or words looking broken. A clients perception of color may also be diminished
Wet
Med management for AMD
Amsler grid
Angiogenisis inhibitors
What is the use of angiogenesis inhibitors
Used to inhibit the development and progression of abnormal blood vessel formation
Group of eye disorders caused by an imbalance between the production of drainage and aqueous fluid
Glaucoma
Glaucoma =
Increased IOP w progressive loss of peripheral vision
In glaucoma, when the drainage system is obstructed, the __ chamber becomes congested with fluid and IOP rises. Optic nerve damage can occur as a result of the increased IOP. Although there is ___, the disease symptoms can be controlled, and optic nerve damage can be prevented
Anterior
Not a cure
__ is the leading cause of blindness for people over 60 yrs old in the United States
Glaucoma
Risk factors for being diagnosed with glaucoma include:
Being over 60
Being black or Hispanic
Having a family history of glaucoma
Having conditions such as myopia(nearsightedness)
Hypertension
In normal eyes, the rate of secretion equals the rate of outflow and the IOP is between __ & __
10 & 21
For clients with glaucoma, the ___ is impeded from flowing out properly
Aqueous humor
__: as the IOP increases, it causes edema if the cornea, atrophy of nerve fibers in the peripheral areas of the retina and degeneration of the optic nerve. This type develops painlessly, and visual changes occur slowly. When discovered, the ocular damage can already be severe
Open-angle glaucoma
(Painless, tunnel vision, can see halo around light)
This glaucoma is less common, but the onset is very sudden, and immediate recognition and treatment are required to prevent blindness
Angle closure glaucoma
This type of glaucoma is an emergency and a delay in treatment may result in partial or total loss of vision in the affected eye
Angle-closure glaucoma
Clients with __ glaucoma may be asymptomatic and the condition may not be discovered until the client has a routine ophthalmology exam. When symptoms do occur, they are often ignored because they are not dramatic. May complain of eye discomfort, occasional and temporary blurred vision, the appearance of halos around lights, reduced peripheral vision, and the feeling that their eyeglass prescription needs to be changed
Open angle glaucoma
When the anterior chamber of the eye of a client with ___ glaucoma is inspected with a penlight or slit lamp, the angle between the iris and cornea is narrow. Tonometry reveals elevated IOP and reduced aqueous outflow. The visual field exam determines a loss of peripheral vision
Angle closure glaucoma
Miotics =
Glaucoma
Miotics such as __ & __ constrict the pupil. These meds pull the iris away from the drainage channel so the aqueous fluid can escape
Carbachol (miostat)
Pilocarpine (Pilocar)
Purpose of Miotics
Construction the pupils. These meds pull the iris away from the drainage channels so the aqueous fluid can escape
__ (drugs that dilate the pupil) must NEVER be administered to clients with glaucoma. Consult the provider if drugs with anticholinergic properties (atropine sulfate) are prescribed because dilation of pupil can further obstruct drainage, raise IOP & damage whatever vision remains
Mydriatics
A condition in which the lens of the eye becomes opaque. One or both eyes may be affected. If both are affected each eye may progress differently
Cataracts
Cataracts form on the __, which is behind the __ and the __. The normal lens focuses light that passes into the eye, producing distinct and sharp images on the retina
Lens
Iris & pupil
In __ a clear sharp image is impeded, and vision becomes more blurred
Cataracts
__ occurs as a result of the again process or are congenitally acquired, caused by injury to the lens, or secondary to other eye disease
Cataracts
One of the earliest symptoms of cataracts
Halo around lights
In cataracts, vision is restored with one of three methods: ___ implants (most common, ___ or a ___
IOL implant
Corrective glasses
A contact lens
Involves insertion of an intraocular lens at the time of cataract surgery and is the most common method for improving vision
Intraocular lens implant
In cataracts, a __ or __ is implanted and reduces the need for corrective glasses.
Monofocal (single vision) or
Multifocal lens
Where are IOLs implanted
Behind the iris
Complication of cataract surgery
Infection
Cataract surgery is usually performed in an __ setting. The client wears a protective eye shield for __ after the procedure and then at __ and during __ for about a __. Clients need to wear __ when in bright light for at least __. __, used several times a day a prescribed for at least ___ to prevent infection
Outpatient setting
24 hrs after procedure
Night
Naps
A week
Sunglasses
1 week
Eye drops
1 week
After cataract surgery, clients need to notify the eye surgeon if they experience new __ in their vision or increased __, __, or __. These are symptoms associated with retinal detachment, a complication of cataract surgery
Floaters
Redness
Flashing lights
Change in vision
Symptoms of retinal detachment, a complication of cataract surgery
New floaters, increased redness, flashing lights or change in vision
The sensory layer becomes separated from the pigmented layer of the retina
Retinal detachment *NO PAIN
___ may fallow a sudden blow, penetrating injury, or eye surgery
Retinal detachment
In retinal detachment, most clients notice __ in their vision or __. They describe the sensation of a curtain being drawn over their field of vision, and they often see flashes of light
Definite gaps
Blind spots
In retinal detachment, complete loss of vision may occur in the affected eye. The condition is not __, but clients are usually extremely apprehensive.
NOT PAINFUL
In ___, when the retina is inspected with an ophthalmoscope, the tissue appears gray in the detached area
Retinal detachment
In retinal detachment, when the retina is inspected with an ophthalmoscope, the tissue appears __ in the __ area
Gray
Detached
Indenting of the surface of the eye
Scleral buckling
* seen in retinal detachment
A surgical procedure in which a tiny synthetic band is attached outside the eyeball to lightly push the wall of the eye against the detached retina
Scleral buckling
* seen in retinal detachment
“Welds” the retina back in place
Scleral buckling
Sjögren’s syndrome-
Decreased saliva production-
Dry eyes; dry mouth
Maslow (airway!!)
If surgery is performed in retinal detachment, the client is kept __ with position ___ for several days. The head may be ___. The client is not __ or __ without orders. If an air bubble is instilled to promote contact between the retina and sclera, the client is positioned with the face __ to the floor so that the bubble floats to the posterior of the eye. If floaters are still seen after the eye heals, the nurse can tell the client that they eventually become absorbed or settled to the inferior floor of the eye, out of the line of vision.
On bed rest
Position restrictions
Immobilized
Turned or moved
Parallel
In retinal detachment: ____ so floats to ___ eye
Prone
Posterior
In retinal detachment surgery, ___ so floats to ___ of eye
Prone
Posterior
When __ is performed, a metal or plastic ball is buried in the capsule of connective tissue from which the eyeball is removed
Enucleation
Enucleation =
Pressure dressing applied to control hemorrhage, a complication of Enucleation
After tissues have healed, during Enucleation, a shell-shaped prosthesis is placed over the buried ball. The shell is painted to match the clients remaining eye. THE __ is the ONLY PORTION THAT IS REMOVED FOR ___
Shell
Cleaning
After Enucleation, the nurse monitors for S&S of _ or __. The client is usually allowed out of the __ the day after surgery. When healing is complete in about __ to __ weeks, the nurse teacher the client how to insert and remove the prosthetic shell
Bleeding or infection
Bed
1-4 weeks
