class 6 the eye

Question 1

what is cataracts

Answer 1

-opacity of the lens of the eye, diminished vision
-decrease in amount of light that reaches
-impairment depends location & density of opacity

Question 2

what is cortical cataracts

Answer 2

-slower progression, less severe diminishing of vision

Question 3

what is nuclear cataracts

Answer 3

progressive, yellowing & hardening of the eye
-usually ages 70+ (dehydration)

Question 4

what is posterior subcapsular cataracts

Answer 4

central vision loss->progresses to blindness

Question 5

pathophysiology of cataracts

Answer 5

-aging causes loss H2O & inc density lens
-compaction of lens fibers reduces H2O content lens
-proteins precipitate & form crystals
-lens less transparent over time

Question 6

etiology of cataracts: age

Answer 6

age: 65+ inc risk

Question 7

etiology of cataracts: comorbities

Answer 7

-comorbities: diabetes, lipid/renal/musculoskeletal disorder inc risk

Question 8

etiology of cataracts: physical factors

Answer 8

-physical:UV light, dehydration trauma

Question 9

etiology of cataracts: occular conditions

Answer 9

retinitis, retinal surgery, eye infection prone

Question 10

etiology of cataracts: toxic factors

Answer 10

smoking, long term steroid use, copper, silver, mercury

Question 11

etiology of cataracts: congenital factors

Answer 11

prev/in utero polio, measles, hepatitis

Question 12

signs and symptoms of cataracts

Answer 12

seeing halo around lights
-decreased visual activity
-increased sensitivity glare
-double or hazy vision
-decreased colour vision
-abscent red reflex
-NO PAIN****

Question 13

Surgical treatments for cataracts

Answer 13

topical and/or regional anesthesia and/or IV sedation
replacement of lens with artificial lens
-only surgical interventions can get rid of cataracts

Question 14

post-op care/teaching for cataracts surgery

Answer 14

-report sudden sharp pain, bleeding, discharge, edema, decreased vision s/s of retinal detachment
-eye drop teaching (abx, steroids->may be painful)
-avoid IOP & prevent injury (not straining, bending, lifting)
-eye patch post op
-no blood thinners

Question 15

characteristics of glaucoma

Answer 15

-abnormal pressure within eyeball
-leading to optic nerve atrophy
-eventual blindness
-imbalance between production & drainage of aqueous fluid; anterior chamber congested & IOP rises
-individual is unaware until there is significant vision loss “silent thief”

Question 16

pathophysio of glaucoma

Answer 16

aqueous production & drainage are not in balance
-aqueous overflow block=inc IOP
-inc IOP causes irreversible emchanical pr ischemic damage

Question 17

glaucoma risk factors

Answer 17

family hx
-40+
-diabetes (x2 chances esp for open-angle)
-cardiovascular disease
-migraine hx
-myopia
-eye trauma
-ethicity
-prolonged use of corticosteroids

Question 18

what is open-angle glaucoma (POAG)

Answer 18

-most common
-usually bilateral & asymptomatic early stages
-structures in drainage system degenerate & exit channels for aqueous fluid blocked
-22-32 degree angle

Question 19

s&s of open angle glaucoma

Answer 19

-inc IOP
-bilateral, gradual, painless onset
-mild aching
-headache
-coloured halos around lights
-reduced peripheral vision & acuity
-opthalmoscopic exam
-optic nerve pale & indented, cloudy aqueous humour, dilated nonreactive pupil

Question 20

angle-closure glaucoma (pupillary block)

Answer 20

-occurs among people with anatomically narrowed angle at junction where iris meets cornea
-when iris protrudes into anterior chamber, aqueous fluid blocked
-occurs suddenly (emergency)
-blindness if not tx
>50 degree angle

Question 21

s&s of angle-closure glaucoma

Answer 21

-occur suddenly
-sudden excruciating pain around eyes
-headache/brow ache
-n&v
-coloured halos around lights
-blurred vision
-occular reddness
-may cause frosted cornea

Question 22

diagnostic tests for glaucoma

Answer 22

-tonometry to assess IOP
-gonioscopy to assess the angle of the anterior chamber
-perimetry to assess vision loss

Question 23

medical management for glaucoma

Answer 23

-early detection & lifelong tx prevent blindless
-medications

Question 24

medications used for tx glaucoma

Answer 24

-miotics (cholinergics) constrict pupil (pilocarpine gtts)
-alpha & beta blockers reduce aqueous humor (propine, timolol gtts)
-osmotic agents (emergency) reduce IOP (IV mannitol)

Question 25

surgical management for glaucoma

Answer 25

-laser trabeculoplasty (inc drainage)
-laser iridectomy
-filtering procedures
-drainage implants

Question 26

nursing care for glaucoma

Answer 26

-do not lie on operative side
-assess IOP and pain
-assist ADL if needed
-stress compliance to meds
-teach gtt administration
-encourage family to be assessed

Question 27

what is macular degeneration

Answer 27

-common in smokers
-deterioration of the macula, area of central vision
- non- exudative vs exudative

Question 28

what is non-exudative macular degeneration

Answer 28

-age related/dry
-characterized by sclerosing of retinal capillaries=ischemia/necrosis of macular cells

Question 29

what is exudative macular degeneration

Answer 29

-presence of drainage (wet)
-rod and cone photoreceptors die - dec central vision
-exudative degeneration = sudden dec in vision

Question 30

tx and nursing management for macular degeneration

Answer 30

-maximize remaining vision/slow the process
-laser therapy limits damage
-education