Exam 4: Assessment and Care of Patients with Eye and Vision problems (10 questions) Flashcards
Age related Eye structural changes
- Decreased eye muscle tone
- Ectropion and dry eye
- Arcus senilis
Caused by fat deposits - Corneal changes
Flattens, irregular surface of curve - Changes in color of sclera
- Less ability to dilate pupil
- More light needed for reading
Age related Eye functional changes
- Yellowing of lens
- Accommodation gradually lost
- Presbyopia
Near point increases - Far point decreases
- Color perception decreases
- IOP ( intraocular pressure) increases
Eye Diagnostic testing: Imaging assessment
CT, MRI, radioisotope scanning, ultrasonography
Eye Diagnostic testing: Slit-lamp examination
Magnifies the anterior structures
Eye Diagnostic testing: Corneal staining
Checks for corneal trauma, abrasions, ulcers
Eye Diagnostic testing: Tonometry
Measures IOP (intraocular pressure)
Eye Diagnostic testing: Fluorescein angiography
- Assesses retinal circulation
- IV access
- Mydriatic eye drops prior to test
- Encourage fluid after test
- Skin may appear yellow for several hours after test
- Urine bright green after test
Eye Diagnostic testing: Electroretinography
Graphing retinal response to light stimulation
Eye Diagnostic testing: Gonioscopy
- Determines if open angle or closed angle glaucoma is present
- Allows visualization of the angle where the iris meets the cornea
Cataract pathophysiology
- Clouding of the lens occurs due to changes in the proteins and lens fibers.
Cataract: subcapsular
Begins at the back of the lens
Cataract: Nuclear cataract
Forms in the center of the lens
Cataract: Cortical cataract
Forms in the lens cortex and extends from the outside of the lens to the center
Cataract treatment
Cataract surgery
- Cataract removal by phacoemulsification.
- Sound waves break up the lens, pieces are sucked out, and the capsule remains largely intact
Cataract postoperative nursing care
- Antibiotics given subconjunctivally
- Eye is unpatched, discharge usually occurs within 1 hour
- Dark glasses required
- Instill antibiotic-steroid eyedrops
- Mild itching normal
- Pain indicates complications
- Reduce IOP (stop strenuous activity)
- Prevent infection
- Assess for bleeding
Cataract patient teaching
- Signs of complications: Sharp, sudden pain in eye Bleeding or increased discharge Lid swelling Decreased vision Flashes of light or floating shapes
- Avoid activities that might increase IOP
- Review procedure for use of eyedrops
Glaucoma pathophysiology
- Increased ocular pressure
- Cupping and atrophy of optic disc
Glaucoma types
- Primary open-angle glaucoma (POAG)
- Primary angle-closure glaucoma (PACG)
Primary open-angle glaucoma (POAG)
- Gradual onset
- Outflow of aqueous humor reduced
- No pain at the beginning, mild headache or eye aching later
- Cupping and atrophy of optic disc
- Late:
Halo around lights
Loss of peripheral vision - IOP: 22 to 32 mm Hg
Primary angle-closure glaucoma (PACG)
- Sudden onset
- Outflow of aqueous humor is closed
- Sudden, severe pain
- Headache with N & V
- Colored halos around lights
- IOP: > 30 mm Hg
Glaucoma medications
- Prostaglandin analogs (Latanoprost)- increase the outflow of aqueous humor
- Beta-adrenergic blockers (Timolol)- decreases the production of aqueous humor
- Alpha2-adrenergic agonist (Brimonidine)- do both
(Got from pharm powerpoints)
Glaucoma treatment
- Pupil constriction allows ciliary muscle contraction and better circulation of aqueous humor
- Reducing production or increasing the absorption of aqueous humor
Glaucoma Nursing interventions
- Teach How eyedrops work
- Teach How to administer
- Monitor for side effects
- Compliance, timely dosing
Macular degeneration pathophysiology
Deterioration of the macula
Macular degeneration types
- Age related macular degeneration (AMD) (Dry)
- Exudative (Wet)
Macular degeneration: Age related (AMD) (Dry)
- Dry: gradual blockage of retinal cells…ischemic & necrotic
Macular degeneration: Exudative (wet)
- Wet: growth of new blood vessels, leak blood & fluid
Macular degeneration: Age related (AMD) (Dry) treatment:
- Antioxidants, Vitamin B12, carotenoids, vitamin E
Macular degeneration: Exudative (wet) treatment
- Bevacizumab (Avastin) injections into vitreal chamber
- Laser therapy to seal leaking vessels
Caring for a patient with reduced vision
- Communication about use of adaptive items
- Safety in familiar settings
- Ambulation assisted with care
- Promote self-care and independence
- Support for difficulty of adapting to lost sight
