Exam 4 (Ch 22 & 23) Flashcards
Assessment of Visual System
What type of information would be included in a health history of hte visual system?
Date of last ocular exam
Glasses
Contact lenses
Etc.
Assessment of Visual System
What kind of medications would the HCP be intrested in regareds to the visula system?
Eye drops
Cold medications can contain a form epinephrine (dilates pupil)
Corticosteroids, thyroid medications, oral hypoglycemics (can contribute to cataracts or glaucoma)
Assessment of Visual System
What kind of surgical history should be included in the assessment of visual system?
Includes ocular and non-ocular surgeries, laser surgeries and invasive treatment like retinal injections
What is diplopia?
The perception of two images when only one exists (double vision)
Potential Causes: Muscle imbalances in the eye (strabismus), cranial nerve palsies, neurological disorders (multiple sclerosis, stroke), thyroid eye disease, and others.
What is photophobia?
Fear of light
Sensitivity to light, causing discomfort or pain in the eyes when exposed to bright light.
Potential Causes: Migraines, uveitis, corneal abrasions, meningitis, subarachnoid hemorrhage, and others.
Nursing Assessment
What are the 6 test performed during the nursing assessment of the eyes?
- Color Vision Testing
- Visual Acuity Testing
- Tonometry
- Keratometry
- Ophthalmoscopy
- Pupil Function Testing
Nursing Assessment
What is the purpose, method, & nursing role for the Color Vision Testing?
- Purpose: Evaluates the patient’s ability to distinguish colors. This is crucial for detecting color blindness, which can be congenital or acquired due to certain diseases or medications.
- Method: Uses standardized tests like the Ishihara color plates, which consist of dots forming numbers or patterns that individuals with normal color vision can see, but those with deficiencies cannot.
- Nursing Role: Administering the test, documenting results, and educating the patient about the implications of any identified color vision deficiency.
Nursing Assessment
What is the purpose, method, & nursing role for the Visual Acuity Testing?
- Purpose: Measures the sharpness and clarity of vision.
- Method: Uses a Snellen chart (for distance vision) or a Rosenbaum chart (for near vision). The patient reads lines of letters or symbols of decreasing size.
- Nursing Role: Assisting with the test, ensuring proper lighting and positioning, accurately recording the results (e.g., 20/20, 20/40), and noting any corrective lenses used.
Nursing Assessment
What is the purpose, method, & nursing role for the Tonometry?
- Purpose: Measures the intraocular pressure (IOP), the fluid pressure inside the eye.
- Method: Uses a tonometer to gently flatten the cornea. There are different types, including Goldmann applanation tonometry (considered the gold standard) and non-contact tonometry (air puff).
- Nursing Role: Assisting with the procedure, instilling anesthetic drops if required, ensuring patient comfort, and recording IOP readings. Elevated IOP is a risk factor for glaucoma.
Nursing Assessment
What is the purpose, method, & nursing role for the Keratometry?
- Purpose: Measures the curvature of the cornea, the eye’s front surface.
- Method: Uses a keratometer, which projects a light pattern onto the cornea and measures the reflected image.
- Nursing Role: Assisting with the procedure, ensuring proper patient positioning, and recording the keratometry readings. This is essential for contact lens fitting and cataract surgery planning.
Nursing Assessment
What is the purpose, method, & nursing role for the Ophthalmoscopy?
- Purpose: Examines the interior structures of the eye, including the retina, optic disc, and blood vessels.
- Method: Uses an ophthalmoscope, which projects a light into the eye, allowing the examiner to visualize the internal structures.
- Nursing Role: Assisting with the procedure, ensuring patient comfort, and documenting observations (e.g., condition of the optic disc, presence of hemorrhages, etc.).
Nursing Assessment
What is the purpose, method, & nursing role for the Pupil Function Testing?
- Purpose: Assesses the pupils’ size, shape, and reaction to light.
- Method: Involves observing the pupils in both dim and bright light, as well as testing their response to direct and consensual light stimulation.
- Nursing Role: Performing the examination, documenting pupil size, shape, equality, and reaction to light (PERRLA: Pupils Equal, Round, Reactive to Light and Accommodation). Abnormal pupil responses can indicate neurological conditions.
Visual Acuity: Snellen Chart
What is the Snellen Chart?
A chart that consists of rows of letters, with each subsequent row containing smaller letters.
Visual Acuity: Snellen Chart
How is the Snellen Chart test conducted?
What eye is always assessed first?
The person being tested stands 20 feet away from the chart and covers one eye. They then read the letters on each row, starting from the top.
Always assess the right eye first followed by left
If the patient has contacts or glasses leave them on.
Visual Acuity: Snellen Chart
How are the results of the Snellen Chart determined?
The smallest line that the person can read accurately determines their visual acuity.
PERRL(A)
What does PERRLA stand for?
pupils are equal, round and reactive to light and accommodation
PERRL(A)
What is the different between direct and consensual responds to light?
Direct: When a light is shone into one eye, that pupil should constrict (become smaller).
Consensual: When a light is shone into one eye, the pupil of the opposite eye should also constrict, even though the light is not directly shining into it.
PERRL(A)
What is anisocoria?
A condition where the pupils of the eyes are different sizes, and it can be a normal variation or a sign of an underlying medical issue.
Assessment Abnormalities: Visual System
What is blurred vision?
Description: Loss of sharpness and clarity of vision, making objects appear hazy or out of focus. (can be sudden or gradual)
Potential Causes: Refractive errors (nearsightedness, farsightedness, astigmatism), cataracts, glaucoma, macular degeneration, dry eye, corneal abrasions, diabetic retinopathy, optic neuritis, and many others.
Assessment Abnormalities: Visual System
What is Dryness in relation to the eyes?
Description: A sensation of grittiness, burning, or irritation in the eyes due to insufficient tear production.
Potential Causes: Dry eye syndrome, environmental factors (wind, dry air), certain medications, aging, autoimmune diseases (Sjogren’s syndrome), and others.
Assessment Abnormalities: Visual System
What is a potential cause of pain in the eye?
Description: Discomfort or aching in or around the eye.
Potential Causes: Corneal abrasions, glaucoma, uveitis, scleritis, optic neuritis, headaches (migraines, cluster headaches), sinus infections, and others. (foreign object)
Assessment Abnormalities: Visual System
What are spots/floaters?
Description: Seeing small specks, threads, or cobweb-like shapes that drift across the field of vision.
Potential Causes: Age-related changes in the vitreous humor (the gel-like substance that fills the eye), posterior vitreous detachment (PVD), retinal tears or detachment, diabetic retinopathy, and others.
Assessment Abnormalities: Eyelids
What are allergic reactions of the eyes?
Symptoms?
Causes?
Description: Inflammation and swelling of the eyelids due to an allergic response.
Symptoms: Redness, itching, swelling, tearing, and discomfort.
Causes: Contact dermatitis (from cosmetics, pollen, pet dander), hay fever, and other allergies.
Assessment Abnormalities: Eyelids
What is Blepharitis?
Symptoms?
Causes?
Description: Inflammation of the eyelid margins, often affecting the base of the eyelashes.
Symptoms: Redness, itching, burning, crusting of the eyelids, and sometimes loss of eyelashes.
Causes: Bacterial infection, skin conditions (seborrheic dermatitis, rosacea), and clogged oil glands.
Assessment Abnormalities: Eyelids
What is ectropion?
Symptoms?
Causes?
Description: Outward turning or drooping of the eyelid margin, usually the lower lid.
Symptoms: Dryness, irritation, excessive tearing, redness, and potential corneal damage due to exposure.
Causes: Age-related muscle weakness, scarring from injury or surgery, and skin diseases.
Assessment Abnormalities: Eyelids
What is hordeolum (sty)?
Symptoms?
Causes?
Description: A small, painful lump on the eyelid caused by a bacterial infection of an oil gland in the eyelid.
Symptoms: Redness, swelling, pain, and a visible bump on the eyelid margin.
Causes: Staphylococcus bacterial infection.
Assessment Abnormalities: Eyelids
What is prosis?
Symptoms?
Causes?
Description: Drooping of the upper eyelid.
Symptoms: Partially or completely covering the pupil, affecting vision.
Causes: Muscle weakness (myasthenia gravis), nerve damage (cranial nerve palsy), congenital conditions, aging, and injury.
Common Diagnostic Tests
What is the purpose, method, and usage of Amsler Grid test?
Purpose: Detects changes in the central visual field, particularly in the macula.
Method: The patient looks at a grid pattern and reports any distortions, blurred areas, or missing lines.
Use: Used to monitor macular degeneration and other macular diseases.
Common Diagnostic Tests
What is the purpose, method, and usage of fluorescein angiography?
Purpose: Visualizes the blood vessels in the retina and choroid.
Method: A fluorescent dye is injected into a vein, and photographs are taken as the dye travels through the retinal blood vessels.
Use: Diagnoses and monitors conditions like diabetic retinopathy, macular degeneration, and retinal vascular occlusions.
Common Diagnostic Tests
What is the purpose, method, and usage of Perimetry testing?
(Visual Field Testing)
Purpose: Measures the extent of peripheral vision and detects blind spots.
Method: The patient indicates when they see a light or target in their peripheral vision while focusing on a central point.
Use: Detects glaucoma, optic nerve damage, and neurological conditions that affect vision.
Common Diagnostic Tests
What is the purpose, method, and usage of refractometry?
Purpose: Measures refractive errors of the eye (nearsightedness, farsightedness, astigmatism).
Method: Uses a phoropter or autorefractor to determine the lens power needed for clear vision.
Use: Prescribes eyeglasses or contact lenses and assesses the need for refractive surgery.
Common Diagnostic Tests
What is the purpose, method, and usage of ultrasonography?
(Ocular Ultrasound)
Purpose: Creates images of the internal structures of the eye using sound waves.
Method: A probe is placed on the eye or eyelid, and sound waves are used to generate images of the eye’s interior.
Use: Visualizes structures obscured by cataracts, detects retinal detachment, tumors, and foreign objects.
Refractive Errors
What is myopia?
Causes?
Correction?
Nearsightedness
Description: Difficulty seeing distant objects clearly, while near objects are seen sharply.
Cause: The eyeball is too long, or the cornea is too curved, causing light to focus in front of the retina.
Correction: Concave (diverging) lenses.
Refractive Errors
What is hyperopia?
Causes?
Correction?
Farsightedness
Description: Difficulty seeing near objects clearly, while distant objects are seen sharply.
Cause: The eyeball is too short, or the cornea is too flat, causing light to focus behind the retina.
Correction: Convex (converging) lenses.
Refractive Errors
What is presbyopia?
Causes?
Correction?
Description: Age-related difficulty focusing on near objects, due to the lens losing its flexibility.
Cause: Natural hardening of the lens with age, reducing its ability to change shape for near vision.
Correction: Reading glasses, bifocals, or progressive lenses.
Refractive Errors
What is astigmatism?
Causes?
Correction?
Description: Blurred vision at all distances due to an irregularly shaped cornea or lens. (football shaped)
Cause: The cornea or lens is curved more in one direction than the other, causing light to focus unevenly on the retina.
Correction: Toric lenses (special cylindrical lenses).
Refractive Errors
What is aphakia?
Causes?
Correction?
Description: Absence of the eye’s lens, usually due to surgical removal (e.g., after cataract surgery).
Cause: Surgical removal of the lens without an artificial lens implant.
Correction: Thick eyeglasses, contact lenses, or intraocular lens (IOL) implant.
Common Corrections for Refractive Errors
What are some common corrections for refractive errors?
Corrective Glasses
Contact Lenses
Surgery can eliminate or reduce the need for eyeglasses or contact lenses and correct refractive errors by changing the focus of the eye.
Common Corrections for Refractive Errors
What are some surgeries used to correct refractive errors?
- LASIK (Laser-Assisted In Situ Keratomileusis): A laser procedure that creates a flap in the cornea and reshapes the underlying tissue. (can be used to correct near and far sidedness) (very drying to the eyes)
- PRK (Photorefractive Keratectomy): A laser procedure that removes the outer layer of the cornea and reshapes the underlying tissue.
- IOL (Refractive Intraocular Lens) Implantation: Replacing the eye’s natural lens with an artificial lens to correct refractive errors, often used in cataract surgery or for high refractive errors.
Visual Impairment
What does visual impairment describe?
vision that cannot be fully corrected by corrective lenses, medical treatment, or surgery
includes conditions ranging from low vision to the absence of all vision or total blindness
Visual Impairment
What is legal blindness defined as?
The best-corrected vision in the better eye of 20/200 or less or 20 degrees or less of remaining visual field.
Visual Impairment
Most blindness in the United States is the result of what?
Common eye diseases, including cataracts, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy.
Cataracts are a big one
Sight Guided Technique
How is the sight guided technique performed?
- Ask the patient whether they would like help.
- Stand slightly in front and to one side of the patient and offer an elbow for the patient to hold.
- Walk slightly in front of the patient at a pace that’s comfortable for them.
- Serve as the sighted guide. As you walk, describe the environment to help orient the patient.
- Never guide someone into a seat backward. Help the patient sit by placing 1 of their hands on the back of the chair. Then, allow the patient to orient themselves to the chair independently.
Gerontologic Considerations
What are some gerontologic considerations for the eyes?
Societal devaluation of older adults may compound the self-esteem or isolation issues associated with visual impairment.
Financial resources may be inadequate to secure vision services or assistive devices.
Decreased vision may compromise the older patient’s ability to function, resulting in concerns about independence and a diminished self-image.
Decreased manual dexterity may make instilling prescribed eye drops hard.
Those with low vision are more likely to make medication errors that are potentially dangerous, such as taking too much insulin or mistaking one drug for another.
Eye Injury/Trauma
Most common eye injuries in the United States are due to what?
What are the main causes of eye injuries at home?
Most common eye injuries in the United States are due to falls and fights.
Injuries at home may be caused by cooking, cleaning, gardening, power tool use, and home repair work.
Sport and work-related injuries are other causes of eye trauma.
Emergency Management
What are some kinds of eye injuries that warrent emergency management?
Chemical Burns (Acid or Alkaline)
Foreign Bodies (Ceramic glass, metal etc.)
Thermal Burn (UV light; direct burn from hot surface)
Trauma (Blunt; penetrating)
Emergency Management
What are the steps to emergency eye management?
Determine mechanism of injury.
Ensure airway, breathing, and circulation.
Assess for other injuries.
Assess for chemical exposures.
Begin eye irrigation immediately in case of chemical exposure. Do not stop until emergency personnel arrive to continue irrigation. Use sterile saline or water if saline is unavailable.
Assess visual acuity.
Do not put pressure on the eye.
Tell patient not to blow nose.
Do not try to treat the injury (except as noted above for chemical exposure).
Stabilize foreign objects.
Cover the eye(s) with dry, sterile patches and a protective shield.
Do not give the patient food or fluids.
Elevate head of bed 45 degrees.
Give proper analgesia.
Morgan Lens
What are Morgan Lenses?
Purpose?
Usage?
Description:
Sterile Plastic Device: Resembles a contact lens.
Floats Over the Eye: Does not physically touch the cornea, minimizing further injury.
Tubing Connection: Connected to tubing that delivers the irrigating solution.
Purpose: Provides continuous irrigation of an injured eye. This is crucial for flushing out harmful substances or debris.
Uses:
Chemical or Thermal Burns: Helps dilute and remove caustic substances from the eye after chemical splashes or burns.
Nonembedded Foreign Materials: Flushes out loose particles or debris that are not embedded in the eye.
Hordeolym (Sty)
What is the most common bacterial infective agent of external hordeolum?
Staphylococcus aureus
Hordeolym (Sty)
What should a patient do if they develope a Hordeolym (Sty)?
Apply warm, moist compresses at least 4 times a day until it improves. May be the only treatment needed.
If it tends to recur, teach the patient to do lid scrubs daily using eye scrub.
On occasion, antibiotic ointments or drops may be needed.
Bacterial Conjunctivitis
What is the most common cause of Bacterial Conjunctivitis?
What are the symptoms?
Bacterial (pinkeye) Staphylococcus aureusis the most common cause.
Symptoms include:
* Discomfort
* Pruritus
* Redness
* Mucopurulent drainage
Typically occurs initially in 1 eye, then spreads to the unaffected eye.
Bacterial Conjunctivitis
How is pinkeye prevented?
Prevention:
Emphasize the importance of handwashing.
Advise patients to avoid contact with infected individuals.
Treatment: Antibiotic drops can shorten the duration of the infection.
Epidemic Keratoconjunctivitis (EKC)
How is EKC spread?
Symptoms?
Treatment>
the most serious ocular adenoviral disease.
This is spread by direct contact.
Symptoms include:
* Tearing
* Redness
* Photophobia
* Foreign body sensation
Treatment is primarily palliative and includes ice packs, artificial tears, and dark glasses.
Treatment for severe cases can include mild topical corticosteroids and topical antibiotic ointment.
Teach the patient the importance of good hygiene practices to avoid spreading the disease.
Trachoma
What is Trachoma?
Trachoma is a chronic conjunctivitis caused byChlamydia trachomatis(serotypes A through C).
It is a major cause of blindness worldwide.
Most often seen in underdeveloped countries.
Trachoma
How is Trachoma transmitted?
Symptoms?
Treatment?
It is transmitted mainly by the hands and flies.
Adult inclusion conjunctivitis (AIC) is caused byC. trachomatis(serotypes D through K).
Symptoms include:
* Mucopurulent eye discharge
* Irritation, redness
* Lid swelling
Antibiotic therapy is usually effective for trachoma and AIC.
Allergic Conjunctivitis
What causes conjuctivitis?
Caused by exposure to an allergen can be mild and transitory, or it can be severe enough to cause significant swelling.
Allergic Conjunctivitis
What is the defining symptom of Allergic Conjunctivitis?
Itching.
- Pt may experience burning, redness, and tearing.
Allergic Conjunctivitis
What are some causes of Allergic Conjunctivitis?
Response to pollens, animal dander, ocular solutions, and medications.
Teach the patient to avoid known allergens if possible.
Allergic Conjunctivitis
How is Allergic Conjunctivitis treated?
Artificial tears can be effective in diluting the allergen and washing it from the eye.
Topical medications include antihistamines and corticosteroids.
Keratitis
What is Keratitis?
Causes?
Inflammation or infection of the cornea.It is caused by a variety of microorganisms or by other factors. If the condition involves the conjunctiva and/or the cornea, it is termed keratoconjunctivitis.
Bacterial
Viral
Keratitis
What is the treatment for Keratitis?
Antibiotics (bacterial); Antiviral agents, Analgesics for pain, topical corticosteroids to reduce inflammation, and mydriatic agents to dilate the pupil and relieve pain.
Corneal Ulcer
How are corneal ulcers produced?
Symptoms?
Tissue loss caused by a corneal infection, due to bacteria, viruses, or fungi, produces a corneal ulcer.
Symptoms: Tearing, Purulent or watery discharge, Redness
Photophobia, Feeling of a foreign body in the eye.
Corneal Ulcer
What is the treatment for corneal ulcers?
Treatment is aggressive to avoid permanent vision loss.
Antibiotic, antiviral, or antifungal eye drops may be given as often as every hour for the first 24 hours.
Corneal transplant may be needed. (keratoplasty)
Cataract
What is a cataract?
Acataractis an opacity within the lens.
Patient may have a cataract in one or both eyes.
If cataracts are present in both eyes, one may affect the patient’s vision more than the other.
Cataract removal is the most common surgery in the United States.
Most are age-related.
Clinical Manifestations and Diagnosis of Cataracts
What are some clinical manifestations of cataracts?
decrease in vision, abnormal color perception, and glare.
Glare is due to light scatter caused by the lens opacities.
May be significantly worse at night when the pupil dilates.
Vision decline is gradual.
Clinical Manifestations and Diagnosis of Cataracts
How are cataracts diagnosed?
Diagnosis is based on decreased visual acuity or another vision problem.
The opacity is directly observable by ophthalmoscopic or slit lamp microscopic examination.
* A totally opaque lens creates the appearance of a white pupil.
Cataract Treatment
What is the only cure for cataracts?
Surgical removal
Presence of a cataract does not necessarily indicate a need for surgery. Changing the patient’s eyewear prescription can improve visual acuity.
Cataract Surgery
What are the 3 different eye drops given before cataract surgery?
- Mydriatic produces pupillary dilation (mydriasis) by contracting the iris dilator muscle
- Cycloplegics, such as tropicamide (Mydriacyl) to block the effects of acetylcholine on the ciliary body and iris sphincter muscles, to produce mydriasis and paralysis of accommodation (cycloplegia)
- Nonsteroidal anti-inflammatory eye drops to reduce inflammation and edema
Cataract Surgery
What is the purpose of intraocular lens implants?
Effect?
Purpose: Replaces the eye’s natural lens, which has become clouded by the cataract.
Effect: Restores clear vision after cataract removal.
Postoperative Cataract Surgery Teaching
Postoperative nursing goals include what?
Teaching about eye care, activity restrictions, medications, follow-up visit schedule, and signs/symptoms of possible complications.
Retinal Detachment
What is retinal detachment?
A separation of the sensory retina and the epithelium, with fluid accumulation between the 2 layers
Emergency situation
Retinal Detachment
What could happen if a retinal detachment is not treated quickly?
If not treated quickly, more of the retina can detach, increasing the risk of permanent vision loss or blindness.
Clinical Manifestations of Retinal Detachment
What are some clinical manifestations of retinal detachment?
Flashes of light
Floaters (small flecks)
“Cobweb,” “hairnet,” or ring in the field of vision
Gradual loss of peripheral or central vision, “like a curtain” coming across the field of vision
Area of vision loss corresponds inversely to the area of detachment.
If the detachment is small or develops slowly, the patient may not be aware of a problem.
Diagnostic Tests for Retinal Detachment
What are some diagnostic tests for retinal detachment?
Visual acuity: Should be first diagnostic procedure with any report of vision loss
Direct and indirect ophthalmoscopy or slit lamp microscopy in conjunction with a special lens to view the periphery of the retina
Ultrasound to find a retinal detachment, if the retina is unable to be seen by the provider (e.g., when the cornea, lens, or vitreous is hazy or opaque)
Surgical Treatment for Retinal Detachment
What are some surgical treatments for retinal detachment?
Laser photocoagulation
Cryopexy
Scleral buckling
Vitrectomy
Intravitreal bubble
Surgical Treatment for Retinal Detachment
What is the purpose of laser photocoagulation?
Mechanism?
Usage?
Purpose: Uses a laser to create small burns around a retinal tear or hole, sealing it and preventing further detachment.
Mechanism: The laser creates scar tissue that adheres the retina to the underlying tissue.
Use: Effective for treating retinal tears or small detachments.
Surgical Treatment for Retinal Detachment
What is the purpose of cryopexy?
Mechanism?
Usage?
Purpose: Uses freezing to create a scar that seals a retinal tear or hole.
Mechanism: A freezing probe is applied to the outside of the eye over the retinal tear, creating a scar that adheres the retina to the underlying tissue.
Use: Effective for treating retinal tears or small detachments.
Surgical Treatment for Retinal Detachment
What is the purpose of scleral buckling?
Mechanism?
Usage?
Purpose: Places a silicone band or sponge on the sclera (white part of the eye) to indent the eye wall, relieving traction on the retina.
Mechanism: The buckle pushes the sclera inward, bringing the RPE closer to the detached retina and allowing it to reattach.
Use: Effective for treating larger retinal detachments.
Surgical Treatment for Retinal Detachment
What is the purpose of vitrectomy?
Mechanism?
Usage?
Purpose: Removes the vitreous gel (the clear gel that fills the eye) to eliminate traction on the retina and allow it to reattach.
Mechanism: Small incisions are made in the eye, and instruments are used to remove the vitreous and any scar tissue.
Use: Effective for treating complex retinal detachments, especially those with significant scar tissue or bleeding.
Surgical Treatment for Retinal Detachment
What is the purpose of intravitreal bubble?
Mechanism?
Usage?
Purpose: Injects a gas bubble into the vitreous cavity to push the detached retina back into place.
Mechanism: The gas bubble acts as a temporary tamponade, holding the retina against the RPE while it heals.
Use: Often used in conjunction with laser photocoagulation or cryopexy.
Patient Education after Retinal Detachment
What are some key patient education points after retinal detachment?
After surgery, the patient may be on bed rest and need special positioning to maintain proper position of an intravitreal bubble.
May need multiple topical medications, including antibiotics, anti-inflammatory agents, or dilating agents.
Give prescribed pain medications.
Teach the patient to take the medication as prescribed after discharge.
Discharge planning and teaching should begin ear
What is a leading cause of irreversible central vision loss and is related to retinal aging?
Age-Related Macular Degeneration (AMD)
Other risk factors include family history, smoking, obesity, hypertension, and ethnicity.
Age-Related Macular Degeneration (AMD)
What are some clinical manifestations of AMD?
Diagnostic study?
Blurred and darkened vision, Scotomas (blind spots in the visual field), Metamorphopsia (vision distortion)
Diagnostic studies: Amsler Grid
AMD Treatment
What medications are injected directly into the vitreous cavity including?
Ranibizumab (Lucentis)
Bevacizumab (Avastin)
Aflibercept (Eylea)
Pegaptanib (Macugen) inhibits vascular endothelial growth factor (VEGF)
Medications help to slow vision loss by stopping new vessels from forming.
Side effects can include blurred vision, eye irritation, eye pain, and photosensitivity.
Injections are given at 4- to 6-week intervals, depending on treatment response.
AMD Treatment
How is disease stability is determined?
By optical coherence tomography (OCT).
Glaucoma
What is Glaucoma?
A group of disorders characterized by increased IOP and its consequences, optic nerve atrophy, and peripheral visual field loss.
It is the second leading cause of permanent blindness in the United States.
It is the leading cause of blindness among African Americans.
Many are unaware of their condition.
Incidence of glaucoma increases with age.
Genetic factors play a role in some types of glaucoma.
Glaucoma
What is the most common type of Glaucoma?
Primary open-angle glaucoma (POAG)
Glaucoma
Angle-closure glaucoma (ACG) is due to what?
A reduction in the outflow of aqueous humor that results from angle closure.
Glaucoma
Acute angle-closure glaucoma (AACG) may be precipitated by what situations?
Situations in which the pupil stays partially dilated long enough to cause an acute and significant rise in the IOP.
Diagnostic test for Glaucoma
What are the diagnostic tests for Glaucoma?
IOP
Slit Lamp Microscopy
Measure of Peripheral and Central Vision
Diagnostic test for Glaucoma
What is the purpose of IOP (Intraocular Pressure)?
Method?
Signficance?
Purpose: Measures the pressure inside the eye.
Method: Uses a tonometer to gently flatten the cornea.
Significance: Elevated IOP is a major risk factor for glaucoma.
Diagnostic test for Glaucoma
What is the purpose of Slit Lamp Microscopy?
Method?
Signficance?
Purpose: Examines the structures of the eye, including the optic nerve, iris, and drainage angle.
Method: Uses a slit lamp, a microscope with a bright light, to visualize the eye’s interior.
Significance: Helps assess the health of the optic nerve and identify any abnormalities in the drainage angle.
Diagnostic test for Glaucoma
What is the purpose of Measure of Peripheral and Central Vision (Visual Field Testing)?
Method?
Signficance?
Purpose: Assesses the extent of peripheral and central vision.
Method: Uses a visual field test (perimetry) to map the patient’s field of vision.
Significance: Detects any loss of peripheral or central vision, which is a hallmark of glaucoma.
Glaucoma Treatment
What are some treatments for glaucoma?
Argon laser trabeculoplasty (ALT)
Trabeculectomy
Laser peripheral iridotomy
Surgical iridectomy
Enucleation
What is Enucleation?
What is the primary reason for it?
Enucleationis the removal of the eye.
Primary reason is a blind, painful eye, resulting from glaucoma, infection, or trauma.
Enucleation
What are some signs of complications after enucleation?
After surgery, observe patient for signs of complications including:
* Excess bleeding or swelling
* Increased pain
* Displacement of the implant
* Fever
Enucleation
What are some pt. teachings after enucleation?
Teaching should include:
* How to instill topical ointments or drops
* Wound cleansing
* How to insert the conformer into the socket in case it falls out
Recognize the patient’s emotional response and provide support to patient and caregivers.
Enucleation
When is the wound, after enucleation, sufficiently healed for the permanent prosthesis?
Six weeks after surgery, wound is sufficiently healed for the permanent prosthesis.
Auditory System
What is the main component of the auditory system?
Hearing
Auditory System
What is hearing?
A complex process that allows us to interact with the environment. It is the basis for social interaction and communication.
Auditory System
Hearing impairment is associated with difficulties with what?
Associated with difficulties in functional ability and cognition
Problems with equilibrium can impair coordination, balance, and orientation.
Effects of Aging on Auditory System
What are some effects of aging on the auditory system?
Presbycusis: Age-related hearing loss, typically a gradual, progressive, bilateral loss of high-frequency hearing.
Calcification: Calcification (hardening) of the ossicles (tiny bones in the middle ear) or other structures within the ear.
Tinnitus: Perception of ringing, buzzing, or other noises in the ears or head when no external sound is present.
Cerumen gland atrophy: Atrophy (shrinkage) of the cerumen glands, which produce earwax.
Hair becomes thicker and courser: Increased growth of thicker and courser hair in the external auditory canal.
Signs of Possible Hearing Loss
What are some Signs of Possible Hearing Loss?
Does not respond to or understand oral communication
Has excessively loud or soft speech
Answers questions inappropriately
Tilts head, leans forward when listening
Constantly needs to clarify conversation
States other people mumble all the time
Increases the volume of radio or TV
Difficulty hearing over the phone
Diagnostic Studies
What is the purpose of Audiometry?
Method?
Significance?
Purpose: Measures hearing sensitivity across different frequencies and intensities.
Method: Uses an audiometer to present tones and speech at various levels, and the patient indicates when they hear the sounds.
Significance: Provides a comprehensive assessment of hearing ability and helps identify the type and degree of hearing loss.
Diagnostic Studies
What is the purpose of Tympanometry?
Method?
Significance?
Purpose: Measures the movement of the eardrum in response to changes in air pressure.
Method: A probe is placed in the ear canal, and air pressure is varied while measuring eardrum movement.
Significance: Helps identify middle ear problems, such as fluid buildup, eardrum perforation, or ossicular chain dysfunction.
Diagnostic Studies
What is the purpose of Rhinne Test?
Method?
Significance?
Purpose: Compares air conduction (AC) to bone conduction (BC) to determine the type of hearing loss.
Method: A vibrating tuning fork is placed on the mastoid bone (behind the ear) and then held near the ear canal.
Significance: Helps differentiate between conductive and sensorineural hearing loss.
Diagnostic Studies
What is the purpose of Weber Test?
Method?
Significance?
Purpose: Assesses lateralization (where the sound is heard) to determine the type of hearing loss.
Method: A vibrating tuning fork is placed on the center of the forehead or top of the head.
Significance: Helps identify unilateral conductive or sensorineural hearing loss.
Diagnostic Studies
What is the purpose of Rotary Chair testing?
Method?
Significance?
Purpose: Evaluates the function of the vestibular system, which is responsible for balance.
Method: The patient is seated in a rotating chair, and eye movements are measured as the chair rotates.
Significance: Helps diagnose vestibular disorders, such as benign paroxysmal positional vertigo (BPPV) or vestibular neuritis.
Methods for Managing Hearing Loss
What are some Methods for Managing Hearing Loss?
Speech Reading
Sign Language
Assistive Listening Devices (ALDs)
Hearing Aids
Cochlear Implant
Hearing Aid Patient Teaching
What are some key points to Hearing Aid Patient Teaching
Start at home or quiet environment
Adjust volume ot vocies & environmental sounds
Then progress to more noise and adjust as needed
When not being worn, the hearing aid should be placed in a dry, cool area
Battery life avergae-1wk. Disconnect or remove when not in use
Ear molds should be cleaned weekly/prn
External Otitis
What is External Otitis?
External otitisis an inflammation or infection of the epithelium (skin) of the auricle (external ear) and canal.
Auricle piercings or other skin trauma causes initial break in the skin, increases risk of infection
External Otitis
What causes “swimmer’s ear?”
Contaminated swimming water changes the flora of the ear canal
External Otitis
What kind of environment provides a good growth medium for microorganisms, resulting in infection developing?
Warm, dark, moist ear canal
Bacterial (Staphylococcus aureus)
Fungal (Candida albicans,Aspergillus)
External Otitis
How long is the antibiotic course for systemic invlovlement?
Control systemic involvement with 7- to 10-day course of systemic antibiotics
Control pain with moist heat, mild analgesics, and topical anesthetic drops (antibiotics, corticosteroids)
Patient Teaching: Ear Drops
What are some key points of Patient Teaching for Ear Drops?
Wash hands before & after
Store at room temperature
Do not touch dropper to ear
Position ear so that drops can run into the canal, stay for 2 min. to allow drops to spread
Carefull handling & disposal of materila saturated with drainage is important
Teach the patient ways to reduce the risk for external otitis
Acute Otitis Media
What is Acute Otitis Media?
An infection of the TM, ossicles, and space of the middle ear.
Infection can be due to viruses or bacteria.
Caused by swelling of the auditory tube from colds or allergies that can trap bacteria.
Acute Otitis Media Diagnosis and Treatment
What are some S/S of acute otitis media?
usually a childhood disease due to the face that the auditory tube that drains fluid from the middle ear is shorter and narrower in children.
Pain, fever, malaise, drainage, and reduced hearing
Prompt treatment of acute otitis media can help prevent spontaneous perforation of the TM.
Acute Otitis Media Diagnosis and Treatment
What are some treatments for acute otitis media?
Antihistamines and a nasal corticosteroid spray can be used if allergies are a causative factor.
Oral antibiotics and eardrops are used if an infection is present.
Surgery can be performed, if no response to medical treatment.
- Myringotomy
- Atympanostomy tubemay be placed short or long term for ventilation of the ear.
Chronic Otitis Media
What causes Chronic Otitis Media?
Symptoms?
recurrent otitis media, especially in adults with a history of recurrent childhood otitis media.
Symptoms: Purulent exudate and inflammation can involve the ossicles, auditory tube, and mastoid bone, hearing loss, nausea, and dizziness; often painless.
The mucous membrane of the middle ear and the air cells of the mastoid bone (which are continuous) can both be involved.
Chronic Otitis Media
What are some treatements for Chronic Otitis Media?
Otic and systemic antibiotics based on culture and sensitivity results; antibiotic resistance is present in many cases.
- May need frequent evacuation of drainage/debris as an outpatient.
- If TM perforations do not heal with conservative treatment, surgery is necessary.
Tympanoplasty (myringoplasty) involves reconstruction of the TM and/or the ossicles.
- Mastoidectomy is often done with a tympanoplasty to remove infected portions of the mastoid bone.
After Ear Surgery Teaching
What are the 9 teaching points post ear surgery?
- Sleep on your back or the unoperated ear for 1 week.
- Avoid air travel and sun exposure for 6 weeks.
- If you need to cough or sneeze, keep your mouth open.
- Blow your nose gently, without blocking either nostril.
- Do not shampoo your hair for 5 days. Wear a shower cap when bathing.
- No swimming. Keep your ear dry for 6 weeks.
- You may resume strenuous activity and contact sports in 1 month.
- Change your ear dressing daily as prescribed.
- Report excess drainage or severe dizziness to the HCP.
Otosclerosis
What is Otosclerosis?
A hereditary autosomal dominant disease that is the most common cause of hearing loss in young adults.
Mechanism: Spongy bone develops from the bony labyrinth (the bony outer wall of the inner ear), preventing movement of the footplate of the stapes in the oval window. This reduces the transmission of vibrations to the inner ear fluids, resulting in conductive hearing loss.
Otosclerosis
What are some treatements for Otosclerosis?
Microdrill or laser surgical Opening the footplate (stapedotomy) or replacing the stapes with a metal or Teflon substitute (prosthesis).
Usually done under conscious sedation.
Ear with poorer hearing is repaired first, then the other ear within a year.
Significant improvement
Decreased hearing level postoperatively because blood and fluid accumulate in the middle ear
Ménière Disease
What is Ménière Disease?
A progressive disorder leading to an accumulation of endolymph in the membranous labyrinth.
Usually affects only one ear, it can affect both.
Cause is unknown. Genetic, immune, and environmental factors may play a role.
Ménière Disease
What are some symptoms of Ménière Disease?
Symptoms usually begin between 40 and 60 years of age.
Significant disability with sudden, severe attacks of vertigo accompanied by nausea, vomiting, nystagmus (involuntary eye movements).
Feelings of being pulled to the ground (drop attacks) or whirling in space.
Attacks can last minutes to hours and can occur several times a year.
A sense of fullness in the ear, increasing tinnitus, and muffled hearing may precede an attack.
Ménière Disease: Nursing Management
What are some key aspects of nursing management of Ménière Disease?
Administer medications and IV hydration as ordered.
Keep pt in a quiet, darkened room in comfortable position.
Have pt avoid sudden head movements & position changes.
Teach pt to close the eyes until vertigo stops.
Avoid fluorescent or flickering lights and television.
Implement fall precautions.
Implement measures to address N/V
Monitor I/O & daily weights.
Help the pt with ambulation as needed.
Drug Therapy: Anticholinergics, antihistamines, antiemetics, benzodiazepines
Benign Paroxysmal Position Vertigo (BPPV)
What is the cause of BPPV?
Symptoms?
Treatment?
Cause: Free-floating debris (“ear rocks” or otoconia) in the semicircular canals causes vertigo with specific head movements.
Symptoms:
* Nystagmus (involuntary eye movements)
* Vertigo (sensation of spinning)
* Light-headedness
* Loss of balance
* Nausea
* No hearing loss
Symptoms are intermittent
Treatment:
Epley Maneuver/Canalith Repositioning Procedure: Symptom relief is achieved by changing the location of the ear debris to less sensitive areas through specific head movements.
Patient Education: A trained Healthcare Provider (HCP) can teach the patient how to perform the maneuver at home.
Which of the following medications can contribute to cataracts or glaucoma? Select all that apply.
A. Eye drops
B. Cold medications
C. Corticosteroids
D. Thyroid medications
E. Oral hypoglycemics
F. Antihistamines
C, D, E
Rationale:
C. Corticosteroids: Can increase intraocular pressure and contribute to cataract formation.
D. Thyroid medications: Can affect eye health.
E. Oral hypoglycemics: Some studies suggest a link between these medications and cataract development.
A patient’s Snellen chart result for the right eye is 20/40. What does this indicate?
A. The patient has normal vision in the right eye.
B. The patient can see at 20 feet what a person with normal vision can see at 40 feet.
C. The patient can see at 40 feet what a person with normal vision can see at 20 feet.
D. The patient is legally blind in the right eye.
B. The patient can see at 20 feet what a person with normal vision can see at 40 feet.
Rationale: The Snellen chart result is a fraction where the numerator represents the distance the patient stands from the chart, and the denominator represents the distance a person with normal vision can see the same line.
A patient presents with a red, swollen, and tender area on their eyelid margin. What treatment should the nurse anticipate?
A. Antibiotic eye drops.
B. Warm, moist compresses.
C. Artificial tears.
D. Topical corticosteroids.
B. Warm, moist compresses.
Rationale: The document states that “The patient should apply warm, moist compresses at least 4 times a day until it improves. May be the only treatment needed.”
A patient scheduled for cataract surgery asks why they need three different types of eye drops before the procedure. What is the best explanation?
A. “They are used to clean your eyes and prevent infection.”
B. “One dilates your pupil, one paralyzes your focusing ability, and one reduces inflammation.”
C. “They numb your eye and help with pain management after surgery.”
D. “These drops help to lower eye pressure and prevent glaucoma.”
B. “One dilates your pupil, one paralyzes your focusing ability, and one reduces inflammation.”
Rationale: This answer accurately reflects the purposes of mydriatic, cycloplegic, and nonsteroidal anti-inflammatory eye drops.
A patient who underwent retinal detachment surgery is being discharged. What is an important teaching point regarding medication?
A. They will not need any medications after discharge.
B. They will only need pain medication for a few days.
C. They may need multiple topical medications, including antibiotics, anti-inflammatory agents, or dilating agents.
D. They should stop taking medications if they experience any side effects.
C. They may need multiple topical medications, including antibiotics, anti-inflammatory agents, or dilating agents.
Rationale: The document states that patients “May need multiple topical medications, including antibiotics, anti-inflammatory agents, or dilating agents” after surgery.
A patient with acute angle-closure glaucoma (AACG) reports severe eye pain, blurred vision, and seeing halos around lights. What is the priority nursing intervention?
A. Administering anti-VEGF medications.
B. Preparing the patient for laser peripheral iridotomy.
C. Providing patient education on the use of the Amsler Grid.
D. Instilling artificial tears to relieve dryness.
B. Preparing the patient for laser peripheral iridotomy.
Rationale: AACG is an emergency that requires immediate intervention to reduce IOP and prevent vision loss. Laser peripheral iridotomy is a common treatment for this condition.
A patient with hearing loss is having difficulty communicating during a group activity. What intervention would be most helpful?
A. Speaking loudly and quickly.
B. Writing notes instead of speaking.
C. Using clear, concise speech and facing the patient.
D. Avoiding communication altogether.
C. Using clear, concise speech and facing the patient.
Rationale: This approach helps the patient understand speech better by providing visual cues and clear auditory input.
