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Med Surg Exam 8 > EYE DISORDERS > Flashcards

EYE DISORDERS Flashcards

1
Q

Assessment of Vision

A

-ocular hx
-visual acuity:
snellen chart : DISTANCE
rosenbaum pocket screener: NEAR
-finger count or hand motion

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2
Q

Examination of the External Structures

A

-note any evidence of irritation, inflammatory process, discharge
-assess eyelids and sclera
-assess pupils & pupillary response; use darkened room
-note gaze and position of eyes
-assess extraocular movements
-ptosis: drooping eyelid
-nystagmus

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3
Q

Impaired Vision

A

refractive errors – can be corrected by lenses that focus light rays on the retina

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4
Q

EMMETROPIA

A

normal vision

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5
Q

MYOPIA

A

NEARsighted

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6
Q

HYPEROPIA

A

FARsighted

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7
Q

ASTIGMATISM

A

distortion caused by irregularity of the cornea

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8
Q

Low vision

A

-visional impairment that requires devices and strategies in addition to corrective lenses
-best corrected visual acuity (BCVA) of 20/70 to 20/200

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9
Q

Blindness

A

-BCVA 20/400 to no light perception
-legal blindness is BCVA that does not exceed 20/200 in better eye or widest field of vision is 20 degrees or less

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10
Q

Assessment of Low Vision

A

-hx
-examination of distance and near visual acuity, visual field, contrast sensitivity, glare, color perception, refraction
-special charts
-RN Assessment: functional ability, coping, adaptation in emotional, physical, and social areas

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11
Q

Management

A

-support coping strategies, grief processes, and acceptance of visual loss
-strategies for adaptation to the environment: placement of items in room, clock method for trays
-communication strategies
-collaboration w/ low vision specialist, occupational therapist
-braille
-service animals

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12
Q

Ophthalmic Medications

A

-ability of the eye to absorb medication is limited
-barriers to absorption incl the size of the conjunctival sac, corneal membrane barriers, blood-ocular barriers, and tearing, blinking, drainage

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13
Q

Intraocular injection or systemic medication (Ophthalmic meds)

A

may be needed to tx some eye structures or to provide high concentrations of medication

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14
Q

Topical medications (Ophthalmic meds)

A

drops and ointments are most frequently used bc they are least invasive, have fewest side effects, and permit self-administration

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15
Q

Topical anesthetics (Ophthalmic meds)

A
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16
Q

Mydriatics & Cycloplegics (Ophthalmic meds)

A

Mydriatics = dilate
Cycloplegics = paralyze

-contraindicated w/ narrow angles or shallow anterior chambers and inpatients on monoamine oxidase inhibitors or TCAs

-may cause CNS symptoms and increased BP, esp in children or older adults

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17
Q

Anti-infective (Ophthalmic meds)

A

-antibiotic, antifungal, or antiviral products

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18
Q

Medications used for Glaucoma

A

-increased aqueous outflow or decrease aqueous production
-may constrict the pupil & may affect ability to focus the lens of the eye, affects vision
-may also produce systemic effects

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19
Q

Anti-inflammatory drugs; corticosteroid suspensions

A

SE: glaucoma, cataracts, increased risk of infection.
To avoid these effects, oral NSAID therapy may be used as an alternate to steroid use

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20
Q

Atropine

A

medication that is administered for glaucoma, uveitis, or surgery

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21
Q

Cyclopentolate, Phenylephrine, & Tropicamide

A

administered for pupillary dilation for ophthalmoscopy and surgical procedures

22
Q

Glaucoma

A
  • a group of ocular conditions in which damage to the optic nerve is related to increased intraocular pressure caused by congestion oft he aqueous humor
    -increases w/ age
23
Q

Glaucoma Risk Factors

A

-black or asian
-cardiovascular disease
-diabetes
-family hx of glaucoma
-migraines
-myopia
-obstructive sleep apnea
-older age
-previous eye trauma
-prolonged use of corticosteroids
-thin cornea

24
Q

Pathophysiology of Glaucoma

A

-in glaucoma, aqueous production and drainage are not in balance
-when aqueous outflow is blocked, pressure builds up in the eye
-increased IOP causes irreversible mechanical or ischemic damage

25
Q

Types of Glaucoma

A

wide angle
narrow angle
congenital
associated w/ other conditions
may be primary or secondary

26
Q

Wide angle glaucoma

A

the anterior chamber angle is open and appears normal

27
Q

Narrow angle glaucoma

A

Obstruction in aqueous humor outflow due to the complete or partial closure of the angle from the forward shift of the peripheral iris to the trabecula. The obstruction results in increased IOP.

28
Q

Signs & Symptoms of Glaucoma

A

-silent thief - unaware of the condition until there is significant vision loss; peripheral vision loss, blurring, halos, difficulty focusing, difficulty adjusting eyes to low lighting

-may also have aching or discomfort around eyes or headache

29
Q

Treatment of Glaucoma

A

-goal is to prevent further optic nerve damage
-maintain IOP w/in a range unlikely to cause damage
-laser procedures
-surgery

30
Q

Medications for Glaucoma

A

-miotics
-beta blockers
-alpha 2 agonists
-carbonic anhydrase inhibitors
-prostaglandins

31
Q

Cataracts

A

-an opacity or cloudiness of the lens
-increased incidence w/ aging
-a leading cause of disability in the US
-risk factor: age
-3 types: traumatic, congenital, senile cataract

32
Q

Signs & Symptoms of Cataracts

A

-painless, blurry vision, surroundings dimmer
-sensitivity to glare
-reduced visual acuity
- myopic shift, astigmatism, diplopia (double vision), color shifts incl brunescens (color value shift to yellow-brown)

33
Q

Surgical Management for Cataracts

A
  • if reduced vision does not interfere w/ normal activities, surgery is not needed
    -surgery is preformed on an outpatient basis w/ local anesthesia
    -surgery usually takes less than 1 hr and pts are discharged soon afterward
34
Q

Phacoemulsification (Types of Cataract Surgery)

A

an ECCE that uses an ultrasonic device to suction the lens out through a tube; incision is smaller than with standard ECCE

35
Q

Lens Replacement (Types of Cataract Surgery)

A

after removal of the lens by ICCE or ECCE, the surgeon inserts an intraocular lens implant (IOL). This eliminates the need for aphakic lenses; however the pt may still require glasses

36
Q

Nursing Mangement -Cataracts

A

-preop care
-instruct pt to call MD immediately if vision changes; continuous flashing lights appear; redness, swelling, or pain increase; type and amount of drainage increases; or significant pain is not relieved by acetaminophen

37
Q

Corneal Dystrophies

A

-inherited autosomal dominant
-manifests at 20 yrs of age
-deposits in corneal layers
-2 types: keratoconus & fuchs endothelial dystrophy

38
Q

Corneal Disorders Tx

A

phtotherapeutic keratectomy, keratoplasty, keratroprosthesis

39
Q

Corneal Disorders Refractive Surgery

A

-elective procedures to correct refractive errors and astigmatism by reshaping cornea
-pt needs counseling regarding potential benefits, risks, and complications

40
Q

Discharge instructions for after cataract surgery

A

-avoid lying on the side of the affected eye
-keep activity light
-avoid lifting, pushing, or pulling objects heavier than 15 lb
-avoid bending or stooping
-be careful climbing/descending stairs
-sneezing should not be held in bc it would increase IOP. sneezing should be done w/ an open mouth to decrease pressure

41
Q

Retinal detachment (retinal disorders)

A

rhegmatogenous detachment

42
Q

Retinal vascular disorders (retinal disorders)

A

-central retina vein occlusion
-branch retinal vein occlusion
-central retinal vein occlusion
-macular degeneration

43
Q

Retinal Detachment

A

-separation of the sensory retina and the RPE (retinal pigment epithelium)

s/s: sensation of a shade or curtain coming across the vision of one eye, bright flashing lights, sudden onset of floaters

44
Q

Retinal Detachment Surgical Treatment

A

Scleral buckle: compresses sclera

Vitrectomy: intraocular procedure. Gas bubble, silicone oil, perflurocarbon and liquids may be injected into vitreous cavity

45
Q

Retinal Vein or Artery Occlusion

A

-loss of vision can occur from retinal vein or artery occlusion

-occlusions may result from:
atherosclerosis, cardiac valvular disease, venous stasis, HTN, or increased blood viscosity

-associated risk factors: diabetes, glaucoma, aging

-pt may report decreased visual acuity or sudden loss of vision

46
Q

Age Related Macular Degeneration (AMD)

A

-accounts for 54% of all blindness in older adults

47
Q

Dry or Nonexudative Type (AMD)

A

-most common (85% to 90%)
- slow breakdown of the layers of the retina w/ the appearance of drusen

48
Q

Wet Type (AMD)

A

-may have abrupt onset
-proliferation of abnormal blood vessels growing under the retina-choroidal revascularization

49
Q

AMD Risk Factors

A

increasing age, smoking hx, HTN, overweight, hyperopia, familial incidence, arthritis

50
Q

Infectious & Inflammatory Disorders

A

-dry eyes
-conjuctivitis “pink eye”. Classified by cause: bacterial, viral, fungal, parasitic, allergic, toxic
Viral is contagious
-uveitis
-orbital cellulitis

51
Q

Ocular Consequences of Systemic Disease

A

-diabetic retinopathy. Diabetes is a leading cause of blindness in ppl aged 20-74 yrs
-ophthalmic complications associated w/ AIDS
-eye changes associated w/ HTN

Med Surg Exam 8 (3 decks)

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