Eye disorders Flashcards
How is Cataracts described?
Opacity or cloudiness of the lens
Cataracts are the leading cause of what in the united states?
disability
What are the four types of cataracts in addition to aging?
- Secondary
- Traumatic
- Radiation
- Congenital
By age of 80 more than half of all Americans have this.
Cataracts
What are the risk factors of cataracts?
- Age
- Environmental
- Heredity
- Diabetes
- Smoking and heavy alcohol
- Drugs
What environmental factors increase the risk of cataracts?
Trauma and excessive sun exposure
Cataracts tend to occur how?
Bilaterally but at different rates
What are the clinical manifestations of cataracts?
- Decreased acuity
- Painless
- Blurred vision
- Diplopia (sensitivity to glare)
- Color distortion
What are the diagnostic tests for cataracts?
-History and eye exam
What is the visual acuity tests used?
Snellen and Rosenbaum
Cataracts have an absence of what?
Red reflex
This type of exam needs to be done in order to truly diagnose a cataract?
Dilated eye exam with ophthalmoscope.
What is an Intracapsular cataract extraction (ICCE)?
Removal of entire lens
*rarely dine today
What is an extra capsular cataract extraction (ECCE)?
Maintains the posterior capsule of the lens.
Reducing potential postoperative complications
What is a Phacoemulsification?
An ECCE that uses an ultrasonic device to suction the lens out through a tube.
Incision is small than with standard ECCE
How is a lens replacement done?
After removal of the lens by ICCE or ECCE, the surgeon inserts an intraocular lens implant.
Having a intraocular lens implant eliminates the need for what?
Aphakic lenses
When is surgery for cataracts indicated?
When vision and ADLs affected
A cataract surgery is typically done how?
Outpatient and using local anesthesia
A patient just had cataract surgery. You should instruct the patient to call the physician immediately if what?
Vision changes Continuous flashing lights appear Redness, swelling or pain increases. Type and amount of drainage increases Significant pain is not relieved by acetaminophen.
When does the pain from Cataract surgery usually subside?
Within 1-2 days
Tends to be mild to moderate discomfort and some discharge
What should the patient make suer to do after Cataract surgery?
- Wear eye protection
- Take medications as ordered
- Avoid rubbing eyes
- Report symptoms
When does most healing complete after Cataract surgery?
7-8 weeks
What is specific in nursing management for a patient undergoing cataract surgery?
Dilating eye drops are ordered.
For a patient who has developed cataracts what does the nursing process become geared to?
Treatment and prevention of injury
What part of the physical exam should be done for a patient with potential cataracts?
Presence of red reflex
What do you need to implement in a patient with cataracts?
- Prevent injury
- Facilitate informed decision-making
- Teach principles of self-care
- Promote wellness
Which of the following statements indicates to the nurse that the client has understood home care instructions following cataract surgery?
- “I should not bend over to pick up objects from the floor.”
- “I can sleep on whichever side I want as long as my head is raised.”
- “I may not watch television for 6 weeks.”
- “I should keep the protective eye shield in place for 24 hours a day.”
- I can sleep on whichever side I want as long as my head is raised
When assessing a client, the nurse notes absence of the red reflex in the clients right eye. On questioning the client responds, “Oh, yes, my doctor told me I have cataracts. When should I have them removed?” How should the nurse respond?
- “It appears that the right eye is due for surgery.”
- “Are you having difficulty reading or doing activities you enjoy?”
- “Are you starting to experience frequent headaches or pain in your right eye?”
- ” Cataracts can be removed at any time that is convenient for you.”
- “Are you having difficulty reading or doing activities you enjoy?”
When a client who has undergone cataract extraction is preparing to go home, the nurse reinforces which of the following instructions?
- Remove the dressing at bedtime.
- Expect a headache for the first few days after the procedure.
- Avoid sleeping on the operative side.
- Set up new appointment with surgeon for 1 month from the day after discharge.
- Expect a headache for the first few days after the procedure.
What is the most common cause of vision loss in people older than 60?
Macular degeneration
What are the types of macular degeneration?
Dry or non exudative
Wet
What is the most common type of macular degeneration?
Dry or non exudative- 85 to 90%
What happens to the eye in a dry or nonexudative type of macular degeneration?
Slow breakdown of the layers of the retinal with the appearance of drusen
What happens in the wet type of macular degeneration?
Abrupt onset
Proliferation of abnormal blood vessels growing under the retina
What is choroidal revascularization?
Proliferation of abnormal blood vessels growing under the retina
What does the macula provide?
Sharp central vision
How does nonexudative macular degeneration occur?
- Gradual accumulation of deposits
- Pigment epithelium detaches in small areas.
- Typically vision loss not significant -slowly progresses
- Risk that disorder will progress to exudative stage
How does the exudative macular degeneration occur?
- Formation of new, weak blood vessels
- New vessels prone to leak
- Elevate retina from choroid
- Bleeding can occur
- Acute vision loss
Who has a lower risk for macular degeneration?
Asians and those with darker pigmentation
How many americans does Macular degeneration effect?
15 million
What are the risk factors for macular degeneration?
- Aging
- Smoking
- Race
What race has a higher risk for macular degeneration?
whites
What are the clinical manifestations of macular degeneration?
Macula damage
- Central vision blurred
- Peripheral vision intact
- Wet AMD (straight lines appear crooked or wavy)
What should be added in the physical exam of a patient with macular degeneration?
Visual acuity
Amsler grid
What are the diagnostic tests used for macular degeneration?
- Vision and retinal examination
- Amsler grid
- Fluorescein angiogram
What types of collaboration therapy is used in patients with macular degeneration?
- Ophthalmologist
- Occupational therapist
- Social working
- Adaptive technology
- Quality of life affected
What does photodynamic therapy use for treating macular degeneration?
Verteporfin
What happens when using photodynamic therapy to treat vascular degeneration?
- Tends to adhere to surface of new blood vessels
- Shining light into affected eye activates drug, destroys new blood vessels
- Can also destroy surrounding healthy tissue, some vision loss, new vessels grow
Surgery for Wet AMD is done how and may do what?
- Laser surgery, photodynamic therapy
- May slow rate of vision loss
What pharmacologic therapy is used for wet macular degeneration?
Antiangiogenic drugs
How are antiangiogenic drugs administered to a patient with wet AMD?
It must be injected into the eye
A patient who is on antiangiogenic drugs to treat wet AMD- what must they report?
Eye pain
Photophobia
Heart attack
Confusion
What does antiangiogenic drugs do in the eye?
Blocks vascular endothelial growth factor that stimulates angiogenesis
What are the three types of antiangiogenic drugs that are used to treat wet AMD?
- Ranibizumab
- Bevacizumab
- Pegaptanib
What are types of nonpharmacologic treatments for the early to intermediate stages of macular degeneration?
Dry AMD can be slowed with high dose of antioxidants and zinc
What are the nonpharmacologic things that can help a person with macular degeneration?
Large print books
Magnifying glass
Lighting
What should the nurse be alert to in any patient?
Clients demonstrating new or rapid onset of macular degeneration
What should you do if you notice a patient is demonstrating one of macular degeneration?
Refer for ophthalmological evaluation
What are the diagnoses for a patient with macular degeneration?
- Risk for injury
- Risk for ineffective self-health management
- Fear
What needs to be implemented for patients with macular degeneration?
- Explain the nature of the condition
- Attend to verbalized concerns
- Assess for factors that may interfere with ability to provide self care
- Recommend visual aids
- Teach client and caregiver about diet
- Offer smoking cessation resources
- Explain need for regular eye exams.
What should be included in the evaluation of a client with macular degeneration?
- Verbalizes concerns and identifies appropriate resources
- Demonstrates ability to safely compensate for visual deficits
- Describes strategies to promote self-care
What is the leading cause of blindness in adults?
Glaucoma
How is glaucoma described?
A group of ocular conditions in which damage to the optic nerve is related to increased intraocular pressure caused by congestion of the aqueous humor.
What increased intraocular pressure that causes optic neuropathy?
Imbalance in its production and its drainage
Glaucoma can be described an an open angle. What does that mean?
Painless, progressive narrowing of visual field
Where does the aqueous humor occupy in the eye?
Anterior and posterior chambers of the eye.
What are the three types of glaucoma?
Open angle
Angle closure (pupillary block)
Congenital glaucomas and glaucoma secondary to other conditions
What are the types of open angle glaucomas?
- Chronic open-angle
- Normal-tension
- Ocular hypertension
What are the types of angle closure glaucoma?
- Acute angle
- Subacute angle
- Chronic angle
What is not balanced in glaucoma?
Aqueous production and drainage are not balanced.
When this is blocked, pressure builds up in the eye.
Aqueous outflow
When this is increased this causes irreversible mechanical or ischemic damage.
Intraoccular pressure
Open-angle glaucoma is what percentage of all glaucoma’s?
90%
Open-angle glaucoma is considered what?
Chronic, gradually progressive and effects the eyes bilaterally.
Angle-closure glaucoma is described as what?
Corneal flattening, bulging of iris into anterior chamber.
IOP rises abruptly
Why is glaucoma called the silent thief?
Patients are unaware of the condition until there is significant vision loss; peripheral vision loss, blurring, halos, difficulty focusing, difficulty adjusting eye to low lighting
Other than the eyes- where else will a patient experience an aching discomfort?
Around the eyes or headaches.
True or False:
Angle-Closure Glaucoma usually is bilateral?
False:
Usually unilateral
What medications should you avoid if you have angle-closure glaucoma?
Any meds that are mydriatics (causing dilation of pupil)
What are the symptoms of angle-closure glaucoma?
Headaches Severe eye pain Nausea Vomiting Rainbows around lights at night Very blurred vision Profuse tearing
What are the 3 Ps of blindness due to open angle glaucoma?
Preventable
Painless
Permanent
What are the risk factors for glaucoma?
Age Genetics African Americans Diabetes Infection Trauma
What are the diagnostic tests for glaucoma?
Tonometry
Funduscopy
Gonioscopy
Visual field testing
What is tonometry used for?
To assess IOP
What is gonioscopy used for?
Assess the angle of the anterior chamber of the eye
What is Perimetry used for?
To assess vision loss
What is the importance of the glaucoma tests?
To assess the progression of visual field defects.
What are the treatment options for glaucoma?
- Prevent further optic nerve damage
- Maintain IOP within a range unlikely to cause damage
- Pharmacologic therapy
- Surgery
What are the Pharmacologic therapies for glaucoma?
- Topical beta-adrenergic blocking agents
- Prostaglandin analogs
- Adrenergic agonists
- Carbonic anhydrase inhibitors
What are the medications used for acute angle-closure glaucoma?
IV diuretic
Fast-acting biotic drops
What are the surgical interventions for open angle glaucoma?
- Laser trabeculoplasty
- Trabeculectomy
- Photocoagulation
- Cyclocryotherapy
- Drainage implants or shunts
What are the surgical interventions for acute angle-closure glaucoma?
Gonioplasty
Laser iridotomy
What should your nursing process focus on in a client with glaucoma?
Effects on client's: Vision loss Lifestyle Safety Psychosocial well being
What focused physical examination should be done on a patient with glaucoma?
Distant and near vision
Peripheral fields
Retina
What nursing diagnoses are there for patients with glaucoma?
- Risk for ineffective Self-Health Management
- RIsk for injury
- Anxiety
What should you plan for the client to do if they have glaucoma?
- Follow care guidelines
- Have no further vision loss
- Remain free from injury
- Report control over environment, reduced anxiety
What should the nurse implement in patients with the nursing diagnosis of prevent injury due to glaucoma?
- Provide instructions related to unilateral loss of vision, depth perception
- Assess clients ability to perform ADLs
- Alert personnel not to change arrangements
- Raise two or three side rails on bed
- Discuss adaptations in the home
What should the nurse implement in patients with the nursing diagnosis of Facilitate Orientation and Environmental Modifications due to glaucoma?
- Address client by name, identify self
- Provide visual aids that are routinely used
- Orient client to environment
- Provide tools, items to help compensate
- Assits with meals
- Assist as needed with mobility and ambulation
What should the nurse implement in patients with the nursing diagnosis of Promote Psychosocial Wellness due to glaucoma?
- Assess verbal, nonverbal indications of anxiety
- Encourage client to verbalize feelings
- Discuss client’s perception of eye condition
- Identify coping strategies useful in past
- Adapt strategies to present situation
What should you include in the evaluation of a client with glaucoma?
- Demonstrates proper self-administration of eye drops
- Describes need for compliance with plan of care to avoid complications
- Lists resources available
