Eye Ear Disorders

Question 1

Cataracts etiology/RF

Answer 1

Opacity of the lens

Etiology/RF:

Aging
Trauma
Culumative exposure to ultraviolet
High altitudes or bright sunlight
Down syndrome
Infections (rubella first trimester)

Question 2

Cataracts patho

Answer 2

Reduced O2 in the lens
⬆️ in water, then dehydration of lens
Electrolyte and protein levels change
Lens yellows becomes opaque

Question 3

Cataracts CM

Answer 3

⬇️. Or blurry vision
Abnormal color perception & glare - worse at night
⬇️ visual acuity
Opaque white pupil

Question 4

Cataracts management

Answer 4

Non sx: temporary and palliative

Most common sx in us:
Outpatient
Topical anesthesia
IV sedation
Small corneal incision
Can correct astigmatism during procedure
Intraocular lens implanted for astigmatism (no stitches)

Question 5

Cataracts post op care

Answer 5

Eye patch/ sunglasses until return visit next am

Photophobia from dilating eye drops

Assistance w/ self care, home 1-2 weeks until vision improves (NO DRIVING)

Avoid activities that ⬆️ IOP

Report unrelieved pain (should have little to no pain)

Question 6

Retinopathy
Etiology
Prevention

Answer 6

Etiology:
-Microvascular damage w/ capillary leakage or hemorrhage
-blurred vision

Prevention:
Control DM & HTN
Annual eye exams

Question 7

Retinopathy
Tx

Answer 7

Watch and wait

Manage DM & HTN

Laser treatment to slow leakage

Vitrectomy to remove blood

Question 8

Retinal detachment
What happens
RF

Answer 8

Separation of retina from choroid with fluid between layers

RF:
Age
Cataract removal
Trauma
Previous detachment
FH

Question 9

Retinal detachment CM

Answer 9

Visual field loss in opposite quadrant from detachment

Floaters, (curtain closing)
Flashing light

Acute onset

No pain

If untreated=blindness will occur

Question 10

Retinal detachment
Sx management

Answer 10

Surgically place retina back : Laser

Nitrous oxide to freeze tissue: freezes the break, then scarring seals the break

Scleral buckling: sponge band

Pneumatic retinopexy: gas bubble injected to close retinal break

Question 11

Retinal detachment
Nursing management

Answer 11

Monitor eye patch for drainage

Restrict activities if air/gas bubble used:
-Head down/side-lying

IV diamox: reduce IOP

Abx, steroid eye drops

Question 12

Age-related macular degeneration
Most common cause of what
What is macular degeneration
What happends over time (also dry vs wet)
CM

Answer 12

Most common cause of vision loss

Macula: central region of retina

Degenerative changes over time:
Dry: atrophy of macular cells
Wet: (most severe) damage BV leak leading to hemorrhage

CM:
Blurred or darkened central vision

Question 13

Age related macular degeneration
Dry vs wet tx
Other supportive care
Risk reduction

Answer 13

Dry: no tx

Wet:
-meds to stop growth of new BV (anti-angiogenic)
-laser photocoagulation to stop bleeding

Other supportive care:
-magnifiers
Brighter lights in home
No driving

Risk reduction:
Stop smoking
⬆️ vitamine C & E
Zinc and copper
Routine eye exams

Question 14

Glaucoma
What happens

Answer 14

Increased IOP (normal 10-21)
Optic nerve atrophy
Peripheral visual field loss

Question 15

Glaucoma
Etiology
RF
Prevention: primary vs secondary

Answer 15

Know early warning signs
HTN, CVD, DM
Age over 60
FH

Primary prevention:
-reducting RF: HTN, CVD, DM

Secondary prevention:
-screenings

Question 16

Glaucoma patho

Answer 16

Not related w/ BP

Buildup of aqueous fluid leads to ⬆️ pressure

⬇️ Blood supply to optic nerve and retina=damage

Question 17

2 types of glaucoma

Answer 17

Primary open-angle glaucoma

Primary angle closure glaucoma

Question 18

Primary open-angle glaucoma
Most common what
Progresses how
Early signs?
What gets clogged
This does what
Dx

Answer 18

Most common glaucoma
Slow progression
No early signs

Trabecular meshwork is clogged: blocks aqueous drainage

⬆️ pressure damages optic nerve

Dx: tonometry

Question 19

Primary angle closure glaucoma

Answer 19

Reduction in outflow of aqueous humor from angle closure

Acute attack d/t prolonged pupil dilation

So…
Pupil dilation= ⬆️ IOP d/t this

Question 20

Primary OPEN angle glaucoma CM

Said before:
S/s:
THEN

Acute angle CLOSURE causes what s/s:

Answer 20

Said before:
No early signs
Gradual visual field loss

Small blind spots develop
Tunnel vision
Blindness if entire optic nerve destroyed

Acute angle closure:
Several pain
N/V
Colored halos, blurred vision

Question 21

Glaucoma tx
Goal
Tx for:
-constrict pupil
-reduce aqueous humor production=⬇️ IOP

Answer 21

Goal: reduce IOP

Constrict pupil:
-topical miotics (Pilocarpine) drops or Ocusert wafer
-Epinephrine
*avoid mydriatics (they dilate pupil) NO ATROPINE

Reduce aqueous humor production:
Topical beta blockers (Timolol)

Question 22

Open glaucoma nursing diagnoses

Answer 22

Greving
Risk for blindness

Risk for ineffective therapeutic regimen management:
Mitics QID
Beta blockers eye drops Q12H

Teach how to administer eye drops
Hold lower eyelid, hold corner of eye

Question 23

Meniere’s disease

Excess what where
Classic s/s

Answer 23

Excess of endolymph in vestibular and semicircular canals

Episodic

Classic s/s:
-vertigo
-tinnitis
-fluctuating hearing loss
-oral fullness

Question 24

Meniere’s disease TX
Things to do
Risk
Avoid
Meds

Answer 24

Things to do or avoid:
-Bed rest during vertigo
-Risk of falls
-Dark room
-Avoid sudden head movement
-Avoid flourescent, flickering lights, TV off

MEDs:
-Antihistamines
-Antiemetics
-Benzodiazepines
-Meclizine (antivert): motion sickness

Question 25

Meniere’s disease
Diet restrictions

Answer 25

NA
Caffeine
Alcohol
Foods w/ MSF during acute attacks

Question 26

OD vs OS vs OU

Answer 26

OD right
OS left
OU both