Glaucoma Diseases and Retinal Problems

Question 1

etiology of glaucoma

Answer 1

disorders that involve many different pathologic changes and symptoms but have in common an optic neuropathy that damages the optic disc, causing atrophy and loss of vision

Question 2

The neuropathy often is caused by

Answer 2

increased intraocular pressure (IOP) (Boyd, 2020)

Question 3

Which explanation accurately describes the calculation of intraocular pressure

Answer 3

Rate of aqueous humor production and outflow

Question 4

Which cause of secondary glaucoma would the nurse include when teaching a class about the eye disorder

Answer 4

A history of retinal detachment

Question 5

What are the danger signals of glaucoma

Answer 5

-Eyeglasses, even new ones, that do not seem to clarify vision
-Blurred or hazy vision that clears up after a while
-Difficulty adjusting to darkened rooms, such as in movie theaters
-Seeing rainbow-colored rings around lights
-Narrowing of vision at the sides of one or both eyes
-Encourage a complete eye examination if any of these signs is present

Question 6

glaucoma screening

Answer 6

People at normal risk for glaucoma should be screened every 2 to 4 years before age 40, every 1 to 3 years from ages 40 to 54, every 1 to 2 years from ages 55 to 64, and every 6 to 12 months after age 65 (Glaucoma.org, 2017).
People who are at high risk should be screened every 1 to 2 years after age 35.

Question 7

risk factors for glaucoma

Answer 7

Diabetes
African Americans
Family history of glaucoma

Question 8

Air Tonometer

Answer 8

-Commonly used screening technique for early detection of glaucoma
-Measures IOP
-A puff of air is directed at the cornea, which causes a momentary indentation while a pressure reading is taken
-Painless
-Nothing but the air touches the eye.

Question 9

Applanation Tonometer

Answer 9

-A more complex instrument (than the air tonometer)
-Verifies the diagnosis of glaucoma
-The cornea is flattened, and pressure is measured with a slit-lamp biomicroscope.

Question 10

Glaucoma treatment

Answer 10

• initial treatment of choice for chronic (open-angle) glaucoma is medication rather than surgery
  -Drug therapy is intended to enhance aqueous humor outflow or decrease its production so that IOP is decreased
  -Miotics:
  Cause blurred vision for 1 to 2 hours after use.
  Cause difficulty adjusting to dark rooms because of pupil constriction

-Pilocarpine:
An eye medication disk that resembles a contact lens.
Inserted into the conjunctival sac in the lower eyelid.
Can remain for up to 7 days.
Slow release of medication.
Does not prevent the wearing of contact lenses

-Diuretics

Question 11

goal of glaucoma surgery

Answer 11

-create an opening so that excess fluid can escape
-A laser is used to create evenly spaced openings in the collecting meshwork (trabeculoplasty) to facilitate aqueous humor drainage in open-angle or chronic glaucoma, A tiny shunt may be placed to drain excess aqueous humor if other surgeries do not produce the desired results.

Question 12

Points to Cover in the Glaucoma Teaching Plan

Answer 12

-Signs of elevated IOP include pain in the eye, redness, tearing, blurred vision, halos around lights, and frequent need for change in eyeglasses.
-Measures to prevent increase in IOP include low-sodium (Furstenberg) diet, little caffeine intake, preventing constipation and Valsalva maneuver, and decreasing stress.
-Taking prescribed medications and refraining from taking over-the-counter or other medications without the health care provider’s knowledge are important. Glaucoma medication must be taken regularly for life.
-Use good aseptic technique when instilling eye medication.
-Wear an ID tag or bracelet stating “glaucoma,” and carry a card in your wallet that states what medications are being taken.
-Keep an extra bottle of eye medication on hand. Carry eye drops.
-Maintain close medical follow-up with the provider.
-Practice safety habits; avoid night driving if possible.

Question 13

S/S of narrow-angled glaucoma

Answer 13

-Narrow-angle glaucoma can be acute or chronic
-Acute conditions are a medical emergency in which there is severe pain in the eye accompanied by:
The appearance of colored halos around lights
Blurred vision
Pain in and around the eye
Nausea and vomiting

Question 14

The cause of narrow-angle glaucoma is

Answer 14

the position of the iris, which lies too close to the drainage canal and bulges forward against the cornea, blocking the drainage of aqueous humor.
The IOP rises suddenly, sometimes reaching a pressure of 50 to 70 mm Hg.
Relief of the situation must be prompt or damage to the optic nerve will cause blindness in the affected eye

Question 15

Diagnosis

Answer 15

Diagnosis is by history, testing of IOP, and slit-lamp eye examination

Question 16

postop care after eye surgery

Answer 16

Eye drop:
-Pilocarpine
-Timolol
-Apraclonidine
-Intravenous (IV) acetazolamide

Question 17

Surgery

Answer 17

-Surgery is performed as soon as inflammation subsides to relieve pressure against the optic nerve endings.
-Procedures that allow filtering of the aqueous humor from the anterior chamber into the subconjunctival space are performed. These include:
Laser iridotomy
Trabeculectomy
Laser trabeculoplasty
Others
-If these procedures fail, sometimes cyclocryotherapy (the application of a freezing tip) may be used on the ciliary body to decrease the aqueous production.

Question 18

Patient education should include:

Answer 18

Teaching about activity precautions during healing
The schedule for eye drops
Symptoms to report to the surgeon
Aseptic handling of the eye drops and eye shield

Question 19

Which change in the eyes would the nurse anticipate after instilling miotic eye drops?

Answer 19

Pupil constriction

Question 20

common causes of retinal detachment

Answer 20

rhegmatogenous detachments where a hole, tear, or break in the neuronal layer allows vitreous humor to seep between layers.

Question 21

Causes of retinal detachment also include:

Answer 21

Traction or exudative mechanisms
Congenital malformations
Trauma
Metabolic disorder, such as diabetic or hypertensive retinopathy

Question 22

Risk factors for retinal detachment are:

Answer 22

high degree of myopia
History of cataract surgery
Direct trauma to the eye
Age older than age 40
Occurs most commonly between ages 40 and 70 years

Question 23

history of retinal detachment in the other eye

Answer 23

15% of people with retinal detachment in one eye develop detachment in the other eye.

Question 24

pathophysiology of retinal detachment

Answer 24

separation of the sensory layers of the retina from the pigmented epithelial layer, the choroid, causing vitreous fluid to leak under the retina, separating a portion of it from the vascular wall and thereby depriving the retina of its blood supply

Question 25

S/S of retinal detachment

Answer 25

-Flashes of colored light accompanied by showers of floaters (black spots)
-Feeling as if a curtain has been drawn over a portion of the visual field
-Later, cloudy vision or loss of central vision
In severe cases, complete loss of vision

Question 26

retinal detachment Diagnosis

Answer 26

-Direct ophthalmoscope
-Stereoscopic indirect ophthalmoscope
-Ultrasound:
Can be used when the eye is clouded by opacity from cataract or hemorrhage

Question 27

treatment for retinal detachment

Answer 27

Laser therapy
Photocoagulator
Cryotherapy
Scleral Buckling
Closed Vitrectomy

Question 28

Postoperative Nursing Management: retnial detachment

Answer 28

-Monitor IOP closely for at least 24 hours.

Head positioning:
Prescribed by the surgeon
Position head so that the area repaired is dependent, preventing the pull of gravity from disrupting the surgical site
If oil or a gas bubble was used, the positioning is calculated to apply pressure to the retina.

Question 29

Postoperative Patient Education: retinal detachment surgery

Answer 29

-Pain: ice packs
-Return of vision: improves gradually over several weeks to months
-Several types of eye drops as well as an antibiotic ointment
-Activity: showering with head back, avoid heavy lifting, straining at stool, and vigorous activity for several weeks
-Flashing lights:
common for the first few weeks, decrease over 2-6 months (if worsen notify surgon)
-Light sensitivity: lessens over a period of 4-6 weeks
-Eye discharge:
moderate amount is not unusual, should be yellowish or pink-tinged
Notify the surgeon if:
The amount increases markedly
The discharge is accompanied by severe pain
The discharge has a foul smell or has a greenish tinge (indicating a potential infection)

-If discharge occurs:
Cleanse the eyelid with a gauze pad or cotton ball moistened with irrigating solution or tap water.
Wipe from the inner to the outer area of the eye.
Use a separate clean pad/cotton ball for each eye.

Question 30

he two major causes of retinopathy are.

Answer 30

diabetes mellitus (DM) and hypertension.
Contributing factors are:
excessive use of nicotine
excessive use of caffeine
high stress levels

Question 31

two forms of diabetic retinopathy

Answer 31

proliferative and nonproliferative retinopathy.

Question 32

proliferative

Answer 32

-Occurs later in the course of DM
-Neovascularization occurs, in which new blood vessels grow from the existing retinal vessels.
The new vessels are thinner and rupture more easily, causing hemorrhage.
-The blood from the hemorrhage causes scarring, which also interferes with vision

Retinal detachment may occur as a result of proliferative retinopathy

Question 33

Nonproliferative

Answer 33

-Microaneurysms develop on the retinal blood vessels.
-These eventually swell and rupture, causing hemorrhage into the vitreous humor, which interferes with vision.

Question 34

As the retinopathy progresses, there are alterations in vision such as

Answer 34

Blurring
Missing areas in the field of vision
Seeing red or black lines or spots

Question 35

retinopathy treated

Answer 35

control of bp
blood glucose control

Question 36

Which education would the nurse provide to a patient with diabetes to prevent retinopathy?

Answer 36

Avoid drinks containing caffeine.

Question 37

neovascularization

Answer 37

The growth of new vessels

Question 38

Which complication is associated with proliferative retinopathy

Answer 38

Retinal detachment