NUR 146 - Week 5- Eye Flashcards
Eye examinations
Ocular hx questions
Visual acuity:
- Snellen chart = distance
- Rosenbaum pocket screener - near/handheld
Finger count or hand motion
Diagnostics for Eyes
- Ophthalmoscopy
- Slit-lamp examination
- Color vision testing
- Amsler grid
- Ultrasonography
- Fundus photography
- Tonometry
- Angiography
Types of Impaired Vision
Reflective errors
Emmetropia: normal vision
Myopia: “nearsighted”
Hyperopia: “farsighted”
Astigmatism: distortion caused by irregularity of cornea
Low vision and blindness:
Definition
Criteria for blindness
Low vision: Visual impairment that requires the use of devices and strategies to perform visual tasks
Blindness:
- 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
- Impaired vision is often accompanied by functional impairment
Low vision:
Assessment
History
Examination of distance and near visual acuity
Visual field
Contrast sensitivity
Glare
Assessment:
- Functional ability
- Coping
- Adaptation in emotional, physical and social issues
Low vision:
Nursing Management
Support coping strategies, grief processes and acceptance of visual loss
Strategies for adaptation to the environment
Ocular medication administration
Ability of the eye to absorb medication is limited
Barriers to absorption:
- Size of conjunctival sac
- Corneal membrane barriers
- Blood-ocular barriers
Intraocular injection or systemic medication may be needed to treat some eye structures or provide high concentration of medication
Ophthalmic medications
Topical anesthetics:
- Mydriatics (dilate), cycloplegics (paralyze)
Glaucoma:
What is it?
Group of ocular conditions in which damage to the optic nerve is related to increased intraocular pressure (IOP) caused by congestion of aqueous humor
Patho:
- Aqueous production and drainage are not in balance
- This leads to pressure build up in
- IOP may cause irreversible damage
Glaucoma:
Clinical manifestations / s&s
“Silent thief”
- Significant vision loss
- Peripheral vision loss
- Blurring
- Halos
- Difficulty focusing
- Difficulty adjusting
- Aching/discomfort around eyes; headache
Glaucoma:
Diagnostic findings
Tonometry: assess IOP
Ophthalmoscopy: inspect optic nerve disc
Central visual field testing: Pt can’t see peripheral areas
Glaucoma:
Treatment / Management
Goal: Prevent further optic nerve damage
Maintain IOP to prevent causing damage
Pharmacologic:
- Miotics
- Beta-blockers
- Alpha1-agonists
- Carbonic anhydrase inhibitors
Apraclonidine
Decreases aqueous humor production
Pilocarpine
Cholinergic drug
Increase aqueous fluid outflow by contracting ciliary muscle and causing miosis and opening of trabecular meshwork
Side effects:
- Blurred vision
- Difficulty seeing in the dark
Caution patients about diminished vision in dimly lit areas
Glaucoma:
Nursing management:
Cataracts
An opacity or cloudiness of the lens
Incidence:
- Increased with aging
- Age 80 = more than half of all Americans
Three types:
- Traumatic
- Congenital
- Senile Cataract
Cataracts:
Clinical Manifestations / s&s
Painless, blurry vision, surroundings dimmer
Sensitive to glare
“Less sharp vision”
Cataracts:
Surgical management
If reduced vision doesn’t interfere with day to day life, surgery is not needed
Surgery takes less than 1 hour, discharges soon after. Not many complications
Cataracts:
Pre op
Post op care
Pre op:
- Dilating eye drops or other medications
Post-Op:
- Patient education
Retinal detachment
Separation of the sensory retina and RPE (retinal pigment epithelium)
Manifestations:
- Sensations of shade or curtain across vision of one eye
- Bright flashing light
- Sudden onset of floaters
Retinal detachment:
Diagnostic findings
Visual acuity
Assessment of retina by indirect ophthalmoscope
Slit lamp
Fluorescein angiography
Retinal detachment:
Treatment
Vitrectomy:
- injected Gas bubble holds retina in place
Scleral buckle:
- Compresses the sclera
