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ACVN - MEDICAL NURSING > Ophthalmology 2 > Flashcards

Ophthalmology 2 Flashcards

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1
Q

What patient factors should be considered in preparation for eye surgery?

A
  • physical mobility
  • systemic health - bloods?
  • conformation/concurrent BOAS
  • ocular complant - eye drops?
  • where and when place IVC
  • insulin or not to diabetic patients?
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2
Q

What is important for anaesthesia during eye surgery?

A
  • smooth induction ideal
  • vacuum bags prevent movement
  • neurmuscular blockage and ventilation
  • non-kinking ‘armoured’ ET tubes and T connectors
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3
Q

How should you clip the eye for surgery?

A
  • wear gloves
  • apply copious amounts of lubriacting gel to the eye(s)
  • use small, clean, sharp clippers
  • sharp scissors for eyelashes
  • clip area required as close to the skin as possible without causing irritation
  • flush hairs and lubricant away with saline
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4
Q

What surgery is clipping not required?

A

globe surgery

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5
Q

How do you surgically prep the eye?

A
  • povidone iodine solution always
  • never povidone scrub or tincture
  • gauze swabs and sterile saline to remove gel and hair from eyes
  • prep globe first the eyelids
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6
Q

What dilution of iodine should youuse for globe surgery?

A

1 part povidone iodine:50 parts sterile saline

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7
Q

What iodine dilution would you use for eyelid surgery?

A

1 part povidone iodine:10 parts sterile saline

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8
Q

What is the contact time for using iodine on the eye area?

A

2 minutes then flush out

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9
Q

What eqipment do you need on the trolley for ocular surgery?

A
  • patient drapes (fenestrated, sticky, drape tape +/- pouch)
  • surgeons chair
  • gown gloves, chair and equipment drapes
  • prepare saline flush
  • operating microscope with sterile handles
  • ventilator and muscle stim if neurmuscular blockade used
  • phacomulsification machine for cataract surgery
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10
Q

What surgical kits do you need for ocular surgery?

A

lid kit, corneal kit, phaeco kit and suture materials

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11
Q

What suture materials are recommended for ocular surgery?

A
  • 8/0 or 9/0 vicryl, spatulated needle for cornea
  • 5/0-6/0 vicryl for lids
  • stay suture material
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12
Q

What are the considerations for enucleation surgery?

A
  • local retrobulbar block?
  • trans-conjunctival 2 phase
  • transpalpebral for en-bloc, suture first
  • oculo-cardiac reflex
  • avoid traction on chiasm
  • haehorrhage
  • histology recommended
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13
Q

What is the oculo-cardiac reflex?

A

reflex bradycardia on eye pressure (vagus)

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14
Q

Why should you avoid traction on the chiasm?

A

avulsioon can blind fellow eye especially in cats

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15
Q

What are common eye/around the eye surgeries?

A
  • entropian, mass removal
  • rhytidectomy (facelift for droopy dogs)
  • distichasis/ectopic cilia with cryosurgery or electrolysis
  • cherry eye
  • lip to lid transpositions
  • parotid duct transposition for dry eye
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16
Q

How would you position the eyes for corneal surgery?

A

horizontal positioning

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17
Q

What happens during corneal surgery?

A

removal of the damaged cornea

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18
Q

What is a common cause of blindness?

A

cataracts

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19
Q

What can you do post-op to check the risk of glaucoma?

A

gonioscopy

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20
Q

What can you do to check functional retina before cataracts surgery?

A

ERG - electroretinogram

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21
Q

What does a gonioscopy do?

A

assess drainage angle

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22
Q

What is a gonioscopy looking for?

A

signs of inherited glaucoma

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23
Q

What can local can you use when doing an ocular ultrasound to desnsitise the corneal?

A

proxymetacaine

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24
Q

What would you do an ocular ultrasound for?

A

assess the structures of the eye, cataracts, retinal displacement, retrobulbar mass, foreign body

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25
Q

What does a electroretinogram assess?

A

if the retinal is functional

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26
Q

What percentage of dogs with diabetes develop diabetic mellitus cataract within 6 months?

A

50%

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27
Q

What percentage of patients with diabetes mellitus develop cataracts within a year?

A

75-80%

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28
Q

What can diabetic cataract ucase?

A

ruptured lens capsule, lens induced uveitis

29
Q

What does cataract surgery do?

A

restores vision

30
Q

What are the success rates for cataract surgery?

A

85%+

31
Q

What pre-op assessment would you do for cataract surgery?

A
  • electro-retinogram
  • high frequency ultrasound of drainage angle and sreen for detached retina/masses
  • gonioscopy
  • full blood and urine workup
32
Q

How long do you give medications for phaeco aftercare?

A

up to 12 times daily in the first week

33
Q

What drugs control uveitis?

A

NSAIDs and steroids

34
Q

What can you give to minimise intraocular pressure spike?

A

glaucoma medications

35
Q

How long do you give antibiotics?

A

until wounds heal

36
Q

What are the risk factors associated with anaesthesia for the ophthalmic patient?

A
  • variety of ages, tend to be older
  • co-morbidities
  • brachycephalics are 25% caseload at referal
  • cardiac
37
Q

What analgesia plan is optimal for these patients?

A

-topical proxymetacaine diagnostic only
- local skin line or retrobulbar
- systemic NSAID/opioids/CRI

38
Q

How do you achieve a ‘central eye’?

A

paralysis extraocular muscles

39
Q

How long does atracurium last?

A

15-35 minutes

40
Q

What should you avoid with neuromuscular bloackade?

A

hypothermia, acidosis andhypokalaemia

41
Q

When should you ventilate?

A
  • if intercostal paralysis used
  • until patient spontaneous breathing
42
Q

What is relative exophthalmos?

A

bulging eye

43
Q

What is seen in brachycephalic ocular syndrome?

A
  • lower medial entropian
  • shallow orbit and relative exophthalmos
  • macropalpebral fissure
  • lagophthamos
  • medial caruncular trichiasis
  • pigmentary ketatiitis
  • nasal fold trichiasis
  • epiphora from kinking of the N-L canaliculi and obscuring punctum
44
Q

What is macropalpebral fissure?

A

excessive limbal or sceral exposure

45
Q

What is lagophthalmos?

A

sleeping with lids incompletely closed

46
Q

What can you do to help a patient with compromised airway?

A
  • pre-oxygenate and provide O2 nasal prongs or nasal catheter in recovery
  • keep cool
  • reduce stress
  • late admission, early discharge
  • upper respiraory tract obstruction at recover
  • late extubation
47
Q

How can regurge risk be decrease?

A

if starvation is shorter

48
Q

What can you use to reduce pain and ulceration with regurge?

A

omeprazole

49
Q

What is a hiatial hernia?

A

when the stomach slides into the chest

50
Q

What do opioids do?

A

reduce GI motility

51
Q

How can you increase peristalsis/

A

keep the patient moving

52
Q

How do you nurse a diabetic patient?

A
  • monitor glucose
  • starve in the morning and withold insulin
  • avoid hypoglycaemia
  • elevated fluid requirement
53
Q

What increased risks are there with diabetic patients?

A
  • systemic hypertension
  • dry eye
  • delayed healing
  • infection
54
Q

What client communication is important with ophthalmic patients?

A
  • client expectations managed
    -training clients to be effective with eye drops
  • training dog with reward for drops
  • habituate brachcephalic puppies to daily lubricants in yourh so accept well when treatment needed later
  • easy tests to monitor or start tear supplementation earlier
  • brachys 3.6x more likely Keratoconjunctivitis Sicca (KCS)
55
Q

What can you do in primary care nurse clinics?

A
  • monitor normal patients to see what is normal compared to abnormal
  • educate owners on conditions
  • supportive medication compliance
    -positive reinforcement training to accept eye drops
56
Q

What does the lipid layer do?

A

prevents avapouration and aids distribution of tears

57
Q

What does the aqueous layer do?

A

supplies corneal nutrition, antibacterial properties and removal and remodelling of proteases and antiproteases

58
Q

What does the mucous layer do?

A

lubrication, refractive properties and anchors aqueous layer to cornea

59
Q

What is keratoconjunctivitis sicca?

A

deficiency of aqueous tear

60
Q

What diagnostic tests can be done for KCS?

A

schirmer tear test

61
Q

What is normal range for schirmer tear test?

A

15-25mm/min

62
Q

What is early suspicion of KCS on schirmer tear test?

A

10-14mm/min

63
Q

What is moderate KCS on schirmer tear test?

A

6-10mm/min

64
Q

What is severe KCS on schirmer tear test?

A

0-5mm/min

65
Q

What are common clinical signs of KCS?

A
  • strings of adherent mucus
  • poor corneal clarity
  • poor corneal shine/poor purkinje reflex
  • low schirmer tear test
66
Q

How can you reduce the risk of regurge and reflux nutrition wise?

A

feed a low fat meal either orally or through NG tube for gastric decompression

67
Q

What is pigmentary keratosis?

A

brown-black discolouration in the eyes surface due to deposition of pigmented melanin granules

68
Q

How can you prevent histamine realse with administration of neuromuscular blockade?

A

dilute in saline and give slowly IV

69
Q

What patients are safe with neuromuscular blockade due to it being non-cumulative?

A

hepatic and renal patients

ACVN - MEDICAL NURSING (22 decks)

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