Sensory: Eye Flashcards
1
Q
Which assessment chart is used for Distance Vision?
A
Snellen Chart
Assess from 20 feet away, unilateral and bilateral acuity
2
Q
Which assessment chart is used for Near Vision?
A
Rosenbaum chart
Assess from 14 inches away, unilateral and bilateral acuity
3
Q
How many symbols can a patient miss on one row of a visual acuity chart without needing to move to the line above?
A
ONE
4
Q
Vision
What should be asked during the history assessment?
A
- Any comorbidities?
- Any known eye conditions?
- Previous eye surgery?
- History of trauma or infection?
- Any recent changes to visual acuity?
- Any photophobia? Night blindness? Double vision?
- Pain? Does anything make it better or worse?
- Duration and onset of complaint?
- Is the issue unilateral or bilateral?
- Have similar symptoms happened before?
- Have symptoms affected ADLs?
5
Q
Vision
What is involved in the physical assessment?
A
- Look for symmetry and placement of eyelids, pupils, and muscles
- Eyelid and eyelash function
- Sclera appearance
- Color/clarity of iris
- Ptosis? (drooping of the eyes)
- Pupillary response
- Strabismus? (cross eyes)
- Amblyopia? (lazy eye)
- Observe for nystagmus - have the patient follow your finger or object without moving the head
6
Q
What is myopia?
A
Patients are nearsighted, with blurred distance
7
Q
What is hyperopia?
A
Patients are farsighted with excellent distance vision and poor near vision
8
Q
What is an astigmatism?
A
The cornea or the lens may be egg shaped causing a mismatched image or blurred vision
9
Q
What is the definition of
Vision Impairment?
A
Having central visual acuity of 20/40 or worse with the best possible correction
10
Q
What is the definition of Low Vision?
A
Vision impairment that affects ADLs/quality of life and requires the use of devices/visual aides (hand magnifier, flashlights, asking for help)
11
Q
What is the definition of
Blindness?
A
A range from no light perception (NLP) to 20/400 visual acuity with best possible correction
12
Q
What is the definition of Legal blindness?
A
Central visual acuity of 20/200 or worse with the best possible correction
OR
widest visual field diameter of 20 degrees or less
13
Q
What is a risk of long term eye drop use?
A
Glaucoma or cataracts
14
Q
How long do topical anesthetic eye drops work for?
A
10 - 20 minutes
- Proparacaine hydrochloride
- Tetracaine hydrochloride
15
Q
Which two eye drop medications are typically used together for longer duration procedures?
A
Mydriatics and Cycloplegics
Contraindicated in patients taking MAOIs or TCAs
16
Q
What are the most common anti-infective eye drops?
A
- Penicillins
- Cephalosporins
- Aminoglycosides
- Fluoroquinolones
- Acyclovir (antiviral)
- Amphotericin (antifungal - serious side effects)
17
Q
What is the definition of
Glaucoma?
A
Damage to the optic nerve related to increased intraocular pressure
18
Q
What are the clinical manifestations for
Glaucoma?
A
- Peripheral vision loss
- Blurring
- Halos
- Difficulty focusing
- Difficulty adjusting eyes to low lighting (trouble with night vision)
- Aching or discomfort in eyes
- Headache
19
Q
What is the medical management of Glaucoma?
A
- Goal: To prevent further optic nerve damage
- Maintain IOP between 10-21 mmHg
- Pharmacologic therapy: Cholinergics, beta blockers (timolol), alpha2 agonists, carbonic anhydrase inhibitors, prostaglandins
- Laser procedures (to open canals)
- Surgery - iStent = allows for drainage
20
Q
What is the nursing management of
Glaucoma?
A
- Assess knowledge level of disease
- Education about eye drop maintenance
- Provide education regarding use and effects of medications (side effects need to be explained to promote adherence)
- Provide support and interventions to aid the patient in adjusting to vision loss or potential vision loss to maintain quality of life
21
Q
What are the three types of Cataracts?
A
- Senile
- Traumatic
- Congenital
22
Q
What is the definition of Cataracts?
A
An opacity or cloudiness of the lens
23
Q
What are the risk factors for
Cataracts?
A
- Age
- Herpes zoster
- Retinal detachment/retinal surgery
- Cigarette smoking
- Long term use of corticosteroids
- Obesity/DM
- UV radiation
- Blunt trauma
24
Q
What are the clinical manifestations of
Cataracts?
A
- Painless
- Blurry vision
- Surroundings appear dimmer
- Reduced visual acuity
- Myopic shift
- Diplopia (double vision)
- Color shifts
- Opacity of the lens
25
When is cataract surgery indicated?
When negative visual acuity affects ADLs
26
What is involved in
**Cataract Surgery**?
* Outpatient
* Takes less than 20 minutes
* **Phacoemulsification:** Liquefies the cataract and extracts the material from the eye
* **Lens Replacement:** Intraocular Lens (IOL) is inserted to replace the natural lens. May or may not need corrective lens afterwards
27
What is the pre-operative nursing management for
**Cataract Surgery**?
* Determine if patient has been taking alpha-antagonists *(eg. Tamsulosin)*: ***These can cause Intraoperative Floppy Iris Syndrome***
* Administer dilating eye drops or other medications as ordered
* Begin educating about post-op eye medication, antibiotics, corticosteroids, and anti-inflamatory eye drops
28
What is the post-operative nursing management for
**Cataract Surgery**?
* Provide written and verbal education
* Instruct pt to call emergency number if there is a **significant decrease in vision or pain not relieved by OTC pain relievers**
* Adhere to eye drop schedule
* Wear eye protection for sleep for **7 nights**
* No public swim/spa for **2 weeks**
* No make-up for **2 weeks**
* No heavy lifting, > 35lbs, excessive bending, yoga, or contact sports for **2 weeks**
29
What is the definition of
**Retinal Detachment**?
* Separation of the retinal pigment epithelium from the neurosensory layer
* **Ocular emergency!** Requires immediate surgical intervention
30
What are the clinical manifestations of
**Retinal Detachment**?
* Sensation of a **shade or curtain** coming across the vision of one eye
* **Bright flashing** lights
* Sudden onset of many **floaters**
* **Painless**
31
What are the diagnostic tests for
**Retinal Detachment**?
* Dilated fundus examination
* Stereo fundus photography
32
What are the surgical procedures for
**Retinal Detachment**?
**Scleral Buckle**
* Compresses sclera (with a scleral buckle or a silicone band) to indent the scleral wall from the outside of the eye and bring the two retinal layers in contact with each other
**Vitrectomy**
* Intraocular procedure
* Gas bubble, silicone oil, or perfluorocarbon and liquids may be injected into vitreous cavity to help push the sensory retina up agains the retinal pigment epithelium
33
What is
**Macular Degeneration**?
* Eye disease that damages the macula, resulting in impaired central vision
* Leading cause of irreversible blindness and visual impairment in the world
34
What is
**Dry Macular Degeneration**?
* Most common
* Slow to come on
* Breakdown of the outer layers of the retina result in a build up of drusen deposits
* When drusen deposits are outside the macular area, no symptoms
* Drusen deposits inside the macula - gradual blurring of near vision
* No cure - trials are being tested
35
What is
**Wet Macular Degeneration**?
* Abrupt onset
* More devastating to vision
* Straight lines appear crooked or distorted
* Leaky blood vessels
* Some patients may benefit from laser therapy
36
What is an Amsler grid?
A grid given to patients to monitor for sudden onset of distortion of vision.
## Footnote
Encourage patients to use grids, one eye at a time, on regular intervals
37
What is the initial target for IOP among Glaucoma patients with increased IOP?
30% reduction in IOP
38
What is significant about **Narrow Angle: Acute Angle-closure Glaucoma**?
**Ocular emergency!**
* Rapidly progressive visual impairment
* Periocular pain
* Nausea, vomiting
* Bradycardia
* Profuse sweating
* Pupil can be vertically oval, fixed, semi-dilated, and unreactive to light and accomodation
* Severely elevated IOP
39
What are the two types of **Wide Angle Glaucoma**?
* **Normal tension**: IOP less than or equal to 21mmHg, optic nerve damage, visual field defects
* **Ocular Hypertension**: Elevated IOP, possible ocular pain or headache
40
What are the clinical manifestations of **Narrow Angle: Subacute Angle-Closure Glaucoma**?
* Transient blurring of vision
* Halos around lights
* Temporal headaches
* Ocular pain
* Pupil may be semi-dilated
41
What are the clinical manifestations of **Narrow Angle: Chronic Angle-Closure Glaucoma**?
* Progression of glaucomatous cupping
* Significant visual field loss
* IOP may be normal or elevated
* Ocular pain and headache
42
What is **Enucleation**?
Surgical procedure that removes the entire eye including the optic nerve and all connections to the orbit
43
What are the indications for
**Enucleation**?
* Intraocular malignancy or high suspicion of malignancy
* Trauma without visual potential
* Blind, painful eye
* Severe infection without visual potential
44
What are Ishihara Polychromatic Plates and what are they used for?
Used to diagnose color blindness
## Footnote
Types of Color Blindness: Red-Green; Blue-Yellow; Complete
45
What is **Color Blindness**?
* A condition where a person has altered ability to perceive color
* Caused by a genetic mutation in **cone cells** or an injury to the retina
* X-linked recessive inheritance = **more common in males**
46
What should be done for an Ocular soft tissue injury/hemorrhage?
* Conservative treatment
* Cold compress for 1st 24 hours
* Warm compress after that
47
What should be done for ocular splash injuries?
Immediate irrigation with normal saline
48
What is a **Blowout fracture**?
* Involve the orbital floor
* Can trap eye muscles or nerves leading to enophthalmos *(sunken eye, inward displacement of the eye)*
* Typically from being hit/blunt force trauma
49
What is involved in an **Orbital Roof Fracture**?
* Can be serious because of potential complications to the brain
* Surgery is usually nonemergent
* Indications for surgery: facial deformity, impaired chewing, impaired vision, or nasolacrimal duct obstruction
50
What is included in Ocular Trauma preventive safety education?
* Ensure spray nozzles are pointed away from faces
* Protect eyes from flying fragments, fumes, and dust particles
* Pay attention to age and maturity of child when selecting toys
* Avoid low hanging branches
* Wear protective caps, helmets, or face protectors when appropriate
* Avoid explosive fireworks
51
What are the causes of
**Conjunctivitis**?
* Virus
* Bacteria
* Allergy
* Chemical Irritation
52
What are the clinical manifestations of
**Conjunctivitis**?
* Eye redness/swelling
* Watery eye
* Gritty feeling
* Itchiness
* Irritation
* Burning
* Discharge from the eye
* Crusting of the eye lids/lashes
## Footnote
*Watery discharge indicates viral or allergic conjunctivitis*
*Mucopurulent discharge indicates bacterial conjunctivitis*
53
What is the treatment for
**Conjunctivitis**?
* Bacterial infections: Antimicrobial eye drops
* Corticosteroids
* NSAIDs
* OTC Lubricating Eye Drops
54
What are some nursing interventions for patients with
**Impaired Vision**?
* Emotional support
* Encourage independence while ensuring safety
* Collaborate with case management/social worker
* Consult with occupational therapy
* Assess patient's functional ability
* Educate!: Use of visual aids, fall proofing home, medication/vision safety
55
What are some strategies for interacting with patients with blindness or low vision?
* Identify yourself as you approach the person/enter the room
* Introduce anyone that approaches
* Let the patient know when you are leaving
* Face the person and speak directly to them in a normal tone of voice
* Allow the person to hold on to your arm for assistance
* Make sure environment is clear of obstacles
* Close doors/cabinets
* Be specific when communicating directions - use clock cues to specify where something is
* Make sure personal items are close
56
**Ocular Medication Administration**
Nursing Management
* Ability of the eye to absorb medication is limited
* Allow 3-5 minutes between drops for the eye, keep eyelids closed
* Drops and ointments are preferred, less invasive, and less systemic side effects
* Instill drops before ointment
* Remove contact lenses
* Never touch tip of bottle to eye
57
**When assisting a patient who is legally blind, which intervention would not be appropriate?**
**a.** Allow the patient to hold the nurse's arm above the elbow while walking a step behind when ambulating to the bathroom
**b.** Describe food items on meal tray using clock terms
**c.** Offer to feed the patient all meals
**d.** Remove obstacles in room and describe furniture placement
**c. Offer to feed the patient all meals**
**Rationale:**
When caring for patients with low vision or blindness, it is important to encourage and support independence
58
**Which instruction would be appropriate to include in discharge instructions after cataract surgery with a lens implant?**
**a.** Sleep on the side of the affected eye the night after surgery
**b.** Resume normal activities on postop day 2
**c.** Avoid bending or stooping for an extended period
**d.** Attempt to hold in a sneeze if it occurs
**c. Avoid bending or stooping for extended period.**
**Rationale:**
Discharge instructions should include:
* Avoid lying on the side of the affected eye the night after surgery
* Keep activity light
* Avoid lifting, pushing, or pulling objects heavier than 10lbs
* Avoid bending or stooping for an extended period
* Be careful when climbing and descending stairs
* Sneezing, if necessary, should not be held in because it would increase IOP. Sneezing should be done with an open mouth to decrease pressure
59
What are potential side effects of Timolol?
* Burning or stinging of the eyes
* Fatigue
* Dizziness
* Bradycardia
