Sensory Issues Flashcards
Review the anatomy of the Eye
Slide 1
Assessment of the eye:
History External assessment Visual fields, & eye movement Eye position- exophthalmos, enophthalmos Eye lids and lashes Blink response Conjunctivae, sclera Light reflex- accommodation v. light reflex
Fundus
Fundus is normally orange-red color- darker on darker complexion
Normal look to blood vessels
Optic Disc where blood vessels converge is yellowish to pale pink with well defined margins
Macula responsible for central vision- always temporal to optic disc
Age Related Changes
Smaller pupils, do not dilate easily- night vision a problem
Lens less elastic- near object difficult to see
Lens becomes opaque- color perception
Decreased depth perception, peripheral
Eyes recessed in socket- tissue folds on lids
Decreased strength of muscles of eye movement
Conjunctivitis
Conjunctiva covers inner lid and external eye Inflammation from bacteria or virus Extremely contagious- “Pink Eye” Redness and itching, gritty sensation Tearing and discharge Inflamed preauricular nodes Treated with antibiotic drops and pills
Nursing Issues with Eye Infections
Pain Analgesics, warm compresses Protect from sun Visual changes No contact lenses, handwashing, blurring Risk for spread of infection Handwashing, wash eyes separately, may use baby tearless shampoo especially for blepharitis
Cataracts
Likely after age 70 Cumulative exposure to UV (sun) Reduced O2 uptake by lens Dehydration of lens, opacity Immature to “ripe” Immature= some light getting through, useful vision Ripe= poor vision, poor light penetration Tend to be bilateral Trauma or chemical irritation
Symptoms of Cataracts
Blurred vision Photophobia Sensitivity to glare Vision better in low light Cloudy appearance of lens
Pre-op Care for Cataract Surgery
Mydriatic medication pre-operatively to produce mydriasis or dilitation of the eye
Educate patient on need to have someone available as will have limitation in vision due to eyepatch, can’t drive
Need to frequently instill drops after surgery
Nursing Care after Cataract Surgery
Leave eye patch on with shield
For 24 hrs limit activity to sitting, resting in bed or limited walking in house
Do not rub eye
Do not lift more than 5 lbs- why?
Do not strain, or bend over, avoid reading, why?
Eye drops as ordered
No aspirin, take Tylenol for pain
Additional Patient Teaching
Report eye pain not relieved by Tylenol Report headache, nausea, severe itching Report swelling of eye Eye patch should not put pressure on eye Tearing is normal Hazards of monocular vision Unrelieved eye pain and nausea sign of increased intraocular pressure
Case: The nurse is performing an assessment on a client with a suspected diagnosis of cataract. The chief clinical manifestation that the nurse would expect to note in the early stages of cataract formation is:
A. Eye Pain
B. Floating spots
C. Blurred vision
D. Diplopia
Glaucoma
Painless increased intraocular pressure Optic nerve atrophy Visual field loss Common preventable cause of blindness 5 times more likely in African Americans than whites
Pathophysiology of Glaucoma
Decreased outflow of aqueous humor
Increased production of aqueous humor
Extra fluid caused increased pressure on retina- which is painless.
Decrease outflow + increased production = increased pressure on retina
Pathophysiology of Glaucoma
Fluid produced in ciliary bodies, travel around the iris from the posterior chamber to the anterior chamber, through Canal of Schlemm and the trabecular mesh, to be absorbed into the vascular supply.
Open Angle Glaucoma
Outflow impaired but still about to get through
Open Angle Glaucoma
Occurs over time Vision changes are often not noticed Loss of peripheral vision Difficulty adapting to dark Halos around lights As pressure increases, acuity decreases
Angle Closure Glaucoma
Angle of Iris blocks drainage of aqueous humor through canal of Schlemm
Requires immediate intervention to prevent damaging increase in ocular pressure
Angle Closure
Narrow angle, closed angle
With dilation of pupil the angle closes completely
This occurs quickly and the increased pressure caused damage to retina and permanent blindness
Happens in darkness, emotional distress which cause pupil dilation
Must avoid mydriatic drugs- atropine, anticholinergics
Symptoms- sudden H/A, red conjunctiva, cloudy cornea, N&V
Angle Closure Glaucoma
Iridectomy often produces a keyhole appearance to the pupil
Treatment of Glaucoma
Meds are not a cure, but can control sx
Cholinergics (miotics)- pilocarpine gtts
Beta-adrenergic blockers- timoptic gtts
Several systemic meds that decrease production of aqueous humor
For Closed Angle- diuretics to bring intraocular pressure down quickly- mannitol (osmotic diuretic)
