Sensory Perception Nursing Process Flashcards
Pathophysiolgy
of
Cataracts (5)
- Opacity of the lense that distorts the image projected into the retina
- Lens density increases, transparency is lost
- Both eyes may get it, but rate of progression is different
- Blindness occurs if left untreated
- Usually age related (over 65)
Causes of cataracts due to eye trama (5)
- heat
- blunt force
- x-rays
- UV light
- radiation
Causes of cataracts due to toxicity (4)
- corticosteroids
- chlorpromazine
- beta blockers
- miotic drugs
Causes of cataracts due to other systemic diseases (4)
diabetes
hypoparathyroidism
down syndrome
chronic sunlight exposure
Causes of cataracts due to Intraocular Disease (4)
retinitis pigmentosa
recurrent uveitis
glaucoma
retinal detachment
Risks associated with cataracts (7)
advanced age
diabetes or other systemic diseases
heredity
smoking
exposure to the sun
eye trauma
chronic corticosteroid use
Subjective manifestations of cataracts (5)
smudged glasses
Blurred vision
Diplopia – double vision
Glare and light sensitivity – photo sensitivity
Halo around lights
Objective manifestations of Cataracts (5)
Progressive and painless loss of vision
decreased color perception
retina opacity
Absent red reflex
Cloudy bluish white pupil (late stage)
Interventions for those with cataracts who have not had surgery (4)
Surgery is only “cure”
Procedure: Phacoemulsification and clear plastic lens replacement
Nursing Priorities
- safety
- teach them how to make best of existing vision
Check visual acuity using Snellen chart.
Interventions for those with catacts that have not had surgery (2nd group of 4)
Check internal/external eye using ophthalmoscope.
Determine functional capacity due to decreased vision.
Increase light in room.
Provide adaptive devices like Magnifying lens, large print books, talking clocks
Pre-Operative Care for cataracts surgery (6)
Mydriatic drug dilates pupil
Reinforce info from opthamologist
stress that care after surgery requires instillation of different eye drops, several times a day, for 2-4 weeks.
assess pt’s ability to evaluate eye appearance and take eye drops
if pt is unable to perform, help find options (family)
ask pt. if they are taking aspirin, warfarin, clopidogrel, or dabigatran
Cataract Post OP education (7)
teach to:
wear dark glasses outdoors or in bright places until pupil is ready
how to instill eye drops properly and fall prevention
watch for infection of bleeding
avoid water in eye for 3-7 days
avoid driving until vision is not blurry
light ADL’s are ok but NO Vacuuming
Create written schedule for timing/order of eye drops
Cataract Post-Op Interventions and Education (6)
suggest use of cool compresses and mild analgesics such as tylenol for discomfort
remind NOT to use Aspirin due to blood clotting
light eyepatch in case of accidental rubbing, NOT COMMON
Teach pt to avoid activities that increase IOP
Teach pt to stand in shower with head AWAY from shower head 1st week post Op.
Wash hair 1-2 days post op, ONLY WITH HEAD TILTED BACK.
activities increasing IOP (5)
bending from the waist
lifting more than 10 pounds
sneezing, coughing
blowing nose
bowel movement strain
Activities that increase IOP (4)
vomiting
sexual intercourse
avoid hyperflexed position
wearing tight shirt collars
cataract surgery complications of concern (5)
significant swelling
bruising
bloodshot eye after initial has cleared
pain with nausea or vomiting
increased eye redness
cataract surgery complications of concern (2nd set of 5)
decreased visual acuity (infection)
increased tears (infection)
photophobia
yellow or green drainage (infection)
flashes of light or floating tracers after initial surgery (infection)
sharp sudden pain in affected eye
Normal or Expected Post Op Manifestations of Cataract Surgery (4)
mild itching
bloodshot appearance (initially)
slightly swollen eyelid
creamy white, dry, crusty drainage on eye lids and lashes
Side Effects for Pilocarpine
blurred vision.
headache
flushing
increased saliva
sweating
harder to see things in dim light
dizziness
chills
Brow ache,
corneal toxicity,
conjunctival inflammation,
transient myopia,
Retinal detachment
Drugs used for glaucoma
Prostaglandin agonists (prost)
- Travoprost
- Latanoprost
Adrenergic Agonists(ine)
-Brimonidine
Beta-Adrenergic Agonists (olol)
- Levobunolol
- Timolol
Cholinergic Agonists- (pine)
-Pilocarpine
Pathophysiology of Glaucoma (6)
Disturbance of functional/structural integrity of optic nerve due to high IOP
Decreased fluid drainage or increased fluid secretion increases IOP,presses on nerve fibers and photoreceptors depleting their oxygen ending in necrosis (blindness)
Vision loss is gradual and painless starting from outsidel without pt knowing
1mL aqueous fluid always present but constantly produced & reabsorbed 5mL per day
Expected IOP range = 10 - 21 mm/Hg.
3 types of Glaucoma
Primary (most common)
- Open angle
- angle closure
Associated
Secondary
Describe open angle glaucoma (POAG)
(4)
both eyes affected w/ no manifestations in early stages
gradual onset
Open-angle refers to the angle between the iris and sclera.
aqueous humor outflow is decreased due to blockages in the eye’s drainage system (Canal of Schlemm and trabecular meshwork)
Causes of Primary glaucoma
Aging
Heredity
Visual Retinal vein occlusion
Describe Primary Angle Closure Glaucoma (PACG)
(4)
considered an emergency
less common form of glaucoma.
IOP rises suddenly. sudden onset
angle between the iris and the sclera suddenly closes
Causes of secondary glaucoma (6)
uveitis
iritis
trauma
Eye surgery or tumors
neovascular disorders
degenerative disease
Causes of associated glaucoma (4)
Diabetes
hypertension
Severe myopia
retinal detachment
Risks associated with glaucoma (6)
Age
Infection
Tumors
Diabetes mellitus
Genetic predisposition
Hypertension
Late POAG manifestations (7)
cupping/atrophy of optic disk
optic disk gets wider and turns grey or white
Peripheral vision loss
decreased visual acuity not correctable w/glasses
double vision
Halos around lights
IOP tonometry reading between 22-32
Acute Angle Closure (PACG) subjective data
sudden, severe pain around the eyes that radiates over the face.
Headache or brow pain,
nausea and vomiting
halos around lights
blurred vision
decreased light perception
PACG objective data (6)
reddened sclera
foggy cornea
shallow anterior chamber
cloudy aqueous humor
moderately dilated, nonreactive pupil.
IOP tonometry reading 30+!!!
Non-Surgical Interventions for glaucoma (4)
Safety Priority: teach about correct technique for eyedrop instillation
Punctal Occlusion- place pressure on corner of eye near nose immediately after administration to prevent systemic absorption
Stress importance of instilling drops on time and no skipped doses
when taking multiple drugs, wait 10-15 min. between next drug to prevent “wash out”
Stress good hygiene: washing hands, cleaning container tips, no touching tip to eye
Surgical Procedures for Glaucoma and how they work (2)
Laser Trabeculoplasty
- Burns trabecular meshwork, shrinking fibers making more spaces for aqueous humor to flow out.
Filtering microsurgery
- Creates drainage hole between post. and anter. chambers
Most serious complications after Glaucoma surgery (2)
Choroidal Hemorrhage
- acute pain deep in the eye
- decreased vision
- vital sign changes
Choroidal Detachment
Pathophysiology of Macular Degeneration (5)
Dry and Wet Macular Degeneration
central loss of vision affecting macula of the eye.
no cure
age related or result of exudate
Mild blurring and distortion at first, followed by complete central vision loss
Describe Dry Macular degeneration (2)
most common
caused by a gradual blockage in retinal capillary arteries, resulting in macula becoming ischemic and necrotic due lack of retinal cells.
Describe Wet Macular Degeneration (4)
sudden decrease in vision after a detachment of pigment epithelium in the macula.
caused by new growth of blood vessels having thin walls allowing blood and fluid to leak from them.
can occur in only one eye or both
can occur at any age
Risks associated with macular degeneration (6)
Smokers
female
short stature
hypertension
family history
diet lacking carotene,vitamin A,b12, antioxidants
Interventions for macular degeneration
(3) subjective
(2) objective
Subjective Data
- lack of depth perception
- distorted objects
- blurred vision
Objective data
- loss of central vision
- blindness
Interventions for Dry macular degeneration (4)
No cure
focus on slowing progression and utilizing existing sight
prevention: eat foods high in antioxidants, vitamin B12, and the carotenoids lutein and zeaxanthin.
suggest assistive devices such as magnifying glass, lg print books, and talking clocks
Interventions for wet macular degeneration
focus on slowing progression & ID further changes in sight
Laser therapy can limit damage
VEGFI’s injected monthly can slow progression
Photodynamic therapy may seal leaking vessels
Retinal detachment pathophysiology (2)
separation of the retina from the epithelium
emergency
subjective manifestations of retinal detachment (4)
sudden, painless onset
flashes of light (photopsia)
floating dark spots (associated with blood)
curtain pulled over visual field
Objective manifestations of retinal detachment (2)
Observations through opthamoscope:
- gray bulges or folds in retina that quiver
- sight of a hole or tear at edge of detachment
Interventions for retinal detachment
If caught while it is a hole or tear, it may be sealed by:
- photocoagulation
- freezing probe
Spontaneous reattachment of fully separated retina is rare
For a full detachment, surgery is needed:
- procedure called a scleral buckling
Preoperative care for retinal detachment
reassure pt. to allay fears of permanent vision loss
teach pt. to restrict activity/head movement before surgery
apply an eye patch over affected eye to reduce eye movement
Administer prescribed topical drugs to inhibit pupil constriction and accommodation
Postoperative care for retinal detachment (4)
Apply eye patch and shield
monitor vitals & asses eyepatch for drainage
position pt. as prescribed to promote reattachment if gas or oil is used
administer prescribed analgesics & antiemetics
Postoperative care for retinal detachment (2nd group of 4)
Instruct pt. to report pain or pain with nausea
Remind pt. to avoid activities contributing to IOP
Remind Pt. to avoid activities w/ REM like reading, writing, sewing, etc…
Report s/s of infections like sudden reduced acuity, eye pain, pupil not constrict to light
Uses and considerations of Latanaprost (4)
Constricts Pupil
Decreases IOP in open-angle glaucoma; maybe narrow-angle glaucoma with more studies
Not recommended for pts with torn or absent lens or eye trauma.
NO contact lenses for 15 minutes after administration.
