Sensory Perception Nursing Process

Question 1

Pathophysiolgy

of

Cataracts (5)

Answer 1

• 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)

Question 2

Causes of cataracts due to eye trama (5)

Answer 2

• heat
• blunt force
• x-rays
• UV light
• radiation

Question 3

Causes of cataracts due to toxicity (4)

Answer 3

• corticosteroids
• chlorpromazine
• beta blockers
• miotic drugs

Question 4

Causes of cataracts due to other systemic diseases (4)

Answer 4

diabetes

hypoparathyroidism

down syndrome

chronic sunlight exposure

Question 5

Causes of cataracts due to Intraocular Disease (4)

Answer 5

retinitis pigmentosa

recurrent uveitis

glaucoma

retinal detachment

Question 6

Risks associated with cataracts (7)

Answer 6

advanced age

diabetes or other systemic diseases

heredity

smoking

exposure to the sun

eye trauma

chronic corticosteroid use

Question 7

Subjective manifestations of cataracts (5)

Answer 7

smudged glasses

Blurred vision

Diplopia – double vision

Glare and light sensitivity – photo sensitivity

Halo around lights

Question 8

Objective manifestations of Cataracts (5)

Answer 8

Progressive and painless loss of vision

decreased color perception

retina opacity

Absent red reflex

Cloudy bluish white pupil (late stage)

Question 9

Interventions for those with cataracts who have not had surgery (4)

Answer 9

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.

Question 10

Interventions for those with catacts that have not had surgery (2nd group of 4)

Answer 10

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

Question 11

Pre-Operative Care for cataracts surgery (6)

Answer 11

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

Question 12

Cataract Post OP education (7)

Answer 12

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

Question 13

Cataract Post-Op Interventions and Education (6)

Answer 13

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.

Question 14

activities increasing IOP (5)

Answer 14

bending from the waist

lifting more than 10 pounds

sneezing, coughing

blowing nose

bowel movement strain

Question 15

Activities that increase IOP (4)

Answer 15

vomiting

sexual intercourse

avoid hyperflexed position

wearing tight shirt collars

Question 16

cataract surgery complications of concern (5)

Answer 16

significant swelling

bruising

bloodshot eye after initial has cleared

pain with nausea or vomiting

increased eye redness

Question 17

cataract surgery complications of concern (2nd set of 5)

Answer 17

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

Question 18

Normal or Expected Post Op Manifestations of Cataract Surgery (4)

Answer 18

mild itching

bloodshot appearance (initially)

slightly swollen eyelid

creamy white, dry, crusty drainage on eye lids and lashes

Question 19

Side Effects for Pilocarpine

Answer 19

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

Question 20

Drugs used for glaucoma

Answer 20

Prostaglandin agonists (prost)

• Travoprost
• Latanoprost

Adrenergic Agonists(ine)

-Brimonidine

Beta-Adrenergic Agonists (olol)

• Levobunolol
• Timolol

Cholinergic Agonists- (pine)

-Pilocarpine

Question 21

Pathophysiology of Glaucoma (6)

Answer 21

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.

Question 22

3 types of Glaucoma

Answer 22

Primary (most common)

• Open angle
• angle closure

Associated

Secondary

Question 23

Describe open angle glaucoma (POAG)

(4)

Answer 23

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)

Question 24

Causes of Primary glaucoma

Answer 24

Aging

Heredity

Visual Retinal vein occlusion

Question 25

Describe Primary Angle Closure Glaucoma (PACG) (4)

Answer 25

considered an emergency less common form of glaucoma. IOP rises suddenly. sudden onset angle between the iris and the sclera suddenly closes

Question 26

Causes of secondary glaucoma (6)

Answer 26

uveitis iritis trauma Eye surgery or tumors neovascular disorders degenerative disease

Question 27

Causes of associated glaucoma (4)

Answer 27

Diabetes hypertension Severe myopia retinal detachment

Question 28

Risks associated with glaucoma (6)

Answer 28

Age Infection Tumors Diabetes mellitus Genetic predisposition Hypertension

Question 29

Late POAG manifestations (7)

Answer 29

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

Question 30

Acute Angle Closure (PACG) subjective data

Answer 30

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

Question 31

PACG objective data (6)

Answer 31

reddened sclera foggy cornea shallow anterior chamber cloudy aqueous humor moderately dilated, nonreactive pupil. IOP tonometry reading 30+!!!

Question 32

Non-Surgical Interventions for glaucoma (4)

Answer 32

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

Question 33

Surgical Procedures for Glaucoma and how they work (2)

Answer 33

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

Question 34

Most serious complications after Glaucoma surgery (2)

Answer 34

Choroidal Hemorrhage * acute pain deep in the eye * decreased vision * vital sign changes Choroidal Detachment

Question 35

Pathophysiology of Macular Degeneration (5)

Answer 35

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

Question 36

Describe Dry Macular degeneration (2)

Answer 36

most common caused by a gradual blockage in retinal capillary arteries, resulting in macula becoming ischemic and necrotic due lack of retinal cells.

Question 37

Describe Wet Macular Degeneration (4)

Answer 37

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

Question 38

Risks associated with macular degeneration (6)

Answer 38

Smokers female short stature hypertension family history diet lacking carotene,vitamin A,b12, antioxidants

Question 39

Interventions for macular degeneration (3) subjective (2) objective

Answer 39

Subjective Data * lack of depth perception * distorted objects * blurred vision Objective data * loss of central vision * blindness

Question 40

Interventions for Dry macular degeneration (4)

Answer 40

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

Question 41

Interventions for wet macular degeneration

Answer 41

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

Question 42

Retinal detachment pathophysiology (2)

Answer 42

separation of the retina from the epithelium emergency

Question 43

subjective manifestations of retinal detachment (4)

Answer 43

sudden, **painless onset** **flashes** of light (photopsia) floating **dark spots** (associated with blood) curtain pulled over visual field

Question 44

Objective manifestations of retinal detachment (2)

Answer 44

Observations through opthamoscope: * **gray bulges** or folds in retina that quiver * sight of a **hole or tear at edge** of detachment

Question 45

Interventions for retinal detachment

Answer 45

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**

Question 46

Preoperative care for retinal detachment

Answer 46

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

Question 47

Postoperative care for retinal detachment (4)

Answer 47

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

Question 48

Postoperative care for retinal detachment (2nd group of 4)

Answer 48

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 infection**s like sudden **reduced acuity, eye pain, pupil not constrict to light**

Question 49

Uses and considerations of Latanaprost (4)

Answer 49

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.