Sensory - Visual Flashcards
How to administer eye drops?
Put medication (not letting bottle touch the eye)
into the nasal lacrimal sac (inner campus)
Press for minimum of 15 secs on the inner eye to prevent systemic effects
- could cause pt to drop BP and HR
How do you know if an eye drop goes systemic?
decrease in Heart rate and BP
drop pt
Leading Causes of Blindness (4)
Macular Degeneration
Cataract
Diabetic Retinopathy
Glaucoma
What is the leading cause of blindness worldwide?
Cataracts
the only cure is surgery
What is the leading cause of blindness in the USA?
Diabetic Retinopathy
Aqueous Humor
fluid in the anterior segment
99.9% water and .1% sugar, vitamins, proteins, and nutrients
Vitreous Body
behind the lens (posterior segment)
99% water and 1% collagen
Aqueous Humor functions
Maintain intraocular pressure
Transports Vitamin C
Antioxidant
Protects from environmental factors (dust, wind, and pollen)
Vitreous Humor/Body functions
keeps the shape of the eye
When people get older, they lose collagen so what happens to their eyes in relation to that?
eye loses shape
difficulty of vision
Normal flow of aqueous humor
The posterior chamber near the lens
Go through the iris in front of the eye
Into the anterior chamber
Trabecular meshwork
Out through the Canal of Schlemm
What cranial nerves are used in eye movements?
2,3,4,6,7
Optic
Oculomotor
Trochlear
Abducens
Facial
Cranial Nerve 2 is and does
Optic
Cranial Nerve 3 is and does
Oculomotor
Cranial Nerve 4 is and does
Trochlear
Cranial Nerve 6 is and does
Abducens
Cranial Nerve 7 is and does
Facial
Cataracts is the
clouding/opaqueness of the lens
- Fibers clump together in front of the eye (drink plenty of water)
Cataracts Causes
age-related (above 80 regardless of health)
congenital
secondary to DM, UV light, use of corticosteroids usage (increase BG)
Trauma
Cataracts S/S
cloudy, opaque lens
low acuity (blurred foggy and fuzzy)
halos around light sources
no pain
gradually (happens over time)
difficulty with color hues
low night vision (NO DRIVING AT NIGHT)
leads to day time lowered
Cataracts start in the what parts of the eyes
Peripheral to center
Number 1 education for pt with cataracts?
no driving at night time
Cataracts Tx
removal of the lens with lens implant
**Surgical replacement
Is there a nonsurgical “cure” for cataracts?
no
What visual aids could be used for cataracts?
changing eyewear prescription
reading glasses
magnifiers
increased lighting
adjust lifestyle by not driving at night
Cataracts Pre-Op Surgical Care
H&P
Medicate with eye drops
IVF - good IV
Allergies
Eye paralytic and won’t be able to move it
discharge teaching - no driving after surgery
Cataracts Intra-Op Surgical Care
Time out
Safety
Check right eye
Cataracts Post-Op Surgical Care
recovery VS
no intraocular pain over 4+ notify the surgeon
Screen taped over the eye to sleep
promote healing
Lay 30-40 degrees
reduce risk
Don’t rub, lift, bend, try not to sneeze, or cough
review med schedule - antibiotic and corticosteroid drops - prevent infection and inflammation stopped when eye is healed
follow up appointment
Hold what cranial nerve to try to keep from sneezing
Number 5
After cataract surgery, the patient is feeling moderate to severe pain at the site, what should the nurse do?
call surgeon
Glaucoma vision decreases in the
peripheral vision
Gatorade to powerade
What are the 2 types of glaucoma?
OPEN
CLOSED
Closed Angle Glaucoma is a __________ and has what type of onset?
emergency
sudden onset
Closed Angle Glaucoma aka
Narrow-angle glaucoma
Congestive glaucoma
Pupillary closure glaucoma
Closed-angle Glaucoma needs to be helped within
48 hours
What happens after 48 hours of closed-angle glaucoma?
permanent damage
What happens during closed-angle glaucoma?
build-up of aqueous humor and goes back into the vitreous body
posterior to anterior and blocked to be pushed back
overfilled with fluid and causes pressure throughout the whole eye
-emergency for tx or permanent damage after 48 hours
What happens during open-angle glaucoma?
some fluid able to move
drainage system/meshwork is clogged and build-up of fluid goes back into the eye causing pressure to build gradually aggravates nerve
What type of glaucoma is most common?
open-angle
Open-angle glaucoma onset
gradual
Open-angle glaucoma aka
Chronic glaucoma
wide-angle glaucoma
Glaucoma in general is
increased intraocular pressure due to an increase in aqueous humor to vitreous humor
Optic nerve is damaged when backflow of fluid and pressure
Glaucoma risk factors
Familial
over 40 y/o
DM
HTN
Hx of ocular problems
In glaucoma, what is necessary to save vision?
early detection
esp. closed angle
S/S of closed-angle glaucoma
acute onset of ocular pain
halos on light sources
eyebrow pain
Nausea
blurred vision
pupils nonreactive to light
light sensitivity or phobia
S/S of open-angle glaucoma
generally painless (until widespread damage)
blindness if untreated
HA
mild eye pain
loss of peripheral vision tunnel vision
halo around light sources
Elevated pressure in eye
What eye exam is used by doctors to see if you have glaucoma?
air puff
Where is the open - angle in the eye?
between the iris and sclera
aqueous humor outflow decreased due to blockage in the eye drainage system (meshwork)
damage to optic nerve over time
Tx of Glaucoma
different eyedrops (beta-blocker or alpha drops) to decrease fluid build-up FOR LIFE and SCHEDULED at certain time of day
Over time, have surgery to correct the angle
3 Ps of Blindness in relation to open-angle glaucoma
Preventable
Painless
Permanent
What is the number 1 thing to remember when educating the pt on Tx for glaucoma?
eye drops for life
Tx eye drops for glaucoma
Beta-blockers
Beta-blockers response to eyes
Lower pressure in the intraocular by reducing production of aqueous humor
- primarily in open angle
initial and maintenance therapy
Can a beta blocker be used in a closed-angle glaucoma pt?
yes along with other meds for emergency lowering the pressure in the eye
What beta-blocker is used in Glaucoma?
Timolol
Contraindications of Timolol
Hx asthma, COPD
bradycardia
heart failure
2-3rd heart blocks
Adverse Reaction of Timolol
bronchospasms
dyspnea
bradycardia
dizziness
heart block
Timolol could potentiate
hypoglycemia
mask s/s
Can Timolol have systemic effects?
yes (hold the inner campus for 15 secs minimum)
hr and BP drop
How long do you wait to but contact lenses in after Timolol?
15 mins
What V/S needs to be checked before giving Timolol?
HR, BP
Macular Degeneration
yellowing of lens
Central vision gradually lost
color perception decreases
presbyopia
pressure increases
What vision is lost in Macular Degeneration?
Central
McDonalds to Chick-Fil-A
Dry Macular Degeneration
fatty deposits (yellow dots in eye)
Wet Macular Degeneration
fatty with neovascular (yellow around red star)
Blood vessels are weak and thin
causes hemorrhage
Dry Macular Degeneration S/S
GRADUAL
need brighter light
haziness of central or overall vision
blurred spot in the center of the field of vision
Wet Macular Degeneration S/S
abrupt onset
rapid worsening and vision loss
well-defined blurry/blind spot of central vision
Is there a cure for macular degeneration?
no, only slow progression
Management of Dry MD (ATROPHIC)
Antioxidants, zinc, and selenium (Vitamin A, C and E
Diet of fruits, veggies, fish with omega3 fatty acids
Management of Wet MD (exudate)
injections into eye
laser
photodynamic therapy
Diabetic Retinopathy
microvascular damage to retina
What are the 2 types of Diabetic Retinopathy?
non-proliferative
proliferative
Non-proliferative Diabetic retinopathy
most common
partial occlusion of small vessels in the retina
causes capillary micro-aneurysms
proliferative Diabetic retinopathy
involves retina and vitreous humor
New blood vessels (neovascularization) form
causes retinal detachment
Non-proliferative Diabetic retinopathy s/s
swelling
hard exudates
macular edema (worsening retinopathy) - due to plasma leaks)
blot hemorrhage
macula affected = severe central loss of vision
proliferative Diabetic retinopathy s/s
abnormal blood vessels forming
= fragile and bleed easily
prevents light from reaching retina and bleed into vitreous humor
*if they pull the retina can cause partial or complete retinal detachment
In the beginning of diabetic retinopathy, what are the changes in visions?
no change till the disease progresses and lose vision gradually or rapidly
With a Type 1 DM pt, they need to have an eye exam within _____ years of dx and then _________
5 years; annually
With a Type 2 DM pt, they need to have an eye exam upon _____ and then _________
upon diagnosis
annually with a dilated eye examination
Diabetic Retinopathy pts need to maintain?
what exercise?
glycemic control (A1C annually) and manage HTN
exercise precautions (if active no strenuous activity - weight lifting, jogging, brass instruments or can cause retinal detachment)
= do low impact activities - swim, station cycle
Diabetic Retinopathy Tx
Laser photocoagulation: Laser destroys ischemic areas of retina and reduce risk of proliferative retinopathy, MD
Vitrectomy: Aspiration of blood, membrane, and fibers inside the eye incision behind cornea
Drugs to block action of vascular endothelial growth factor (VEFG)
Diabetic FRetinopathy pts have a greater risk for what other eye diseases?
Glaucoma (hard to tx and often blind)
Cataracts
- The nurse is developing a teaching plan for a client with glaucoma. Which instruction should the nurse include in the plan of care?
a. Eye medication will need to be administered for life.
- What part of the eye do you administer eye drops?
a. Nasolacrimal duct/conjunctival sac.
- How long do you hold pressure on the inner eye after administering eye drops?
at least 15 secs
- Why do you want to apply pressure to the nasolacrimal duct/ conjunctiva after administering eye drops?
a. To prevent systemic absorption (Decrease of blood pressure and heart rate)
- What are the four leading causes of blindness?
age related macular degeneration, Cataract, Diabetic Retinopathy, Glaucoma.
- What is Cranial nerve #2 responsible for?
a. Optic nerve is responsible for the visual acuity.
- What is Cranial nerve # 3 responsible for?
a. Oculomotor is responsible for opening of eyelids, eye movement upward/medial, upward/lateral, medial, downward/lateral.
- What is Cranial nerve #4 responsible for?
a. Trochlear nerve is responsible for eye movement downward/medial)
- What is Cranial nerve #6 responsible for?
abducens nerve is responsible for eye movement lateral
- What is Cranial nerve #7 responsible for?
a. Facial nerve is responsible for facial muscle movement (except chewing), and eyelid closing.
- What is Cataract defined as?
a. Opacification of the lens.
- What is the number one risk factor for cataracts?
a. Age is the number one risk factor followed by diabetes mellitus, UV light, 2nd use of corticosteroids, and trauma.
- What safety education do you want to provide the patient diagnosed with cataracts?
a. Do not drive at night because of low visibility from light not being able to go through. There will be a glare/Halo around light sources at nighttime.
- What is the treatment for cataracts?
SURGERY
- If the patient has any unexpected complications after cataract surgery, what should you do?
a. Call the surgeon even if it is just pain!
- What part of the vision does glaucoma affect?
a. Peripheral vision (Glaucoma, Peripheral) Gatorade and Powerade
- What is the difference between open and closed glaucoma?
a. Open is gradual IOP build up. Closed is a rapid buildup 24-48 hour to fix before permanent damage.
- What part of the vision does macular degeneration affect?
CENTRAL
- What is the difference between dry and wet macular degeneration?
a. Dry is drusen buildup that is gradual. Wet is drusen with hemorrhage and neovascularization that is rapid
- Is there a cure for macular degeneration?
a. No cure just slowing of progression.
- For a type I diabetic when should they have an eye appointment?
a. Within 5 years of dx and then yearly
- For a type 2 diabetic, when should they have an eye appointment?
a. Upon dx and then yearly
