UNIT 3 Chapter 42 SENSORY: Concepts of Care With Eye and Vision Cataract, Glaucoma, Macular Degeneration, Retinal Detachment

Question 1

What is Cataract and what are the signs and symptoms?

Answer 1

-gradual loss of vision
-blurred vision
-decreased color perception
-diplopia
-reduced visual acquity
-white/cloudy pupil
-*Halos visible especially when looking at a light during night-time driving

Age is important because cataracts are most prevalent in the older adult. Ask about these other predisposing factors

Earlysigns and symptoms of cataracts are slightly blurred vision and decreased color perception. At first the patient may think that his or her glasses are smudged, or contacts are not fi ing correctly. As lens cloudiness continues, blurred and/or double vision occurs and the patient may have difficulty with ADLs.

Question 2

6. The nurse is teaching about signs and symptoms of cataracts. Which change would the nurse emphasize as possibly indicating beginning cataract formation?
   a. Diplopia
   b. Cloudy pupil
   c. Loss of peripheral vision
   d. Blurred vision

Answer 2

ANS: D
A cloudy pupil is a sign of late cataracts and loss of peripheral vision is more common in clients who have glaucoma. Diplopia occurs with a number of neurologic diseases. Blurred vision is the earliest sign that the lens of the eye is undergoing changes.

Question 3

Risk factors for cataract

Answer 3

• Recent or past trauma to the eye
• Exposure to radioactive materials, x-rays, or UV light
• Prolonged use of corticosteroids, chlorpromazine, or beta blockers * Presence of intraocular disease (e.g., recurrent uveitis)
• Presence of systemic disease (e.g., diabetes mellitus,
  hypoparathyroidism, hypertension)
• Previous cataract, or family history of cataracts * History of smoking

Question 4

13. The caregiver of a patient with macular degeneration. The patients caregiver becomes
    increasingly is frustrated because of food spills on the patients clothing. Which explanation
    should help the caregiver understand what the patient is experiencing?

a. The patients vision is blurred.
b. There is total blindness in one eye occurring.
c. The central vision is gone and only peripheral vision remains.
d. There are black dots in the field of vision that cause confusion.

Answer 4

c. The central vision is gone and only peripheral vision remains.

Question 5

12.A patient with glaucoma is prescribed pilocarpine 1% eye drops every 6 hours. What outcome should the nurse expect from this medication?

a. Reduction of inflammation of the iris and choroids
b. Prevention of dryness of the cornea and conjunctiva
c. Dilation of the pupil by paralyzing the ciliary muscle
d. Promotion of drainage of aqueous humor from the anterior chamber of the eye

Answer 5

d. Promotion of drainage of aqueous humor from the anterior chamber of the eye

Question 6

Health Promotion and Prevention for Cataracts

Answer 6

Although most cases of cataracts in North America are age related, the onset of cataract formation occurs earlier with heavy sun exposure or exposure to other sources of ultraviolet (UV) light.

Teach adults to reduce the risk for cataracts by wearing sunglasses that limit exposure to UV light whenever they are outdoors in the daytime.

Cataracts also may result from direct eye injury. Urge adults to wear eye and head protection during sports, such as baseball, or any activity that increases the risk for the eye being hit.

Individuals who smoke are at higher risk for development of cataracts versus nonsmokers (Boyd, 2020).

Question 7

Which of the following is an early sign of Cataracts

A. Blurry vision
B. Loss of peripheral fields
C. Loss of central fields
D. Hypoxia

Answer 7

A. Blurry vision

Early signs and symptoms of cataracts are slightly blurred vision and decreased color perception. At first the patient may think that his or her glasses are smudged, or contacts are not fi ing correctly.

Question 8

Should a patient be taking any medication that affects blood clotting?

Answer 8

NO

Ask whether the patient takes any drugs that affect blood clott ing, such as aspirin, warfarin, clopidogrel, and dabigatran. Communicate this information to the surgeon because, for some patients, these drugs may need to be discontinued before cataract surgery.

Question 9

After Cataract surgery should a patient do activities increase Intraocular pressure?

A. Yes
B. NO

Answer 9

B. NO

• Bending from the waist
• Lifting objects weighing more than 10 lb.
• Sneezing, coughing
• Blowing the nose
• Straining to have a bowel movement
• Vomiting
• Having sexual intercourse
• Keeping the head in a dependent position
• Wearing tight shirt collars

Question 10

Which of the following findings should a patient NOT expect immediately after cataract surgery?

A. Bloodshot eye
B. Mild itching
C. Blurred vision
D. bruising

Answer 10

D. bruising

Remind the patient that mild eye itching is normal, as is a “bloodshot appearance.” The eyelid may be slightly swollen. However, significant swelling or bruising is abnormal. Cool compresses may be beneficial. Discomfort at the site is controlled with acetaminophen or acetaminophen with oxycodone as prescribed. Aspirin is avoided because of its effects on blood clott ing.

• Sharp, sudden pain in the eye
• Bleeding or increased discharge from the eye
• Green or yellow, thick drainage from the eye
• Eyelid swelling of the eye
• Reappearance of a bloodshot sclera after the initial appearance has
  cleared
• Decreased vision in the eye that had surgery
• Flashes of light or floating shapes seen in the eye

Question 11

Post-Operative Teaching for pt’s after Cataract surgery

Answer 11

Immediately after surgery, antibiotic and steroid ointments are instilled. The patient is usually discharged within an hour after surgery, after stabilization and monitoring.

Instruct him or her to wear dark glasses outdoors or in brightly lit environments until the pupil responds to light. Teach the patient and family members how to instill the prescribed eyedrops. Help them create a wri en schedule for the timing and the order of eyedrops administration.

Remind the patient that vision in that eye will be blurred and to not drive or operate heavy machinery until the ointment is removed. Stress the importance of keeping all follow-up appointments.

Infection is a potential and serious complication. Teach the patient and family to observe for increasing eye redness, a decrease in vision, or an increase in tears and photophobia.

Creamy white, dry, crusty drainage on the eyelids and lashes is normal.

However, yellow or green drainage indicates infection and must be reported. Stress the importance of proper handwashing to reduce the potential for infection.

Post-operative antibiotics and anti-inflammatories
* Have patient wear dark glasses until pupils react to light again
* Wear patch to prevent rubbing of eye
* Avoid activities that increase intraocular pressur

Question 12

What amount of time after cataract surgery will the patient get best vision?

A. 1 week after surgery
B. 4-6 weeks after surgery
C. 1-2 weeks after surgery
D. 30-60 minutes post op

Answer 12

B. 4-6 weeks after surgery

Patients usually experience a dramatic improvement in vision within a day of surgery. Remind them that final best vision will not occur until 4 to 6 weeks after surgery.

Question 13

Which client statement affirms that nurse teaching about instillation of multiple different eyedrops has been effective? Select all that apply.

A. “It will be very easy for me to instill all of the drops at one time.”
B. “A schedule will help me remember when to instill the eyedrops.”
C. “If I have trouble instilling the drops, there are devices that can be
helpful.”
D. “I can label the eyedrops by color to help me easily distinguish
which one is which.”
E. “I will not touch the droppers to my eyes as this can cause contamination and infection.”

Answer 13

B,C,D,E

Question 14

Are Post-Op eye drops important for a pt who has just gone through Cataract Surgery?

A. Yes
B. No

Answer 14

A. Yes

To achieve best results of cataract removal, the patient must be taught to closely adhere to the eyedrop regimen after surgery. Providing the patient or family with accurate information and demonstration of needed skills are nursing priorities.

Question 15

When are pt who has just gone through cataract surgery usually discharged?

A. Same day
B. 15 days
C. 20 days
D. 1 month

Answer 15

A. Same day

Because the patient is usually discharged within an hour after cataract surgery, nursing interventions focus on helping the patient and family plan the eyedrop schedule and daily home eye examination.
EYE PATCH IMPORTANT

Remind the patient to avoid activities that can increase IOP (see Table 42.5). Some patients are prescribed to wear a light eye patch at night to prevent accidental rubbing. Instruct the patient to avoid ge ing water in the eye for 3 to 7 days after surgery.

Question 16

7. The nurse is teaching a client about cataract surgery. Which statement would the nurse include as part of preoperative preparation?
   a. You will receive general anesthesia for the surgical procedure.
   b. You will be in the hospital for only 1 to 2 days if everything goes as expected.
   c. You will need to put several types of eyedrops in your eyes before and after surgery.
   d. You will be on bedrest for about a week after the surgical procedure.

Answer 16

ANS: C
Cataract surgery is done as an ambulatory care procedure and the client is not hospitalized, does not receive general anesthesia, and does not need to be on bedrest postoperatively.

Question 17

8. A client’s intraocular pressure (IOP) is 28 mm Hg. What action would the nurse anticipate?

a. Educate the client on corneal transplantation.
b. Facilitate scheduling the eye surgery.
c. Teach about drugs for glaucoma.
d. Refer the patient to local Braille classes.

Answer 17

ANS: C
This increased IOP indicates glaucoma. The nurse9s main responsibility is teaching the client about drug therapy. Corneal transplantation is not used in glaucoma. Eye surgery is not indicated at this time. Braille classes are also not indicated at this time.

NORMAL IOP IS 10-20 measured by tonometry

Question 18

What is Glaucoma

Answer 18

Glaucoma is a group of eye disorders resulting in increased intraocular pressure (IOP).

Definition
* The eye normally drains intraocular
fluid…with glaucoma the drainage is
disrupted
Open and Closed (Open is more common

OVERFLOW OF FLUID AROUND THE EYE WITH MINIMAL OR NO DRAINAGE

Question 19

Open - Angle Glaucoma (some drainage still occurs)

Answer 19

Open - Angle
* Develops slowly
* Usually affects both eyes
* No symptoms in beginning
stages
* Foggy vision
* Mild eye ache or headaches
* Late s/s include halos, and loss
of peripheral vision

Question 20

Closed- Angle Glaucoma (no drainage occurs)

Answer 20

Primary angle- closure glaucoma (PACG) or acute glaucoma has a sudden onset and is an emergency. The problem is a forward displacement of the iris, which presses against the cornea and closes the chamber angle, suddenly preventing outflow of aqueous humor.

Question 21

Health Promotion and Maintenance for Glaucoma

Answer 21

At this time, there are no known ways to prevent glaucoma. The best prevention against damage that glaucoma can cause is for adults to have eye examinations with glaucoma checks done every 2 to 4 years before age 40, every 1 to 3 years between ages 40 and 54, every 1 to 2 years between ages 55 and 64, and every 6 to 12 months over the age of 65 (Glaucoma Research Foundation, 2017).

Question 22

What type of vision loss does a patient with Glaucoma have?

Answer 22

In POAG, patients are often asymptomatic in the early stages. The visual fields first show a small loss of peripheral vision that gradually progresses to a larger loss.

Question 23

What finding does the nurse anticipate when assessing a client with a new diagnosis of glaucoma?
A. Seeing “shooting stars”
B. Decrease in central vision
C. Gradual loss of visual fields
D. Abrupt onset of excruciating pain

Answer 23

C. Gradual loss of visual fields

Question 24

Proper Eye Drop Administration/ Patient Teaching

Answer 24

The priority nursing intervention for the patient with glaucoma is teaching.
Teach the patient that the benefit of drug therapy occurs only when the drugs are used on the prescribed schedule; therefore, patients must instill drops on time and not skip doses.

When more than one drug is prescribed, teach the patient to wait 5 to 10 minutes between drug instillations to prevent one drug from diluting another drug.

Stress the need for good handwashing, keeping the eyedrop container tip clean, and avoiding touching the tip to any part of the eye.

Also teach the technique of punctal occlusion (placing pressure on the corner of the eye near the nose) immediately after eyedrop instillation to prevent systemic absorption of the drug

Question 25

The pt is suffering from open angle glaucoma, What drug would you anticipate the HCP to prescribe?

A. Benztropine
B. Diphenhydramine
C.Pilocarpine
D. Morphine

Answer 25

C.Pilocarpine

Issue with Glaucoma is too much fluid in
eye
* Treatment:
* 1. Timolol: reduces production of aqueous humor by the ciliary body
* 2. Pilocarpine: opens the meshwork allowing drainage of fluid
* 3. Mannitol: osmotic diuretic which decreases aqueous humor

Question 26

What is Macular Degeneration

Question 27

12. A client is taking timolol eyedrops. The nurse assesses the client’s pulse at 48 beats/min. What action by the nurse is the priority?

a. Ask the client about excessive salivation.
b. Take the client9s blood pressure and temperature.
c. Give the drops using punctal occlusion.
d. Hold the eyedrops and notify the primary health care provider.

Answer 27

d. Hold the eyedrops and notify the primary health care provider.

ANS: D
The nurse would hold the eyedrops and notify the primary health care provider because beta blockers can slow the heart rate. Excessive salivation can occur with cholinergic agonists. Taking the blood pressure and temperature are not necessary. If the drops are given, the nurse uses punctal occlusion to avoid systemic absorption.

Question 28

14. A client is brought to the emergency department after a car crash. The client has a large piece of glass in the left eye. What action by the nurse takes priority?
    a. Administer a tetanus booster shot.
    b. Ensure that the client has a patent airway.
    c. Prepare to irrigate the client’s eye.
    d. Turn the client on the unaffected side.

Answer 28

b. Ensure that the client has a patent airway.

Airway always comes first. After ensuring a patent airway and providing cervical spine precautions (do not turn the client to the side), the nurse provides other care that may include administering a tetanus shot. The client9s eye may or may not be irrigated.

Question 29

The client is diagnosed with glaucoma. Which symptom should the nurse expect the client to report?
1. Loss of peripheral vision.
2. Floating spots in the vision.
3. A yellow haze around everything.
4. A curtain coming across vision.

Answer 29

1. Loss of peripheral vision.

Question 30

The client is scheduled for right-eye cataract removal surgery in five (5) days. Which preoperative instruction should be discussed with the client?
1. Administer dilating drops to both eyes for 72 hours prior to surgery.
2. Prior to surgery do not lift or push any objects heavier than 15 pounds.
3. Make arrangements for being in the hospital for at least three (3) days.
4. Avoid taking any type of medication which may cause bleeding, such as aspirin.

Answer 30

4. Avoid taking any type of medication which may cause bleeding, such as aspirin.

Question 31

The 65-year-old client is diagnosed with macular degeneration. Which statement by the client indicates the client needs more discharge teaching?
1. “I should use magnification devices as much as possible.”
2. “I will look at my Amsler grid at least twice a week.”
3. “I need to use low-watt light bulbs in my house.”
4. “I am going to contact a low-vision center to evaluate my home.”

Answer 31

3. “I need to use low-watt light bulbs in my house.”

Question 32

The nurse who is at a local park sees a young man on the ground who has fallen and has a stick lodged in his eye. Which intervention should the nurse implement at the scene?
1. Carefully remove the stick from the eye.
2. Stabilize the stick as best as possible.
3. Flush the eye with water if available.
4. Place the young man in a high-Fowler’s
position.

Answer 32

2. Stabilize the stick as best as possible.

Question 33

The employee health nurse is teaching a class on “Preventing Eye Injury.” Which information should be discussed in the class?
1. Read instructions thoroughly before using
tools and working with chemicals.
2. Wear some type of glasses when working
around flying fragments.
3. Always wear a protective helmet with eye
shield around dust particles.
4. Pay close attention to the surroundings so eye
injuries will be prevented.

Answer 33

1. Read instructions thoroughly before using
   tools and working with chemicals.

Question 34

7. The 65-year-old male client who is complaining of blurred vision reports he thinks his glasses need to be cleaned all the time, and he denies any type of eye pain. Which eye disorder should the nurse suspect the client has?
8. Corneal dystrophy.
9. Conjunctivitis.
10. Diabetic retinopathy.
11. Cataracts.

Answer 34

4. Cataracts.

Question 35

8. The nurse is administering eyedrops to the client. Which guidelines should the nurse adhere to when instilling the drops into the eye? Select all that apply.
9. Do not touch the tip of the medication
   container to the eye.
10. Apply gentle pressure on the outer canthus of
    the eye.
11. Apply sterile gloves prior to instilling
    eyedrops.
12. Hold the lower lid down and instill drops into
    the conjunctiva.
13. Gently pat the skin to absorb excess eyedrops
    on the cheek.

Answer 35

1. Do not touch the tip of the medication
   container to the eye.
2. Hold the lower lid down and instill drops into
   the conjunctiva.
3. Gently pat the skin to absorb excess eyedrops
   on the cheek.

Question 36

10. The client diagnosed with glaucoma is prescribed a miotic cholinergic medication. Which data indicate the medication has been effective?
11. No redness or irritation of the eyes.
12. A decrease in intraocular pressure.
13. The pupil reacts briskly to light.
14. The client denies any type of floaters.

Answer 36

2. A decrease in intraocular pressure.

Question 37

What is Macular Degeneration

Answer 37

Macular degeneration, also known as age-related macular degeneration (AMD), is the deterioration of the macula (the area of central vision) and can be age related or exudative. It is the leading cause of blindness in individuals in the United States who are 65 years of age and older . There are two types of age- related macular degeneration (AMD): dry and wet.

The center vision loses clarity

Question 38

How does macular degeneration appear in the patients point of view?

Answer 38

Loss of central vision/acuity still has peripheral vision

Question 39

Risk Factor for Macular Degeneration

Answer 39

Modifiable
* Hypertension
* Obesity
* Hyperlipidemia
* Smoking
* Diet poor in vitamin E &
carotene

Nonmodifiable
* Age
* More common in Caucasians
* More common in women
* Family history

Question 40

Foods high in Vitamin e and Carotene

Answer 40

FOODS HIGH IN VIT E
1. Wheat Germ Oil
2. Sunflower Seeds
3. Almonds
4. Hazelnut Oil
5. Mamey Sapote
6. Sunflower Oil
7. Almond Oil
8. Hazelnuts

FOODS HIGH IN CAROTENE

The richest sources of beta-carotene are yellow, orange, and green leafy fruits and vegetables (such as carrots, spinach, lettuce, tomatoes, sweet potatoes, broccoli, cantaloupe, and winter squash).

Question 41

What are the two types of Macular Degeneration?

Answer 41

Wet and Dry

Dry
* Associated with the
development of yellow cellular
debris
* Slower
* Most common

Wet
Associated with hemorrhage and
ischemia
* Fast progressing
* Only about 10%

Question 42

Symptoms of Macular Degeneration

Answer 42

Symptoms
* Blurry central vision
* Dark spots
* Metamorphopsia
* Decreased contrast sensitivity

Question 43

Patient teaching for Macular Degeneration

Answer 43

-Injury prevention
-recognition of safety hazard
-use of large print book
-Use of the Amsler grid (Grille d’amsler)

Central vision loss reduces the ability to read, write, recognize safety hazards, and drive. Suggest alternatives (e.g., large-print books, public transportation) and refer to community resources that provide adaptive equipment.

Question 44

What is Retinal Detachment

Answer 44

. A retinal detachment is the separation of the retina from the epithelium. Detachments are classified by the type and cause of their development.

The patient may experience small flashes of light seen as “shooting stars” or thin “lightning streaks” in one eye, most visible in a dark environment. These flashes of light may be accompanied by “floaters.

Question 45

Clinical Manifestations or S/S of Retinal Detachment - SELF REPORTED BY PATIENT

Answer 45

The patient may experience small flashes of light seen as “shooting stars” or thin “lightning streaks” in one eye, most visible in a dark environment. These flashes of light may be accompanied by “floaters.

• CURTAINS
  -FLOATERS
  -FLASHES OF LIGHTS
  -BLURRED VISSION
  -FLOATER OR BLACK SPOTS
  -LOSS OF VISUAL FIELDS

Question 46

Patient Teaching Post op Retinal Detachment

Answer 46

Instruct the patient to avoid reading, writing, and work that requires close vision in the first week after surgery because these activities cause rapid eye movements and detachment. Teach the signs and symptoms of
infection and detachment (sudden reduced visual acuity, eye pain, pupil that does not constrict in response to light) and to notify the surgeon immediately if these symptoms occur.