Visual (Cataracts, Retinopathy & Detached Retina) Flashcards
This type of patient usually suffers from retinopathy:
Diabetic patient (due to micro-vascular changes)
Cataract surgery is not the most common surgery for Americans that are 65 years+
True or False
False- Cataracts surgery is the most common surgery for Americans, 65 and older
Describe how a patient with cataracts might visualize something compared to someone with normal vision:
Consistently fuzzy, cloudy- like there is vasoline on the eye
The issue with the cataracts is related to:
a. the pupil
b. the retina
c. the lens
d. the sclera
c. the lens
Facts about the lens include:
- it sits behind the pupil
- it changes shape as needed to help focus an image
- Along with the cornea, the lens helps the eye accommodate
- Due to the Len’s pliability, it can focus on something far away and then shift to something closer
As someone ages, what occurs with the lens that leads to cataracts?
- the lens becomes cloudy and stiff
- decreased visual acuity
- decreased accommodation
Glare that is due to light scatter caused by the opacities is called ____ ____.
Flood Glare
Nonsurgical care to help with cataracts include:
Palliative measures:
- adjust glasses prescription
- increase lighting for reading and close-up work/activity
- day driving (to reduce the chance of evening glares)
Reasons why surgery may become an option for a cataracts patient include:
- When decreased vision acuity/accommodation impede safety
- When palliative measures are no longer satisfactory
- If the lens is causing an increased IOP
- If the lens opacity prevents monitoring of the retina in high-risk patients (ex: the diabetic patient)
In the diabetic patient, due to micro-vascular changes, it is difficult to view the retina because of cataracts:
True or False
True. Cataracts makes it difficult to see the retina.
Cataract Surgery
Name 5 pre-op medications the RN may administer:
- Mydriatic drops
- Cycloplegic drops
- NSAID drops
- Anxiety Meds
- Topical antibiotic - may be ordered prophylactically
Myotic drops ____ pupils.
constrict
Mydriatic drops ____ pupils.
dilates
*remember the “d” in Mydriatic and in dilates can help you remember these go together.
When do you give the mydriatic drops?
prior to the surgery so the doctor can see
Why is it helpful to decrease room lights when given mydriatic drops?
Because photophobia is common
What is important to remember with mydriatic drops?
- To avoid systemic effects
- It can produce significant cardiovascular effects
What do cycloplegic drops cause?
Paralysis of accommodation (it paralyzes the eyeball)
What is an important medical history consideration before Cataract surgery?
If the patient has closed (narrow) angle glaucoma, you can not give dilating eye drops. Closing the angle can increase IOP
What medication will you not give to someone with Closed (narrow) angle glaucoma who is about to undergo cataract surgery?
a. cycloplegic drops
b. mydriatic drops
c. myotic drops
d. NSAID drops
b. mydriatic drops (it can further increase the IOP)
Does a cataract patient need to be NPO prior to cataract surgery?
Yes. 6-8 hours.
Please recall Cataract surgery POST-op facts:
- Topical antibiotics and steroids may be given before the patient goes home
- An eye patch or shield will be used to cover the eye
- At home eye drops given (antibiotic/corticosteroid)
- Minor activity restrictions (so the IOP does not increase)
- Night time patch may be worn
What should be avoided so the IOP does not increase?
bending, stooping, lifting, coughing, bearing down
these movements should be avoided post cataract surgery
The initial post-op visit following cataract surgery is usually __ day(s) after the procedure
1 day (24 hours). The patch may be removed at this point.
Directly following cataract surgery, the patient may experience…
- Improved or decreased visual acuity (which is normal, initially)
- the eye drops will also slowly decrease and then stopped once the eye is healed
When the patient has their post Cataract surgery follow-up visits with the ophthalmologist, they will be monitored for:
(name 4)
- IOP
- Visual acuity
- Anterior Chamber Depth
- Corneal clarity
Cataract Surgery considerations for Patient/family teaching are:
- Use of proper hygiene/eye care techniques
- S/S of infection
- Importance of complying with post-op restrictions
- Correct use and instillation of eye medications
- Importance of attending follow-up visits
Retinopathy is typically caused by:
(SATA)
a. DM
b. Steroids
c. decreased IOP
d. HTN
e. Hyperlipidemia
f. Hypotension
g. Staring at a computer all day when studying for nursing school
a. DM
d. HTN
What are they key factors in controlling Retinopathy?
Prevention and treatment of both blood sugar and blood pressure
Also be sure to monitor for progression and take measures to prevent progression
What does the vision of someone with retinopathy look like compared to normal vision?
splotchy haze
Retinal detachment is not an urgent situation:
True or False
False. It is an urgent situation.
What is occurring while the retina is detaching?
a sudden onset of multiple small floaters and/or light flashes begin to occur
What happens once the retina detaches?
It is painless and the vision becomes shielded as if it were a curtain coming across the field of vision
Name 2 major methods used to repair/seal retinal detachment:
- Laser photocoagulation
2. Cryopexy
How do Laser photocoagulation and Cryopexy repair the detached retina?
They seal retinal breaks by creating an inflammatory reaction that causes adhesion/scar and reattaches it to the back of the eye
An extraocular procedure that repairs a retinal detachment and involves a silicone patch wrapped around the eye is called:
Sclera Buckle Procedure
A sclera buckle procedure involves a patient under _______ anesthesia and is an inpatient/outpatient procedure. (choose 1)
Local; outpatient
What are some important considerations when it comes to positioning after a Scleral buckling procedure?
- may be on bedrest
- keep HOB elevated at all times
- may need to lean forward
Why is it important to keep the HOB elevated post procedure (Scleral buckling)?
To keep the IOP low.
Scleral Buckling Post-procedure medications may include:
Topical eye ointments:
- antibiotics
- anti-inflammatories
- dilating agents
Post-procedure care for a Scleral Buckling should include:
- Activity restrictions
a. do not bend over or strain with lifting/bowel movements
b. Vigorous exercise should be avoided for 3-4 weeks - Teach prescribed activity restrictions
Scleral Buckling discharge teachings should include:
- Proper hygiene and eye care techniques
- S/S of infection
- Importance of complying with activity restrictions
- Proper instillation of topical meds
- Pain control
- Importance of post-surgery follow-up
An intraocular procedure/surgery for a detached retina is called:
Pneumatic Retinopexy
What is injected into the vitreous cavity during a Pneumatic Retinopexy?
a gas bubble
What is the ideal position following the injection of the gas bubble in a pneumatic retinopexy? Why?
Head down and to one side
(however, position depends on where the bubble is)
Why?
This position allows the bubble to apply maximal pressure on the retina by the force of gravity
The visual prognosis following a detached retina surgery depends on: (3 things)
extent, length, and area of detachments
Detached Retina reattachment is ___% successful
90%
