Visual Sensory Alterations Flashcards
Eye drop administration
Place eye drop in Lasoacrimal sac or inner canthus and hold pressure for 15 seconds
Why do you want to hold pressure after eye drops?
To prevent any systemic effect and it can slowly absorb ( can cause low bp, low hr and pt to drop-beta blocker
Leading causes of blindness
Muscular degeneration
Cataract
Diabetic retinopathy
Glaucoma
What is the leading cause of blindness world wide
Cataracts
What is the leading cause of blindness in the United States
Diabetic retinopathy
Aqueous humor
Job is to maintain intraoccular pressure, helps transport vitamin c and works as an antioxidant. It’s going to protect us from dust wind and pollen (or anything else) from getting into eye
99% water 1% sugar vitamins proteins and nutrients
Vitreous humor
Fluid in the back of eye.
99% water 1 % collagen
Helps keep the shape of the eye
Vitreous humor flow
Posterior chamber into the interior chamber, goes thru the trobecular mesh workout into the canal of Schlemm
Cataracts
Clouding of the lends
Age #1 risk factor
By age 80 about half of people have cataract build up
T or f if you are diabetic you have a higher chance of getting cataracts quicker
True
What can cause cataracts quicker
Diabetes
Corticosteriods( increasing blood glucose)
UV light
Congenital
Trauma
S/s/ ofcataracts
Blurry foggy or fuzzy vision
Halos around light sources
What can people with cataracts have trouble seeing
Color
Ex. Red and orange look the same
What is the only treatment for cataract?
Surgery
Phacoemulsification
Surgical care for cataracts
H&P
Medication-eye drops
IVF
Postoperative phase for cataract surgery
Recovery VS
Promote healing
Reduce risk
Review medications (schedule)
What medication are used to paralyze the eye
Cycloplegics
When do you start discharge planning for surgery ?
Before surgery
Make sure they have a ride home
Teach to not to rub eyes
Avoid lifting ( under 10lb)
Avoid sneezing (hold cranial #5)
No coughing
No bending
Lay 30 -45 degrees if possible ( laying flat puts too much pressure)
Do all of this for at least two weeks
Pain after cataract surgery
Any pain over a 4 ( above mild) call surgeon
What type of medication to give for inflammation post surgery cataracts
Corticosteriods
Eye drops for cataracts surgery
Eye drops gradually reduced but stopped after healed
What should you give pt post surgery cataracts during discharge
Follow up appointment
Glaucoma
Decrease peripheral vision
Glaucoma, Gatorade, Powerade peripheral
Two types of glaucoma
Open angle and closed angle
Closed angle
A build up of aqueous humor and it builds into vitreous body (goes backward)
It is a medical emergency have have 48 hours to get treatment
After 48 hours it will cause permanent damage
Sudden onset
Open angle
Most common
Gradual onset (fluid will graduallyvitreous)
Angle between iris and the sclera
Aqueous humor outflow is decreased due to the blockages of the eye drainage system
(Trabecular mesh work not draining appropriately
PERIPHERAL vision lost first then central vision as nerve gets damaged
Early diagnosis of gluacoma prevents
Permanent damage
S/s of glaucoma closed angle
Acute onset of ocular pain, halo around light sources, eyebrow pain, nausea, blurred vision,pupils non reactive to light and light sensitivity
Treatment of closed glaucoma
Betablocker drop
Andrenergic drop
Over time pt can have surgery
Pt with open angle glaucoma
Don’t experience s/s until there is widespread damage ( why its good to get eyes checked annually)
Important teaching for glaucoma
Have to be on eyedrops for the rest of their life for both open and closed
S/s of open ended glaucoma
Headache, loss of peripheral vision, halo around light sources, elevated pressure in eye , mild eye pain
3 Ps of blindness due to open angle glaucoma
Preventable ( if get eyes check regularly so medication get be administered)
Painless
Permanent
BETA-adrenergic blocking agent
Lowers intraoccular pressure by reducing production of aqueous humor
Used primarily for open angle but can be used to treat closed angle at first along for emergency management with other medication butwill need surgery
Can be used open angle for a longer period of time
***inital therapy and maintenance therapy
TIMOLOL
Beta blocking agent for glaucoma
Ask for history of asthma, COPD, sinus, bradycardia, heart failure, 2nd 3rd degree heart block
Can cause bronchospasms, Dyspnea, bradycardia, heart block
What do you do before administering timolol ?
Vital signs , bp, hr
If pt have low bp or low hr below 60 we have to hold medication and educate why they can’t have it
Macular degeneration
Central vision loss
Yellowing of lens
Color perception decrease because of yellowing
IOP increases
McDonald’s and Chick-fil-A
Dry AMD
Fatty deposit build up inside fovea central
WET AMD
Fatty deposits with Blood vessels ( really weak and will rupture) and will cause hemorrhage ( blood in the eye)
Dry amd s/s
Develops gradually
Need for brighter light
Gradual haziness of centeral vision or overall vision
Blurred spot in the center field of vision
Wet amd s/s
Abrupt onset(blood vessels rupture)
Rapid worsening and vision loss
Well defined blurry/ blind spot of central vision
Treatment of MD
No cure only slowing of progression
Atrophic(dry)
Antioxidants, zinc, and selenium (vitamin a,c,e,)
Diet fruits, vegetables, fish w omega 3 fatty acids
Exudative wet MD
Injections into eye / laser to get rid of blood vessels /neovascularizetion
Or light therapy
Exudative WET MD treatment
Injections or laser in eye to help get rid of blood vessels or neuorvascularization
Photodynamic (light) therapy
Diabetic retinopathy
Non prolifertative
And prolifertative
Non-prolifertative
Most common
Capillary micro aneurysm
(Rupturing of capillaries in the eye)
Non prolifertative s/s
Retinal swelling
Hard exudates ( any build up in eye will be harder build up)
Macular edema (worsening of retinothopy)
Blood vessels weaken and rupture so blood within macula
Severe central vision loss
Prolifertative
New blood vessels formed (neovascularizetion )
Fragile and can rupture causing blood in the eye (bleeding in vitreous body and will block central vision )
Get regular eye checks and they feel like they are losing their vision or a curtain went over their vision get to specialist immediately because blood vessels can cause retinal detachment
Diabetic retinopathy
Initially. No changes in vision
But over time visual acuity will decrease either rapid (detachment of retinal) or slowly depending on what is going on
When pt is a type 1 diabetic
Have eye exam within 5 years of diagnosis and annually after that
Type 2 diabetic
Schedule eye appointment upon diagnosis and annually after that
Diabetic retinopathy precautions
Maintain glycemica control and manage hypertension
Excercise precautions for diabetic retinopathy
Avoid jogging, weight lifting, playing instruments
Can semi or stationary cycling ( low impact exercises)
Diabetic retinopathy treatment
Laser photocoagulation
Vitrectomy
Drugs to block actions of vascular enothelial growth factor
Diabetic retinopathy increases risk for
Glaucoma(neovascularizetion) and cataracts (type1,type 2 and corticosteroids use)
