Week 10; Acute Care Endocrine Flashcards
Most common causes of eye injury
– Abrasions
– Lacerations
– Foreign bodies
* Traumatic injury can also be caused by penetrating object, blunt force, burns
Prevention of eye injury
Protective eyewear prevents >90%
– >78% of individuals not wearing eyewear at time of injury
* Type of protection depends on activity
– Home use: eyewear labeled “ANZI Z87”
– Sports and recreation: depends on sport
– Proper UV protection when water or snow skiing
– OSHA determines what eye protection is required in workplace
Corneal abrasion
– Disruption of superficial epithelium
– Caused by objects such as contact lenses, eyelashes, small foreign bodies
– Superficial abrasions painful but heal rapidly without complications, scarring
– Photophobia, tearing common
– Stroma damage
▪ Increased risk of infection
▪ Slowed healing, scar formation
Burns to the eye
– Caused by heat, radiation, explosion, chemical
– Chemical burns most common
▪ Both acid and alkaline substances
▪ Alkaline eye burns particularly serious
▪ Acid burns: rapid damage, less serious
– Explosions, flash burns → greatest risk for thermal burns
UV damage to eyes
UV rays → corneal damage
▪ Depending on source: snowblindness, welder’s arc burn, flash burn
– History of face, eye contact with caustic substance or other burning agent
– Eye pain, decreased vision
– Eyelids, face, lips may be affected
– Sloughing with chemical burns
– Cloudy, hazy cornea with ulcerations
Penetrating injury
▪ Layers of eye spontaneously reapproximate
▪ Single entrance wound
– May be hidden because of tissue swelling
– May be missed when patient has other significant injuries
– Vital to inspect underlying eye tissue for damage
– Pain
– Partial or complete loss of vision
– Possible bleeding
Perforating injury
▪ Layers of eye do not spontaneously reapproximate → rupture of globe,
potential loss of ocular contents
Orbital blowout fracture
– Diplopia
– Pain with upward movement of eye
– Enophthalmos, limited movement
Hyphema
– Eye pain, decreased acuity, reddish tint
Detached retina
– Separation of retina from choroid
– Usually occurs spontaneously but may be precipitated by trauma
– Retina may tear, fold back on itself or may remain intact but not adhere to
choroid
– Detached area may enlarge rapidly, increasing vision loss
– Permanent vision loss unless contact reestablished
– Floaters, spots, lines, flashes of light
– Sense of curtain drawn across vision
– No pain, eye appears normal
Detached retina risk factors
▪ Aging
▪ Myopia
▪ Glaucoma
▪ Trauma
▪ Previous retinal detachment
▪ Aphakia
Eye injury dx
- Visual acuity tests
- Extraocular movement evaluation
- Flashlight or ophthalmoscope: pupil reactivity, size
- Ophthalmoscope: red reflex
- Slit lamp, fluorescein stain: corneal defect
- Facial x-rays
- CT scans
- Ultrasonography
Severe chemical burns to the eye treatment
– Debridement
– Tissue grafting
– Corneal transplant
Pain medication, steroids, cycloplegic drops
Retinal detachment: treatment
– Cryotherapy
– Laser photocoagulation
– Scleral buckling
– Pneumatic retinopexy
Steroids to reduce inflammation
Corneal abrasion treatment
After removal of foreign body, antibiotic ointment
Children eye injuries
Common causes of eye injuries
▪ Blunt trauma from ball or fist
▪ Sharp trauma from projectiles, sticks
▪ Chemical trauma from household chemicals
▪ Burns from fireworks
– Treatment same for all ages
– Help prevent injuries via patient teaching
– External eye injuries
▪ Two black eyes may suggest abuse
Older adults and eye injury
Older adults
– Most frequent cause: falling
▪ Slipping on wet surfaces
▪ Falling down stairs
– More at risk for falls
▪ Poor eyesight
▪ Bifocals that may alter depth perception
▪ Decreased cognition
– Patient teaching to prevent falling
Eye assessment injury
Nursing history
– Time, type, extent of injury
– Circumstances of injury
* Physical assessment
– Vision assessment
– Eye movement unless penetrating object
– Inspection
– Early manifestations of retinal detachment
Reduce risk for impaired vision
– Assess vision in each eye and both eyes: with, without correction
– Inspect eyes
– For burn or foreign body, consider anesthetic drops, irrigating eye
– Remove loose foreign bodies
– For severe or penetrating injury, promote rest, stabilize injured eye
– Apply eyedrops, ointment as prescribed
Interventions for retinal detachment
– Notify healthcare provider, ophthalmologist immediately
– Position patient so area of detachment is inferior
– Maintain calm, confident attitude
– Reassure patient that most retinal detachments are successfully treated
– Explain all procedures fully
– Allow supportive family members to remain
Discuss preparations for home care
▪ Limitations on positioning head before and after repair
▪ Activity restrictions
–No bending
–No straining at stool
▪ Use of eye shield
▪ Early manifestations, importance of immediate care and follow-up treatment
DIABETES MELLITUS
IS A COMMON CHRONIC ENDOCRINE
DISORDER OF IMPAIRED GLUCOSE REGULATION
Complications of DM management
CAN BE GREATLY REDUCED WITH GLYCEMIC
CONTROL BY MANAGEMENT OF HTN AND HYPERLIPIDEMIA AND LIFESTYLE CHANGES
