Sensory: Eys from Med/Surg Text

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What are some things that happen to the eyes as a patient ages?: ~Decrease in pupil size
~Slowing of accomodation(ability to focus and refocus)
~Increase in kens opaqueness(clouding)
-these changes result in less eficient vision
What is Oculus Dexter (OD) stand for?: right eye
What does Oculus Sinister (OS) stand for?: left eye
What does Ocular Unitas (OU) stand for?: both eyes
Tonometry measures ________ by determining the force necessary to indent or flatten a small anterior area of the globe of the eye.: intraocular pressure (IOP)
You need to prepare Mrs. Adams for tonometry. What two things would you tell her about the procedure?: 1. It is a simple, nonivasive, painless procedure with no sideeffects.
2. a topical anathesticis instilled in the lower conjuctival sac before measurement.
What does refractive ophthalmology cosits of?: placing varoius types of lenses in front or the pts eyes to determine which lens best improves the pts vision.
The dpctor came into the room and told Ms. Baker that she has emmetropia. How would you explain emmetropia to Ms. Baker?: Tell her that ;ight rays focuses on her retina and she does not need eye glasses or contact lenses.
What is Myopia?: (nearsightnedness) light rays focuses in front of the retina.
What is Hyperopia?: (farsightnedness) cannot read at 14inches and light rays focuses behind the retina.
Another cause of refractive error is _________, an irregularity in the curve of the cornae that may result in a decreased acuity of both distance and near vision.: astigmatism
During a routine eyeexam, Angie complains that ahe is unable to read road signs at a distance wehn driving her car. You know to check for _______.: myopia
Your patients visual acuity is 20/200. Is he legally blind?: yes
What are some nursing plans and interventions for the blind pt?: ~nounce presence
~call pt by name
~do not touch the pt unless the know you are there
~orient ot to surroundings
~guide pt by walking with their hand in the bedn of your elbow
~assist with meals and describe food
What is the leading cause of irreversible blidness in the world?: glacoma
What is the most effective helath promotion measure related to glaucoma that a nurse could teach pts?: For pts 40 yrs of age and older to have annual tenometry done for early diagnosis and treatment of glaucoma.
Glaucoma can be classified as ________ or _______. Then each classification has 3 different types of glaucoma.: Open angle and Angle closure
Mrs. Pickles had COAG. How does COAG damage a pts eyesight?: there is an obstruction in the trabacular meshwork that results in backup of aqueous humor and increase in IOP which eventually causes destruction og the retinas nerve fibers.
What is the most commen/early side of COAG?: painless slow peripheral vision loss, resulting in tunne; vision.
What are more ealry side effects other than the peripheral vision loss?: ~increase in IOP
~decrease in accomodation or ability to focus
What are some late signs of COAG?: ~halos around eyes
~decreased vision not correctable with eye glasses
~headache or eye pain that may be severe enough to cause vomiting and nausea
what are the four major examinations used in glaucoma evaluation, diagnosis, and management?: 1. tenometry to measure IOP
2. gonioscopy to obtain direct visualzation of the lens
3. opthalamoscopeto inspect optic nerve
4. perimetry to asses visual fields
What is an example and action of Cholernergics (miotics)? are there any side effects you need to tell the pt about?: Example: Pilocarpine
Action: increase aqueous fluid outflow by contracting the ciliary muscle and causing miosis (constriction of the pupil) and opening of trabecular meshwork
Side effects: blurred vision for 1-2 hrs and adaptation to dark enviroment may be difficult due to papillary constriction
What is an example and action of beta blockers? are there any aide effects you should tell the pt about?: Example: timolol and betaxolol
Action: decrease aqueous humor production.
Side effects: bradycardia and hypotension
A pt is haveing trabeculectomy performed for her glaucoma. How would you explain the procedure to her?: it requires hospitalization. it is a filtering procedure in which an opening is made at the edge under a partial thickness sclera flap. the new opening circumvents the obstruction and aqueous humor flows into the subconjunctival spaces.
What is the postoperative care for the surgiical procedure trabeculectomy?: protection of operative eye with patch and shiled and maintain comfort in the operative eye by using cold compresses.
A pt is considering surgical management to treat her glaucoma. You are asked to inform her about trabeculoplasty. What would you say?: application of a laser beam on the trabecular meshwork produces a non penetrating burn that changes the confoguration of the meshwork and leads to increased outflow of aqueus humor. This is done outpatient but the pt must remain at the office 3-4 hours to have IOP checked.
what is a possible serious complication of trabeculoplasty?: a sudden rise in IOP usually 2 hrs after surgery.
What might be some important iformation to tell your pt after he/she has had trabeculoplasty done?: To continue their glaucoma medicaine that they were on preoperatively because it takes 4-8 wks ti see if the procedure has been effictive.
Mr. Arnold is diagnosed with acute angle closure claucoma. Name six symptoms you would expect him to complain of?: 1. severe eye pain
2. decreased vision
3. pupil enlarged and fixed
4. colored halos around lights
5. red eyes
6. steamy cornea
T/F An acute episode of angle closure glaucoma is a medical emergancy that can repidly lead to blindness if left untreated.: True
What is an example and the action of the drug class Carbonic anhydrase inhibitors CAI?: Example: acetazolamide (diamox tablet)
Action: decrease aqueous humor
What is an example and the action of the drug class alpha- adrenergic agonist?: Example: apraclonidine opthalmis
Action: decreases aqueous humor
if you were told by the doctor to explain the surgical procedure, iridotomy or laser surgery, to a patient how would you explain the procedure?: eye drops will provide anesthesia for surgery. a hole will be created in the periphery of the iris, which will allow the aqueous humor to flow into the anterior chamber.
What are 2 contraindicated drugs for glaucoma patients?: 1. Atropine sulfate (mydriatic agent)
2. Nitroglycerin
Why is atropine sulfate contraindicated with glaucoma patients?: because it causes pupil dilation and increases IOP.
Why is nitroglycerin contraindicated in glaucoma patients?: it causes vasodilation which increases IOP, and can triger an attack causing pain and loss of vision.
Mrs. Davis ask you, When can I stop taking medications for glaucoma? How would you respond?: I would tell her not to discontinue her meds. It is a lifetime medication because loss of vision can not be restored.
What does it mean to say a person has a cateract?: he or she has opacity or cloudiness of the lens.
You are the postoperative nurse assigned to take care of Ms. Adams. The pt is a 73 yr old female scheduled for cateract extraction with intraocular lens implant. Ms. Adams ask you, What causes cateracts? Name 5 causes.: 1. senile (age related) cateracts
2. history of eye injury
3. ingestion of injurious substances
4. congenital (at birth)
5. Secondary
Ms. Adams ask you, What does the lens of the eye do?: it focuses light rays on the retina
what 2 early signs would you expact with Ms. Adams who has cateracts?: 1. gradual, painless blurring of the vision
2. decreased color perception
What are some late signs of cateracts?: 1. diplopia
2. reduced visual acuity
3. clouded pupil
What examinations are used for cateracts?: 1.Ophtalmoscope
2.slit lamp biomicroscope
3.Snellen visual acuity test
Mrs. Johnson ask you to explain her cateract surgery. What would you tell her?: there is 90-95% success THERE ARE THREE LENS REPLACMENT OPTIONS. wHAT ARE THEY?rate. a local anasthetic is injected behind the eye and in and around the eyelids and the lens is removed.
Mrs. Johnson decides to endergo surgery for her cateracts. What are somepreoperative things you should discuss with her?: eyelashes may be cut, face scurbs may be perscribed, she may be given some sedation for apprehension.
What are 4 postoperative goals you would implement for Mrs. Johnson?: 1. prevent increase in IOP by no bending her head below the waist, not coughing, sneezing, crying,or strainging. Also no miving heavy objects.
2. prevent stress on suture line by positioning on unoperative side.
3. prevent intraocular hemmorage
4. healing takes 6-12 wks. usually up the same day and resume normal patterns before third day.
There are three options with lens replacement. What are they?: 1. Contact lens
2. Intraocular lens implant
3. Cateract glasses
How would you explain intraocular lens implant to your patient?: the lens is implanted within the eye at the time of surgery. this is commonly used. vision is better than with the other procedures.
What is the postoperative care for IOP lins implant surgery?: May have a slight morning discharge and a scratchy feeling can be expected for a few days. Burning of vision may be experienced for several days to weeks.
What are the advantages and disadvantages of contact lenses?: Advantages: improved visual correction and better cosmetic appearence.
Disadvantages: conscientious care and finger dexterity are prerequisites. Some visual distortion.
For what reasons would you not recommened cateract glasses to a pt?: if 1 eye is normal, the difference in the eyes will cause diplopis(double vision)and there is greater visual distortion and everything has a curved shape.
Ms. Adams complains of a sharp pain in the operative eye, what does this indicate?: intraocular hemorage
What are five symptoms that you would tell Mrs. Adams to report immediatly because they could indicate retinal detachment?: 1. New floaters vicion
2. flashing lights
3. increse redness in the eye
4. decrease vision
5. pain
What would you include in your discharge planning for a pt that just had lens replacement done?: 1. assess home enviroment for safty hazards
2. arrangment for home care is needed
3. teach pt to relearn to judge distances accuratly
Why might a patient need a keratoplasty done?: From a corneal scar from a severe infection, a chemical burn of the eye, inherited corneal thinning with visual disturbances (keratoconus)
How does a penetrating graft differ from a lamellar graft?: a penetrating graft is the most common including all layers of the cornea and a lamellar graft only invovles the outer layers of the cornea.
Explain how a keratoplasty is done?: the graft should be removed with 8-10 hrs following the death of the donor to prevent the cornea from softening and transplanted within 2 days.
What are the preoperative instructions for a pt undergoing a keratoplasty?: pt should be free from respiratory or eye infections prior to surgery to promote postoperative healing.
What are the postoperative goals for a pt the had a keratoplasty?: 1. Moniter for and avoid an increase in IOP
2. Avoid pressure on the operative eye
3. rest the eye
4. orevent infection of the eye.
How long does full recovery of a jeratoplasty take?: up to 1 yr
Ms. Hepburn is a 60 yr old female with retinal detachment. Explain the pathology of this retinal disorder?: 2 layers of the retina seperate allowing fluid to enter.
What is the most common etiology (cause) of retinal detachment?: 1.Myopic (near sightedness) degeneration
2.trauma
3.aphakia(absence of crystalline lens) after cateract surgery
What are 3 symptoms that you would expect Ms. Smith to have with retinal detachment?: 1. sensation of a shade or curtain going over 1 eye.
2. seeing cobwebs
3. seeing bright flashing lights
Ms. Hepburn ask, what are floaters caused by? How would you respond?: Floaters are caused by blood cells that are released in vitorous humor by the detachment. You would respond by telling her to reduce rapid eye movement because it can enlarge or worsen the detachment.
After visual acuity is determined the pt must have a dilated fundus examination using an ________ when assessing for retinal detachment.: indirect opthalmoscopy (binocular lenses, which are mounted on the examiners head)
Ms. Hepburn askd, What is the prognosis of restoring my eye sight sfter surgery? How would you respond?: 95 % of pts can be successfully treated with surgery.
With a sclera buckling resealing is done by: _______, _______, _________: Cryotherapy (freezing)
Phoyocoagulatoin (lazor surgery)
Deathermy (heat)
When a retinal detachment surgery, sclera bukling, is done aon a pt what might you postoperative nursing diagnosis be?: risk for injury r/t vision impairment
What do mydriatics/cycloplegics do?: they dilate the pupils and paralyze the accomodative muscle of the ciliary body.
After retinal detachment surgery, sceler buckling, what 3 medications are given for post op pain/: 1. demerol
2. tyelonol
3. oxycodone
During a sclera buckling, why might a gas bubble be injected into the viterous cavity? What would you instruct the pt to do after the bubbles are injected?: to help flatten the retina. To lie face down or on their side for days so a bubble can rise against the area to be reattached.
What are 8 teaching points you would include in Ms. Hepburns d/c papers after having retinal detachment durgery, sclera buckling?: 1. ou patched for 2-3 days
2. have family assist for eye drainage
3. resume activity gradually
4. resume usual activity 4-6 wks
5. avoid abrupt movement of head
6. report signs of floaters
7. intill eyedrops
8. limit reading for 3 wks
what is the most common cause of visuakl loss in pts over 60 yrs of age?: macular degeneration
Mr. Car is 75 yr old man who has AMD. What would you see when performing his opthalmoscope exam?: Dursen's (yellow spots) that develop beneath the retina.
What symptom would Mr. Car complain of if he had macular degeneration?: gradual, painless loss of central vision over months and yrs.
Wen pts have maculer degeneration when do they often reliaze they need to seek help?: when they can no longer read fine print
What is macular degeneration?: idiopathis process that disrupts the normal retina.
What could you suggest to a pt that has macular degeneration?: That they would benefit from: lg print books, magnification devices, and bright lightening. Also refer them to a low-vision center. Inform them that laser surgery is helpful in a minority of pts.
What is the Amsler Grid?: used when pt has maculer degeneration. It is viewed wearing normal reading glasses, each eye is tested seperatly, the pt will stare at central fixation spot on the grid. Encourgae the pt to check daily.
What would be a priority nursing goal while your pt was in the hospital after having surgery for maculer degeneration/: to provide a safe enviroment and effective care
As a safty measure, what would you teach Mr. Car to expand his visual field?: when he walks he should move his head side to side to prevent falls.
What is the leading cause of blindness in choldren and young adults, espically male trauma victims?: ocular trauma
What are the most common injuries that cause ocular trauma?: 1. Occupational
2. Sports
3. Weapons
4. Assualt
5. Motor vehicle crash
6. War
Amy Brown is an Army Nurse. SGT Sanders is transported to the aid station via helicopter. The medic tells Ms. Brown, A grenade exploded and SGT Sanders has sharpnel in his eyes. Name 6 nursing interventions that Ms. Brown should implement to save SGT San: 1. Position pt reletive to type of injury. Sitting will decreases IOP
2. remove conjuctival foriegn body unless embedded
3. never attempt to remove a penetrating or embedded object
4. eye patch may be applied to rest eye. reading & watching tv may be restricted for 3-5 days
5. administer eye meds as ordered.
6. explain a sudden increase in eye pain should be reported.
What diagnostic test are used for ocular trauma?: slit lamp exam, visual acuity,and yellowish green dye that is used to detect abrasions and ulcers.
What is a corneal ulcer?: It is inflammation of the cornea(keratitis) with loss of corneal tissue. Causes 10% of blindness.
What is generally used to outline the ulcers?: fluorecein
How can you prevent corneal ulcers?: by prompt removal of foriegn bodies and early treatment of scratches and infections.
What are symptoms and treatments of corneal ulcers?: 1. pain treated with optical anesthetics
2. unusal tolerance to light (photophobia) treated with dark glasses
3. excessive productions of tears (epiphora)
~antibiotics & chemotherapeutic agents are used to treat
What are ocular burns caused by?: Acid(bleach, car batteries), alkali(ammonia), and other chemicals.
A pt comes into your offic and says that a car battery exploded and acid got in your eyes. What interventions would you use?: Irrigation of the lids, conhynctiva, and cornea with a syringe of normal saline or tap water for 15 min.
Differentiate a thermal injury and a photochemical injury: A thermal injury results from exposure to hot objects whereas photochemical injuried result uv irradiation and (infrared exposure (reflections from the snow).
How are thermal injuries and a photochemical injuries treated?: You treat with antibiotics and apply a pressure oatch for 24 hrs with mild injuries.
How would you treat a pt that comes into the clinic with a hemmorage due to tramu to his eye?: This is a black eye. For 1st 24 hrs you apply cold compress to reduce bleeding and swelling. After 1st 24 hrs, apply warm compresses at 15 min intervals to hasten absorption of the blood.
What is the most common ocular disease world wide?: conjunctivitis (pink eye0
What is the etiology of conjunctivitis?: pink eye may be viral, bacterial, fungalm or allergic.
If a pt calls the ask a nurse wanting to know the symptoms of conjuntivitis what would the nurse say?: dilation of the conjuntival blood vessels(hyperemis), edema of conjuntiva, moderate to copious ocular discharge.
What would be the rationale for telling a pt to apply heat to their eye for conjuctivitis?: heat relieves pain and increases circulation.
Why would you use cold compresses with allergic conjuntivitis?: Because it causes a capillary constriction that tends to reduce the amount of secretion and relieve pain and itching.
What are some common eye complications diabetics are at rick for?: 1.Diabetic retinopathy
2.Cateracts
3.Glaucoma necessitating eye assessment and exam
Mr. Bensinger is a 58 yr old who's right eye does not close completely due to neurosensory problems. Name 2 nursing interventions that you would implement: 1. use normal saline to moisten eye
2. paten over eye
Where in the eye do you instill eye drops at? What is the rational?: in the lower conjuctival sight to achieve maximum absorption and avoids the risk of corneal damage.
why would you want to apply gentle pressure on the inner canthus near the bridge of the nose for about 1-2 minutes after instilling eye drops?: to prevent medication for entering the lacrimal (tear) duct.
Why is it important not to let medication enter the tear duct?: Because if the drops enter the tear ducr, it can enter the nose and pharynx, where it may be absorbed and cause toxic symptoms.
After you put 1 drop in a pts eye, how long should you wait before you instill another drop in your pts eye?: 5-10 minutes
Would you intill eye drops or ointment in a pts eye first?: You would instill the eye drops first
Mrs. Baker has called the office for instructions on applying her eye ointment to her eye. How would you respond?: Tell her to apply 1/2 rippon to the lower conjunctival from the inner to the outer canthus. Tell her to avoid touching the eye or eyelid with the tube.

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