Exam 4: Assessment and Care of Patients with Eye and Vision problems (10 questions) Flashcards Preview

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Flashcards in Exam 4: Assessment and Care of Patients with Eye and Vision problems (10 questions) Deck (30):

Age related Eye structural changes

- Decreased eye muscle tone

- Ectropion and dry eye
- Arcus senilis
Caused by fat deposits

- Corneal changes
Flattens, irregular surface of curve

- Changes in color of sclera
- Less ability to dilate pupil
- More light needed for reading


Age related Eye functional changes

- Yellowing of lens
- Accommodation gradually lost
- Presbyopia
Near point increases

- Far point decreases
- Color perception decreases
- IOP ( intraocular pressure) increases


Eye Diagnostic testing: Imaging assessment

CT, MRI, radioisotope scanning, ultrasonography


Eye Diagnostic testing: Slit-lamp examination

Magnifies the anterior structures


Eye Diagnostic testing: Corneal staining

Checks for corneal trauma, abrasions, ulcers


Eye Diagnostic testing: Tonometry

Measures IOP (intraocular pressure)


Eye Diagnostic testing: Fluorescein angiography

- Assesses retinal circulation
- IV access
- Mydriatic eye drops prior to test
- Encourage fluid after test
- Skin may appear yellow for several hours after test
- Urine bright green after test


Eye Diagnostic testing: Electroretinography

Graphing retinal response to light stimulation


Eye Diagnostic testing: Gonioscopy

- Determines if open angle or closed angle glaucoma is present
- Allows visualization of the angle where the iris meets the cornea


Cataract pathophysiology

- Clouding of the lens occurs due to changes in the proteins and lens fibers.


Cataract: subcapsular

Begins at the back of the lens


Cataract: Nuclear cataract

Forms in the center of the lens


Cataract: Cortical cataract

Forms in the lens cortex and extends from the outside of the lens to the center


Cataract treatment

Cataract surgery
- Cataract removal by phacoemulsification.
- Sound waves break up the lens, pieces are sucked out, and the capsule remains largely intact


Cataract postoperative nursing care

- Antibiotics given subconjunctivally
- Eye is unpatched, discharge usually occurs within 1 hour
- Dark glasses required
- Instill antibiotic-steroid eyedrops
- Mild itching normal
- Pain indicates complications
- Reduce IOP (stop strenuous activity)
- Prevent infection
- Assess for bleeding


Cataract patient teaching

- Signs of complications:
Sharp, sudden pain in eye
Bleeding or increased discharge
Lid swelling
Decreased vision
Flashes of light or floating shapes

- Avoid activities that might increase IOP

- Review procedure for use of eyedrops


Glaucoma pathophysiology

- Increased ocular pressure
- Cupping and atrophy of optic disc


Glaucoma types

- Primary open-angle glaucoma (POAG)
- Primary angle-closure glaucoma (PACG)


Primary open-angle glaucoma (POAG)

- Gradual onset
- Outflow of aqueous humor reduced
- No pain at the beginning, mild headache or eye aching later
- Cupping and atrophy of optic disc
- Late:
Halo around lights
Loss of peripheral vision

- IOP: 22 to 32 mm Hg


Primary angle-closure glaucoma (PACG)

- Sudden onset
- Outflow of aqueous humor is closed
- Sudden, severe pain
- Headache with N & V
- Colored halos around lights

- IOP: > 30 mm Hg


Glaucoma medications

- Prostaglandin analogs (Latanoprost)- increase the outflow of aqueous humor

- Beta-adrenergic blockers (Timolol)- decreases the production of aqueous humor

- Alpha2-adrenergic agonist (Brimonidine)- do both

(Got from pharm powerpoints)


Glaucoma treatment

- Pupil constriction allows ciliary muscle contraction and better circulation of aqueous humor

- Reducing production or increasing the absorption of aqueous humor


Glaucoma Nursing interventions

- Teach How eyedrops work
- Teach How to administer
- Monitor for side effects
- Compliance, timely dosing


Macular degeneration pathophysiology

Deterioration of the macula


Macular degeneration types

- Age related macular degeneration (AMD) (Dry)
- Exudative (Wet)


Macular degeneration: Age related (AMD) (Dry)

- Dry: gradual blockage of retinal cells…ischemic & necrotic


Macular degeneration: Exudative (wet)

- Wet: growth of new blood vessels, leak blood & fluid


Macular degeneration: Age related (AMD) (Dry) treatment:

- Antioxidants, Vitamin B12, carotenoids, vitamin E


Macular degeneration: Exudative (wet) treatment

- Bevacizumab (Avastin) injections into vitreal chamber
- Laser therapy to seal leaking vessels


Caring for a patient with reduced vision

- Communication about use of adaptive items
- Safety in familiar settings
- Ambulation assisted with care
- Promote self-care and independence
- Support for difficulty of adapting to lost sight