Sensory - Visual Flashcards
1
Q
How to administer eye drops?
A
Put medication (not letting bottle touch the eye)
into the nasal lacrimal sac (inner campus)
Press for minimum of 15 secs on the inner eye to prevent systemic effects
- could cause pt to drop BP and HR
2
Q
How do you know if an eye drop goes systemic?
A
decrease in Heart rate and BP
drop pt
3
Q
Leading Causes of Blindness (4)
A
Macular Degeneration
Cataract
Diabetic Retinopathy
Glaucoma
4
Q
What is the leading cause of blindness worldwide?
A
Cataracts
the only cure is surgery
5
Q
What is the leading cause of blindness in the USA?
A
Diabetic Retinopathy
6
Q
Aqueous Humor
A
fluid in the anterior segment
99.9% water and .1% sugar, vitamins, proteins, and nutrients
7
Q
Vitreous Body
A
behind the lens (posterior segment)
99% water and 1% collagen
8
Q
Aqueous Humor functions
A
Maintain intraocular pressure
Transports Vitamin C
Antioxidant
Protects from environmental factors (dust, wind, and pollen)
9
Q
Vitreous Humor/Body functions
A
keeps the shape of the eye
10
Q
When people get older, they lose collagen so what happens to their eyes in relation to that?
A
eye loses shape
difficulty of vision
11
Q
Normal flow of aqueous humor
A
The posterior chamber near the lens
Go through the iris in front of the eye
Into the anterior chamber
Trabecular meshwork
Out through the Canal of Schlemm
12
Q
What cranial nerves are used in eye movements?
A
2,3,4,6,7
Optic
Oculomotor
Trochlear
Abducens
Facial
13
Q
Cranial Nerve 2 is and does
A
Optic
14
Q
Cranial Nerve 3 is and does
A
Oculomotor
15
Q
Cranial Nerve 4 is and does
A
Trochlear
16
Q
Cranial Nerve 6 is and does
A
Abducens
17
Q
Cranial Nerve 7 is and does
A
Facial
18
Q
Cataracts is the
A
clouding/opaqueness of the lens
- Fibers clump together in front of the eye (drink plenty of water)
19
Q
Cataracts Causes
A
age-related (above 80 regardless of health)
congenital
secondary to DM, UV light, use of corticosteroids usage (increase BG)
Trauma
20
Q
Cataracts S/S
A
cloudy, opaque lens
low acuity (blurred foggy and fuzzy)
halos around light sources
no pain
gradually (happens over time)
difficulty with color hues
low night vision (NO DRIVING AT NIGHT)
leads to day time lowered
21
Q
Cataracts start in the what parts of the eyes
A
Peripheral to center
22
Q
Number 1 education for pt with cataracts?
A
no driving at night time
23
Q
Cataracts Tx
A
removal of the lens with lens implant
**Surgical replacement
24
Q
Is there a nonsurgical “cure” for cataracts?
A
no
25
What visual aids could be used for cataracts?
changing eyewear prescription
reading glasses
magnifiers
increased lighting
**adjust lifestyle** by not driving at night
26
Cataracts Pre-Op Surgical Care
**H&P**
Medicate with eye drops
IVF - good IV
Allergies
**Eye paralytic** and won't be able to move it
discharge teaching - no driving after surgery
27
Cataracts Intra-Op Surgical Care
Time out
Safety
Check right eye
28
Cataracts Post-Op Surgical Care
recovery VS
no intraocular pain over 4+ notify the surgeon
**Screen taped over the eye to sleep**
promote healing
**Lay 30-40 degrees**
reduce risk
**Don't rub, lift, bend, try not to sneeze, or cough**
review med schedule - **antibiotic and corticosteroid drops** - prevent infection and inflammation stopped when eye is healed
follow up appointment
29
Hold what cranial nerve to try to keep from sneezing
Number 5
30
After cataract surgery, the patient is feeling moderate to severe pain at the site, what should the nurse do?
call surgeon
31
Glaucoma vision decreases in the
peripheral vision
*Gatorade to powerade*
32
What are the 2 types of glaucoma?
OPEN
CLOSED
33
Closed Angle Glaucoma is a __________ and has what type of onset?
emergency
sudden onset
34
Closed Angle Glaucoma aka
Narrow-angle glaucoma
Congestive glaucoma
Pupillary closure glaucoma
35
Closed-angle Glaucoma needs to be helped within
48 hours
36
What happens after 48 hours of closed-angle glaucoma?
permanent damage
37
What happens during closed-angle glaucoma?
**build-up of aqueous humor and goes back into the vitreous body**
posterior to anterior and blocked to be pushed back
**overfilled with fluid and causes pressure throughout the whole eye**
-emergency for tx or permanent damage after 48 hours
38
What happens during open-angle glaucoma?
some fluid able to move
drainage system/meshwork is clogged and build-up of fluid goes back into the eye causing pressure to build gradually aggravates nerve
39
What type of glaucoma is most common?
open-angle
40
Open-angle glaucoma onset
gradual
41
Open-angle glaucoma aka
Chronic glaucoma
wide-angle glaucoma
42
Glaucoma in general is
increased intraocular pressure due to an increase in aqueous humor to vitreous humor
**Optic nerve is damaged when backflow of fluid and pressure**
43
Glaucoma risk factors
Familial
over 40 y/o
DM
HTN
Hx of ocular problems
44
In glaucoma, what is necessary to save vision?
early detection
esp. closed angle
45
S/S of closed-angle glaucoma
**acute onset of ocular pain**
halos on light sources
**eyebrow pain**
Nausea
blurred vision
pupils **nonreactive to light**
light sensitivity or phobia
46
S/S of open-angle glaucoma
generally painless (until widespread damage)
blindness if untreated
**HA
mild eye pain
loss of peripheral vision tunnel vision
halo around light sources
Elevated pressure in eye**
47
What eye exam is used by doctors to see if you have glaucoma?
air puff
48
Where is the open - angle in the eye?
between the iris and sclera
aqueous humor outflow decreased due to blockage in the eye drainage system (meshwork)
damage to optic nerve over time
49
Tx of Glaucoma
different eyedrops (beta-blocker or alpha drops) to decrease fluid build-up **FOR LIFE and SCHEDULED at certain time of day**
Over time, have surgery to correct the angle
50
3 Ps of Blindness in relation to open-angle glaucoma
Preventable
Painless
Permanent
51
What is the number 1 thing to remember when educating the pt on Tx for glaucoma?
eye drops for life
52
Tx eye drops for glaucoma
Beta-blockers
53
Beta-blockers response to eyes
Lower pressure in the intraocular by reducing production of aqueous humor
- primarily in open angle
**initial and maintenance therapy**
54
Can a beta blocker be used in a closed-angle glaucoma pt?
yes along with other meds for emergency lowering the pressure in the eye
55
What beta-blocker is used in Glaucoma?
Timolol
56
Contraindications of Timolol
Hx asthma, COPD
bradycardia
heart failure
2-3rd heart blocks
57
Adverse Reaction of Timolol
bronchospasms
dyspnea
bradycardia
dizziness
**heart block**
58
Timolol could potentiate
hypoglycemia
mask s/s
59
Can Timolol have systemic effects?
yes (hold the inner campus for 15 secs minimum)
hr and BP drop
60
How long do you wait to but contact lenses in after Timolol?
15 mins
61
What V/S needs to be checked before giving Timolol?
HR, BP
62
Macular Degeneration
yellowing of lens
**Central vision gradually lost**
color perception decreases
presbyopia
pressure increases
63
What vision is lost in Macular Degeneration?
Central
*McDonalds to Chick-Fil-A*
64
Dry Macular Degeneration
fatty deposits (yellow dots in eye)
65
Wet Macular Degeneration
fatty with neovascular (yellow around red star)
Blood vessels are weak and thin
causes hemorrhage
66
Dry Macular Degeneration S/S
GRADUAL
need brighter light
haziness of central or overall vision
blurred spot in the center of the field of vision
67
Wet Macular Degeneration S/S
abrupt onset
rapid worsening and vision loss
well-defined blurry/blind spot of central vision
68
Is there a cure for macular degeneration?
no, only slow progression
69
Management of Dry MD (ATROPHIC)
Antioxidants, zinc, and selenium (**Vitamin A, C and E**
Diet of fruits, veggies, **fish with omega3 fatty acids**
70
Management of Wet MD (exudate)
injections into eye
laser
photodynamic therapy
71
Diabetic Retinopathy
microvascular damage to retina
72
What are the 2 types of Diabetic Retinopathy?
non-proliferative
proliferative
73
Non-proliferative Diabetic retinopathy
most common
partial occlusion of small vessels in the retina
**causes capillary micro-aneurysms**
74
proliferative Diabetic retinopathy
involves retina and vitreous humor
New blood vessels (neovascularization) form
causes retinal detachment
75
Non-proliferative Diabetic retinopathy s/s
swelling
hard exudates
macular edema (worsening retinopathy) - due to plasma leaks)
blot hemorrhage
macula affected = severe central loss of vision
76
proliferative Diabetic retinopathy s/s
abnormal blood vessels forming
= fragile and bleed easily
prevents light from reaching retina and bleed into vitreous humor
*if they pull the retina can cause partial or complete retinal detachment
77
In the beginning of diabetic retinopathy, what are the changes in visions?
no change till the disease progresses and lose vision gradually or rapidly
78
With a Type 1 DM pt, they need to have an eye exam within _____ years of dx and then _________
5 years; annually
79
With a Type 2 DM pt, they need to have an eye exam upon _____ and then _________
upon diagnosis
annually with a dilated eye examination
80
Diabetic Retinopathy pts need to maintain?
what exercise?
glycemic control (A1C annually) and manage HTN
**exercise precautions (if active no strenuous activity - weight lifting, jogging, brass instruments or can cause retinal detachment)
= do low impact activities - swim, station cycle**
81
Diabetic Retinopathy Tx
Laser photocoagulation: Laser destroys ischemic areas of retina and reduce risk of proliferative retinopathy, MD
Vitrectomy: Aspiration of blood, membrane, and fibers inside the eye incision behind cornea
Drugs to block action of vascular endothelial growth factor (VEFG)
82
Diabetic FRetinopathy pts have a greater risk for what other eye diseases?
Glaucoma (hard to tx and often blind)
Cataracts
83
1. The nurse is developing a teaching plan for a client with glaucoma. Which instruction should the nurse include in the plan of care?
a. Eye medication will need to be administered for life.
84
17. What part of the eye do you administer eye drops?
a. Nasolacrimal duct/conjunctival sac.
85
18. How long do you hold pressure on the inner eye after administering eye drops?
at least 15 secs
86
19. Why do you want to apply pressure to the nasolacrimal duct/ conjunctiva after administering eye drops?
a. To prevent systemic absorption (Decrease of blood pressure and heart rate)
87
20. What are the four leading causes of blindness?
age related macular degeneration, Cataract, Diabetic Retinopathy, Glaucoma.
88
21. What is Cranial nerve #2 responsible for?
a. Optic nerve is responsible for the visual acuity.
89
22. What is Cranial nerve # 3 responsible for?
a. Oculomotor is responsible for opening of eyelids, eye movement upward/medial, upward/lateral, medial, downward/lateral.
90
23. What is Cranial nerve #4 responsible for?
a. Trochlear nerve is responsible for eye movement downward/medial)
91
24. What is Cranial nerve #6 responsible for?
abducens nerve is responsible for eye movement lateral
92
25. What is Cranial nerve #7 responsible for?
a. Facial nerve is responsible for facial muscle movement (except chewing), and eyelid closing.
93
26. What is Cataract defined as?
a. Opacification of the lens.
94
27. What is the number one risk factor for cataracts?
a. Age is the number one risk factor followed by diabetes mellitus, UV light, 2nd use of corticosteroids, and trauma.
95
28. What safety education do you want to provide the patient diagnosed with cataracts?
a. Do not drive at night because of low visibility from light not being able to go through. There will be a glare/Halo around light sources at nighttime.
96
29. What is the treatment for cataracts?
SURGERY
97
30. If the patient has any unexpected complications after cataract surgery, what should you do?
a. Call the surgeon even if it is just pain!
98
31. What part of the vision does glaucoma affect?
a. Peripheral vision (Glaucoma, Peripheral) Gatorade and Powerade
99
32. What is the difference between open and closed glaucoma?
a. Open is gradual IOP build up. Closed is a rapid buildup 24-48 hour to fix before permanent damage.
100
33. What part of the vision does macular degeneration affect?
CENTRAL
101
34. What is the difference between dry and wet macular degeneration?
a. Dry is drusen buildup that is gradual. Wet is drusen with hemorrhage and neovascularization that is rapid
102
35. Is there a cure for macular degeneration?
a. No cure just slowing of progression.
103
36. For a type I diabetic when should they have an eye appointment?
a. Within 5 years of dx and then yearly
104
37. For a type 2 diabetic, when should they have an eye appointment?
a. Upon dx and then yearly
