Week 10; Acute Care Endocrine Flashcards
(56 cards)
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
Blood glucose regulation
ALL BODY PARTS REQUIRE CONSTANT SUPPLY OF GLUCOSE. SKELETAL MUSCLE, CARDIAC MUSCLE AND ADIPOSE TISSUE REQUIRE INSULIN FOR GLUCOSE TO MOVE INTO CELL.
* NORMAL BLOOD GLUCOSE IN HEALTHY CLIENTS REGULATED BY INSULIN AND GLUCAGON.
* INSULIN IS LIKE A “KEY” THAT OPENS LOCKED MEMBRANES TO GLUCOSE ALLOWING BLOOD GLUCOSE TO MOVE INTO CELLS TO
GENERATE ENERGY
Type 1 DM
- BETA-CELL DESTRUCTION LEADING TO ABSOLUTE INSULIN DEFICIENCY
- AUTOIMMUNE
- IDIOPATHIC
