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Gloucoma
- Increased intraocular pressure
- Optic nerve atrophy
- Visual field loss
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Primary open angle vs angle closure gloucoma
- Primary open-angle glaucoma
- --Most common (90%)
- --Genetic component
- --Bilateral
- --Insidious in onset
- --Slow to progress
- Angle-closure glaucoma
- --acute attack develops in an eye in which the anterior chamber angle is anatomically narrow
- --attack occurs because of a sudden blockage of the anterior angle by the base of the iris
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POA vs AC Gloucoma SnSs
- Primary open-angle glaucoma
- --Symptoms appear late in the disease
- --Mild aching in the eyes
- --Loss of peripheral vision
- --Seeing halos around lights
- Acute angle-closure glaucoma
- --Ophthalmic emergency due to rapid onset
- --Unilateral inflammation and pain
- --Pressure over the eye
- --Moderate pupil dilation that’s nonreactive to light
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Diagnostics for Gloucoma
- Triad of signs: loss of visual field, cupping of optic disc, ^ intraocular pressure.
- Tonometry (air puff). (Good to know for test). Eye will be more firm than person w/out gloucoma.
- Slit-lamp examination
- Gonioscopy
- Ophthalmoscopy
- Perimetry or visual field tests
- Fundus photography
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Tx for Gloucoma
- Drug therapy to decrease aqueous humor production and to lower IOP
- --beta blockers
- --alpha agonists
- --miotic eyedrops
- ----facilitate outflow of AH
- Argon laser trabeculoplasty
- --thermal burn increases the outflow of aqueous humor
- Trabeculectomy
- --flap of sclera is dissected free and removed, followed by peripheral iridectomy
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Nursing considerations for pt/Gloucoma
- Dilating agents are contraindicated in narrow-angle glaucoma
- --Mydriatic agents dilate the pupil
- --Cycloplegic agents paralyze the ciliary muscle and the dilator muscle of the iris
- Desired outcomes
- --Patient will report no further loss of vision, adapt to any visual loss, be able to perform ADLs, and recognize clinical manifestations of complications
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Cataracts
A condition which develops when the crystalline lens of the eye begins to develop barriers stopping light from getting through it.
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Cataracts SnSs
- Blurred vision
- Monocular diplopia
- Photophobia
- Glare
- See better in low light
- No complaint of pain
- Cloudy lens
- Red reflex seen with the direct ophthalmoscope is distorted or absent
- Accurate determination of type and extent of lens change requires slit-lamp examination
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Tx for Cataracts
- Surgery to remove the opacified lens
- ICCE
- --removing lens and lens capsule
- ECCE
- --removing lens and anterior portion of lens capsule
- most common
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Patient education for pt w/gloucoma
- Leave eye patch until f/u visit next day
- Limit activity 24 hrs
- Do not lift more than 5 pounds (gal of milk)
- Do not strain
- Take eye drops
- Take Tylenol for pain or itching (common)
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Diabetic retinopathy
- Progressive disorder
- --Caused by microscopic damage to the retinal vessels, resulting in occlusion of the vessels
- --Inadequate blood supply causes sections of the retina to deteriorate
- --Vision is permanently lost
- A leading cause of blindness worldwide
- Two types: nonproliferative and proliferative
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Retinal detachment
(Secondary to a tear in the retinaretinal hole)
- liquid in the vitreous body with access to the hole
- subsequent fluid accumulation between the retina and the retinal pigment epithelium
- liquid seeps through the hole and separates the retina from its blood supply
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SnSs of retinal detachment
- Described as shadow or curtain falling across the field of vision
- No pain
- Usually sudden onset
- Burst of black spots or floaters indicate that bleeding has occurred
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Surgical repair (scleral buckling)
- Places retina back in contact with the choroid
- Vision may improve over weeks and months as healing takes place
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Floaters
Floaters are tissue remnants located in the vitreous body. They will often move after a vigorous blink. Patients view.
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Hearing loss
- Conductive
- --otosclerosis
- --trauma
- Sensorineural
- --presbycusis
- --noise-induced
- --sudden
- Mixed hearing loss
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Presbycusis
- Progressive hearing loss, predominantly in the elderly (age related.)
- Involves changes in the labyrinthine structures over time
- Initially, a decrease in high-frequency sound
- Tinnitus (noise in ear) may accompany
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Meniere’s Disease
- Affects both vestibular and auditory function
- Caused by excess endolymph in the vestibular and semicircular canals. NS is CX for pt w/Miniere's.
- Hearing loss is fluctuant, usually subtle, and reversible in early stages
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Nursing considerations for pt w/hearing loss
- Talk directly to the client while facing him or her
- Speak clearly but do not overaccentuate words
- Speak in a normal tone; do not shout
- Mover closer to the client and toward the better-hearing ear
- Do not smile, chew gum, or cover the mouth
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