Unit IV - Eye

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tiffanydawnn
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23651
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Unit IV - Eye
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2010-06-21 21:17:29
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nursing eye
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Unit IV Eye
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  1. Blindness
    • "Visually Impaired"
    • Congenital (birth defects)
    • Acquired (diabetic retinopahy, glaucoma, cataracts, retinal degeneration, trauma)
    • Legally Blind - 20/200 or visual field < 20 degrees
    • Loss of peripheral vision, halos, orbital pressure, bulging
    • Emotional support, assistive devices, family teaching, safety, ADLs
    • ID self when approaching
  2. Refractory Errors
    • Astigmatism: defect in the curvature of the lens - blurred vision
    • Strabismus: cross eyes
    • --esotropia - in
    • --exotropia - out
    • Myopia: nearsightedness (cannot see far)
    • Hyperopia: farsightedness (cannot see close)
    • --presbyopia - due to aging
  3. Refractory Errors Dx
    • Opthalmoscope
    • Retinoscopy
    • Visual acuity tests
    • Refraction tests
  4. Refractory Errors Treatment
    • Glasses, contacts, laser surgery
    • Radial Keratotomy: inscisions to flatten cornea
    • LASIK: laser correction with corneal flap
  5. Eye Surgery Nursing Care
    • No NSAIDs or aspirin for one week prior
    • No contacts 1-2 days prior
    • Eye patch til next morning
    • Eye drops for comfort/anti-infective
    • Follow up appointment 1-2 days
  6. Ophthalmic Med Administration
    • Sterile, eye dropper should never touch eye
    • Drops: Look up - drop into conjuntival sac
    • Ointment: small line along lower lid
  7. Ophthalmic Meds - Anti-Infectives
    Kill bacteria

    • Gentamicin
    • Tobrex
    • Mycostatin
  8. ´╗┐´╗┐Ophthalmic Meds - Anti-inflammatories
    • Control inflammation
    • Side effects - increased IOP, masking infection

    • Decadron
    • Maxitrol
  9. Ophthalmic Meds - Anesthetics
    • For eye exam and minor surgery
    • Side effects: temporary burning, loss of lid reflex

    • Ophthaine
    • Pontocaine
  10. Ophthalmic Meds - Lubricants
    • Replace tears, lubricate contacts
    • Usually given at night - blurred vision

    • Hypotears
    • Lacrilube
  11. Ophthalmic Meds - Beta Blockers
    • Decrease IOP by decreasing production of aqueous humor
    • Side effects: cardiac - monitor HR and BP

    • Timoptic
    • Betoptic
    • Timolol
    • Betagen
  12. Ophthalmic Meds - Carbonic Anhydrase Inhibitor
    • Decrease IOP by decreasing production of aqueous humor
    • Side effects: drowsiness, depression, malaise, diuresis, paresthesia

    Diamox
  13. Ophthalmic Meds - Osmotic Diuretics
    • Profound diuresis - decreases intraocular pressure
    • given IV in emergency (eye trauma)
    • Side effects: HA, N&V, thirst, diarhhea, agitation

    • Mannitol
    • Oral glycerin
  14. Ophthalmic Meds - Cycloplegic Mydriatics
    • Pupil dilation, paralyzes accomodation
    • Used during eye exam/surgery
    • Side effects: increased IOP, photophobia, dry mouth, hypertension

    Need sunglasses

    Cyclogyl, Mydriacyl, Mydriafair
  15. Ophthalmic Meds - Miotics
    • Constricts the pupil, opens canal of Schlemm, drains aqueous humor, decreases IOP
    • Side effects: blurred vision, decreased light into eye (provide more light to see)

    Pilocarpine, Isopto, Carpine
  16. Conjunctivitis
    • Pink eye
    • Inflammation of conjuntiva (bacterial or sometimes viral)
  17. Conjunctivitis S/S
    • Erythema
    • Edema
    • Crusting discharge
    • Tearing
  18. Conjunctivitis Dx
    C&S
  19. Conjunctivitis Nursing Interventions
    • Saline eye irrigations
    • Cold compresses for itching/edema
    • Topical antibiotics/steroids
    • Antihistamines/decongestants (if due to allergies)
    • Patient teaching - infection control (keep hands out of eye), cross contamination, wash linens separately, no contacts/smoke/fumes
  20. Cataracts
    • Opacity of the lens
    • Usually due to age but can be congenital
  21. Cataracts Risk Factors
    • UV light exposure
    • Diabetes
    • Age
    • Steroids
    • Nutritional deficiencies
    • Alcohol
    • Congenital defects
    • Trauma
    • Intraocular infections
    • Smoking
  22. Cataracts S/S
    • Blurred/hazy vision
    • Fog/film over objects
    • Profound glare (night driving)
    • No pain
    • Changes in color vision
    • Visible white/gray spot behind pupil
  23. Cataracts Dx
    Ophthalmoscope and Silt Lamp
  24. Cataracts Treatment
    • Surgery is only treatment
    • Extracapsular extraction
    • Phacoemulsification - ultrasound to break up and extract cataract
    • Corticosteroids and antibiotics intra/post-op
    • Rare complications - Increased IOP, hemorrhage, retinal detachment, macular edema
  25. Cataracts Nursing Care
    • Avoid increased eye pressure: coughing, sneezing, constipation, vomiting, bending, stooping, lifting
    • Limited activity for one week
    • Sleep with eye sheid
    • Do not lay on affected side
    • Prescribed eye drops
  26. Diabetic Retinopathy
    • Diabetes causes vascular changes in retina
    • Venous capillaries dilate and develop microscopic aneurysms
    • Edema and small hemorrhages into retina

    • 10 years post diabetes DX
    • Increased in poorly controlled diabetes
    • 85% of diabetics develop
  27. Diabetic Retinopathy S/S
    • Diabetic history
    • Floaters
    • Blurred/spotty vision
    • Opacities, hemorrhages, lesions visible
  28. Diabetic Retinopathy Dx
    • Ophthalmoscope - dilated vessels, narrow arteries
    • Angiography - shows microaneurysms
  29. Diabetic Retinopathy Treatment
    • Evaluate 3-5 years after Dx then annually
    • ACE inhibitors: dilate retinal vessels
    • Phoocoagulation: destroys new vssels, seals leaking vessels, prevents retinal edema
    • Cryotherapy: decrease bleeding by freezing
    • Vitrectomy: removal of the vitreous
    • Vitrase (ovine hyalurondase): clears bloodied vitreous in 1 month
  30. Diabetic Retinopathy Nursing Care
    Same as other eye surgery
  31. Macular Degeneration
    • Deterioration of the macula (center of the retina)
    • Leading cause of visual impairment in US
  32. Macular Degeneration Risk Factors
    • Family history
    • Diabetes
    • Smoking
    • Caucasian
    • UV light exposure
  33. Types of Macular Degenration
    • Dry: age related, gradual onset
    • Wet: caused by blockage in capillaries, sudden onset
  34. Macular Degeneration S/S
    • No early symptoms
    • Loss of color vision
    • Blured vision
    • Distortion of lines
    • Empty spot in central vision
    • Appearance of drusen (yellow exudates)
  35. Macular Degeneration Dx
    • Amsler Grid Test
    • Ophthalmoscope
  36. Macular Degeneration Treatment
    • Dry: no treatment
    • Wet: photocoagulation of new vessels to prevent growth into macula

    • No way to restore central vision
    • Visual aids - lenses, magnifying glass
    • Vitamins C, E, beta-carotene help slow progression
    • Early detection critical
  37. Detached Retina
    • Retina detaches from choroid layer, causing hemorrhage or leakage of vitreous
    • Caused by degenerative changes or trauma
    • Partial detachment: progressive vision loss
    • Total detachment: blindness
  38. Detached Retina S/S
    • Sudden change in vision
    • Floaters or flashing light
    • "Veil" or "curtain" over vision
    • No pain (no receptors on retina)
  39. Detached Retina Dx
    • Ophthalmoscope and silt lamp
    • Ultrasound
  40. Detached Retina Treatment
    • Laser photocoagulation: burn off tears/breaks
    • Cryotherapy: freezes retina
    • Diathermy: burns retina via ultrasound
    • Scleral Buckling: silicone band around eyeball to seal tears
  41. Detached Retina Nursing Care
    • Eye bandaged post op
    • Antibiotic, cycloplegic, and mydriatic drops
    • Antianxiety meds
    • Limited activities 3-5 weeks (to prevent another detachment)
    • Avoid constipation and vomiting
  42. Detached Retina Prognosis
    • Reattachment 90% successful
    • Maximum sight within 3 months
    • If not reattached, retina dies -> blindness
  43. Glaucoma
    • Increase in pressure in he eye caused by changes in outflow of aqueous humor
    • Affects peripheral vision
    • One of the leading causes of blindness
    • Over age 35
    • No cure
  44. Open Angle Glaucoma
    • Chronic
    • Elderly
    • Risk factors - hypertension, previous eye inury, African-American
    • Possibly hereditary
  45. Closed Angle Glaucoma
    • aka Narrow Angle
    • Sudden onset
    • Eye injury interferes with drainage of aqueous humor, increases pressure
    • Medical emergency
    • Eye drops, Mannitol, surgery
  46. Open Angle Glaucoma S/S
    • Gradual onset
    • Tired eyes
    • Headache
    • Difficulty focusing
    • Peripheral vision loss
    • Halos
    • Inability to detect colors
    • Increased IOP - Optic disk cupping
  47. Closed Angle Glaucoma S/S
    • Rapid onset
    • Severe pain
    • Decreased vision
    • N&V
    • Enlarged, fixed pupil
    • Colored halos
    • Increased IOP - Optic disk cupping
  48. Glaucoma Dx
    • Tonometer
    • Visual field studies - decreased peripheral vision
  49. Glaucoma Medications
    • Eye drops - improve flow, decrease production of aqueous humor
    • Miotics - constrict pupil, open canal of Schlemm, drain aqueous humor
    • Carbonic anhydrase inhibitors, beta blockers - decrease production of aqueous humor
    • Osmotics - IV for emergency
  50. Glaucoma Surgery
    • Trabeculoplasty/Trabeculectomy: laser procedure on iris/surrounding tissue to facilitate aqueous humor flow
    • Iridotomy: inscion into iris to create opening for aqueous humor

    Both increase aqueous humor outflow/decrease IOP
  51. Glaucoma Nursing Care
    • Use eye drops regulary
    • Medic alert bracelet
    • Regular eye exams (q 2-4 years, q 1-2 years > 65)
    • Post-surgical eye precautions
    • Patient and family teaching - treatment, care, and compliance
    • Patient safety
    • No OTC allergy meds
  52. Corneal Injuries
    • Foreign bodies - dust, propellants, eye lashes, contact lenses
    • Burns
    • Penetrating wounds
  53. Corneal Injuries S/S
    • No bleeding (cornea non-vascular)
    • Pain with eye/lid movement
    • Tearing
    • Redness
    • Pruritis
    • Vision Loss
  54. Corneal Injuries Dx
    • Visual/ophthalmoscope exam
    • Fluorescein staining
    • Peripheral vision tests
    • Silt lamp exam
    • Ultrasound, X-ray, CAT scan
    • MRI
  55. Corneal Injuries Treatment
    • Ask about first aid given at scene
    • Burns: flush eye 15-20 mins with tap water to prevent scarring -> ER
    • Penetrating wounds: do not remove object, cover both eyes -> ER
    • Foreign objects:
    • -Eye flush - saline
    • -Moist q-tip/gauze to remove visible object
    • Antibiotic ointment/drops
  56. Corneal Injuries Nursing Care
    • Assist with procedures
    • Patient teaching
    • Handwashing
    • Eye safety
  57. Keratitis & Corneal Ulcers
    • Inflammation of the cornea
    • Caused by irritation, bacteria, or virus
    • Contact lens wears more succeptible
  58. Keratitis & Corneal Ulcers S/S
    • Severe eye pain, increased with blinking
    • Tearing
    • Photophobia, photosensitivity
    • Visual disturbances
    • Untreated - vision loss
  59. Keratitis & Corneal Ulcers Dx
    • Ophthalmic exam
    • C&S
  60. Keratitis & Corneal Ulcers Treatment
    • Topical antibiotics/steroids (systemic if severe)
    • Cycloplegic mydriatic drugs - paralyze ocular muscles, dilate pupil
    • Analgesics
    • Sunglasses
    • Pressure dressings
  61. Encleation
    Surgical removal of the eye (eyeball or eyeball + surrounding structures) due to tumor or trauma
  62. Enucleation Nursing Care
    • Emotional support
    • Pain relief
    • Pressure dressings to control bleeding
    • Routine post op care
    • Prosthetic fitting 4 weeks

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