Transcript INTERFERENCES TO SAFETY NEEDS

INTERFERENCES TO SAFETY NEEDS
DUE TO SENSORY DEPRIVATION AND
AGING
2009
HOW TO DETECT VISUAL
IMPAIRMENT IN INFANT
SIGHTED
CHILD
Response to objects
Eye contact
Body image
development
Motor function
Crawling
How learns
VISUALLY
IMPAIRED
CHILD
REHAB OF VISUALLY IMPAIRED CHILD
GRIEVING
Play
Overprotection
Feeding
Sensorimotor stimulation
Safety
Bonding
Speed of Development
Touch
Mobility
COURTESIES TO
BLIND HOSPITALIZED PATIENT
CATEGORY
Environment
walking
What to say to pt as enter room
Words like “see”
Touching pt
Object in room
Food tray
WHAT TO DO
DIAGNOSTIC EVALUATION
DIAGNOSTIC EVALUATION
Tonometry
Tonography
Gonioscopy
slit lamp
opthalmoscopic exam
A scan ultrasound (echography)
PURPOSE
GLAUCOMA
• What is the major characteristic of this
disorder?
• How does this impair vision?
• What situations increase intraocular pressure
normally?
• Why don’t we all get increased intraocular
pressure?
GLAUCOMA
• PRIMARY OPEN ANGLE GLAUCOMA
• ANGLE CLOSURE GLAUCOMA
Primary open angle glaucoma
• What happens to the outlflow of
aqueous humor?
• How does this effect intraocular
pressure?
Angle closure glaucoma
• What changes occur to the iris?
• With these changes what happens to the
outflow of aqueous humor?
COMPARISON OF EARLY AND LATE SYMPTOMS
OF GLAUCOMA
EARLY SIGNS
LATE SIGNS AND
AND SYMPTOMS SYMPTOMS
visual fields
visual acuity
Around lights
pain
TWO TYPES COMPARED
PRIMARY OPEN ANGLE
• With progressive
changes what happens
to aqueus humor?
• Tonometry reading:
ANGLE CLOSURE
• OTHER NAMES:
• EMERGENCY
• When must the pt be
treated?
• What happens if they
aren’t treated?
• Tonometry reading:
DRUGS: MIOTICS
• Miotics: do what?
PUPIL SIZE
(MIOSIS)
OUTFLOW AQUEOUS HUMOR
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IOP
RELIEF OF GLAUCOMA
pilocarpine hydrochloride (Isopto Carpine, Pilocar, Spersacarpine, Akarpine, Pilopine):
enhances aqueous outflow
carbachol (Carboptic, Carbastat)
Isopto Carbachol, Miostat): may be used with or in place of pilocarpine
DRUGS: CARBONIC ANHYDRASE
INHIBITORS:
How do the Carbonic anhydrase inhibitors treat glaucoma?
EXAMPLES:
• acetazolamide (Acetazolam, Diamox)
• brinzolamide (Azopt),
• dorzolamide (Trusopt)
• Methazolamide (Neptazane)
ALERT ALERT ALERT ALERT ALERT!
Drug interactions:
• Digitalis, Steroids, Diuretics, Lithium
DRUGS: SYMPATHOMIMETICS
How do SYMPATHOMIMETICS treat glaucoma?
EXAMPLE:
• brimonidine (AlphaganP)
• apraclonidine (Iopidine)
• epinephryl ( Epifrin, Glaucon),
• dipivefrin HCl (Propine)
PRECAUTIONS with soft contact lenses?
DRUG COMBINATION CONCERNS?
DRUGS:
OSMOTIC DIURETICS
OSMOTIC DIURETICS:
How does this treat glaucoma?
What situations is this used?
EXAMPLE:
oral glycerin (Osmoglyn)
IV mannitol (Osmitrol
Or topically: glycerin (Ophthalgan)
DRUGS: BETA ADRENERGIC BLOCKERS
How do they treat glaucoma?
How do they effect the pupil?
ALERT ALERT:WHAT MAJOR PRECAUTION MUST BE USED
WITH ORAL BETA BLOCKERS AND CALCIUM CHANNEL
BLOCKERS?
EXAMPLES: (what letters do all these drugs have in common?
levobunolol HCl (Betagen Liquifilm)
betaxolol HCl (Betoptic)
metipranolol HCl (Metipranolol, OptiPranolol)
carteolol HCl (Ocupress)
timolol (Betimol, Timoptic)
levobetaxolol (Betaxon)
DRUGS: Alpha 2 Adrenergic Agonist
• HOW DO THESE DRUGS MANAGE GLAUCOMA?
Dilate pupil, decrease aqueous production at the ciliary body,
inhibit production of aqueous, but they can also facilitate
the outflow of aqueous from the eye
EXAMPLES:
• brimonidine tartrate ( Alphagan):
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ALERT:
cannot combine with MAOI (monoamine oxidase inhibitor)
Can precipitate hypertensive crisis
Cannot be used with contact lens; wait 15 minutes before
inserting after administration
DRUGS: PROSTAGLANDIN AGONIST
HOW DO THESE TREAT GLAUCOMA?
• What does it do to the outflow of aqueous fluid?
• How does it effect aqueous fluid production?
EXAMPLES OF DRUGS:
• ****latanoprost (Xalatan)
• travoprost (Travatan): not to be used with pregnancy
• bimatoprost (Lumigan)
• unoprostone isopropyl (Rescula)
WHAT DO ALL THESE DRUGS HAVE IN COMMON IN
TERMS OF EFFECTING THE IRIS?
SURGERY FOR BOTH TYPES OF
GLAUCOMA
• PURPOSE: to create a permanent way to drain
fluid
• TYPES
1.
2.
POSTOP NURSING CARE
• Where is the procedure done?
• How long do patients stay?
• What precautions should be taught to the
client?
• How is the eye protected?
• What should be reported to the doctor?
• What complications occur?
• What assessments indicate complications?
POSTOP NURSING CARE CONTINUED
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AVOID ASA : why?
What is effective for pain control?
What is used prophylactically for 5 days?
What is used for several weeks to reduce
inflammation and prevent scarring?
• Why avoid reading ?
• What should they wear forever? wear medic
alert
• What medical care do they need routinely?
CATARACTS
Described as what?
ASSESSMENTS
• How is vision changed?
• How do objects appear?
• What happens when pt is faced with bright
light?
• Is there pain?
• How does the lens appear?
TREATMENT
• When does the pt need surgery? Pt chooses
to have surgery when the loss of vision
interferes with life and safety
• Where is the surgery done? Done with local,
short stay hospital
• What is done surgically? lens is extracted
• What is given on surgical day?
• Why does the client receive oral
acetazolamide (Acetazolam )?
TYPES OF CATARACT SURGERY
• Extracapsular - incision through schlera, lens
capsule excised, lens is expressed by pressure;
most popular
• Intracapsular extraction - remove lens and
capsule that encases it; rare today
• Phacoemulsification - extracapsular; small
incision, uses high frequency ultrasound
device, breaks up lens, aspirate it, irrigation
TYPES OF SURGERY FOR CATARACTS
• Intraocular lens implant: prosthetic lens
implant inserted after any type of extraction;
good for pt over 65 who has arthritis who
cannot manage contact lens insertion
POSTOP NRSG CARE/ TEACHING
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What medications are given subconjunctivally?
How is the eye protected?
When is the client discharged?
When does the client return to see the doctor who
instills what drugs?
When assessing the eye what would you see?
What pain level is felt by the client?
What drugs should be avoided?
What should be taught to client to report?
When will sight changes be noted by pt?
RETINAL DETACHMENT
• NORMALLY WHAT DOES RETINA DO?
• WHAT HAPPENS WHEN THERE IS A
DETACHMENT?
• Who is more at risk for this?
ASSESSMENT INDICATING
RETINAL DETACHMENT
• What do pts see suddenly?
• How is sight effected?
• How quickly does this occur
SURGICAL TREATMENT
Same day surgery with general anesthesia
• laser photocoagulation: scar tissue formed to
closed the leakage
• schleral buckling: silicone buckle sutured into
schlera supports the breaks in retina
POSTOP NURSING CARE
DISCHARGE TEACHING
• How is the eye protected?
• What activity is allowed?
• Why is the client positioned on his or her
abdomen if gas or oil has been used during
surgery?
• How will the client feel postop?
• What should be avoided?
DIABETIC RETINOPATHY
CAUSED BY
• Damage to or occlusion of the blood vessels
that nourish the retina as a result of
inadequate blood glucose control
• Weakened vesels become hyperpermeable
and leak causing microhemorrhages
• Observe for cloudy or hazy vision of sudden
onset
• TREATMENT: laser surgery to close leak
MACULAR DEGENERATION
• DEFINED: deterioration of the macula
• TWO TYPES: wet and dry
DRY TYPE
• DRY TYPE CAUSED BY: degeneration from age,
retinal cells become ischemic, leads to
blurring and distortion, with central vision
declining seen with smokers
PREVENTION: use of antioxidants, carotenoids
lutein and zeaxanthin
WET TYPE
• Sudden decrease in vision
• Seen after serous detachment of pigment
peithelium in the macula
• Newly formed blood vessels invade the area,
fluid and blood collect under the macula like a
blister
ENUCLEATION
• Surgical removal of the entire eyeball
• A ball implant is inserted as a base for the
socket prosthesis
• This is covered with tissue, muscles
• See p 1107 for insertion and removal of ocular
prosthesis
KEY CONCEPTS FOR CLIENTS WITH
EYE AND VISION PROBLEMS
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Safe effective Care Environment
Health Promotion and Maintenance
Psychosocial Integrity
Physiologic Integrity
MENIERE’S DISEASE
ASSESSMENTS SEEN
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Incapacitating vertigo
fluctuating hearing loss
Tinnitus, nystagumus
Nausea and vomiting
not central nervous system or brain disease
cause is unknown
episodic
NONSURGICAL TREATMENT
DIET: low Na diet
DRUGS: ANTIHISTAMINES- helps with vertigo
• Diphenhydramine hydrochloride (Benadryl)
• Dimenhydrinate (Dramamine)
Medication support
What class of drugs to decrease the fluid?
Why use nicotinic acid?
What SEDATIVE is used and why?
What class of drugs are these and what are they
used for?
chlorpromazine hydrochloride (Thorazine),
trimethobenzamide hydrochloride (Tigan)
SURGICAL TREATMENT
• Endolymphatic sac decompression - shunt
used to drain the extra fluid
• Middle and inner ear perfusion of antibiotics done during overnight stay in hospital; use
gentamycin, streptomycin
• Vestibular Nerve resection - pt has already lost
hearing, nerve is cut, stops vertigo, brief
hospital stay