Transcript Indezine Template

Chapter 49
Care of Patients with Eye and
Vision Problems
Mrs. Marion Kreisel MSN, RN
Nu230 Adult Health 2
Fall 2011
Blepharitis
• Inflammation of the eyelid edges
• Itchy, red, and burning eyes
• Seborrhea (dermatitis presents with scaly, flaky, itchy, red
skin.) of the eyebrows and eyelids with greasy scales and
mattering
• Control with eyelid care using warm, moist compresses
followed by gentle scrubbing with diluted baby shampoo
• Avoid rubbing the eyes
Entropion
• Turning inward of the eyelid causing the lashes to
rub against the cornea of the eye
• Caused by eyelid muscle spasms or trauma
• Eyelid turned inward; red conjunctiva
• Surgical correction of eyelid position
• Instruction in procedure to instill eyedrops
Ophthalmic Ointment
Ectropion
• Turning outward and sagging of the eyelid
• Caused by relaxation of the orbicular muscle
• Reduced washing action of tears, leading to
corneal drying and ulceration
• Surgery to restore proper lid alignment
Hordeolum
• Stye can be external or internal.
• Treatment is with warm compresses four times a
day and antibacterial ointment, which may blur
vision.
• To remove ointment, close the eye and gently
wipe the closed eyelid from the nasal side of the
eye outward.
Hordeolum (Cont’d)
Chalazion
• Inflammation of sebaceous gland in eyelid.
• Most protrude on the inside of eyelid.
• Eye fatigue, light sensitivity, and excessive tears
result.
• Treatment consists of warm compresses for 15
minutes 4 times per day, followed by instillation of
ophthalmic ointment.
• Surgery is an option.
Chalazion (Cont’d)
Keratoconjunctivitis Sicca
• Also called dry eye syndrome, results from
changes in tear composition, lacrimal gland
malfunction, or altered tear distribution
• Artificial tears, lubricating ointment
• Surgery
Conjunctival Hemorrhage
• Small, well-defined area of hemorrhage that is
bright red under the conjunctiva
• No pain
• No visual impairment
• Resolves in 14 days without treatment
Conjunctivitis
Trachoma
• Chronic, bilateral scarring form of conjunctivitis
caused by Chlamydia trachomatis
• Chief cause of preventable blindness in the world
• Infection control
Corneal Disorders
• Keratoconus is the degeneration of the cornea,
deposits in the cornea, dystrophies, keratitis, or
ulceration of the corneal surface.
• Reduce symptoms, restore corneal clarity,
enhance patient’s ability to use remaining vision.
• Antibiotics, antifungals, antivirals, steroids.
Keratoconum
Keratoplasty
• Surgical removal of diseased corneal tissue and
replacement with tissue from a human donor cornea
(transplant)
• Regional anesthesia
• Postoperative care—subconjunctival antibiotic
injection, antibiotic ointment, pressure patch and
protective shield to cover eye. Watch for S&S of
rejection such as vision problems
Corneal Transplantation
Eye Donation
• Corneal tissue from donors free of infectious
disease or cancer at the time of their deaths.
• Care of potential eye donors at death:
• Raise head of bed 30 degrees.
• Apply antibiotic eyedrops.
• Close the eyelids, and apply small ice pack.
• Discuss donation with family and physician.
Cataract
• Clouding and blurring of the lens distort the image
and color projected onto the retina.
• As cataract matures, opacity makes it difficult to
see the retina.
• Visual acuity is restricted.
• No pain or eye redness is associated with agerelated cataracts.
Cataract (Cont’d)
Cataract Surgery
Cataract Surgery: Collaborative Management
• Preoperative
• Intraoperative
• Postoperative
Cataract: Postoperative Care
• Antibiotics are given subconjunctivally.
• Eye is unpatched. Discharge usually occurs within
1 hr with dark glasses.
• Instill antibiotic-steroid eyedrops.
• Mild itching is normal.
• Pain indicates a complication.
• Reduce IOP.
• Prevent infection.
• Assess for bleeding.
Cataract: Community-Based Care
• Home care management
• Health teaching
• Health care resources
Health Teaching
• Report to surgeon—sharp, sudden pain in the
eye, bleeding or increased discharge, lid swelling,
decreased vision, or flashes of light or floating
shapes.
• Avoid activities that might increase IOP.
• Review procedure for use of eyedrops.
Glaucoma
• Group of ocular diseases resulting in increased IOP
Normal IOP is 10-21 mm Hg
• Primary open-angle glaucoma: The most common
form of glaucoma, usually affects both eyes,
asymptomatic in early stages outflow of aqueous
humor through the chamber angle is reduced. Going in
more than out-> IOP
• Angle-closure glaucoma: Less common, sudden
onset and emergency. Displacement of the iris and go
blind.
Clinical Manifestations
• Cupping and atrophy of the optic disc; disc wider
and deeper and turns white or gray
• Visual field measurement
• Headache or brow pain, nausea and vomiting,
colored halos around lights, and sudden blurred
vision with decreased light perception
Diagnostic Tests
• Cut down on the prevalance by assessment of the
optic nerve, tonometry, annual eye exams/
• Perimetry: Test to screen visual fields, perpherial
vision
• Gonioscopy: Determines if open angle or closed
angle glaucoma is present by IOP levels
• Optic nerve imaging: used for ocular HTN who
are at risk for eye problems
Measurement of Ocular Tension
Glaucoma Drug Therapy
• Constrict the pupil
• Reduce production or increase absorption of
aqueous humor
• Prostaglandin agonists
• Adrenergic agonists
• Beta-adrenergic blockers
• Cholinergic agonists: Pilocarpine gtts: PAGE
1099
• Carbonic anhydrase inhibitors
Glaucoma Surgical Treatment
Other Disorders
• Vitreous hemorrhage
• Uveitis: Uveal tract has 3 related parts: iris, the
ciliary body, & the choroid are inflamed.
Retinal Disorders
• Macular degeneration: degeneration of the
macula (the area of central vision)
• Retinal hole
• Retinal tear
• Retinal detachment
Macular Degeneration
• The macula—the area of central vision—
deteriorates.
• Degeneration can be atrophic age-related (dry) or
exudative (wet).
• Rod and cone photoreceptors die.
• Central vision declines; patient describes “mild
blurring” and “distortion.”
Retinal
Detachment
Hypersensitive Retinopathy
• As blood pressure increases, retinal arterioles
narrow and take on a classic “copper wire”
appearance.
• Nicking or narrowing of the vessels occurs.
• If blood pressure remains elevated, areas of
ischemia or “cotton wool” spots, small
hemorrhages, headaches, and vertigo occur.
Diabetic Retinopathy
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Retinal blood vessel complication
Retinopathy worsened with poor glucose control
Background diabetic retinopathy
Microaneurysms
Proliferative diabetic retinopathy
Laser therapy
Vitrectomy performed if frequent bleeding into the
vitreous occurs
Refractory Errors
• Myopia—nearsightedness
• Hyperopia—farsightedness
• Presbyopia—age-related problem in which lens
loses its elasticity
• Astigmatism—curve of the cornea is uneven
Surgery for Treatment of
Refractive Errors
• Laser in-situ keratomileusis (LASIK)
• Intact corneal ring
Eye Trauma
• Hyphema: Hemorrhage in the anterior chamber
Force to eye and blood vessels break
• Contusion
• Foreign bodies
• Lacerations
• Penetrating injuries
Ocular Melanoma
• Most common malignant eye tumor in adults
• Manifestations not readily apparent
• Enucleation—surgical removal of the entire
eyeball
• Radiation therapy
Reduced Vision
• Interventions include:
• Communication regarding use of adaptive
items
• Safety in familiar settings
• Ambulation assisted with care
• Self-care and independence promoted
• Support for the difficulty of adapting to loss of
sight
Chapter 48
NCLEX
TIME
Question 1
Which circumstance places the patient at the
greatest risk for developing vision
disturbances?
A.
B.
C.
D.
History of working with computer
Advanced age
History of diabetes mellitus
Previous employment as a road
construction worker
Question 2
What characteristic would the nurse expect
to see with age-related changes in an
older patient’s eyes?
A.
B.
C.
D.
Yellowing of the sclera
Retinal atrophy
Color blindness
Early-onset glaucoma
Question 3
Which is a priority nursing intervention when
providing care to an older patient who has
problems with vision?
A. Review the medication administration
record for artificial tears
B. Review medications before administration
C. Ensure adequate, nonglare lighting in the
patient’s room
D. Provide written and verbal instruction for
nursing education interventions
Question 4
In performing a psychosocial assessment of a patient
who has recently experienced vision changes, the
nurse should:
A. Provide the patient with a list of services for the
visually impaired.
B. Meet with family members or significant others to
determine if the patient can still perform his ADLs.
C. Ask the patient how he feels about the changes in
his vision and the effectiveness of his coping
methods.
D. Ask the patient if he has made appropriate
adjustments in his lifestyle to accommodate his
vision changes.
Question 5
What is an appropriate expected outcome for
the patient who has undergone an
examination of the eye using fluorescein
angiography?
A. Administering mydriatic eye drops for 1
week
B. Drinking fluids to eliminate the dye
C. Appearance of bright red–colored urine
until the dye is excreted
D. Staining of the skin for up to 1 week after
the test