Transcript Interferences to Safety Needs Due to Sensory Deprivation and Aging

Cataracts
 Definition: opacity of the lens
 Pathophysiology:
 Lens looses water
 Density increases
 Lens becomes opaque
 Etiology/Genetic Risk (see table 50-2)
 Congenital
 Age-related  most common, > age of 70
 Traumatic
 Toxic agents
 Other diseases
 Prevention
 Sunglasses
 Eye protection
 Clinical Manifestations (see chart 50-6)
 No pain or eye redness w/ age related cataracts
 Blurred vision
 Double vision
 Impaired color perception
 Absent red reflex
 Cloudy, whitish pupil
 Interventions
 Phacoemulsion
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Extracapsular extraction of lens
Intracapsular extraction
 Disadvantage: greater risk for retinal detachment, loss of
structural support for implanted lens
Corrective vision after implant may be 20/20 for distance, may
require reading glasses, may require no glasses at all.
 Preop care
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Outpatient procedure great need for preop teaching
Drop instillation technique
Medications given: (see chart 50-2 on drug therapy)
 Sedative, Acetazolamide, Mitotics, Sympathomimetics, eye
paralytics, anesthesia agents
 Post op care
 Meds

Antibiotics, steroids, mild analgesics (AVOID ASA)
 Dark glasses
 S/S of trouble:
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Pain early after surgery, esp. if assoc. w/ N/V
Infection: increasing redness, change in visual acuity, tears,
photophobia, yellow/green drainage
Bleeding w/ assoc. vision changes  report immediately
 Home care instructions
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Light housework, cooking
See table 50-3 avoid these activities
See Best Practice for Eyedrop Administration chart 50-5
Glaucoma
Pathophysiology
 Normal IOP = 10-21 mm Hg
 Decreased outflow of aqueous fluid
 Overproduction of aqueous humor
 Resulting in increased IOP
 Increased pressure within eye reduces blood flow to
optic nerve and retina ischemia and death, blindness.
 Starts at periphery and works toward center of vision 
classic sign of tunnel vision.
 Painless, loss of vision so insidious as to not be noticable
until it’s too late.
 Age-related
 Occurs in about 10% of people older than 80
Etiology
 Primary open-angle
Most common
 Usually bilateral, asymptomatic in early stages
 Outflow reduction, pressure 22-32mm Hg

 Angle-closure
Narrow angle, acute glaucoma
 Sudden onset  medical emergency
 Outflow blockage, pressure 30mmHg or higher

 Secondary
Results from ocular diseases which cause narrowing of
chamber angle or increased fluid volume within eye
 Sudden

Interventions
 Primarily drug therapy
See chart 50-2 Drug Therapy for Eye Problems
 See Evidence Based Practice: adherence to ocular drug tx

 Surgical Management – when drugs don’t work
Laser surgery
 trabeculoplasty
 Standard surgical therapy
 To create new drainage channel
 Destroy structures that are overproducing aqueous humor

 See Chart 50-10 Nursing Focus on the Older Adult
Diabetic Retinopathy
Pathophysiology
 Complication of diabetes mellitus  poor BS control
 Background retinopathy
Cells of retinal vessels die with leakage of fluid into eye
creating thick yellow-white hard exudates
 Microaneurysms form leading to hemorrhages in nerve layer
of retina
 Visual acuity is reduced

 Proliferative retinopathy
 Network of fragile new blood vessels develop, leak blood and
protein into surrounding tissue
 Leads to reduced visual acuity/blindness
Treatment dependent on severity of retinal damage
Use of laser therapy to seal microaneurysms, decrease
bleeding
Vitrectomy performed if frequent bleeding into
vitreous occurs and retinal detachment becomes high
risk.
Macular Degeneration
 Pathophysiology
 Atrophic = age related, dry
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Gradual blockage of retinal capillaries leading to ischemia and death
of retinal cells  blindness
Long term dietary intake of antioxidants and lutein and zeaxanthin
may decrease risk of disease or slow progression of disease process
 Exudative = wet
 Sudden decrease in vision after serous detachment of pigment
epithelium in macula
 Blood collection under macula causes scar formation, visual
distortion
 Treatment goal
 Maximize remaining vision
 Review Trauma section in text pg 1105-1106
 Hyphema
 Contusion
 Foreign bodies
 Lacerations
 See Best Practice for eye irrigation
 Be sure to read Key Points at chapters end
Meniere’s Disease
Pathophysiology
 Tinnitis
 Unilateral sensorineural hearing loss
 Vertigo
 Attacks sudden, can last days
 Caused by overproduction of or decreased reabsorption
of endolymphatic fluid  distortion of inner canal
system of the ear
 Eventual hearing loss – permanent
 Cause unknown but is associated w/ infections, allergic
reactions, fluid imbalances, long term stress
 Age 20-50 years
 White males
 Prelude to attacks: HA, increasing tinnitus, feeling of
fullness in affected ear
 Periods of remission early in disease process
 Hearing loss develops with increase in attacks
 Patient c/o n/v, rapid eye movements = nystagmus,
severe HA.
 Interventions:
 Drug therapy – primarily for control of symptoms

Diuretics, nicotinic acid, antihistamines, antiemetics,
diazepam
 Surgical management
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Last resort  deafness in affected ear
Labyrinthectomy
Endolymphatic decompression
 Inner ear drained and shunt placed
 Retention of hearing
 Short term vertigo
 Be sure to review Key Points at chapters end
 You are also responsible for any general nursing care
that would apply to the disease you have learned
about, ie, hearing loss, etc.