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Category: Nursing
Type: Lecture Notes
Tags: vision, patient, decrease, retinal, therapy, disorders, pressure, prevent, disease, teaching, damage, eyedrops, surgery, dilating, vessels
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Description
Sensory preception - eye disorders
Transcript
SENSORY PERCEPTION
Ability to receive sensory input, and through various physiologic processes in the body, translate the stimulus or data into meaningful information.
Exemplars:
Glaucoma
Patho:
loss of peripheral vision
increase IOP (intra-ocular pressure) - pressure compresses retinal blood vessels/photoreceptors resulting in poorly oxygenated photoreceptors/nerve fibers - ischemic & die
Risk:
Primary: age/heredity/central retinal vein occlusion
Associated: DM/HTN, severe myopia, retinal detachment
Secondary: Uveitis, iritis, neovascular disorders, trauma, ocular tumors, degenerative disease, eye surgery
S/S:
slow vision loss blurred vision
distorted vision eye pain
headache halo’s around lights
nausea/vomiting eye redness
Diagnosis:
Electroretinopathy gonioscopy
Tonometry laser imaging of retina & optic nerve
Education:
TX: drug therapy (eye drops) – reduce I&O to prevent further damage.
Does not “fix” impaired vision.
Prostglandins - decrease IOP by dilating blood vessels – drains aq. Humor Fluid faster
Adrenergic agonist /beta-adrenergic blockers – decrease IOP by limiting production of aq. Humor & dilating pupils.
Cholinergic agonist – decrease IOP, decrease aq humor, makes more room
Carbonic – directly / strongly decrease aq humor
Surgery:
Trabeculoplasty – fixes old channel
Trabeculoectomy – makes new channel *if fails – shunt may be placed
Education:
use schedule - Punctual wait 5-10 minutes if more than 1 medication
hand washing
Keep clean eye dropper DO NOT TOUCH TIP TO EYE
Meds:
timolol – beta blocker… when teaching patient, they need to put finger in corner of eye to keep drops from getting into corner as it will cause HR to go low – because they absorb systemically
Latanoprost (Xalatan)
NCLEX QUESTION:
The nurse is developing a teaching plan for the client with glaucoma.
Which of the following instructions would the nurse include in the plan of care?
Decrease fluid intake to control the IOP
Avoid overuse of eyes
Decrease the amount of salt in the diet
Eye medications will need to be administered lifelong
Cataracts
Patho/risk:
lens opacity that distorts the image age related
trauma exposure to toxins
other disease & disorders: diabetes, hypoparathyroidism, etc
s/s:
blurred vision decreased color perception
double vision difficulty w/ ADL’S
lens is cloudy pupil is blueish white
Diagnosis:
eye chart brightness acuity testing
use ophthalmoscope: describe & observe density by size, shape and location
TX/Education
Corrected by surgery
Phacoemulsification: sound waves breaking the ions -> removed by suction
Pre-Op: eyedrops that dilate pupils vasoconstrict & paralyze pupil
Post-Op: antibiotic & steroid ointments, wear dark glasses, avoid bright lights, antibiotic eyedrops 2-4 weeks.
Normal abnormal
Discomfort pain
Blood shot purulent drainage
Slightly swollen eyelids
After surgery – patient should have some improvement in vision, if vision gets worth, something is wrong and need to notify DR.
Family to assist in planning. Be careful for ocular pressure, eye drop schedule adherence, daily eye exams, keep patient safe
NCLEX QUESTION
A male patient just had a cataract operation without a lens implant. In discharge teaching, the nurse will instruct the clients wife to:
feed him soft foods for several days to prevent facial movement
keep the eye dressing on for one week
have her husband remain in bed for 3 days
allow him to walk upstairs only with assistance
Peripheral neuropathy
Patho/risk
A condition that develops as a result of damage to the peripheral nervous system.
Can be inherited or acquired through disease process or trauma
No known cause – idiopathic
Acquired d/t: physical injury (trauma)
Repetitive stress “entrapment neuropathies (compression injury)
Diseases or disorders – metabolic and endocrine disorders “diabetic mellitus”
Autoimmune diseases (sjogren’s syndrome, lupus, rheumatoid arthritis)
Kidney disorders Cancers
Neuromas Infections
Exposure to toxins
Signs and symptoms
Burning numbness in extremities nocturnal leg pain
Decrease sensation of touch sensitive to pain
Poor balance chronic pain
Acute pain
Types: Guillain Barre
Carpel tunnel syndrome
Diagnostics
test of muscle strength
evaluate ability to sense touch, temp, vibration, body position
nerve conduction velocity (NCV)
electromyography (EMG) – fine needle inserted into muscle
MRI Skin and nerve biopsy
Examination of cerebrospinal fluid Blood test (vitamin deficiencies, liver/renal damage)
TX/Education
Check shoes prior to wearing Monitor blood sugar
Wear soft loose cotton socks and padded shoes
Quit smoking, exercise, good nutrition, avoid excessive alcohol
Check temp of water prior to bathing Assess feet daily
Gabapentin (Neurontin)
Physical therapy / surgery
Plasma exchange and IV immune globulin
TENS transcutaneous electrical nerve stimulation
NCLEX QUESTION:
A patient with DMII has been admitted to the ed/surg unit with redness and swelling of his LLE. The healthcare provider has ordered imaging studies of the lower extremities. What other nursing orders can be expected? (select all that apply)
blood glucose checks ACHS
BP checks every hour
Pt permitted to ambulate barefoot
Monitor temperature/pulse of lower limbs
Monitor pain in big toe of left foot
Eye injuries: trauma & corneal ulcers
Patho/Risk:
scrape/scratch burns
contact lens use foreign body contact
malnutrition (dry eye) emergency – no blood supply
bacterial or fungal infection cancer therapy
S/S:
decreased vision secretions
cloudy vision hazy cornea
photophobia
Diagnostic Tests
Microbial culture/ corneal scraping Fluorescein staining
No MRI if you think metal is in eye visual field tests
Treatment & education
Gloves to be worn eye drops q 1 hr for 1st 24 hours
Anti-infective therapy started immediately to decrease vision loss
Wash hands do not treat unaffected eye
No contact lens Steroids decrease inflammation
No make-up Ocular irrigation
Eye patch may be used after removal Ice packs to reduce swelling
Discard all contact lens solution & make up
Medications
Gentamycin (antibiotic) Prednisolone acetate (steroid)
Amphotericin B (antifungal)
Eye drops every hour w/in 1st 24 hours to prevent infection – so patient doesn’t lose vision. Patient will even need to wake up to instill eye drops.
NCLEX QUESTION:
The client sustains a contusion of the eye ball following a traumatic injury with a blunt object.
What intervention should be initiated immediately?
Apply ice to the affected eye
Irrigate with cool water
Notify HCP
Accompany patient to E.D.
Macular degeneration
age related – happens because you get old
PATHO/RISK:
gradual blockage of retinal capillaries -> retinal cells
To become ischemic/necrotic
RISK FACTORS:
HTN, diabetes, hereditary, poor diet, smoking, low vit e & carotene
S/S:
loss of center vision, initial symptoms, mild blurring/distortion
Diagnosis:
fluroscien angiography- looking for leaking vessels or new vessels
Asmler grid – looks like checkerboard – if lines are wavy, they could have macular degeneration
TX/Education:
dietary therapy slows progression, there is no cure. Vit E, B12, lutein
Safety is a big issue – the patient will get to the point they can’t drive, increase risk for fall precautions
RETINAL DETACHMENT
Like a curtain coming over your eye. If it happens 1 time you have a greater chance it will happen again because it is weakened. You want to get reattached as soon as possible, because you can lose your vision.
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