ch 22: assessment and management: visual problems

extra ocular muscle function

-corneal light reflex -eye movement: 6 cardinal positions (CN III, CN IV, CN VI)

contacts lenses

-know pattern of wear; daily vs extended -monitor for complications - keratitis

surgery therapy - laser (3)

-laser-assisted in situ keratomileusis: uses laser to create a flap in the cornea; used in low to moderate myopia, hyperopia -photorefractive keratectomy: ablate corneal stroma to correct refractive errors -laser-assisted sub epithelial keratomileusis: detachment of the epithelial flap

surgery therapy - implant (2)

-refractive intraocular lens: elective surgery that removes your eye's natural lens and replaces it with an intraocular to improve vision -phakic intraocular lens: lens made of plastic that are implemented into eye to reduce a person's need for glasses

pupil function and intraocular pressure

-PERRLA: Anisocoria-unequal pupils -intraocular pressure: tonometry: Normal 10-21 mmHg

Five nursing measures that should be implemented to increase a visually impaired patient's safety and comfort.

1) Address the patient, not others with the patient, in normal conversational tones 2) Face the patient and make eye contact 3) Introduce self when approaching and let the patient know when you leave. 4) Orient to sounds, activities, and physical surroundings, 5) Use sight-guide technique to ambulate and orient patient

identify assessment techniques used to obtain following assessment data 1. peripheral vision field 2. extra ocular muscle functions 3. near visual acuity 4. visual acuity 5. intraocular pressure

1. confrontation test 2. corneal light reflex and cardinal field of gaze 3. ganger chart 4. snellen chart 5. tone-pen or other tonometry equipment

identify the cranial nerves that are responsible for the following eye functions 1. elevating eyelids 2. closing eyelids 3. visual acuity

1. open CN III (oculomotor) 2. close CN VII (facial) 3. CN II (optic)

identify the causes of the following assessment findings of the eye that are associated with aging 1. floaters 2. ectropion 3. pinguecula 4. arcus senilis 5. yellowish sclera 6. dry, irritated eyes 7. decreased pupil size 8. changes in color perception

1. vitreous liquefaction and retinal holes or tears 2. loss of visual fat 3. chronic exposure to ultraviolet (UV) light or other environmental irritants 4. cholesterol deposits in the peripheral cornea 5. deposition of lipids 6. decreased tear secretion or composition 7. increased rigidity of iris 8. decrease in number of cones

A patient tells the nurse on admission to the health care facility that he recently has been classified as legally blind.What does the nurse understand about the patient's vision? a. Has lost usable vision but has some light perception b. Will need time for grieving and adjusting to living with total blindness c. Will be dependent on others to ensure a safe environment for functioning d. May be able to perform many tasks and activities with vision enhancement techniques

d

A patient with early cataracts tells the nurse that he is afraid cataract surgery may cause permanent visual damage.What should the nurse teach the patient? a. The cataracts will only worsen with time and should be removed as early as possible to prevent blindness. b. Cataract surgery is very safe and with the implantation of an intraocular lens, the need for glasses will beeliminated. c. Progression of the cataracts can be prevented by avoidance of ultraviolet (UV) light and good dietarymanagement. d. Vision enhancement techniques may improve vision until surgery becomes an acceptable option to maintain desired activities.

d

Increased intraocular pressure may occur as a result of a. edema of the corneal stroma. b. dilation of the retinal arterioles. c. blockage of the lacrimal canals and ducts. d. increased production of aqueous humor by the ciliary process.

d

The most important intervention for the patient with epidemic keratoconjunctivitis is a. cleansing the affected area with baby shampoo. b. monitoring spread of infection to the opposing eye. c. regular instillation of artificial tears to the affected eye. d. teaching the patient and caregivers good hygiene techniques

d

The nurse documents PERRLA following assessment of a patient's eyes. What is one finding that supports this statement? a. A slightly oval shape of the pupils b. The presence of nystagmus on far lateral gaze c. Dilation of the pupil when a light is shined in the opposite eye d. Constriction of the pupils when an object is brought closer to the

d

The patient is diagnosed with presbyopia. When he asks the nurse what that is, what is the best explanation the nurse can give to the patient? a. Abnormally long eyeballs b. Absence of crystalline lens c. Correctable with cylinder lens d. Loss of accommodation associated with age

d

What is in the posterior cavity of the eye? a. Zonules b. Cornea c. Aqueous humor d. Vitreous humor

d

What should the nurse teach all patients with conjunctival infections to use? a. Artificial tears to moisten and soothe the eyes b. Dark glasses to prevent the discomfort of photophobia c. Warm moist compresses to the eyes to promote drainage and healing d. Frequent and thorough hand washing to avoid spreading the infection

d

When examining the patient's eyes, which finding would be of most concern to the nurse? a. Intraocular pressure of 16 mm/Hg b. Slightly yellowish cast of the sclera c. Outward turning of the lower lid margin d. Small, white nodule on the upper lid margin

d

myopia

nearsightedness

pupil

opening in iris; controls amount of light that enters

orbit openings (3 fissures)

optic canal, superior orbital tissue, inferior orbital fissure channels for arteries, veins, and nerves

keratitis

inflammation of the cornea -can be a result of contact complications

corrective glasses

- myopia, hyperopia, presbyopia (readers), astigmatism - combined presbyopia and other refractive errors - bifocals or trifocals

upper eyelid

levator palpebral superiors and muscle and CN III: elevate and retract orbicularis muscle and CN VII: close eyelids

what does having 20/20 vision mean?

-first number means the distance that the patient is standing away from reading chart -second number is what the normal person should be able to read

focused assessment objective data -inspect -assess

-inspect: eye discoloration or drainage; color and vascularity of conjunctiva and sclera; lens for clarity; ptosis of eyelid -assess: vision (snellen chart or look at nurse), EOM, peripheral vision, PERRL

visual pathway

light passes through cornea, aqueous humor, lens and vitreous human to retina -> optic nerve -> optic chasm -> occipital cortex

eye trauma -causes -chemical burns -prevention

Causes -most common are due to falls and fights -home: cook, clean, garden, power tools, home repairs -sports -work related Chemical burns -Morgan lens can be used for continuous irrigation of injured eye Prevent: protective eyewear

What is the function of the sclera? a. Secrete aqueous humor b. Focus light rays on the retina c. Protective white outer layer of the eyeball d. Photoreceptor cells stimulated in dim environment

c

When examining the patient's eye with an ophthalmoscope, which finding would be of most concern to the nurse? a. Depression at the center of the optic disc b. Blurring of the nasal margin of the optic disc c. A break in the retina at the site of the macula d. Pieces of liquefied vitreous in the vitreous chamber

c

When the patient has a diagnosis of hyperthyroidism, which abnormal assessment of the eye could be found? a. Light intolerance b. Unequal pupil size c. Protrusion of eyeball d. Deviation of eye position

c

Which characteristics of glaucoma are associated with only primary open-angle glaucoma (POAG) (select allthat apply)? a. Gradual loss of peripheral vision b. Treated with iridotomy or iridectomy c. Causes loss of central vision with corneal edema d. May be caused by increased production of aqueous humor e. Treated with cholinergic agents such as pilocarpine (Pilocar) f. Resistance to aqueous outflow through trabecular meshwork

a, d, f

Which tissue nourishes the ciliary body, iris, and part of the retina? a. Pupil b. Cones c. Choroid d. Canal of Schlemm

c

Ishihara color test

This measure of color perception tests for red or green color deficiencies

What nursing action is most important for the patient with age-related macular degeneration(AMD)? a. Teach the patient how to use topical eyedrops for treatment of AMD. b. Emphasize the use of vision enhancement techniques to improve what vision is present. c. Encourage the patient to undergo laser treatment to slow the deposit of extracellular debris. d. Explain that nothing can be done to save the patient's vision because there is no treatment for AMD.

b

photoreceptors (rods and cones)

convert light to neural signals; nervous systems translate to vision -rods: peripheral vision and night vision -cones: central vision and color vision -> 3 types: red, green, blue -O2 and nutrients come from choroid and retinal artery and vein

A patient with bilateral cataracts is scheduled for an extracapsular cataract extraction with an intraocular lensimplantation of one eye. What should be done by the nurse preoperatively? a. Assess the visual acuity in the unoperated eye to plan the need for postoperative assistance. b. Inform the patient that the operative eye will need to be patched for 3 to 4 days postoperatively. c. Assure the patient that vision in the operative eye will be improved to near normal on the first postoperative day. d. Teach the patient routine coughing and deep-breathing techniques to use postoperatively to prevent respiratorycomplications.

a

Always assess the patient with an ophthalmic problem for a. visual acuity. b. pupillary reactions. c. intraocular pressure. d. confrontation visual fields.

a

Following a pneumatic retinopexy, what does the nurse need to know about the postoperative care for the patient? a. Specific positioning and activity restrictions are likely to be required for several days. b. The patient is frequently hospitalized for 7 to 10 days on bed rest until healing is complete. c. Patients experience little or no pain, and development of pain indicates hemorrhage or infection. d. Reattachment of the retina commonly fails, and patients can be expected to grieve for loss of vision.

a

To determine if an unconscious patient has contact lenses in place, what should be done by the nurse? a. Use a penlight to shine a light obliquely over the eyeball. b. Apply drops of fluorescein dye to the eye to stain the lenses yellow. c. Touch the cornea lightly with a dry cotton ball to see if the patient reacts. d. Tense the lateral canthus to cause a lens to be ejected if it is present in the eye.

a

What describes inflammation of the cornea? a. Keratitis b. Blepharitis c. Hordeolum d. Conjunctivitis

a

When obtaining a health history from a patient with cataracts, what is most important for the nurse to ask about the use of? a. Corticosteroids b. Oral hypoglycemic agents c. Antihistamines and decongestants d. β-Adrenergic blocking agents

a

Which intervention would be part of the plan of care for a patient who has new vision loss? a. Allow the patient to express feelings of grief and anger. b. Have the UAP perform all self-care activities for the patient. c. Address any family present first when discussing care concerns. d. Speak loudly and clearly, addressing the patient with each contact.

a

Which patient behaviors would the nurse promote for healthy eyes (select all that apply)? a. Protective sunglasses when bicycling b. Taking part in a smoking cessation program c. Supplementing diet intake of vitamin C and beta-carotene d. Washing hands thoroughly before putting in or taking out contact lenses e. A woman avoiding pregnancy for 4 weeks after receiving MMR immunization

a, b, c, d

Endophthalmitis can be a complication of intraocular surgery or penetrating ocular injury. What manifestations are expected when the nurse assesses a patient with this disorder (select all that apply)? a. Ocular pain b. Photophobia c. Eyelid edema d. Reddened sclera e. Bleeding conjunctiva f. Decreased visual acuity

a, b, f

What are possible abnormal assessment findings when assessing the eyelid (select all that apply)? a. Ptosis b. Strabismus c. Blepharitis d. Anisocoria e. Swelling of the pinna

a, c

Which characteristics of glaucoma are associated with only primary angle-closure glaucoma (PACG) (select allthat apply)? a. Caused by lens blocking papillary opening b. Treated with trabeculoplasty or trabeculectomy c. Causes loss of central vision with corneal edema d. Treated with β-adrenergic blockers such as betaxolol (Betoptic) e. Causes sudden, severe eye pain associated with nausea and vomiting f. Treated with hyperosmotic oral and IV fluids to lower intraocular pressure

a, c, e, f

Before injecting fluorescein for angiography, it is important for the nurse to (select all that apply) a. obtain an emesis basin. b. ask if the patient is fatigued. c. administer a topical anesthetic. d. inform patient that skin may turn yellow. e. assess for allergies to iodine-based contrast media

a, d

For the patient with a retinal break, what extraocular techniques may be used with sclera buckling to seal the breakby creating an inflammatory reaction that causes a chorioretinal adhesion or scar (select all that apply)? a. Cryopexy b. Vitrectomy c. Pneumatic retinopexy d. Laser photocoagulation e. Penetrating keratoplasty

a, d

Myopia is present in 25% of Americans. Which characteristics are associated with myopia (select all that apply)? a. Excessive light refraction b. Abnormally short eyeball c. Unequal corneal curvature d. Corrected with concave lens e. Image focused in front of retina

a, d, e

What should be included in the discharge teaching for the patient who had cataract surgery (select all that apply)? a. Eye discomfort is often relieved with mild analgesics. b. A decline in visual acuity is common for the first week. c. Stay on bed rest and limit activity for the first few days. d. Notify the provider if an increase in redness or drainage occurs. e. Following activity restrictions is essential to reduce intraocular pressure

a, d, e

What surgical choices are available for correction of a refractive error (select all that apply)? a. LASIK b. Contact lenses c. Corrective lenses d. Photorefractive keratectomy (PRK) e. Surgical implantation of intraocular lens

a, d, e

aphakia

absence of the lens of the eye -congenital or removed during surgery

dexterity

administration of eye drops or other medications

Cornea -what does he do?

allows entry of light -6 layers -curve allows light to bend (refract) to focus on retina

focused assessment subjective data

ask about change in vision; eye redness, itching, or discomfort, drainage from eye

In a patient who has a hemorrhage in the posterior cavity of the eye, the nurse knows that blood is accumulating a. in the aqueous humor. b. between the lens and the retina. c. between the cornea and the lens. d. in the space between the iris and the lens.

b

In which individuals should the nurse expect to find a yellow cast to the sclera? a. Infants b. Dark-skinned persons c. Persons with brown irises d. Patients with eye infections

b

Presbyopia occurs in older people because a. the eyeball elongates. b. the lens becomes inflexible. c. the corneal curvature becomes irregular. d. light rays are focusing in front of the retina

b

To determine the presence of corneal abrasions or defects in a patient with an eye injury, what would the nurse provide? a. A tonometer b. Fluorescein dye c. Pocket penlight d. An ophthalmoscope

b

To prepare a patient for a fluorescein angiography, what should the nurse explain about the test? a. Measures curvature of the cornea b. Involves IV dye injection to evaluate blood flow through epithelial and retinal blood vessels c. Application of eyedrops containing a dye that will localize arterial abnormalities in the retina d. Anesthetizes the eye so that probes can be inserted into the anterior chamber to measure intraocular pressure

b

What best describes pinkeye? a. Blindness b. Acute bacterial conjunctivitis c. Epidemic keratoconjunctivitis d. Chronic inflammation of sebaceous glands

b

presbyopia

impaired vision as a result of aging -loss of accommodation -seen around early-mid 40s

what causes glaucoma?

increased intraocular pressure

retina

back of eye from optic nerve to ciliary body -composed of neurons; can't regenerate -converts images to a form that brain understands and processes as vision -two main parts: peripheral and central retina

legal blindness

best-corrected vision in better eye of 20/200 or less OR 20 degrees or less of remaining visual field

what vitamins are good for your eyes

beta carotene, carotenoids, omega-3 fatty acids

lens

biconvex; behind iris; connects ciliary body by ligament -function: change shape to alter focal distance -accommodation: allows person to focus

blepharitis

bilateral lid inflammation -antibiotic eye ointment, cleansing, monitor for keratitis or other infetions

refractive errors

blurred vision

A 60-year-old patient is being prepared for outpatient cataract surgery. When obtaining admission data from thepatient, what would the nurse expect to find in the patient's history? a. A painless, sudden, severe loss of vision b. Blurred vision, colored halos around lights, and eye pain c. A gradual loss of vision with abnormal color perception and glare d. Light flashes, floaters, and a "cobweb" in the field of vision with loss of central or peripheral vision

c

A patient is admitted to the emergency department with a wood splinter imbedded in the right eye. Whichintervention by the nurse is most appropriate? a. Irrigate the eye with a large amount of sterile saline. b. Carefully remove the splinter with a pair of sterile forceps. In a patient who has a hemorrhage in the posterior cavity of the eye, the nurse knows that blood is accumulating c. Cover the eye with a dry sterile patch and a protective shield. d. Apply light pressure on the closed eye to prevent bleeding or loss of aqueous humor.

c

A patient says she was diagnosed with astigmatism. When she asks what that is, what is the best explanation the nurse can give to the patient? a. "It happens because the lens of the eye is absent." b. "People with astigmatism have abnormally long eyeballs." c. "The cornea of the eye is uneven or irregular with astigmatism." d. "Astigmatism occurs because the eye muscles weaken with age."

c

A patient with wet AMD is treated with photodynamic therapy. What does the nurse instruct the patient to do afterthe procedure? a. Maintain the head in an upright position for 24 hours. b. Avoid blowing the nose or causing jerking movements of the head. c. Completely cover all the skin to avoid a thermal burn from sunlight. d. Expect to experience blind spots where the laser has caused retinal damage.

c

Question patients using eyedrops to treat their glaucoma about a. use of corrective lenses. b. their usual sleep pattern. c. a history of heart or lung disease. d. sensitivity to opioids or depressants.

c

The nurse provides postoperative instructions for an adult patient after cataract surgery. Which written statement, if provided by the nurse, would be most appropriate? a. "To avoid contamination of the eye, use aseptic technique when applying eyedrops." b. "Conjunctivitis may result if the eye is contaminated with wet or dirty eye patches." c. "To prevent infection in the eye, wash your hands before changing the eye patch or using eyedrops." d. "Coughing and bending over can cause increased intra ocular pressure, resulting in retinal damage or displacement of the intra ocular lens

c

What accurately describes the conjunctiva? a. Junction of the upper and lower eyelids b. Point where the optic nerve exits the eyeball c. Transparent mucous membrane lining the eyelids d. Drains tears from the surface of the eye into the lacrimal canals

c

What is an important health promotion nursing intervention related to glaucoma? a. Teaching individuals at risk for glaucoma about early signs and symptoms of the disease b. Preparing patients with glaucoma for lifestyle changes necessary to adapt to eventual blindness c. Promoting regular measurements of intraocular pressure for early detection and treatment of glaucoma d. Informing patients that glaucoma is curable if eye medications are administered before visual impairment has occurred

c

ciliary body -choroid

ciliary muscle and ciliary processes -focuses eye by changing shape of lens of refract light -makes aqueous humor -choroid: vascular structure, provides nourishment

aqueous humor

clear, watery fluid that fills anterior chamber; nourishes nonvascular structures -important to maintain intraocular pressure at 10-21mmHg

conjunctivitis

inflammation of the conjunctiva

astigmatism

defective curvature of the cornea or lens of the eye

orbit

eye socket -7 bones: frontal, zygoma, maxilla, ethmoid, sphenoid, lacrimal, and palatine -muscles, nerves, blood vessels, and fat

refraction

eye's ability to bend light rays so they fall on retina; create sharp image

ocular adnexa -what is included (4) -what does it do

eyebrows, eyelids, eyelashes, and lacrimal system -protect eye from dust and foreign particles -blinking protects from injury, distributes tears, and provides nourishment

what are the 3 parts of the visual system and what do each do?

eyes: image receptors brain: processes and interprets info from receptors into images composed of: orbit, ocular adnexa, eye, and visual pathway

hyperopia

farsightedness

iris

gives eye color

chalazion

granuloma of lid -warm compresses, drainage, corticosteroids

non-24-hour sleep-wake disorder

struggle for legally blind people circadian rhythm sleep disorder due to lack of light -trouble falling asleep and staying asleep -may result in insomnia, excessive sleepiness, and social and work consequences -treatment: melatonin or melatonin receptor agonist

external hordeolum

sty -warm compresses or antibiotics -daily eye scrubs fro recurring problem

extra ocular muscles

superior and inferior rectus; medial and lateral rectus; and superior and inferior oblique

dilation of the pupil is part of the ________ nervous system

sympathetic

lacrimal system -tears -nasolacrimal drainage system

tear production and drainage -tears: lacrimal glands; moistens eyes, provides O2 -nasolacrimal drainage system: puncta, canaliculi, lacrimal sac, and nasolacrimal duct

stereopsis

three-dimensional vision; depth perception, used for judging distance

optic nerve

transmits visual info from retina to brain

vitreous humor

transparent gel-like substance; fills posterior cavity -if nontransparent - blocks light

conjunctiva -glands -tenon's capsule

transparent mucous membrane -glands secrete mucus and tears -Tenon's capsule: fascial encases eyeball; fuses with optic nerve

Sclera

white part of eye, CT -protects eye, maintains shape and structure -extends from cornea to optic nerve

describe what is meant by the finding that the patient has a visual acuity of right eye: 20/40; left eye: 20/50

with the right eye, the patient standing at 20 feet from a smelled chart can read to the 40-foot line on chart with 2 or fewer errors. with the left eye, the patient can read only to 50-foot line on chart. this patient can read at 20 feet what a person with normal vision can read at 40 and 50 feet