Chapter 42: Drugs Used to Treat Glaucoma and Other Eye Disorders

The nurse is assisting with applanation tonometry on a patient at the ophthalmologist's office. The results indicate the patient's reading to be 15 mm Hg. The nurse interprets this result as _____ IOP. a. decreased b. normal c. slightly increased d. severely increased

b. normal Normal IOP using an applanation tonometer is 10 to 21 mm Hg.

What is the action of timolol maleate (Timoptic), a beta-adrenergic blocking agent? a. Draws aqueous humor from the eye into the circulatory network. b. Increases the production of aqueous humor. c. Increases the outflow of aqueous humor. d. Decreases the production of aqueous humor.

d. Decreases the production of aqueous humor. Timolol maleate is a beta-adrenergic blocking agent used to reduce increased intraocular pressure. The exact mechanism of action of these medications is unknown, but they are believed to reduce the production of aqueous humor. Timolol is believed to decrease the production of aqueous humor.

Which statement(s) about aqueous humor is/are true? (Select all that apply.) a. Bathes and feeds the lens, posterior surface of the cornea, and iris. b. Maintains the iris color. c. Drains out of the eye through drainage channels located near the junction of the cornea and sclera. d. Manufactures fluid for tear production. e. Flows out of the canal of Schlemm into the venous system of the eye.

a. Bathes and feeds the lens, posterior surface of the cornea, and iris. c. Drains out of the eye through drainage channels located near the junction of the cornea and sclera. e. Flows out of the canal of Schlemm into the venous system of the eye. Aqueous humor bathes and feeds the lens, posterior surface of the cornea, and iris. After it is formed, the fluid flows forward between the lens and the iris into the anterior chamber. Aqueous humor drains out of the eye through drainage channels located near the junction of the cornea and sclera. Aqueous humor drains into a meshwork leading into the canal of Schlemm and into the venous system of the eye. Eye color is not dependent on the aqueous humor. Tears are produced by the lacrimal glands in the upper and lower eyelids.

A patient recently diagnosed with glaucoma is to begin drug therapy with carbonic anhydrase inhibitors. For which assessment(s) would the nurse need to contact the healthcare provider? (Select all that apply.) a. Electrolyte levels b. Any signs of gastric symptoms before initiating drug therapy c. Allergy to sulfonamides d. Patient history of menopause e. Elevated IOP levels

a. Electrolyte levels c. Allergy to sulfonamides Baseline electrolyte studies, weight, hydration data, vital signs, and mental status should be obtained before beginning drug therapy. Carbonic anhydrase inhibitors should be held and the healthcare provider notified if the patient is pregnant or allergic to sulfonamides. If the patient is experiencing gastrointestinal symptoms, the medication should be administered with milk or food. Menopause is unrelated to the condition of glaucoma or its treatment. Elevated IOP levels are associated with glaucoma and are an expected condition. They do not need to be reported to the healthcare provider.

What is the purpose of administering a cycloplegic agent? (Select all that apply.) a. Facilitate examination of the eye. b. Facilitate surgery on the eye. c. Cause pupillary dilation. d. Paralyze the ciliary muscle. e. Decrease the production of aqueous humor.

a. Facilitate examination of the eye. b. Facilitate surgery on the eye. d. Paralyze the ciliary muscle. The eye is easier to examine in some cases if the ciliary muscle is paralyzed. Surgery on the eye is easier when the ciliary muscle is paralyzed. Cycloplegic agents are used to paralyze the ciliary muscle in preparation for examination or surgery. Drugs that cause pupillary dilation are called mydriatic agents. Cycloplegic agents do not decrease the production of aqueous humor.

Which medication is used to produce miosis following a diagnostic procedure? a. Pilocarpine (Pilocar) b. Mannitol (Osmitrol) c. Atropine (Isopto Atropine) d. Epinephrine (EpiPen)

a. Pilocarpine (Pilocar) Pilocarpine is a direct acting cholinergic agent that is used to counter the effects of mydriatic and cycloplegic agents after surgery or eye ophthalmoscopic examinations. Cholinergic agents also reduce IOP in glaucoma patients by widening the filtration angle that permits outflow of aqueous humor. Mannitol is an osmotic diuretic given to decrease ocular pressure by drawing aqueous humor from the eye. Atropine is a mydriatic agent given to dilate the pupil. Epinephrine may be used to treat certain types of glaucoma.

Which are important teaching points for the nurse to review with a patient recently diagnosed with open-angle glaucoma? (Select all that apply.) a. The disease will cause damage to the optic disk if left untreated. b. Symptoms are sudden and painful when the disease begins. c. Loss of peripheral vision is a common trigger for diagnosis. d. Total blindness may result if the glaucoma is not treated. e. Glaucoma is not a serious disease and will cause only mild inconvenience to the patient. f. Treatment is only necessary when symptoms are bothersome.

a. The disease will cause damage to the optic disk if left untreated. c. Loss of peripheral vision is a common trigger for diagnosis. d. Total blindness may result if the glaucoma is not treated. IOP builds up and, if not treated, will damage the optic disk. Initially, the patient has no symptoms, but over the years, peripheral vision is gradually lost. If glaucoma is left untreated, total blindness may result. Patients with glaucoma are initially asymptomatic. Glaucoma is a serious disease that, if left untreated, may result in total blindness. If glaucoma is not treated, IOP builds up and will damage the optic disk.

What information will the nurse include when teaching the patient and family about postoperative care for a trabeculectomy? (Select all that apply.) a. Use aseptic technique for all dressing changes and medication administration. b. Place the patient on the operated side. c. Avoid heavy lifting. d. Redness in the eye, pain, and swelling are common occurrences after surgery. e. Avoid straining on defecation.

a. Use aseptic technique for all dressing changes and medication administration. c. Avoid heavy lifting. d. Redness in the eye, pain, and swelling are common occurrences after surgery. e. Avoid straining on defecation. Teach the patient and family proper hygiene and eye care techniques to ensure that medications, dressings, and/or surgical wounds are not contaminated during necessary eye care. Explain and enforce activity and exercise restrictions. To prevent an increase in IOP, instruct the patient to avoid heavy lifting, straining on defecation, coughing, or bending and placing the head in a dependent position. Teach the patient and family about signs and symptoms of infections and when and how to report them to allow early recognition and treatment of possible infection. Straining increases IOP and should be avoided. The patient is positioned on the unoperated side or the back.

A factory worker had a chemical inadvertently splashed into his right eye. An eyewash was used at the work site. Which nursing assessment(s) would be important to include? (Select all that apply.) a. Visual acuity b. Presence of pain, blurred or halo vision, or lack of vision c. Type of chemical d. Presence of nystagmus e. Presence of contacts or use of eyeglasses

a. Visual acuity b. Presence of pain, blurred or halo vision, or lack of vision c. Type of chemical e. Presence of contacts or use of eyeglasses Important nursing assessments would include visual acuity and baseline vital signs. These assessments would also include subjective data such as pain, clarity, and acuity of vision; observation of any physical abnormalities of the eye or lid; pupil characteristics; drainage or excessive tearing; edema or redness; and interventions completed before arrival. Important nursing assessments would include the type and cause of injury and whether contacts or eyeglasses are worn. Nystagmus is involuntary, rhythmic, repeated oscillations of one or both eyes. The cause is unknown. It would be unrelated to chemical eye injury.

What information will the nurse include when instructing a patient on the correct method of instilling eyedrops? (Select all that apply.) a. With an infection, prevent cross-contamination and use a separate source of medication and droppers for each eye. b. Wash hands before and after administration. c. Place the lid on the surface area as instructed to avoid contamination. d. Never touch the tip of the dropper or opening of the ointment container. e. Wipe eye from the outer to inner canthus.

a. With an infection, prevent cross-contamination and use a separate source of medication and droppers for each eye. b. Wash hands before and after administration. c. Place the lid on the surface area as instructed to avoid contamination. d. Never touch the tip of the dropper or opening of the ointment container. Separate medication sources should be used when an eye infection is present to avoid cross-contamination. Washing of hands before and after instillation will prevent infection. The medication lid should not lie with the opening down on any surface. Any medications instilled into the eye should be sterile. The medication tip should not touch anything, including the eye, face, or fingers. Wipe the eye from the inner canthus outward.

The nurse is educating a patient about a newly prescribed cholinergic agent. When relaying common adverse effects of this type of medication, the nurse will include information about: (Select all that apply.) a. conjunctival irritation. b. headache. c. salivation. d. hypotension. e. bradycardia.

a. conjunctival irritation. b. headache. Conjunctival irritation and headache are common adverse effects of cholinergic agents. Salivation, hypotension, and bradycardia are systemic adverse effects of cholinergic agents and may indicate toxicity.

Which type of medication would be used to dilate the pupils before an eye examination? a. Osmotics b. Adrenergic agent c. Beta-adrenergic agent d. Corticosteroid

b. Adrenergic agent Adrenergic agents are sympathomimetic. They cause pupil dilation, increased outflow of aqueous humor, vasoconstriction, relaxation of ciliary muscle, and a decrease in the formation of aqueous humor. Adrenergic agents are used to lower intraocular pressure (IOP) in open-angle glaucoma, relieve congestion and hyperemia, and produce mydriasis for ocular examinations. Osmotics are given to reduce IOP. Beta adrenergics are given for the treatment of asthma. Corticosteroids are given for acute allergic reactions in the eye.

The nurse is preparing a patient for an ophthalmic examination. Which action occurs when the nurse instills eyedrops to produce mydriasis? a. Drying of tears in the eyes b. Extreme dilation of the pupil c. Opening of the canal of Schlemm d. Paralysis of the ciliary muscle

b. Extreme dilation of the pupil Dilating the eye before eye examinations allows for better visualization of the interior of the globe. Anticholinergic drugs may produce drying of tears in the eye as an adverse effect of use. Obstruction of the canal of Schlemm results in glaucoma. Paralysis of the ciliary muscle is cycloplegia.

Which is a potential serious adverse effect associated with mannitol (Osmitrol)? a. Bradycardia b. Fluid overload c. Anaphylaxis d. Fever

b. Fluid overload Mannitol, an osmotic agent, acts on blood volume by pulling fluid from the tissue spaces into the general circulation (blood). Patients should be assessed at regularly scheduled intervals for signs and symptoms of fluid overload, pulmonary edema, or heart failure. Osmotic agents are not likely to cause bradycardia, anaphylaxis, or fever.

What is the mechanism of action of osmotic agents when used to decrease IOP? a. Promoting outflow of the aqueous humor into the tear ducts b. Increasing plasma osmolarity and drawing extracellular fluid into the blood c. Blocking production of aqueous humor d. Decreasing viscosity of the tears and allowing fluid to drain away from the eye

b. Increasing plasma osmolarity and drawing extracellular fluid into the blood Osmotic agents elevate the osmotic pressure of the plasma, causing fluid from the extravascular spaces to be drawn into the blood. The effect on the eye is reduction of volume of intraocular fluid, which produces a decrease in IOP. Osmotic agents do not promote flow of aqueous humor into tear ducts, block production of aqueous humor, or decrease viscosity of tears.

Which discharge instruction will the nurse include for a patient sent home from the clinic who is taking an adrenergic ophthalmic solution for an acute inflammation? a. Headaches and eye pain are adverse effects to be reported to the healthcare provider immediately. b. Mouth dryness should be reported immediately. c. Avoid driving or operating machinery until blurring subsides. d. "Halos" or yellow rings around objects will be seen while taking this medication.

c. Avoid driving or operating machinery until blurring subsides. Adrenergic agents cause the smooth muscle of the ciliary body and iris to relax, producing mydriasis. Blurred vision will temporarily occur until the patient can adjust to the increased light coming into the eyes. Activities such as driving or operating machinery should be avoided until vision stabilizes. Sunglasses help reduce the brightness. These are common, mild adverse effects and usually resolve with continued therapy. Mouth dryness is a common adverse effect. Halos are a sign of acute closed-angle glaucoma.

The nurse is caring for a patient immediately following a right-sided trabeculectomy. When positioning this patient, the nurse will encourage a _____ position. a. prone b. right side-lying c. left side-lying d. Trendelenburg

c. left side-lying Following right-sided trabeculectomy, the patient is usually positioned on the back or on the unoperated side. Prone position, right side-lying, and Trendelenburg positions are not recommended after a trabeculectomy.