Sensory

plasty

transplant from a cadaver

hyperopia

farsighted

patient education for retinal detachment

eye surgery is most often done as outpatient so education is vital s/s of complications especially increased IOP and infection promote comfort patient may need to lie in a prone position

what determines visual acuity in refractive errors?

eyeball shape

diabetic retinopathy symptoms

floaters, blurriness, dark areas of vision, difficulty perceiving colors. blindness may occur

what is often accompanying impaired vision?

functional impairment

articial cornea complications

glaucoma, endophthalmitis need close follow ups

glaucoma treatment

goal is to prevent further optic nerve damage maintain IOP within a range unlikely to cause damage meds: miotics, beta blockers, alpha2 agonists, carbonic anhydrase inhibitors, prostaglandins laser procedures surgery

A nurse in an ophthalmology clinic is interviewing a client who was referred by his primary care provider for suspicion of cataracts. The nurse should expect the client to report

having a decreased ability to perceive colors

The client arrives in the emergency room after sustaining a chemical eye injury from a splash of battery acid. The initial nursing action is to:

irrigate the eye immediately with sterile normal saline

crosslinking

is a minimally invasive procedure that uses ultraviolet light and eye drops in order to strengthen the collagen fibers in the cornea. The procedure is used for patients with keratoconus, a condition in which the cornea grows thin and weak

tonometry

is an IOP screen and manages glaucoma. nursing: avoid squeezing the eyelids, holding breath or valsalva maneuver because it can result in an abnormally high IOP

phototherapy for slowing the progression of age related macular degeneration

light sensitive verteporfin dye is injected into vessels. as laser then activates the dye

A nurse at an outpatient surgery center is providing discharge teaching to a client and his spouse following surgical removal of a cataract. Which of the following should the nurse include in the teaching?

the client should wear dark glasses while outdoors

The clinic nurse is preparing to test the visual acuity of a client using a Snellen chart. Which of the following identifies the accurate procedure for this visual acuity test?

the right eye is tested followed by the left eye, and then both eyes are tested together

glaucoma diagnostics

tonometry to assess IOP ophthalmoscopy to inspect the optic nerve disc central visual field testing

Types of cataracts

traumatic congenital senile

fuchs endothelial dystrophy

type of corneal dystophy slow death of cells in endothelial cornea more common in women over 50 blurry/hazy vision corneal transplant is needed

keratoconus

type of corneal dystrophy hereditary, more common in women blurred vision, conical protuberances of the cornea

Wide angle glaucoma

usually bilateral, anterior chamber is open/normal

cataracts diagnostics

visual acuity ophthamoscope slit lamp inspection

assessment and evaluation of vision

visual acuity: snellen chart: distance rosenbaum pocket screener: near finger count or hand motion

A nurse is providing education for a client who has glaucoma. Which of the following statements should the nurse include in the teaching?

without treatment, glaucoma can cause blindness

congenital glaucoma

A rare disease that occurs in infants; due to a malformation of the anterior chamber angle

retinal detachment manifestations

sensation of a shade or curtain coming across the vision of one eye, bright flashing lights, sudden onset of floaters

ocular medication administration

Things to remember: •Limited size of conjunctival sac (50mcL) •Tearing, blinking, drainage (dilute) •How to administer ocular medication

low vision

Visional impairment that requires devices and strategies in addition to corrective lenses Best corrected visual acuity (BCVA) of 20/70 to 20/200

glaucoma

a group of ocular conditions in which damage to the optic nerve is related to increased intraocular pressure (ICP) caused by congestion of the aqueous humor

A nurse at an ophthalmology clinic is providing teaching to a client who has open-angle glaucoma and a new treatment regimen of timolol and pilocarpine eye drops. Which of the following instructions should the nurse provide?

administer the medications 5 min apart

cataracts risk factor

age

when does corneal dystophies manifest?

at 20 years of age

A nurse is caring for a client following cataract surgery. Which of the following comments from the client should the nurse report to the client's provider?

i need something for the pain in my eye. i cant stand it

surgical management for cataracts

if reduced vision does not interfere with normal activities, surgery is not needed surgery is preformed on an outpatient basis with local anesthesia surgery usually takes less than 1 hour and patients are discharged soon after complications are rare but may be significant

corneal dystophies

inherited, autosomal dominant deposits in the corneal layers

myopia

nearsighted

refractive surgery

elective procedures to correct refractive errors and astigmatism by reshaping the cornea patients need counseling requiring potential benefits, risks and complications

fundus photography

tests for retinal lesions

perimetry testing

tests the field of vision

how to administer optic meds

1.Hand hygiene 2.Remove contacts 3.Have client sit down and tile head slightly backward 4.Gently pull the tissue underneath the eye downward to expose the lower conjunctival sac 5.Hold the dropper and stabilize your hand on the client forehead 6.Have client look up while you instill the number of prescribed drops 7.Gently press on the puncta with the eyes closed

age-related macular degeneration

54% of blindness in older adults cant see the middle of view eye has spots in it

types of refractive surgeries

PRK LASIK

A nurse at an ophthalmology clinic is providing teaching to a client who has open angle glaucoma and a new prescription for timolol eye drops. Which of the following instructions should the nurse provide?

The medication should be applied on a regular schedule for the rest of the client's life.

Glaucoma risk factors

age, african america, CV disease, DM, family hx, migraine syndromes, eye trauma, steroids, thin cornea

patho of glaucoma

aqueous production and drainage are not in balance when aqueous outflow is blocked, pressure builds up in the eye increased IOP causes irreversible mechanical or ischemic damage

glaucoma nursing management

assess for knowledge level and adherence education about self care focus on maintaining the therapeutic regimen for lifelong control of a chronic condition provide education regarding use and effects of medications meds used may cause vision alterations and other side effects. the action and efforts of medications need to be explained to promote compliance provide support and interventions to aid the patient in adjusting to vision loss or potential vision loss

diagnostic findings for retinal detachment

assess visual acuity assessment of retina by indirect ophthalmosope, slit lamp, stereo fundus photography and fluorescien angiography tomography ultrasound

A nurse is reviewing discharge instructions with a client following a right cataract extraction. Which of the following instructions should the nurse include?

avoid lifting anything heavier than 4.5 kg (10 lbs) for 1 week

blindness

best-corrected visual acuity of 20/400 to no light perception legal blindness is BVCA that does not exceed 20/200 in the better seeing eye or widest field is 20 degrees or less

cornea graft failure

blurred vision, discomfort, tearing, redness of the eye

refractive errors

can be corrected by lenses that focus light rays on the retina

diabetic retinopathy treatment

careful diabetes management advanced cases may require laser treatment or surgery

phacoemulsification

cataract surgery that uses an ultrasonic device to suction the lens out through a tube; incision is smaller than with a standard Extracapsular Cataract Extraction

lens replacement

cataract surgery; after removal of lense by Extracapsular Cataract Extraction or intracapsular Cataract Extraction, the surgeon inserts an intraocular lens implant (IOL). this eliminates the need for aphakic lenses; however the patient still may require glasses

diabetic reinopathy

caused by damage to the blood vessels in the tissues at the back of the eye (retina). poorly controlled blood sugar is a risk factor

narrow angle glaucoma

complete closure of angle, acute=emergency

astigmatism

distortion caused by irregularity of the cornea

retinal vein or artery occulsion

loss of vision can occur, patient may report decreased visual acuity or sudden loss of vision results from atherosclerosis, cardiac valvular disease, venous stasis, hypertension, or increased blood viscosity; associated risk factors are diabetes, glaucoma, and aging

wet type of macular degneration

may have abrupt onset proliferation of abnormal blood vessels growing under the retina-choroidal revascularation

how to perform a snellen test

measuring tape, snellen chart and a blinder for one eye

A nurse is teaching a class of older adults about the expected physiologic changes of aging. Which of the following changes should the nurse include in the discussion? (Select all that apply.)

more difficulty seeing due to greater sensitivity to glare decreased cough reflex decreased bladder capacity dehydration of intervertebral discs

dry or nonexudative type macular degeneration

most common slows breakdown of layers of the retina with the appearance of drusen

emmetropia

normal vision

A nurse is caring for a client who is postoperative following a left corneal transplant. The nurse observes purulent drainage from the affected eye. Which of the following actions is the nurse's priority?

notify the provider

cataracts

opacity or cloudiness of the lens

diagnostic evaluations for eyes

ophthalmoscopy (direct and indirect) slit lamp exam (magnification 10-40) color vision testing (color blindness) amsler grid (geometric squares with central points) ultrasonography (used when view of retina obscured, B scan: orbital tumors, retinal detached, A scan: axial length for implants prior to cataract surgery) optical coherence tomography (tests retinal and macular disease non invasive)

cataracts clinical manifestation

painless, bury vision, surrounding dimmer sensitivity to glare reduced visual acuity myopic shifts, astigmatism, diplopia (double vision), color shifts including brunescens (color shift of yellow to brown) decreased visual acuity and opacity of the lens by opthalmascope, slit lamp or inspection

treatments for diseased corneal tissue

phototherapuetic kerartectomy keratoplasty keratoprosthesis

cataract nursing management

preop: ask patient if they are taking any alpha antagonists and it can cause intraoperative floppy iris syndrome usual preop care for ambulatory surgery dilating eye drops or other meds as ordered postop: have patient wear eye shield at night for 1st week

patient education with cataracts

provide written and verbal instructions instruct patient to call doctor immediately if vision changes, continuous flashing lights appear, redness, swelling or pain increases, type and amount of drainage increases or significant pain not relieved by APAP

A patient who received a corneal transplant 2 weeks ago calls to report that his vision hasn't improved with the transplant. Which action should the nurse take?

remind the patient it may takes months to restore vision after a transplant

A nurse is talking with a client who is scheduled for surgery to repair retinal detachment. Which of the following preoperative instructions should the nurse include?

restrict head movement

retinal disorders

retinal detachment (rhegmatogenous detachment is the most common) retinal vascular disorders (Central retina vien occlusion, branch retinal vein occlusion, central regional vein occlusion, macular degeneration)

surgical treatment for retinal detachment

scleral buckle: compresses the sclera. basically a belt that goes around the eye vitrectomy: intraocular procedure. gass bubble, silicone oil, perfluorocarbon and liquids may be injected into vitreous cavity

retinal detachment

seperation of the sensor retina and the retinal pigment epithelium

glaucoma clinical manifestations

silent theif: unaware of the condition until there is significant vision loss, peripheral vision loss, blurring, halos, difficulty focusing, difficulty adjusting eyes to low lighting. may also have aching or discomfort around the eyes or HA

Which of the following instruments is used to record intraocular pressure?

tanometer

what indicates success after a cornea transplant?

tears and blinking

angiography

tests for macular edema macular capillary non-perfusion and neovascularization. nursing: check BUN/Cr due to contrast, patient needs to be well hydrated, may turn urine yellow or orange for 24 hrs, encourage fluids after

laser scanning

tests for optic nerve disease (glaucoma)