Sensory Chapter 63 Enrichment

s/s of AMD

"wet"=exudative, or neovascular, more abrupt onset, 15% of pt's with AMD; "dry"=nonexudative, or nonneovascular, 85% of pt's with AMD (see fig. 63-15, p.1867)

refractive errors

In __________ ______, vision is impaired because a shortened or elongated eyeball prevents light rays from focusing sharply on the retina; can be corrected with eyeglasses or contact lenses

strategies for interacting with ppl who are blind or have low vision

ID yourself upon approach, use clock cues when serving food, place person's hand on seat when offering one, usually appropriate to touch the person's hand or arm to indicate you are about to speak

cataract

a(n) ________ is a lens opacity or cloudiness that can develop at any age

blindness

absence of light perception; ranges from 20/400 to no light perception at all

risk factors for cataracts

aging, obesity, diabetes, poor nutrition, renal disorders, retinal detachment

types of conjunctivitis

allergic; irritating toxic stimuli; microbial (viral or bacterial---if viral, can be acute or chronic with common causes being adenovirus or herpes simplex---> if adenovirus, very contagious, usually preceded by URI)

risk factors for AMD

arthritis, hyperopia, overweight, increased age, hypertension, smoking hx, fam. hx

color vision test

assesses ability to differentiate colors; sometimes indicated conditions of the optic nerve

s/s of glaucoma

blurred vision, difficulty focusing, halos around lights, loss of peripheral vision, aching or discomfort around eyes, difficulty adjusting eyes in low light

diabetic retinopathy

changes in the small blood vessels in the retina; leading cause of new cases of blindness in ages 20-74; subject to many visual complications

emmetropia

condition of the eye in which vision is accurate

common gerontologic changes in the eye

decreased visual acuity, decreased tear production, thickening and flattening of cornea, loss of skin elasticity, decreased muscle tone, wrinkles develop

risk factor for diabetic retinopathy

diabetes

diplopia

double vision

ptosis

drooping of the eye lid

risk factors for glaucoma

family hist., thick cornea, African Am. race, older pop., diabetes, cardiovascular dz, migraine ha, myopia, use of steriods

hyperopia

farsightedness; eyeballs shallow in the socket

myopia

nearsightedness; eyeballs set deeper in socket

Tx for AMD

no tx for dry AMD; wet AMD can be treated

s/s of cataracts

painless, blurry vision; perception that surroundings are dimmer as if glasses need cleaned; astigmatism; diplopia

s/s of diabetic retinopathy

painless, blurry vision; symptoms indicative of hemorrhaging include floaters or cobwebs in visual field

glaucoma

refers to a group of ocular conditions characterized by optic nerve damage (esp. in older pop.); increased IOP damages the optic nerve causing congestion of the aqueous humor in eye; "silent thief of sight"

astigmatism

refractive error due to irregularity in the curvature of the cornea

instilling eye medications

remove contacts---may reinsert after med is absorbed; instill in lower conjunctival sac; do not touch tip of med container to any part of eye; wait 5 min b4 instilling another drop in same eye and 10 min b4 instilling a different med; after drops, keep eye lid closed and apply gentle pressure to inner canthus

ultrasonography

tests for lesions

trichiasis

turning in of the eye lashes

entropian

turning in of the lower eye lid

ectropian

turning out of the lower eye lid

when assessing for conjunctivitis look for

type of discharge (watery, mucoid, or purulent), type of conjunctival reaction

post op care after cataract surgery

wear eye patch first 24 hrs, then wear glasses during day and eye shield at night; expect morning discharge from eye, redness, scratchy feeling for few days; report new "floaters" in line of vision, flashing light, decrease in vision, increased redness, or pain

post-op teaching for common eye surgeries

wear eye shield, avoid straining (coughing, sneezing, Valsalva maneuver), avoid lifting or bending, report sharp pain, hemorrhage, or infection

tx of diabetic retinopathy

maintain normal b/p and BS, cessation of smoking, laser treatment to destroy leaking blood vessels

tonometry

measures intraocular pressure (IOP) needed to flatten the cornea; TEACH: do not squeeze eyes, hold breath, or perform Valsalva maneuver b/c will increase IOP

Tx of conjunctivitis

meds, isolation of infected patients

pin hole vision test

By looking through a pinhole (an occluder with small holes), the refractive errors of the peripheral cornea and crystalline lens of the eye are significantly reduced or eliminated, simulating corrected vision. No pinhole improvement indicates refractive error is less likely the cause of subnormal visual acuity.

s/s of conjunctivitis

itching, photophobia, foreign body sensation, scratching or burning sensation

Pt Teaching for glaucoma

keep record of eye pressure measurements and visual field test results to monitor own progress (see chart 63-7; p.1857)

Amsler grid

for pt's with macular problems (like macular degeneration) test each eye separately

Tx of glaucoma

goal of Tx: prevention of optic nerve damage (cannot be reversed or cured); pharmacological Tx, laser procedures, surgery, or combination of these

age-related macular degeneration (AMD)

gradual blurring of vision esp. in older adults; clusters of debris or waste material in macula or beneath retina called drusen (yellowish spots assoc. with aging)

conjunctivitis

inflammation of the conjunctiva characterized by a pink appearance, hence "pink eye"

nystagmus

involuntary, oscillating movements of the eye; esp after trauma or neurologic concerns