Test 2 PP#4 Eye Disorders
Types of visual aids
Clean, repaired eyeglasses Adequate light + night lights Sunglasses or shades to decrease glare Contrasting colors Magnifying glass Phone with large #s Clock/wristwatch with large #s or sound Talking clocks Color code or texture to stove, washer, medi, etc Colored or raised rims on dishes Large print reading stuff Braille or recorded books Computer software that converts to speech
The nurse is caring for a client with a diagnosis of detached retina. Which assessment sign would indicate that bleeding has occurred as a result of the retinal detachment? Complaints of a burst of black spots or floaters A sudden sharp pain in the eye Total loss of vision A reddened conjunctiva
Complaints of a sudden burst of black spots or floaters indicate that bleeding has occurred as a result of the detachment.
The nurse is performing an admission assessment on a client with a diagnosis of detached retina. Which of the following is associated with this eye disorder? Pain in the affected eye Total loss of vision A sense of a curtain falling across the field of vision A yellow discoloration of the sclera.
A characteristic manifestation of retinal detachment described by the client is the feeling that a shadow or curtain is falling across the field of vision. No pain is associated with detachment of the retina. Options B and D are not characteristics of this disorder. A retinal detachment is an ophthalmic emergency and even more so if visual acuity is still normal.
Nutrition and Macular Degeneration (Age Related Eye Disease Study) - AREDS2
Omega-3 acids - not lutein Zeaxanthin Zinc 80 mg (zinc oxide) Copper, 2 mg Vitamins C 500 mg Vitamin E 400 IU Vitamin A 25,000 IU (beta-carotene) nop
Preoperative Nursing Interventions (Cataracts)
-Instruct to withhold anticoagulants - may not be necessary -Assess for alpha-agonist use (Flomax) -Instruct the pt. regarding the measures to prevent increased IOP -Stress to the pt. that care after surgery requires different types of gtts several times per day -Administer gtts preoperatively (antibiotics, dilating, steroid)
Cataract surgery results in aphakia. Which of the following statements best describes this term? Absence of the crystalline lens A "keyhole" pupil Loss of accommodation Retinal detachment
Aphakia means without lens, a keyhole pupil results from iridectomy. Loss of accommodation is a normal response to aging. A retinal detachment is usually associated with retinal holes created by vitreous traction.
Pathophysiology of Glaucoma
Aqueous production > drainage ↓ aqueous outflow = ↑ IOP ↑ IOP causes irreversible mechanical and/or ischemic damage to optic nerve
Geriatric Considerations
Accommodation Peripheral vision Iris and Pupilary response Entropian/Ectropian Nystagmus Colored Vision
Angle-Closure Glaucoma
Accounts for 5% of all glaucoma Usually unilateral; caused by Stress, impact injury, or medications Iris pushed over drainage area; causes angle to narrow and close Causes sudden increase in IOP Medical Management Hyperosmotics Occular hypotensive agents Iridotomy
Primary Open-Angle Glaucoma
Accounts for 90% of cases Usually bilateral IOP develops slowly over years Asymptomatic Iris does not cover opening Medical Management Treated with medications as 1st line Laser procedures - A.L.T. Laser Treatment Trabeculectomy Drainage Implants
For a client having an episode of acute narrow-angle glaucoma, a nurse expects to give which of the following medications? Acetazolamide (Diamox) Atropine Furisemide (Lasix) Urokinase (Abbokinase)
Acetazolamide, a carbonic anhydrase inhibitor, decreases intraocular pressure (IOP) by decreasing the secretion of aqueous humor. Atropine dilates the pupil and decreases outflow of aqueous humor, causing further increase in IOP. Lasix is a loop diuretic, and Urokinase is a thrombolytic agent; they aren't used for the treatment of glaucoma
Risk Factors For Cataracts
Aging Associated Ocular Conditions Toxic Factors Nutritional Factors Physical Factors Systemic Diseases and Syndromes
What is Tonometry?
An eye test that measures the pressure inside your eyes, to determine whether or not you may be at risk for glaucoma. Glaucoma is an eye disease in which fluid buildup within the eye can damage the optic nerve.
Cataracts
An opacity or cloudiness of the lens Increased incidence with aging; by age 80, more than half of all Americans have cataracts A leading cause of blindness in the world (WHO)
How can you prevent eye disorders?
Annual Exams Know Family Hx Diet Healthy Wt Eyewear No smoking Sunglasses Rest your Eyes Wash
The patient with glaucoma has been prescribed travoprost (Travatan), a prostaglandin analog, to improve the outflow of aqueous humor and reduce ocular pressure. Of the following signs or symptoms, which will the nurse teach the patient to report immediately to the eye doctor? Burning in the eye when the eye drops are used Tearing in the eye when the eye drops are used Changes in the color of the eyes Intolerable pain in the eyes after the drops are used
Intolerable pain in the eyes after the drops are used Rationale: Prostaglandin analogs have some adverse effects, such as blurred vision and stinging, and, when used long-term, cause permanent darkening of the iris of the eye and eyebrows, increased growth of eyelashes, and conjunctival redness.
Nursing Management for AMD
Prevention of injuries - p. 1868 Supportive care Environmental Safety promotion Recommendations include improving lighting, getting magnification devices, color codes
Drugs to Treat Glaucoma
Prostaglandins - Drug of Choice for Glaucoma ↑ outflow of aqueous humor (AH) Travatan Beta-Adrenergic Blockers ↓ the prod of AH Betoptic, Timoptic Alpha-Adrenergic Agonists ↓ the prod of AH Alphagan Carbonic Anhydrase Inhibitors ↓ the prod of AH Trusopt Cholinergic Agonists (Miotics) constrict pupil and contract ciliary muscle Pilocarpine Non Selective Sympathomimetics pupil dilation and increased outflow Dipivefrin Osmotic diuretics ↓ plasma volume so ↓ AH Opthalgan
Common Visual Problems
Refractory Errors Glaucoma Cataracts Retinal Detachment Age-Related Macular Degeneration (AMD)
What is accomodation?
The adjustment of the optics of the eye to keep an object in focus on the retina as its distance from the eye varies. It is the process of adjusting the focal length of a lens
What is the snellen chart?
The projected or wall-mounted Snellen eye chart, usually topped by the big letter "E", is a common visual acuity test used to measure your sharpness of vision at multiple distances.
History For Aging Adult
Visual Difficulty Glaucoma Test Cataracts Eye dryness Decreased activities
Risk Factors for Macular Degeneration
Being Caucasian and Female Aging* Smoking* Heredity Hypertension/diabetes Obesity and Inactivity Light eye color ( darker color protects) Drug side effects (anti-malarial, antipsychotics) * ONLY CONSISTENT DATA
Nutrition and Cataract Prevention
Lutein and Zeaxanthin -filter out high-energy wavelengths of light so they act as antioxidants in the eye - need 6-6.9mg/day Multivitamin/mineral supplements Sources of Lutein and Zeaxanthin
Newborn Considerations
Newborns Check for sensitivity to light - blink Can fixate on objects 8"-10" Observe eyes for opacities or white
Surgical Management of Cataracts
No surgery unless ADLs are affected Surgery is outpatient w/local Takes less than 1 hour Complications are rare but may be significant: pp. 1859 Table 63-6
Assessment and Evaluation of Vision
Ocular history Visual acuity Snellen & Rosenbaum (far and near vision) Finger count or hand motion - functional visual test Visual fields Accommodation Cover test Cardinal gazes
Diagnostic Evaluation
Ophthalmoscopy Slit-lamp examination Color vision testing Amsler grid Ultrasonography Angiography Tonometry Goniometry Fundus Photography
Immediate Nursing Interventions (Ret. Det.)
Provide bed rest Cover both eyes Speak to pt. before approaching Minimize eye stress (position head as ordered by physician) Protect them from injury Prepare for surgical treatment (drops?)
Manifestations of Retinal Detachment
Sensation of shade or curtain coming across the vision of one eye Loss of portion of visual field Bright flashing lights Cobwebs Sudden onset of floaters No pain
Retinal Detachment
Separation of the sensory retina and the retinal pigment epithelium (RPE)
The patient is in the preoperative holding area, having been brought to surgery from the Emergency Department because of a detached retina. The tear has occurred in the right posterior aspect of the retina. The nurse places the patient in which of the following positions? At a 45-degree angle (semi-Fowler's position) At a 90-degree angle (high Fowler's position) Prone Supine
Supine Rationale: The patient's head is positioned so that gravity pulls the detached portion of the retina into closer contact with the choroid. In this example, the patient's head should be flat and turned slightly to the right.
Nursing Management for Retinal Detachment
Supportive pre and post surgical. Comfort post surgically Teach s/s of postoperative IOP and infection Depending on type of procedure may have to lie face down or to the side for days (to keep bubble in place) Monitor for sudden sharp eye pain Prevent nausea/vomiting/cold s/s Limit reading for 3-5 weeks or traveling in car Wear dark glasses and eye patch No air travel
What is a Slit-lamp examination?
This exam allows the doctor to see areas at the front of the eye, including the eyelids, conjunctiva, iris, lens, sclera, and cornea. The retina and optic nerve can also be seen.
Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse analyzes the test results as documented in the client's chart and understands that normal intraocular pressure is: 2-7 mmHg 10-21 mmHg 22-30 mmHg 31-35 mmHg
Tonometry is the method of measuring intraocular fluid pressure using a calibrated instrument that indents or flattens the corneal apex. Pressures between 10 and 21 mmHg are considered within normal range.
History for Infants and Children
Vaginal infection during delivery Post delivery infections Developmental milestones Routine vision testing InfantSEE Assessment Safety measures
The client with glaucoma asks the nurse is complete vision will return. The most appropriate response is: "Although some vision as been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan." "Your vision will return as soon as the medications begin to work." "Your vision will never return to normal." "Your vision loss is temporary and will return in about 3-4 weeks."
Vision loss to glaucoma is irreparable. The client should be reassured that although some vision has been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan. Option C does not provide reassurance to the client.
A male client has just had a cataract operation without a lens implant. In discharge teaching, the nurse will instruct the client's 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.
Without a lens, the eye cannot accommodate. It is difficult to judge distance and climb stairs when the eyes cannot accommodate. Therefore, the client should walk up and down stairs only with assistance.
Which of the following statements by a patient with newly prescribed contact lenses indicates a need for additional teaching? "I think it is so cool that my best friend, Taylor, and I have the same prescription. She has blue lenses and I have brown lenses, so we'll be able to trade to see what we would look like with different eyes." "If I run out of cleaning and wetting solution, I'll have to wait until I get a new supply before I'll be able to wear my lenses again." "I'll follow the manufacturer's guide to tell me when I need to take them out." "If I have eye redness or pain in my eyes, I'll take out my lenses and call the ophthalmologist first thing."
"I think it is so cool that my best friend, Taylor, and I have the same prescription. She has blue lenses and I have brown lenses, so we'll be able to trade to see what we would look like with different eyes." Rationale: Manufacturer's recommendations indicate to the wearer proper length of time for wear, cleaning, and storing. Patients are instructed to use cleaning and wetting solutions recommended by the optometrist, ophthalmologist, or lens manufacturer. Patients are instructed not to use water or homemade solutions for wetting or cleaning lenses. If eye redness, tearing, vision loss, or pain occurs, the patient should remove the lenses and contact the eye care professional as soon as possible. Lenses should not be shared or "tried on" by another person.
The 77-year-old male smoker has developed cataracts on both eyes, and is awaiting surgery. The cataracts have prevented the patient from driving, reading, and seeing television. Which of the following statements would be appropriate for the nurse in the preoperative holding area to communicate to the patient? "Did your eye doctor explain to you that you could choose to use eye drops six times a day to dissolve the cataract?" "You are wise to have both eyes done at the same time." "If you were a non-smoker, you would never have developed cataracts." "Most patients undergoing cataract surgery do well and enjoy the improved vision."
"Most patients undergoing cataract surgery do well and enjoy the improved vision." Rationale: Surgical removal is the only treatment used at this time for cataracts; no medical treatment is available to prevent or treat them. Surgical removal of the cataract and lens is indicated when the cataract has developed to the point that vision and activities of daily living are affected. If the patient presents with bilateral cataracts, surgery is only performed on one eye at a time. Complications from cataract surgery are unusual, and occur in less than 1% of the surgeries.
What is Goniometry?
A goniometer is an instrument that either measures an angle or allows an object to be rotated to a precise angular position. The term goniometry is derived from two Greek words, gōnia, meaning angle, and metron, meaning measure.
In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the physicians orders, expecting which type of eye drops to be instilled? An osmotic diuretic A miotic agent A mydriatic medication A thiazide diuretic
A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are used preoperatively in the cataract client. These medication act by dilating the pupils. They also constrict blood vessels. An osmotic diuretic may be used to decrease intraocular pressure. A miotic medication constricts the pupil. A thiazide diuretic is not likely to be prescribed for a client with a cataract.
Which of the following instruments is used to record intraocular pressure? Goniometer Ophthalmoscope Slit lamp Tonometer
A tonometer is a device used in glaucoma screening to record intraocular pressure. A goniometer measures joint movement and angles. An ophthalmoscope examines the interior of the eye, especially the retina. A slit lamp evaluates structures in the anterior chamber in the eye.
Patient Education after Lasik Procedure
Avoid soaps, sprays, creams on facial area Avoid rubbing eyes X7 d No make-up X 7days - discard old/buy new No immersion in pools, hot tubs, bathtub X 14 d Avoid exercise for 2-3 d Wear protective goggles with sports for 30 days Wear sunglasses for 12 months+ Wear eye shield at night for 7 days No tap water in eyes for 7d Avoid dusty/dirty places X 7 days Any adverse s/s (d/c, swelling, redness) call provider
Drug Therapy for Glaucoma
Determine history of certain conditions Heart block, bradycardia, heart failure Chronic obstructive pulmonary disease (COPD) Establish baseline blood pressure and pulse
The nurse providing postoperative teaching for a patient who has undergone LASIK surgery advises the patient to contact the office if he experiences: Dry eyes. Undercorrection of visual acuity. Decreased night vision with halos. Drainage from the eye.
Drainage from the eye. Rationale: Following surgery, patients can experience a temporary loss of sharpness, over- or undercorrection of visual acuity, dry eyes, or temporarily decreased night vision with halos, glare, and starbursts. Bleeding or drainage could indicate a surgical complication, and should be reported immediately.
Manifestations of AMD
Dry eventually may become wet AMD Usually slow, or rarely, sudden painless loss of vision. Early signs: Shadowy areas in central vision Unusually fuzzy or distorted vision
Manifestations of Angle-Closure Glaucoma
Dull to severe eye pain, headache Bloodshot eyes, foggy vision with halos, bulging iris Medical emergency
Postoperative Nursing Interventions (Cataracts)
Elevate the HOB 30-45 degrees Turn the pt to the back or nonoperative side Maintain an eye patch as prescribed; orient to environment Position pt. belongings on nonoperative side Prevent nausea and vomiting Use side rails if ordered for safety Assist with ambulation Teach s/s that require notification of physician
Refractory Errors
Emmetropia: normal vision Myopia: nearsighted Hyperopia: farsighted Presbyopia: no close vision Astigmatism: distortion due to irregularity of the cornea
What is Angiography?
Examination by X-ray of blood or lymph vessels, carried out after introduction of a radiopaque substance.
Risk Factors for Glaucoma
Family history of glaucoma African-American or Asian Race Older age Diabetes Mellitus Cardiovascular disease Migraine syndromes Nearsightedness (myopia) Eye trauma (acute closed angle) Prolonged use of topical or systemic corticosteroids, antihypertensives, antidepressants, antihistamines
Glaucoma Pharmacotherapy
Goal is to prevent damage to optic nerve by lowering IOP Treatment begins When IOP is between 21 and 30 mm/Hg (normal is 10-20 mm/Hg) or When signs of optic nerve damage or visual-field changes are present regardless of IOP Combination therapy may be necessary to achieve goal May require surgery if drugs don't ↓ pressure
Glaucoma
Leading cause of blindness in U.S 2nd leading cause in the world 3 million have it and 5-10 are at risk More prevalent in people > 40 More prevalent in men than women More prevalent in African American and Asian populations "Silent thief of sight"
Nursing Management for Glaucoma
Lifelong control of a chronic condition Need for adherence to therapy, provide education regarding use and effects of medications (e.g. diuretic effects, bradycardia) Provide support and interventions to aid the patient in adjusting to vision loss/potential vision loss Instruction on proper installation of gtts
Photodynamic Therapy for Slowing Progression of AMD
Light-sensitive dye is injected into vessels; a laser then activates the dye, shutting down the vessels without damaging the retina The result is to slow or stabilize vision loss Patient must avoid exposure to sunlight or bright light for 5 days after treatment to avoid activation of dye in vessels near the surface of the skin
Environmental Safety
Lighting Furniture Elimination of Hazards Use of Color Contrast Hallways and Stairways Signs Telephones
Misc. Drugs Used in Eyes
Lubricants - Lacrilube, Liquifilm Tear Producers - Restasis Mydriatics - Paredine Dilate pupil to allow better visualization Cause photophobia, can increase IOP, can cause CNS effects Cycloplegics - Atropine Sulfate Causes paralysis of the iris sphincter Causes severe blurred vision, loss of near vision, angle-closure glaucoma attacks
Which of the following procedures or assessments must the nurse perform when preparing a client for eye surgery? Clipping the client's eyelashes Verifying the affected eye has been patched 24 hours before surgery Verifying the client has been NPO since midnight, or at least 8 hours before surgery. Obtaining informed consent with the client's signature and placing the forms on the chart.
Maintaining NPO status for at least 8 hours before surgical procedures prevents vomiting and aspiration. There is no need to patch an eye before most surgeries or to clip the eyelashes unless specifically ordered by the physician. The physician is responsible for obtaining informed consent; the nurse validates that the consent is obtained.
When developing a teaching session on glaucoma for the community, which of the following statements would the nurse stress? Glaucoma is easily corrected with eyeglasses White and Asian individuals are at the highest risk for glaucoma. Yearly screening for people ages 20-40 years is recommended. Glaucoma can be painless and vision may be lost before the person is aware of a problem.
Open-angle glaucoma causes a painless increase in intraocular pressure (IOP) with loss of peripheral vision. A variety of miotics and agents to decrease IOP and occasional surgery are used to treat glaucoma. Blacks have a threefold greater chance of developing with an increased chance of blindness than other groups. Individuals older than 40 should be screened.
Manifestations of Cataracts
Painless, blurry vision Sensitivity to glare Reduced visual acuity Other effects include: diplopia (double vision) color shifts including brunescent c. (color value shift to yellow-brown) Diagnostic findings include: opacity of the lens by ophthalmoscope, slit-lamp, or inspection
Health History
Perceived problem? Is vision diminished? Blurred, double or distorted vision? Pain? - describe Itching or foreign body? Hx of discharge? appearance? Happened before? Remedies or Exascerbations? Are both eyes affected? Health status + meds? Any other eye problems? Any eye surgery? Any family members with same problems?
The nurse's first action for a patient who presents to the Emergency Department with manifestations of corneal perforation is to: Contact the patient's ophthalmologist. Place the patient in a supine position. Cover the eye with gauze. Administer tears for dry eyes.
Place the patient in a supine position. Rationale: If corneal perforation is suspected, the nurse should first place the patient in the supine position, then close the eye, and cover it with a dry, sterile dressing. Thereafter, the nurse should notify either the patient's ophthalmologist or an on-call ophthalmologist to see the patient. The complications of corneal perforation include infection of deep eye structures and loss of ocular contents. Nothing should be placed in the eye.
LASIK Surgery
Refractive surgery Elective procedures to re-contour corneal tissue and correct refractive errors Patients need counseling regarding potential benefits, risks, and complications
National Eye Institute Audacious Goals Challlenge
Regenerative Therapy for Retinal Disease Restoration of Vision by Opto-electronic Stim. Gene Editing In Vivo
During the early postoperative period, the client who had a cataract extraction complains of nausea and severe eye pain over the operative site. The initial nursing action is to: Call the physician Administer the ordered main medication and antiemetic Reassure the client that this is normal. Turn the client on his or her operative side
Severe pain or pain accompanied by nausea is an indicator of increased intraocular pressure and should be reported to the physician immediately. The other options are inappropriate.
25. Which of the following symptoms would occur in a client with a detached retina? Flashing lights and floaters Homonymous hemianopia Loss of central vision Ptosis
Signs and symptoms of retinal detachment include abrupt flashing lights, floaters, loss of peripheral vision, or a sudden shadow or curtain in the vision. Occasionally visual loss is gradual.
Manifestations of Open Angle Glaucoma
Silent Thief Early signs include decreased accommodation Starts with blurred vision or halos around lights Problems adjusting to low lighting Loss of peripheral vision
A spry 77-year-old female patient has been diagnosed with simple glaucoma. She lives alone, takes medications for asthma, is on a fixed income, and walks to Catholic Mass on Sunday mornings. The nurse must be certain that the ophthalmologist is aware of which of the aforementioned facts about the patient? Lives alone. Takes medications for asthma. Lives on a fixed income. Walks to Catholic Mass on Sundays.
Takes medications for asthma. Rationale: Living alone and a fixed income should be concerns addressed through a Social Services consultation. The patient could be listed on a clergy visit list if hospitalized. Most importantly, the nurse wants to be certain that the patient takes medications for asthma because beta-adrenergic blockers are used topically to treat glaucoma. In asthmatic patients, beta-adrenergic blockers can cause bronchospasm, and are contraindicated
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 intraocular pressure Avoid overuse of the eyes Decrease the amount of salt in the diet Eye medications will need to be administered lifelong.
The administration of eye drops is a critical component of the treatment plan for the client with glaucoma. The client needs to be instructed that medications will need to be taken for the rest of his or her life.
What is ophthalmology?
The branch of medicine concerned with the study and treatment of disorders and diseases of the eye.
The client is being discharged from the ambulatory care unit following cataract removal. The nurse provides instructions regarding home care. Which of the following, if stated by the client, indicates an understanding of the instructions? "I will take Aspirin if I have any discomfort." "I will sleep on the side that I was operated on." "I will wear my eye shield at night and my glasses during the day." "I will not lift anything if it weighs more that 10 pounds."
The client is instructed to wear a metal or plastic shield to protect the eye from accidental and is instructed not to rub the eye. Glasses may be worn during the day. Aspirin or medications containing aspirin are not to be administered or taken by the client and the client is instructed to take acetaminophen as needed for pain. The client is instructed not to sleep on the side of the body on which the operation occurred. The client is not to lift more than 5 pounds.
The nurse is developing a plan of care for the client scheduled for cataract surgery. The nurse documents which more appropriate nursing diagnosis in the plan of care? Self-care deficit Imbalanced nutrition Disturbed sensory perception Anxiety
The most appropriate nursing diagnosis for the client scheduled for cataract surgery is Disturbed sensory perception (visual) related to lens extraction and replacement. Although the other options identify nursing diagnoses that may be appropriate, they are not related specifically to cataract surgery.
Age Related Macular Degeneration (AMD)
The most common cause of vision loss in persons older than age 60 Types: Dry or nonexudative type is most common, 85%-90% Slow breakdown of the layers of the retina with the appearance of drusen bodies Wet type May have abrupt onset Proliferation of abnormal blood vessels growing under the retina in the choroid layer- choroidal neovascularization (CNV)
Anti-VEGF Injections
VEGF - Vascular endothelial Growth Factor Contributes to neovascularization Won't cure wet Injections are into eye Macugen Lucentis Avastin Eylea (new)
The client's vision is tested with a Snellen's chart. The results of the tests are documented as 20/60. The nurse interprets this as: -The client can read at a distance of 60 feet what a client with normal vision can read at 20 feet. -The client is legally blind. -The client's vision is normal -The client can read only at a distance of 20 feet what a client with normal vision can read at 60 feet.
Vision that is 20/20 is normal, that is, the client is able to read from 20 feet what a person with normal vision can read from 20 feet. A client with a visual acuity of 20/60 only can read at a distance of 20 feet of what a person with normal vision can read at 60 feet.
The clinic nurse is preparing to test the visual acuity of a client using a Snellen's chart. Which of the following identifies the accurate procedure for this visual acuity test? -Both eyes are assessed together, followed by the assessment of the right and then the left eye. -The right eye is tested followed by the left eye, and then both eyes are tested. -The client is asked to stand at a distance of 40ft. from the chart and is asked to read the largest line on the chart. -The client is asked to stand at a distance of 40ft from the chart and to read the line than can be read 200 ft away by an individual with unimpaired vision.
Visual acuity is assessed in one eye at a time, and then in both eyes together with the client comfortably standing or sitting. The right eye is tested with the left eye covered; then the left eye is tested with the right eye covered. Both eyes then are tested together. Visual acuity is measured with or without corrective lenses and the client stands at a distance of 20ft. from the chart.
The nurse is performing an assessment in a client with a suspected diagnosis of cataract. The chief clinical manifestation that the nurse would expect to note in the early stages of cataract formation is: Eye pain Floating spots Blurred vision Diplopia
gradual, painless blurring of central vision is the chief clinical manifestation of a cataract. Early symptoms include slightly blurred vision and a decrease in color perception.