H.A. ch. 11 eyes

lid retraction & exophthalmos

-a wide-eyes stare suggests retracted eyelids. retracted lids & a lid lag are often due to hyperthyroidism -the eyeball protrudes forward. when bilateral, it suggests the infiltrative ophthalmopathy of Grave hyperthyroidism. edema of the eyelids & conjunctival injection may be associated. unilateral exophthalmos is seen in Graves dz or a tumor or inflammation in the orbit

cataracts

-opacities of the lenses visible through the pupil; most common in old age -nuclear cataract: looks gray when seen by a flashlight. if the pupil is widely dilated, the gray opacity is surrounded by a black rim

what systemic dzs may cause nodular episcleritis

-systemic lupus erythematosus -rheumatoid arthritis

a pt in the clinic where you work is considered legally blind. the nurse knows that this means the vision is in his better eye, corrected by glasses, is what?

20/200 or less

pinguecula

a harmless yellowish triangular nodule in the bulbar conjunctiva on either side of the iris. appears frequently with aging, first on the nasal & then on the temporal side

episcleritis

a localized ocular redness from inflammation of the episcleral vessels. vessels appear pink & are moveable over the scleral surface. may be nodular, or may show only redness & dilated vessels

sty (hordeolum)

a painful, tender red infxn in a gland at the margin of the eyelid

Chalazion

a subacute nontender & usually painless nodule involving a meibomian gland. may become acutely inflamed but, unlike a sty, usually points inside the lid rather than on the lid margin

corneal arcus

a thin grayish white arc or circle not quite at the edge of the cornea. accompanies normal aging but also seen in younger people, esp. African Americans. in young people, suggests possible hyperlipoproteinemia. usually benign

pterygium

a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side. reddening may occur. may interfere with vision as it encroaches on the pupil

what are you testing when you ask the pt to follow your finger or pencil as you move it in toward the bridge of the nose?

convergence -converging eyes normally follow the object within 5-8 cm of the nose

ptosis

drooping of the upper lid. causes include myasthenia gravis, damage to the oculomotor nerve, & damage to the sympathetic nerve supply (Horner syndrome). a weakened muscle, relaxed tissues, & the weight of herniated fat may cause senile ptosis. Ptosis may also be congenital

the nurse observes an inward turning of the lower lid in a 77-yr-old pt. the nurse documents

entropion

what is a characteristic of graves hyperthyroidism?

exophthalmos -eyeballs protruding forward

a pt has conjunctivitis. the nurse understands that conjunctivitis differs from conjunctival hemorrhage in that conjunctivitis..

has a watery, mucoid discharge

what is vital in maintaining vision & a healthy outlook for pts?

health education

the nurse is using the ophthalmoscope to examine the pts eyes. the nurse hold the scope

in the right hand for the right eye & in the left hand for the left eye

you are assessing visual fields on a pt newly admitted for eye surgery. the pts left eye repeatedly does not see your fingers until they have crossed the line of gaze. you would document that the pt has what?

left temporal hemianopsia

a pt complains of feeling like he is slowly losing his central vision. the nurse knows this symptom could represent

macular degeneration

when examining the eye w/ an ophthalmoscope, where would the nurse look to visualize the optic disc?

medially toward the nose -follow the blood vessels as they get wider -follow vessels medially toward the nose & look for the round yellowish orange structure which is the optic disc

what are the glands that are located on the tarsal plates & open on the lid margins?

meibomian glands

entropion

more common in the elderly; an inward turning of the lid margin. the lower lashes, which are often visible when turned inward, irritate the conjunctiva & lower cornea. asking the pt to squeeze the lids together & then open them may reveal an entropion that is not obvious

you not anterior bulging of the physiologic cup when performing a funduscopic exam of the pts eyes. what would you document?

papilledema -swelling of the optic disc & anterior bulging of the physiologic cup

xanthelasma

slightly raised, yellowish, well-circumscribed plaques that appear along the nasal portions of one or both eyelids. may accompany lipid disorders

corneal sac

superficial grayish white opacity in the cornea, secondary to an old injury or to inflammation. size & shape are variable. do not confuse with the opaque lens of a cataract, visible on a deeper plane & only through the pupil

inflammation of the lacrimal sac (dacryocystitis)

swelling between the lower eyelid & nose. a acute inflammation is painful, red & tender. chronic inflammation is associated with obstruction of the nasolacrimal duct. tearing is prominent & pressure on the sac produces regurgitation of material through the puncta of the eyelids

ectropion

the margin of the lower lid is turned outward, exposing the palpebral conjunctiva. when the punctum of the lower lid turns outward, the eye no longer drains satisfactorily & tearing occurs. more common in the elderly

what is the primary purpose of the health history in relation to the eyes?

to identify changes

T/F; a parent is very upset because she is told her child has a refractive error. the nurse reassures the parent that refractive errors are the most common visual change in children

true

T/F; the nurse tests the six cardinal directions to test extraocular movement of the eye

true

the nurse notes that the ophthalmologist suspects death of the optic nerve. when looking into the eye, the nurse would expect to see what color is the disc is dead?

white