Semester 2 nursing - Glaucoma

Which finding related to primary open-angle glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report? A-Absence of pain or pressure B-Blurred vision in the morning C- Seeing colored halos around lights D-Eye pain accompanied with nausea and vomiting

A-Absence of pain or pressure Primary open-angle glaucoma is typically symptom free, which explains why patients can have significant vision loss before a diagnosis is made unless regular eye examinations are being performed. Primary angle-closure glaucoma manifestations include sudden, excruciating pain in or around the eye, seeing colored halos around lights, and nausea and vomiting.

13. A patient with glaucoma who has been using timolol (Timoptic) drops for several days tells the nurse that the eyedrops cause eye burning and visual blurriness for a short time after administration. The best response to the patient's statement is a. "These are normal side effects of the drug, which should become less noticeable with time." b. "If you occlude the puncta after you administer the drops, it will help relieve these side effects." c. "The drops are uncomfortable, but it is very important for you to use them as prescribed to retain your vision." d. "These symptoms are caused by glaucoma and may indicate a need for an increased dosage of the eyedrops."

ANS: C Patients should be instructed that eye discomfort and visual blurring are expected side effects of the ophthalmic drops but that the drops must be used to prevent further visual-field loss. The temporary burning and visual blurriness might not lessen with ongoing use, are not relieved by avoiding systemic absorption, and are not symptoms of glaucoma.

When administering a scheduled dose of pilocarpine, in which area should the nurse place the drops? A- Inner canthus B- Outer canthus C- Center of the eyeball D- Lower conjunctival sac

D- Lower conjunctival sac Ocular medications such as pilocarpine should be instilled into the lower conjunctival sac. Never apply eye drops directly to the cornea. Applying the drops to the inner canthus will cause them to be distributed systemically.

The nurse instructs a patient prescribed dipivefrin eye drops to manage chronic open-angle glaucoma. Which statement, if made by the patient to the nurse, indicates that further teaching is needed? A-"The eye drops could cause a fast heart rate and high blood pressure." B-"I will need to take the eye drops twice a day for at least 2 to 3 months." C-"I may experience eye discomfort and redness from the use of these eye drops." D-"I will apply gentle pressure on the inside corner of my eye after each eye drop."

D-"I will apply gentle pressure on the inside corner of my eye after each eye drop." To avoid systemic reactions such as tachycardia and hypertension, the patient should apply punctual occlusion after instillation of the eye drops. Dipivefrin will control chronic open-angle glaucoma but will not cure the disease. Side effects associated with dipivefrin include ocular discomfort and redness, tachycardia, and hypertension.

The nurse is teaching a patient with glaucoma about administration of pilocarpine. What statement is important for the nurse to include during the instructions? A-"Prolonged eye irritation is an expected adverse effect of this medication." B-"This medication will help to raise intraocular pressure to a near normal level." C-"This medication needs to be continued for at least 5 years after your initial diagnosis." D-"It is important not to do activities requiring visual acuity immediately after administration."

D-"It is important not to do activities requiring visual acuity immediately after administration." Pilocarpine causes blurred vision and difficulty in focusing, so it is important not to engage in any activities requiring visual acuity until the vision clears. It should not cause prolonged eye irritation, and this should be immediately reported to the prescribing care provider. This medication will decrease intraocular pressure.

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? A-Decrease fluid intake to control the intraocular pressure B-Avoid overuse of the eyes C-Decrease the amount of salt in the diet D-Eye medications will need to be administered lifelong.

D-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.

A client with glaucoma asks the nurse if complete vision will return. The nurse makes whichresponse to the client? 1. "Although some vision has been lost and cannot be restored, further loss may be prevented byadhering to the treatment plan." 2. "Your vision will return as soon as the medication begins to work." 3. "Your vision will never return to normal." 4. "Your vision loss is temporary and will return in about 3 to 4 weeks."

1. "Although some vision has been lost and cannot be restored, further loss may be prevented byadhering to the treatment plan." Rationale: Vision loss to glaucoma is irreparable. The client needs to be reassured that, althoughsome vision has been lost and cannot be restored, further loss may be prevented by adhering tothe treatment plan. Options 2, 3, and 4 are incorrect.

12. To determine whether treatment is effective for a patient with primary open-angle glaucoma (POAG), the nurse will evaluate the patient for improvement in a. eye pain. b. visual field. c. blurred vision. d. depth perception.

ANS: B POAG develops slowly and without symptoms except for a gradual loss of visual field. Acute closed-angle glaucoma may present with excruciating pain, colored halos, and blurred vision. Problems with depth perception are not associated with POAG.

When developing a teaching session on glaucoma for the community, which of the following statements would the nurse stress? A-Glaucoma is easily corrected with eyeglasses B-White and Asian individuals are at the highest risk for glaucoma. C-Yearly screening for people ages 20-40 years is recommended. D-Glaucoma can be painless and vision may be lost before the person is aware of a problem.

D-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.

A 56 year old client visits the Drs office for a change in vision. The client's vision is blurred with rainbow halos around lights. The nurse suspects glaucoma. Which condition predisposes the client to glaucoma? 1 Obesity 2 Eye trauma 3 head injury 4 severe myopia

Obesity HTN, CVD, DM, and Obesity are associated with the development of glaucoma.

The nurse is preparing to administer eyedrops. Which interventions should the nurse take to administer the drops? Select all that apply 1. Wash hands. 2. Put gloves on. 3. Place the drop in the conjunctival sac. 4. Pull the lower lid down against the cheek bone. 5. Instruct the client to squeeze the eyes shut after instilling the eyedrop. 6. Instruct the client to tilt the head forward, open the eyes, and look down.

1. Wash hands. 2. Put gloves on. 3. Place the drop in the conjunctival sac. 4. Pull the lower lid down against the cheek bone.

A miotic medication has been prescribed for the client with glaucoma. The client asks the nurse about the purpose of the medication. The nurse should tell the client which? 1. "The medication will help dilate the eye to prevent pressure from occurring." 2. "The medication will relax the muscles of the eyes and prevent blurred vision." 3. "The medication causes the pupil to constrict and will lower the pressure in the eye." 4. "The medication will help block the responses that are sent to the muscles in the eye."

3. "The medication causes the pupil to constrict and will lower the pressure in the eye."

A client arrives in the emergency room with a penetrating eye injury caused by wood chipswhile the client was cutting wood. The nurse checks the eye and notes the piece of wood protruding from the eye. The nurse immediately prepares the client for which of the following? 1. Removal of the piece of wood using a sterile eye clamp 2. Application of an eye patch 3. Visual acuity tests 4. Irrigation of the eye with sterile saline

3. Visual acuity tests Rationale: If the laceration is the result of a penetrating injury, an object may be noted protruding from the eye. This object must never be removed except by the ophthalmologist, because it may be holding ocular structures in place. Application of an eye patch or irrigation of the eye may disrupt the foreign body and cause further tearing of the cornea.

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: A 2-7 mmHg B 10-21 mmHg C 22-30 mmHg D 31-35 mmHg

B 10-21 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.

When teaching a patient about the pathophysiology related to open-angle glaucoma, which statement is most appropriate? A-The retinal nerve is damaged by an abnormal increase in the production of aqueous humor." Incorrect B- "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." C-"The lens enlarges with normal aging, pushing the iris forward, which then covers the outflow channels of the eye." D-"There is a decreased flow of aqueous humor into the anterior chamber by the lens of the eye blocking the papillary opening."

B- "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." With primary open-angle glaucoma, there is increased intraocular pressure because the aqueous humor cannot drain from the eye. This leads to damage to the optic nerve over time. Primary angle-closure glaucoma is caused by the lens bulging forward and blocking the flow of aqueous humor into the anterior chamber.

Question patients using eye drops to treat their glaucoma about a. use of corrective lenses. b. their usual sleep pattern. c. a history of heart or lung disease. d. sensitivity to opioids or depressants.

a history of heart or lung disease.

Increased intraocular pressure may occur as a result of a. edema of the corneal stroma. b. dilation of the retinal arterioles. c. blockage of the lacrimal canals and ducts. d. increased production of aqueous humor by the ciliary process.

d. increased production of aqueous humor by the ciliary process.

The client with glaucoma asks the nurse is complete vision will return. The most appropriate response is: A-"Although some vision as been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan." B-"Your vision will return as soon as the medications begin to work." C-"Your vision will never return to normal." D-"Your vision loss is temporary and will return in about 3-4 weeks."

A-"Although some vision as been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan." 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 client sustains a contusion of the eyeball following a traumatic injury with a blunt object.The nurse takes which action immediately? 1. Notifies the physician 2. Irrigates the eye with cool water 3. Applies ice to the affected eye 4. Accompanies the client to the emergency room

3. Applies ice to the affected eye Rationale: Treatment for a contusion begins at the time of injury. Ice is applied immediately.The client should receive a thorough eye examination to rule out the presence of other eyeinjuries. Eye irrigation is not indicated in a contusion. Options 1 and 4 will delay immediatetreatment. Following the application of ice, the physician would be notified.

A client has undergone surgery for glaucoma. The nurse provides which discharge instructions to the client? a) the sutures are removed after 1 week b) wound healing usually takes 12 weeks c) expect that vision will be permanently impaired d) a shield or eye patch should be worn to protect the eye

a shield or eye patch should be worn to protect the eye After ocular surgery, the client should wear an eye patch or eyeglasses for the protection of the eye. Healing takes place in about 6 weeks. When the postoperative inflammation subsides, the client's vision should return to the preoperative level of acuity. Sutures are usually absorbable.

14. A patient who is being admitted to the hospital for abdominal pain and nausea tells the nurse about a history of glaucoma. Which of these prescribed medications should the nurse question? a. morphine sulfate 4 mg IV b. diazepam (Valium) 5 mg IV c. betaxolol (Betoptic) 0.25% eyedrops d. scopolamine patch (Transderm Scop) 1.5 mg

ANS: D Scopolamine is a parasympathetic blocker and will relax the iris, causing blockage of aqueous humor outflow and an increase in intraocular pressure. The other medications are appropriate for this patient.

1. Administer the eyedrop first, followed by the eye ointment. 2. Administer the eye ointment first, followed by the eyedrop. 3. Administer the eyedrop, wait 15 minutes, and administer the eye ointment. 4. Administer the eye ointment, wait 15 minutes, and administer the eyedrop.

Administer the eyedrop first, followed by the eye ointment

The nurse is teaching a patient about timolol eye drops for the treatment of glaucoma. What statement made by the patient demonstrates that teaching was effective? A-"I may feel some palpitations after instilling these eye drops." B-"I should withhold this medication if my blood pressure becomes elevated." C-"I should keep my eyes closed for 15 minutes after instilling these eye drops." D-"I may have some temporary blurring of vision after instilling these eye drops."

D-"I may have some temporary blurring of vision after instilling these eye drops." It is common for patients to have a temporary blurring of vision for a few minutes after instilling eye drops. This should not cause concern to the patient. Because timolol is a β-blocker, heart rate may slow, and blood pressure is more likely to decrease if absorbed systemically.

Which of the following instruments is used to record intraocular pressure? A-Goniometer B-Ophthalmoscope C-Slit lamp D-Tonometer

D-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.

A client with glaucoma has partial vision loss and is angry that his vision has not returned after being treated for glaucoma. he states that he has faithfully put eye drops in his eyes as ordered, yet it has not helped. What is the nurses response? 1- I know you are angry with the lack of improvement in your vision from the eye drops, however, the eye drops could prevent further deterioration

I know you are angry with the lack of improvement in your vision from the eye drops, however, the eye drops could prevent further deterioration Vision loss to glaucoma is irreparable and even with the most aggressive medical or surgical intervention, vision loss may progress

9. In reviewing a 50-year-old patient's medical record, the nurse notes that the last eye examination revealed an intraocular pressure of 28 mm Hg. The nurse will plan to assess a.visual acuity. b.pupil reaction. c.color perception. d.peripheral vision

ANS: D The patient's increased intraocular pressure indicates glaucoma, which decreases peripheral vision. Because central visual acuity is unchanged by glaucoma, assessment of visual acuity could be normal even if the patient has worsening glaucoma. Color perception and pupil reaction to light are not affected by glaucoma.

The patient informs the nurse that he has a "sty" that has been present for some time on the upper eyelid and reports using warm moist compresses with no improvement. What is the best response by the nurse? A-"Go to the pharmacy to get some eye drops." B-"Come in so the ophthalmologist can assess the lesion." C-"The health care provider will need to inject it with an antibiotic." D-"Wash the eyelid margins with baby shampoo to remove the crusting."

B-"Come in so the ophthalmologist can assess the lesion." A chalazion may evolve from a "sty" or hordeolum as it did for this patient. Initial treatment is with warm compresses, but when they are ineffective, the lesion may be surgically removed or injected with corticosteroids. Washing the eyelid margins with baby shampoo is done with blepharitis.

When planning care for a patient with disturbed sensory perception related to increased intraocular pressure caused by primary open-angle glaucoma, what nursing action would be a priority? A-Recognizing that eye damage caused by glaucoma can be reversed in the early stages B-Giving anticipatory guidance about the eventual loss of central vision that will occur C- Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision D-Managing the pain experienced by patients with glaucoma that persists until the optic nerve atrophies

C- Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision Drug therapy is necessary to prevent the eventual vision loss that may occur as a consequence of glaucoma. For this reason, encourage the patient to remain compliant with drug therapy.

The nurse is preparing to administer timolol eye drops for treatment of glaucoma. What statement made by the patient would cause the nurse to hold the medication and report to the health care provider? A-"I have sinusitis." B-"I have migraine headaches a lot." C-"I have chronic obstructive pulmonary disease." D-"I have a history of chronic urinary tract infections."

C-"I have chronic obstructive pulmonary disease." Timolol is a nonselective β-adrenergic blocker that could lead to bronchoconstriction and bronchospasm. For this reason, it should not be used in patients with COPD. Timolol may be used to treat migraine headaches, and it does not affect sinusitis or chronic urinary tract infections.

A client is diagnosed with glaucoma. Which data gathered by the nurse indicate a risk factor associated with glaucoma? 1. A history of migraine headaches 2. Frequent urinary tract infections 3. Cardiovascular disease 4. Frequent upper respiratory infections

Cardiovascular disease Hypertension, cardiovascular disease, diabetes mellitus, and obesity are associatedwith the development of glaucoma. Smoking, ingestion of caffeine or large amounts alcohol,illicit drugs, corticosteroids, altered hormone levels, posture, and eye movements may causevarying transient increases in intraocular pressure