Med Surg 3 ATI ch 12

Diagnostic procedures for macular degeneration are?

Ophthalmoscopy and visual acuity tests

Primary angle-closure glaucoma is?

IOP rises suddenly. The angle between the iris and the sclera suddenly closes, causing a corresponding increase in IOP. The onset is sudden and requires immediate treatment.

MEDICATIONS The priority intervention for treating glaucoma is medication therapy. IV mannitol is?

IV mannitol is an osmotic diuretic used in the emergency treatment for primary angle-closure glaucoma to quickly decrease IOP.

cataracts complications infection

Infection ● Infection can occur after surgery. ● CLIENT EDUCATION: Manifestations of infection that the client should report include yellow or green drainage, increased redness or pain, reduction in visual acuity, increased tear production, and photophobia.

THERAPEUTIC PROCEDURES Glaucoma surgery

Laser trabeculectomy, iridotomy, or the placement of ashunt are procedures used to improve the flow of theaqueous humor by opening a channel out of the anterior chamber of the eye.

Glaucoma DIAGNOSTIC PROCEDURES Tonometry:

Measures IOP (expected reference range is 10 to 21 mm Hg). IOP is elevated with glaucoma, especially angle-closure.

Glaucoma DIAGNOSTIC PROCEDURES Visual Assessments:

Measures decrease in visual acuity and peripheral vision

common causes of cataracts complicated

intraocular disease such as retinitis pigmentosa, glaucoma, or retinal detachment

what type of vision loss is macular degeneration?

is the CENTRAL loss of vision that affects the macula of the eye.

common causes of cataracts toxic

long term use of corticosteroids, phenothiazine derivatives, beta blockers, or miotic medications

Primary open‐angle glaucoma (POAG) is?

more common form. Open-angle refers to the angle between the iris and sclera. The aqueous humor outflow is decreased due to blockages in the eye's drainage system (Canal of Schlemm and trabecular meshwork), causing a gradual rise in IOP.

what causes wet macular degeneration?

new growth of blood vessels that have thin walls that leak blood and fluid

AMD is a common cause of vision loss in?

older adults

Glaucoma INTERPROFESSIONAL CARE if surgery is necessary, refer to an?

ophthalmologist

what is another name for a eye surgeon?

ophthalmologist

DRY MACULAR DEGENERATION what is the result of a gradual blockage in retinal capillary arteries

results in the macula becoming ischemic and necrotic due to the lack of retinal cells

what is a visual acuity test?

snellen and Rosenbaum eye charts used as a diagnostic procedure for macular degeneration

Therapeutic procedures for cataracts

surgical removal of the lens A small incision is made, and the lens is either removed in one piece, or in several pieces, after being broken up using sound waves. The posterior capsule is retained. A replacement or intraocular lens is inserted. Replacement lenses can correct refractive errors, resulting in improved vision

what is the less common form of macular degeneration?

wet macular degeneration

RISK FACTORS for Glaucoma

● Age ● Infection ● Tumors ● Diabetes mellitus ● Genetic predisposition ● Hypertension ● Eye trauma

Risk factors for getting cataracts?

-Advanced age -diabetes -heredity -smoking -eye trauma -excessive exposure to the sun -chronic corticosteroid use

HEALTH PROMOTION AND DISEASE PREVENTION for Glaucoma

-Encourage annual eye examinations and good eye health, especially adults over the age of 40. -Educate clients about the disease process and early indications of glaucoma, such as reduced vision and mild eye pain.

There are two primary types of glaucoma.

-Primary open‐angle glaucoma (POAG) -Primary angle-closure glaucoma

health promotion and disease prevention for cataracts?

-Teach clients to wear sunglasses while outside. -Educate clients to wear protective eyewear while playing sports and performing hazardous activities, such as welding and yard work. -Encourage annual eye examinations and good eye health, especially in adults over the age of 40.

what are some common causes of cataracts?

-age related -traumatic -toxic -associated -complicated

expected findings with macular degeneration

-lack of DEPTH perception -objects appear distorted -BLURRED vision -loss of CENTRAL vision -blindness

what are the risk factors for dry macular degeneration?

-smoking -hypertension -female -short body stature -family history -diet lacking carotene and vitamin E

Glaucoma The expected reference range for IOP (inter ocular phase) is

10 to 21 mm/Hg.

Is there a cure for macular degeneration?

NO

what is a cataract?

A cataract is an opacity in the lens of an eye that impairs vision.

A nurse is caring for an older adult client who has diabetes mellitus and reports a gradual loss of peripheral vision. The nurse should recognize this as a manifestation of which of the following diseases? A. Cataracts B. Open‐angle glaucoma C. Macular degeneration D. Angle‐closure glaucoma

A. A client who has cataracts experiences a decrease in peripheral and central vision due to opacity of the lens. B. CORRECT: This is a manifestation of open‐angle glaucoma. A gradual loss of peripheral vision is a manifestation associated with this diagnosis. C. A client who has macular degeneration experiences a loss of central vision. D. A client who has angle‐closure glaucoma experiences sudden nausea and severe pain and halos around lights.

A nurse is providing teaching for a client who has a new diagnosis of dry macular degeneration. Which of the following instructions should the nurse include in the teaching? A. Increase intake of deep yellow and orange vegetables. B. Administer eye drops twice daily. C. Avoid bending at the waist. D. Wear an eye patch at night.

A. CORRECT: The nurse should instruct the client to increase dietary intake of carotenoids and antioxidants to slow the progression of the macular degeneration. B. A client who has primary open‐angle glaucoma should administer eye drops twice daily. C. A client who is at risk for increased intraocular pressure, such as following cataract surgery, should avoid bending at the waist. D. A client who has had eye surgery, such as cataract surgery, should wear an eye patch at night to protect the eye from injury.

A nurse is caring for a clientwho has a new diagnosis of cataracts. Which of the following manifestations should the nurse expect? (Select all that apply.) A.Eye pain B.Floating spots C.Blurred vision D.White pupils E.Bilateral red reflexes

A. Eye pain is manifestation associated with primary angle‐closure glaucoma. B. Floating spots are a manifestation associated with retinal detachment. C. CORRECT: Blurred vision is a manifestation associated with cataracts. D. CORRECT: White pupils are a manifestation associated with cataracts. E. Bilateral red reflexes are absent in a client who has cataracts.

A nurse is caring for a male older adult client who has a new diagnosis of glaucoma. Which of the following should the nurse recognize asrisk factors associated with this disease? (Select all that apply.) A. Gender B. Genetic predisposition C. Hypertension D. Age E. Diabetes mellitus

A. Gender is not a risk factor associated with glaucoma. B. CORRECT: Genetic predisposition is a risk factor associated with glaucoma. C. CORRECT: Hypertension is a risk factor associated with glaucoma. D. CORRECT: Age is a risk factor associated with glaucoma. E. CORRECT: Diabetes mellitus is a risk factor associated with glaucoma.

A nurse is providing postoperative teaching to a client following cataract surgery. Which of the following statements should the nurse include in the teaching? A. "you can resume playing golf in 2 days." B. "you need to tilt your head back when washing your hair." C."you can get water in your eyes in 1 day." D."you need to limit your housekeeping activities."

A. The nurse should not instruct the client to resume playing golf for several weeks. This could cause a rise in intraocular pressure (IOP) or possible injury to the eye. B. The nurse should not instruct the client to tilt his head back when washing his hair. This could cause a rise in IOP or possible injury to the eye. C. The client should not get water in his eyes for 3 to 7 days following cataract surgery to reduce the risk for infection and promote healing. D. CORRECT: The nurse should instruct the client to limit housekeeping activities following cataract surgery. This activity could cause a rise in IOP or injury to the eye.

what is a ophthalmoscopy?

An ophthalmoscope is used to examine the back part of the eyeball (fundus), including the retina, optic disc, macula, and blood vessels. used as a diagnostic procedure for macular degeneration

Medications for cataracts

Anticholinergic agents (atropine 1% ophthalmic solution): This medication prevents pupil constriction for prolonged periods of time (mydriasis) and relaxes muscles in the eye (cycloplegia). It is used to dilate the eye preoperatively and for visualization of the eye's internal structures.

MEDICATIONS The priority intervention for treating glaucoma is medication therapy. Carbonic anhydrase inhibitors (acetazolamide, dorzolamide, and brinzolamide) Nursing Considerations?

Ask clients whether they are allergic to sulfa. Carbonic anhydrase inhibitors are sulfa-based.

DIAGNOSTIC PROCEDURES Cataracts

Cataracts can be determined upon examination of the lens using an ophthalmoscope.

MEDICATIONS The priority intervention for treating glaucoma is medication therapy. Beta‐blockers (timolol) is?

Beta-blockers are first-line drug therapy for glaucoma,and decrease IOP by reducing aqueous humor production.

cataracts complications bleeding

Bleeding is a potential risk several days following surgery. CLIENT EDUCATION: Clients should immediately report any sudden change in visual acuity or an increasein pain.

Glaucoma COMPLICATIONS

Blindness is a potential consequence of untreated glaucoma.

MEDICATIONS The priority intervention for treating glaucoma is medication therapy. Beta‐blockers (timolol) nursing considerations

Can be absorbed systemically and cause bronchoconstriction and hypoglycemia. Use with caution in clients who have asthma, COPD, anddiabetes mellitus. Can potentiate systemic effects of oralbeta-blockers and cause bradycardia and hypotension.

INTERPROFESSIONAL CARE for cataracts

Consult with an ophthalmologist (eye surgeon) for cataract surgery.

Glaucoma is a

Glaucoma is a disturbance of the functional or structuralintegrity of the optic nerve.

MEDICATIONS The priority intervention for treating glaucoma is medication therapy. Carbonic anhydrase inhibitors (acetazolamide, dorzolamide, and brinzolamide) is?

Decrease IOP by reducing aqueous humor production.

THERAPEUTIC PROCEDURES Glaucoma surgery Nursing Actions?

Educate clients about the disease and importance of adhering to the medication schedule to treat IOP.

Glaucoma COMPLICATIONS CLIENT EDUCATION:

Encourage adults 40 or older to have an annual examination, including a measurement of IOP.

MEDICATIONSThe priority intervention for treating glaucoma is medication therapy. Pilocarpine ophthalmic solution is?

Pilocarpine is a miotic medication, which constricts the pupil and allows for improved circulation and out flow of the aqueous humor. Miotics can cause blurred vision. Pilocarpine is considered a second-line drug for POAG.

Glaucoma CLIENT EDUCATION

Set up services such as community outreach programs, meals on wheels, and services for the blind.

Medications for cataracts NURSING CONSIDERATIONS:

The medication has a long duration, but a fast onset.

Glaucoma DIAGNOSTIC PROCEDURES Gonioscopy:

Used to determine the drainage angle of the anterior chamber of the eyes.

Macular degeneration is often called?

age-related macular degeneration (AMD)

Glaucoma is a frequent cause of

blindness. -Early diagnosis and treatment is essential in preventing vision loss from glaucoma.

common causes of cataracts traumatic

blunt or penetrating injury or foreign body in the eye, exposure to radiation or ultra violet light

Miotics can cause

blurred vision. Pilocarpine is considered a second-line drug for POAG.

PATIENT‐CENTERED CARE NURSING CARE with CATARACTS

● Check visual acuity using the Snellen chart. ● Examine external and internal eye structures usingan ophthalmoscope. ● Determine the client's functional capacity due todecreased vision .● Increase the amount of light in a room. ● Provide adaptive devices that accommodate forreduced vision. ◯ Magnifying lens and large print books/newspapers ◯ Talking devices, such as clocks

expected findings with cataracts

● Decreased visual acuity (prescription changes, reduced night vision, decreased color perception) ● Blurred vision ● Diplopia (double vision)

what are the risk factors for wet macular degeneration?

can occur at any age

what causes dry macular degeneration?

caused by a gradual blockage in retinal capillary arteries

common causes of cataracts associated

diabetes mellitus, hypoparathyroidism, down syndrome, chronic sunlight exposure.

what is the most common macular degeneration?

dry macular degeneration

common causes of cataracts age-ralated

drying of lens due to water loss; increase in lens density due to lens fiber compaction

client education for macular degeneration?

● Encourage clients to consume foods high in antioxidants, carotene, and vitamins E and B12. The provider may prescribe a daily supplement high in carotene and vitamin E. ● As loss of vision progresses, clients will be challenged with the ability to eat, drive, write, and read, as well as other activities of daily living. ● Refer clients to community organizations that can assist with transportation, reading devices, and large-print books.

EXPECTED FINDINGS Primary open‐angle glaucoma

● Headache ● Mild eye pain ● Loss of peripheral vision ● Decreased accommodation ● Halos seen around lights ● Elevated IOP (greater than 21 mm Hg: usually 22 to 32)

Patient centered care for wet macular degeneration?

● Laser therapy to seal leaking blood vessels ● Ocular injections to inhibit blood vessel growth

PATIENT‐CENTERED CARE NURSING CARE for Glaucoma

● Monitor for increased IOP (greater than 21 mm Hg). ● Monitor for decreased vision and light sensitivity. ● Assess for aching or discomfort around the eye. ● Explain the disease process and allow clients to express their feelings. ● Treat severe pain and nausea that accompanies angle-closure glaucoma with analgesics and antiemetics.

MEDICATIONS The priority intervention for treating glaucoma is medication therapy. what are some client teachings?

● Prescribed eye medication is beneficial if used every 12 hr. ● Instill one drop in each eye twice daily. ● Wait 5 to 10 min between eye drops if more than one is prescribed to prevent one medication from diluting another. ● Avoid touching the tip of the application bottle to the eye. ● Always wash hands before and after use. ● Once eye drop is instilled, apply pressure using the punctal occlusion technique (placing pressure on the inner corner of the eye).

-Therapeutic procedures for cataracts -NURSING ACTIONS -Postoperative care should focus on:

● Preventing an increase in intraocular pressure. ● Preventing infection. ● Administering ophthalmic medications. ● Providing pain relief. ● Teaching the client about self-care at home andfall prevention.

expected physical assessment findings with cataracts

● Progressive and painless loss of vision ● Visible opacity ● Absent red reflex

EXPECTED FINDINGS Primary angle‐closure glaucoma

● Rapid onset of elevated IOP (30 mm Hg or higher) ● Decreased or blurred vision ● Colored halos seen around lights ● Pupils nonreactive to light ● Severe pain and nausea ● Photophobia

Medications for cataracts CLIENT EDUCATION

● Remind the client that the effects of the medication canlast 7 to 12 days. ● The medication can cause photosensitivity, so remind the client to wear sunglasses to protect the eyes.

CLIENT EDUCATION for cataracts

● Wear sunglasses while outside or in brightly lit areas. ● Report signs of infection, such as yellow orgreen drainage. ● Avoid activities that increase IOP .◯ Bending over at the waist◯ Sneezing◯ Coughing◯ Straining◯ Head hyperflexion◯ Restrictive clothing, such as tight shirt collars◯ Sexual intercourse● Limit activities.◯ Tilting the head back to wash hair◯ Cooking and housekeeping◯ Rapid, jerky movements, such as vacuuming◯ Driving and operating machinery◯ Playing sports ● Report pain with nausea/vomiting (indications of increased IOP or hemorrhage). ● Best vision is not expected until 4 to 6 weeks following the surgery. ● The client should report if any changes occur,such as lid swelling, decreased vision, bleeding ordischarge, sharp sudden eye pain, flashes of light, or floating shapes.

THERAPEUTIC PROCEDURES Glaucoma surgery Client Education?

● Wear sunglasses while outside or in brightly lit areas. ● Report signs of infection, such as yellow orgreen drainage. ● Avoid activities that increase IOP.◯ Bending over at the waist◯ Sneezing◯ Coughing◯ Straining◯ Head hyperflexion◯ Restrictive clothing, such as tight shirt collars◯ Sexual intercourse ● Clients should not lie on the operative side and should report severe pain or nausea (possible hemorrhage). ● Clients should report if any changes occur, such as lid swelling, decreased vision, bleeding or discharge, a sharp, sudden pain in the eye and/or flashes of light or floating shapes. ● Limit activities. ◯ Tilting head back to wash hair◯ Cooking and housekeeping◯ Rapid, jerky movements, such as vacuuming◯ Driving and operating machinery◯ Playing sports ● Report pain with nausea/vomiting (indications of increased IOP or hemorrhage) .● Final best vision is not expected until 4 to 6 weeks after surgery.