NURS 267: Ch. 13

A 52-year-old patient with myopia calls the ophthalmology clinic very upset. She tells the nurse, "I keep seeing semi-clear spots floating across my vision. What is wrong with me?" What would be the most appropriate response by the nurse?

"It is not an uncommon finding in people older than 40 years of age for this to happen. They are called 'floaters'."

A patient comes to the clinic, reporting that he woke up this morning with a painful right eye. What would be the most appropriate response from the nurse?

"You will need to see the doctor to have you eye checked out"

Which of the following scores for distance vision indicates the patient with the poorest vision?

20/100

Which of the following patients would require immediate nursing care?

A 20-year-old man with sudden visual loss after playing football

This person can read at about 6 m (20 ft.) what the normal person can read at about 6 m (20 ft.).

A patient with 20/20 vision

Which of the following teaching points would the nurse emphasize related to eye health

Always wear eye protection for occupational exposures

the use of protective eyewear for contact sports and occupational exposure.

An important health promotion activity

Reduce blindness and visual impairment in children and teens 17 years and younger

Assess for family history of blindness or visual impairment

Reduce occupational eye injury and increase the use of appropriate personal protective eyewear in recreational activities and hazardous situations around the home

Assess with each patient the use of safety equipment in occupational settings

Allows you to detect muscle defects that cause misalignment or uncoordinated eye movements

Cardinal fields of gaze

Covers the recessed portion of the eye

Choroid

Contains the muscle that controls the shape of the lens

Ciliary body

vision include pain, trauma, visual change, blind spots, floaters, halos, discharge, and a related change in ADLs.

Common symptoms related to the eye and vision

include being nearsighted or farsighted, astigmatism, ptosis, and nystagmus.

Common unexpected findings

Peripheral vision is evaluated by the nurse using the

Confrontation test

Is transparent and avascular

Cornea

Tests for strabismus

Corneal light reflex

Test for presence and amount of ocular deiviation

Cover test

include CN II (optic nerve), III (oculomotor), IV (trochlear), and VI (abducens).

Cranial nerves involved with the eyes

A patient asks a nurse if any foods promote eye health. What food would the nurse include as a response?

Deep-water fish

Reduce uncorrected visual impairment due to refractive errors

Discuss with patients the need for vision screens

Increase proportion of adults with diabetes who have an annual clinical eye assessment

Discuss with patients the purpose and need for dilated eye examination to establish the health of the retina

Remove hazards from room, such as razors and matches

Disturbed Sensory Perception

Converse with touch and patient frequently

Disturbed Visual Sensory Perception

Sudden visual loss is an

Emergency

Increase the proportion of public and private schools that require use of appropriate head, face, eye and mouth protection for students participating in school-sponsored physical activities

Emphasize proper eye protection, which can prevent many sports-related eye injuries

Loose and mobile structures that protect the eye from foreign bodies

Eyelids

A patient has been found to have abnormal vision. What would be the nurse's next step?

Facilitate a referral to an ophthalmologist

Which of the following symptoms would the nurse expect the patient to report as translucent specks that drift across the visual field

Floater

(translucent specks that drift across the visual field) common in people older than 40 years of age and nearsighted patients

Floaters

When working with an older adult what would the nurse emphasize as increased risks for the patient?

Glaucoma and cataracts

The cranial nerves involved with eye movement include

III, IV, and VI

Turns the eye upward and abducts and turns the eye laterally

Inferior oblique

Rotates the eye downward and adducts and rotates the eye medially

Inferior rectus

Regulates the amount of light that enters the pupil

Iris

A client frequently experiences dry, irritated eyes. These findings are consistent with a problem in what part of the eye?

Lacrimal apparatus

This protects and lubricates the cornea and conjunctiva by producing and draining tears

Lacrimal apparatus

Moves the eye laterally

Lateral rectus

Refracts and focuses light on to the retina

Lens

The lower eyelid's margin is at the ___________, which is the border between the cornea and sclera

Limbus

Moves the eye medially

Medial rectus

Jerking movement of the eye that can be quick and fluttering or slow and rolling, similar to a tremor

Nystagmus

Cataracts, glaucoma, and macular degeneration are more common in

Older adults

The nurse assesses the response of the eye to light and documents normal findings as

PERRLA

is documented when the pupils are equal, round, and reactive to light and accommodation

PERRLA

Is the almond-shaped open space between the eyelids

Palpebral fissure

often have a decreased ability to accommodate, moving the object further away to read.

Patients older than 40 years of age

Drooping of the eyelids

Ptosis

Permits light to enter the eye

Pupil

Reduce visual impairment due to diabetic retinopathy, glaucoma, and cataracts

Review importance of maintaining blood glucose levels in the normal range to reduce eye damage

Teach patient to clear cords and furniture from pathways, and use good lighting

Risk for injury

Helps to maintain the size and shape of the eye

Sclera

The nurse is caring for a 63-year-old client who can neither read nor speak English. What would be the appropriate chart to use to assess this patient's vision?

Snellen E

A public health nurse is performing annual vision screening for residents in senior housing. Which of the following charts would the nurse most likely be using?

Snellen chart

measure peripheral vision

Static and kinetic confrontation tests

Turns the eye downward and abducts and rotates the eye laterally

Superior oblique

Elevates the eye upward and adducts and rotates the eye medially

Superior rectus

used to assess far vision

The Snellen chart

allows you to detect muscle defects that cause misalignment or uncoordinated movement of the eyes.

The cardinal fields of gaze test

A patient has a nursing diagnosis of disturbed visual sensory perception. Which of the following is the most appropriate outcome for this patient's care planning?

The patient will remain free from harm resulting from a loss of vision

A higher number at the bottom of the recording for the Snellen chart indicates

Worse vision

Assessment of the eye with an ophthalmoscope is considered an

advanced skill

Cloudiness in the lens may indicate a

cataract

is used for near vision

the Jaeger test

The nurse recognizes that the 60-year-old patient may have difficulty reading fine print because of

the loss of accomodation