Chapter 63: Vision

A patient is brought into the emergency department with chemical burns to both eyes. What is the priority action of the nurse for this patient's care? a) Flushing the lids, conjunctiva, and cornea with tap water or normal saline b) Cleansing the conjunctiva with a small cotton-tipped applicator c) Applying hot compresses at 15-minute intervals d) Administering local anesthetics and antibacterial drops for 24 to 36 hours

a) Flushing the lids, conjunctiva, and cornea with tap water or normal saline With a chemical burn, the eye should be immediately irrigated with tap water or normal saline. The corneal surfaces and conjunctival fornices are immediately and copiously irrigated with normal saline or any neutral solution.

A patient presents to the ED complaining of a chemical burn to both eyes. Which of the following is the priority nursing intervention? a) Irrigate both eyes. b) Assess visual acuity. c) Assess the pH of the corneal surface. d) Obtain the Material Safety Data Sheet (MSDS).

a) Irrigate both eyes. The eyes should immediately be irrigated to remove the chemical and preserve the eye. If the chemical is allowed to remain on the eye surface, it may cause ulcerations and permanent damage to the eye. It is appropriate to obtain the MSDS and assess the pH of the corneal surface after irrigation has begun. Irrigation should continue until the pH normalizes. Visual acuity can be assessed once the emergent phase is over.

A colleague has been splashed in the eye with cleaning solution. Which of the following would be the priority? a) Irrigating the eye immediately with tap water b) Finding out what the substance was c) Covering the eye with a clean sterile dressing d) Instilling a local anesthetic into the eye

a) Irrigating the eye immediately with tap water With any ocular burn, the priority is to irrigate the eye with tap water immediately. While or after this is done, information about the substance can be obtained. A local anesthetic is instilled, particulate matter is removed, and irrigation continues until the pH normalizes. Then antibiotics are instilled and the eye is patched.

A client accidentally splashes chemicals into one eye. The nurse knows that eye irrigation with plain tap water should begin immediately and continue for 15 to 20 minutes. What is the primary purpose of this first-aid treatment? a) To prevent vision loss b) To eliminate the need for medical care c) To serve as a stopgap measure until help arrives d) To hasten formation of scar tissue

a) To prevent vision loss Prolonged eye irrigation after a chemical burn is the most effective way to prevent formation of permanent scar tissue and thus help prevent vision loss. After a potentially serious eye injury, the victim should always seek medical care. Eye irrigation isn't considered a stopgap measure.

When assessing the pressure of the anterior chamber of the eye, a nurse normally expects to find a pressure of: a) over 30 mm Hg. b) 10 to 20 mm Hg. c) 20 to 30 mm Hg. d) 5 to 10 mm Hg.

b) 10 to 20 mm Hg. Normally, pressure in the anterior chamber of the eye remains relatively constant at 10 to 20 mm Hg.

A nurse conducted a history and physical for a newly admitted patient who states, "My arms are too short. I have to hold my book at a distance to read." The nurse knows that the patient is most likely experiencing: a) Opacity in the lens. b) Loss of accommodative power in the lens. c) Decreased eye muscle tone. d) Shrinkage of the vitreous body.

b) Loss of accommodative power in the lens. Presbyopia is a refractive change that occurs with age. The lens of the eye loses accommodative power. Opacity in the lens indicates a cataract.

A 52-year-old woman comes to the clinic for a follow-up examination after being diagnosed with glaucoma. The client states, "I'm hoping that I don't have to use these drops for very long." Which response by the nurse would be most appropriate? a) "Most clients need to use the drops for only about a few months." b) "These drops are just the first step to make sure that your vision doesn't get worse." c) "You'll need to use the drops for the rest of your life to control the glaucoma." d) "If the drops don't work, surgery may be needed to cure your condition."

c) "You'll need to use the drops for the rest of your life to control the glaucoma." The client is demonstrating a lack of understanding about the condition and its treatment. The nurse needs to provide additional information to the client that the condition can be controlled but not cured. The statement about lifelong therapy would be most appropriate. Eye medications would most likely be needed for the long term, not just a few months. Surgery may be used in conjunction with medication therapy; however, neither method cures the condition. The goal of therapy is to reduce the intraocular pressure to prevent optic nerve damage. In some clients, medication may be all that is needed. In other cases, additional or combination treatment with surgery or laser procedures may be necessary.

A major role for nursing in the management of glaucoma is health education. Which of the following is the most important teaching point that the nurse should advise the patient of? a) Keep all follow-up appointments. b) Keep a record of eye pressure measurements. c) Adhere to the medication regimen. d) Participate in the decision-making process.

c) Adhere to the medication regimen. All of the teaching points are important but the most important is emphasizing the strict adherence to the medication regimen because glaucoma cannot be cured but its progression can be slowed.

What patient activity indicates to the nurse that a patient understands how to correctly instill ophthalmic medications? a) Client rubs the eye after administering medication. b) Client allows the tip of the container to touch the eyelid while administering the medication. c) Client pulls the tissue near the cheek downward to instill medication. d) Client wipes the lids and lashes prior to instillation in a direction toward the nose with moistened, soft gauze.

c) Client pulls the tissue near the cheek downward to instill medication. Pull the cheek downward to form a sack in the lower lid. Instill the drops into the conjunctival pocket. The lid and lashes would be wiped in a direction away from the nose to avoid contamination. The tip of the container will be contaminated if it touches eye or eyelid. Do not rub the eye because it may irritate the eye.

Which of the following is an accurate statement regarding refractive surgery? a) Refractive surgery will alter the normal aging of the eye. b) Refractive surgery may be performed on all patients, even if they have underlying health conditions. c) Refractive surgery is an elective, cosmetic surgery performed to reshape the cornea. d) Refractive surgery may be performed on patients with an abnormal corneal structure as long as they have a stable refractive error.

c) Refractive surgery is an elective, cosmetic surgery performed to reshape the cornea. Refractive surgery is an elective procedure and is considered a cosmetic procedure (to achieve clear vision without the aid of prosthetic devices). It is performed to reshape the cornea for the purpose of correction of all refractive errors. Refractive surgery will not alter the normal aging process of the eye. Patients with conditions that are likely to adversely affect corneal wound healing (corticosteroid use, immunosuppression, elevated intraocular pressure) are not good candidates for the procedure. The corneal structure must be normal and the refractive error stable.

The nurse is assessing an older client's vision. The nurse integrates knowledge of which of the following during the assessment? a) Increased fat will be around the orbit. b) The depth of the eyeball will be increased, leading to myopia. c) The power of the lens to accommodate will be decreased. d) The skin around the eyes will be more elastic.

c) The power of the lens to accommodate will be decreased. In the older adult, the accommodative power of the lens decreases, resulting in the need to hold reading materials at increasing distances to focus. Orbital fat and skin elasticity decrease. The depth of the eyeball does not change with age.

The nurse is giving a visual field examination to a 55-year-old male client. The client asks what this test is for. What would be the nurse's best answer? a) "This test measures visual acuity." b) "This test measures how well your eyes move." c) "This test is to see how well your eyes are aging." d) "This test measures peripheral vision and detects gaps in the visual field."

d) "This test measures peripheral vision and detects gaps in the visual field." A visual field examination or perimetry test measures peripheral vision and detects gaps in the visual field. Therefore options A, B, and C are incorrect.

A nurse practitioner examines the fundus of the eye using direct ophthalmoscopy and notes a yellow lipid in the retina. What is this indicative of? a) Intraretinal hemorrhage b) Macular degeneration c) Hypertension d) Diabetes

d) Diabetes A yellow lipid is indicative of hypercholesterolemia or diabetes. Hypertension is associated with intraretinal hemorrhages. Macular degeneration is suspected when drusen is present.

The nurse at the eye clinic is caring for a patient with suspected glaucoma. What complaint would be significant for a diagnosis of glaucoma? a) Diminished acuity b) Pain associated with a purulent discharge c) A significant loss of central vision d) The presence of halos around lights

d) The presence of halos around lights Glaucoma is often called the "silent thief of sight" because most patients are unaware that they have the disease until they have experienced visual changes and vision loss. The patient may not seek health care until he or she experiences blurred vision or "halos" around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around the eyes, and headache.