Disorders of the Eye: Retinal Detachment, Glaucoma, and Cataracts
On assessment, what will the nurse find with angle-closure glaucoma?
pupils are nonreactive to light
Prior to the procedure, the nurse should advise the client to...
rest the eye
What surgical interventions can be performed for a retinal detachment?
scleral buckling retinal rebinding
Signs of hemorrhage in the eye following glaucoma surgery*
severe pain and nausea
What allergy should the nurse assess the client for prior to administration of acetazolamide?
sulfa; it is a sulfa-based medication
What is angle-closure glaucoma?
the angle between the iris and sclera is closed; IOP rises suddenly less common
What is open-angle glaucoma?
the angle between the iris and sclera where the aqueous humor outflow is decreased due to blockages = causing IOP
What is retinal rebinding?
the application of a: diathermy (high frequency current); cryotherapy (freezing probes), or photocoagulation (laser beams) to create an inflammatory response ---> for the retinal attachment
Atropine 1% has a long duration, but a slow onset. What should the nurse advise the client?
the medication takes more than 24 hours to begin working
Why are sound waves used during cataract surgery?
they allow to break up the lens in several peices
Why is atropine 1% used pre-operatively?
to dilate the eye; and visualize the eyes internal structures
What medication is given for retinal detachment?
tobramycin with dextamethasone (antibiotic-steroid combo)
What measures the IOP?
tonometry
How should the nurse assess the client's visual acuity?
use the Snellen and Rosenbaum charts
How is cataracts determined?
via opthalamscope
To prevent retinal detachment, clients should take precautions when?
when engaging in sports that can cause blow to the head or eye
The client asks when his vision will be back following cataract surgery. The nurse should say?
within 4 - 6 weeks
What are signs of an infected eye?
yellow/green drainage
What causes increased IOP?
Decreased fluid drainage increased fluid secretion
What position should the nurse place the client in following cataract surgery?
- Turn the client to the back/non-operative side - Elevated HOB 30 - 45 degrees
What are disease prevention strategies to avoid eye problems?
- Wear sunglasses outside - Wear protective eyewear working in areas such as yardwork/yelding - Avoid rubbing eyes - Regular eye exams starting at age 40
A client is recently diagnosed with open angle glaucoma. What client teaching should the nurse provide?
- avoid cold medicines that contain pseudoephedrine (dilatory effect on the pupil can increase IOP) - laser surgery can correct the flow of aqueous humor - expect impaired vision at night - driving may be dangerous due to loss of peripheral vision ati question**
What interventions should the nurse provide to the client to use at home?
- increase the amount of light in the room - provide adaptive devices
The client with cataracts asks how does the atropine opthalamic medication work. What does the nurse say?
- it prevents pupil constriction for prolonged periods of time - and it relaxes the muscles of the eyes
What is the normal range of IOP
10 - 21 mmHG
Name risk factors for forming cataracts
Advanced age; hereditary Diabetes* ====> Josh's dog Jazz Smoking Trauma Excessive exposure to sun Chronic Corticosteroid use
What are examples of activities that increase IOP?
Bending at the waist coughing/sneezing/straining vomiting head hyperflexion restrictive clothing -- tight shirts
Name manifestations of retinal detachment
Bright flashes of light Floating dark spots sensation of a "Curtain drawing over the visual field"
What medications are prescribed for cataracts?
Cholinesterase inhibitor --> atropine 1% opthalamic solution acetazolamide
What medication will the nurse anticipate giving for emergency treatment of acute angle-closure glaucoma?
IV mannitol = decreases IOP
Risk factors for retinal detachment
Nearsightedness Family history Previous cataract surgery Eye injury Retinal tear Fibrous vitreous tissue Exudate
What are manifestations of angle-closure glaucoma?
Rapid onset of IOP Decreased/blurred vision* severe pain* halos around lights severe pain nausea photophobia
What nursing interventions should be provided with a client with retinal detachment?
Restrict activity to avoid additional detachment Cover the eye with an eye patch
T/F: Glaucoma is the leading cause of blindness*
True!
Following cataract surgery, what should the nurse advise the client to do?
Wear sunglasses outside* Avoid activities that increase IOP (Sexual intercourse) Avoid activities such as... - sports -driving - vacumning -jerky movements - cooking/housekeeping - tilting the head back to wash the hair
What test is used for hearing loss?
Webers test
Is retinal detachment a medical emergency?
Yes! retinal detachment IS a medical emergency
What is a cortical cataract?
a cataract that forms in the lens cortex ; and extends from the outside of the lens to the center
What is glaucoma?
a disturbance of the function/structure of the optic nerve
What is retinal detachment?
a painless separation of the retina from the epithelium ---> resulting in loss of field of vision
What does examination reveal?
a sudden loss of vision without pain***
What is the onset of retinal detachment?
abrupt
What is another medication given pre-operatively for cataracts?
acetazolamide
What is scleral buckling? scleral = silicone
an application of a silicone sponge to promote attachment; local or general anesthesia is given stitches or an encircling band is used
During the procedure, what is applied to the eye? How will the client be positioned?
an eye patch and shield; lying with the affected eye up
What are cataracts?
an opacity in the lens of the eye that impairs vision
Following the procedure, the client should avoid what?
avoid activities that cause rapid eye movement - reading/writing Avoid going outside withOUT sunglasses Avoid activities that increase IOP
What changes in the eye should the client report?
bleeding discharge lid swelling decreased vision floating shapes/light pain - sharp, sudden
What is a side effect of the mitotic, pilocarpine?
blurred vision
What medication can cause cataracts from chronic use?
corticosteroids
How does timolol and acetazolamide work?
decrease IOP by reducing aqueous humor production
Upon assessment, what will the nurse find with open-angle glaucoma?
decreased accomodation
What are manifestations of open-angle glaucoma?
decreased accomodation* loss of peripheral vision -> "tunnel vision" IOP > 21 mmHG
What does a gonioscopy do?
determines the drainage angle
How does acetazolamide work?
dilates the pupils; reduces IOP causes paralysis ---> thus preventing lens movement during surgery
What manifestations will the client experience with cataracts?
diplopia * Blurred vision* Decreased visual acuity* Sensitivity to glare/light = photo sensitivity Diagnostics: hx of visual problems Progressive/painless loss of vision Visible opacity absent red reflex
A client is scheduled to undergo LASIX surgery. What are potential side effects following LASIX surgery?
dry eyes sensitivity to light (photophobia) halos and glaring when driving at night
What is a nuclear cataract?
forms in the center (nucleus) of the lens
A client complains of pain with nausea and vomiting. What complication should the nurse suspect?
hemorrhage; increased IOP
What occurs with glaucoma?
increased IOP
What are risk factors of glaucoma?
infection age tumors diabetes mellitus* genetic predisposition*
There are 3 types of cataracts. What is a subscapular cataract?
it begins at the back of the lens
What is the use of pilocarpine for glaucoma?
it is a mitotic that constricts the pupil; and allows for better circulation of the aqueous humor
What is the purpose of infiltrating a gas bubble during scleral buckling?
it pushes the retina back to the wall of the eye
What type of adaptive devices can be used for a client with cataracts?
magnifying glass large print newspapers/books talking devices ---> clocks
Is there pain with retinal detachment?
no
What is the most common form?
open-angle
What are the two types of glaucoma?
open-angle glaucoma angle-closure glaucoma
What diagnostic is used for retinal detachment?
opthalmascope
What assessment method should a nurse use for mastoiditis?
palpation to determine degree of edema, tenderness, erythema
A client just underwent scleral buckling with injection of a gas bubble. What position will the surgeon anticipate prescribing?
prone position with the operated side up, or sitting on the side of the bed with head resting on the bedside table the prone position is appropriate because it allows the gas bubble to float up and apply pressure to the retina in the back of the eye ---> reinforcing it ati question****
