NU272 PrepU Week 1 (Visual Impairment)

A nursing instructor is teaching about eye disorders in childhood. Which statement made by a student indicates a need for further instruction?

"Cataracts are only present in adults." - A cataract is a marked opacity of the lens and may be present at birth. It can cause blindness if not treated early. The cataract can be removed as early as 2 weeks of age and the best results are achieved if removed by 3 months of age. Glaucoma is increased intraocular pressure causing damage to the optic nerve.

Which type of glaucoma presents an ocular emergency?

Acute angle-closure glaucoma - Acute angle-closure glaucoma results in rapid progressive visual impairment. Normal tension glaucoma is treated with topical medication. Ocular hypertension is treated with topical medication. Chronic open-angle glaucoma is treated initially with topical medications, with oral medications added later.

A client reports sudden, acute left eye pain with blurred vision and a headache on the affected side. The client is most likely experiencing:

Acute angle-closure glaucoma - The sudden onset of eye pain, blurred vision, and a headache on the affected side indicate acute angle-closure glaucoma, which is an ophthalmic emergency. Subacute angle-closure glaucoma manifests as recurrent short episodes of unilateral pain, conjunctival redness, and blurring of vision associated with halos around lights. Open-angle glaucoma is usually asymptomatic and chronic.

The nursing student who is studying pathophysiology correctly identifies the condition that characteristically has an increase in the aqueous humor that fills the anterior and posterior chambers of the eye. What is this disease called?

Glaucoma - Glaucoma is a chronic degenerative optic neuropathy characterized by optic disk cupping and visual field loss. It is usually associated with an elevation in intraocular pressure. Amblyopia is lazy eye. Retinopathy is a disorder of the retinal vessels that interrupts blood flow to the visual receptors leading to visual impairment. A cataracts is a lens opacity that interferes with the transmission light to the retina.

For a client diagnosed with Parkinson's and narrow angle glaucoma, what medication would be contraindicated?

Levodopa - Levodopa is contraindicated in clients with known hypersensitivity to the drug. Because levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma (because it increases intraocular pressure).

Which is the most common cause of visual loss in people older than 65 years of age?

Macular degeneration - Macular degeneration is the most common cause of visual loss in people older than 65 years of age.

Epinephrine is contraindicated in clients with which diseases or disorders?

Narrow-angle (or closed-angle) glaucoma - Epinephrine and other adrenergic drugs are contraindicated in clients with narrow-angle glaucoma (closed-angle glaucoma) because the drugs increase intraocular pressure and mydriasis. Asthma, bronchoconstriction, and hypotension are among the disorders and diseases treated with adrenergic drugs.

A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client?

Pressure on the optic nerve - Partial blindness may result from pressure on the optic nerve. Glaucoma does not occur suddenly, and the client did not report injury to suspect corneal abrasions or retinal detachment.

The nurse is reviewing the medical record of a client with glaucoma. Which of the following would alert the nurse to suspect that the client was at increased risk for this disorder?

Prolonged use of corticosteroids - Risk factors associated with glaucoma include prolonged use of topical or systemic corticosteroids, older age, myopia, and a history of cardiovascular disease.

A provider orders timolol (Timoptic) for glaucoma. The order reads Timoptic 1 gtt PO bid. The nurse knows that something is wrong with this order. What is it?

Timoptic is given in the eye, not PO. - Timoptic is an ophthalmic medication that treats glaucoma and is dosed in drops (gtt). It is given twice a day in the eye, not by mouth.

A patient is suspected of having retinal detachment. The nurse would expect to prepare the patient for which of the following? Select all that apply.

visual acuity testing indirect ophthalmoscopy slit lamp biomicroscopy fluorescein angiography - Testing for retinal detachment includes visual acuity testing, indirect ophthalmoscopy, slit lamp biomicroscopy, and fluorescein angiography. The Amsler grid is used to evaluate for macular degeneration. Tonometry is used to evaluate for glaucoma.

The father of a third-grade girl has brought his daughter to a walk-in clinic because he believes the child has pink eye, which has been going around the students in her class. The nurse at the clinic concurs with the father's suspicion of conjunctivitis. Which follow-up explanation by the nurse is most accurate?

"The surfaces of her eyes have bacteria or a virus established, and it's important to maintain good hand hygiene until it goes away." - Conjunctivitis often spontaneously resolves, so diligent hand hygiene is critical. The pain associated with conjunctivitis usually produces only mild discomfort compared with severe discomfort associated with corneal lesions or deep and severe pain associated with acute glaucoma. Conjunctivitis may spread to other family members. The corneal surface is not primarily involved and pain that is severe suggests corneal involvement rather than conjunctivitis. Sight damage is not likely to result.

On ocular examination, the health care provider notes severely elevated IOP, corneal edema, and a pupil that is fixed in a semi-dilated position. The nurse knows that these clinical signs are diagnostic of the type of glaucoma known as:

Acute angle-closure. - Acute angle-closure glaucoma is characterized by the symptoms listed, as well as by being rapidly progressive and accompanied by pain.

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?

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.

A client with visual agnosia due to extensive damage to the visual association cortex is learning how to cope with this impairment. What should the nurse prioritize in teaching this client?

Applying touch and sound when interacting in the environment will lessen the deficits of visual agnosia. - Extensive damage to the visual association cortex that surrounds an intact primary visual cortex results in a loss of the learned meaningfulness of visual images (i.e., visual agnosia). The person can see the patterns of color, shapes, and movement, but no longer can recognize formerly meaningful stimuli that affect the person's quality of life. However, if other sensory modalities, such as hearing and touch, can be applied, full recognition occurs. This is not a painful condition and does not lead to blindness.

A nurse is caring for a legally blind client. What would the nursing interventions can the nurse use to promote the client's control over the hospital environment?

Ask where to store the client's self-care items - Ask client's preference for where to store hygiene articles and other objects needed for self-care. Involving the client promotes in self-care, promotes control over the environment.

Following cataract removal, discharge instructions will be provided to the client. Which of the following instructions is most important?

Avoid any activity that can increase intraocular pressure. - For approximately 1 week, the client should avoid any activity that can cause an increase in intraocular pressure. Clients may sleep on back or unaffected side. Clients may use a clean damp cloth to remove eye discharge and wash face. An eye shield is often ordered for the first 24 hours and during the night to prevent rubbing or trauma to the operative eye.

The nurse is caring for a client with glaucoma and is aware that which category of preanesthetic medication is contraindicated in this client?

Cholinergic blocking - Cholinergic blocking agents are contraindicated in clients with prostatic hypertrophy, glaucoma, and myocardial ischemia. Opioids, antiemetics, and antianxiety drugs are not contraindicated in clients with glaucoma.

A client has been prescribed eye drops for the treatment of glaucoma. At the yearly follow-up appointment, the client tells the nurse that she has stopped using the medication because her vision did not improve. Which action by the nurse is appropriate?

Explain the therapeutic effect and expected outcome of the medication. - The nurse needs to explain the therapeutic effect and expected outcome of the medication. The medication is not a cure for glaucoma, but can slow the progression. The client will not see improvements in vision with the use of the medication but should experience little to no deterioration of vision. The doctor may choose to switch the medication, but not because the vision is not improving; it would be based on not obtaining the set intraocular pressure. Administering the medication immediately or referring the client to the emergency department is not appropriate because this is not an emergent situation.

The nurse is reviewing the history of a patient who is to receive midodrine. Which would alert the nurse to a contraindication for the drug?

Glaucoma - Glaucoma is a contraindication for the use of midodrine, an alpha-specific adrenergic agonist, because the condition could be exacerbated by the arterial constriction. Thyrotoxicosis requires cautious use of midodrine, an alpha specific adrenergic agonist. Diabetes requires cautious use of midodrine, an alpha specific adrenergic agonist. Vasomotor spasm requires cautious use of midodrine, an alpha-specific adrenergic agonist.

A client who is legally blind had orthopedic surgery 3 days ago and wants to urinate. She is using a walker for ambulation. It would be best for the nurse to

Guide the client's hand to the armrest on the bedside commode prior to the client sitting on the commode. - When the nurse offers seating to a client with low vision or blindness, the nurse should place the client's hand on the arm of the chair. This helps to guide the client in sitting. Though placing the bedside commode next to the bed is a good idea, it is not the best choice. The nurse will encourage the client to use the bedside commode, not the bedpan, for better emptying of the urinary bladder.

An older adult in an assisted care facility with documented presbyopia has lost his or her glasses. The nurse should instruct unlicensed assistive personnel that the client will need assistance with tasks that involve which part of sight?

Near vision - Presbyopia involves difficulty focusing on near objects. It is common in older adults and is caused by decreased elasticity of the lens and atrophy of the ciliary muscle. The nurse should instruct unlicensed assistive personnel to assist the client with tasks involving near vision. In hyperopia, or farsightedness, the image theoretically falls behind the retina. Disparity between the laterally displaced images seen by the two eyes provides a powerful source to three-dimensional depth perception for objects within a distance of 100 ft (30 m). Color blindness is inherited as an X-linked deficiency of a specific type of retinal photoreceptor.

The spouse of a blind client calls the nurse practitioner to ask what is causing the client such a difficult time sleeping and what can be done. What might the client be suffering from, and which would be the most accurate response?

Non-24 hour sleep-wake syndrome; regulate wake and sleep times. - Sleep-wake cycle disturbance is a circadian rhythm disorder and is a common problem for people who are blind. This disturbance is classified as free-running sleep disorder (FRSD) or non-24 hour sleep-wake syndrome. Treatments include regulating the sleep-wake times, bright light therapy, and melatonin.

Cortical blindness is the bilateral loss of the primary visual cortex. What is retained in cortical blindness?

Pupillary reflexes - Crude analysis of visual stimulation at reflex levels, such as eye- and head-orienting responses to bright moving lights, pupillary reflexes, and blinking at sudden bright lights, may be retained even though vision has been lost.

The nurse takes a client's blood pressure in the primary care provider's office. The last three times the client has been in the office it has been high. What structure in the eye is this adverse effect of hypertension most likely to affect?

Retina - The adverse effect of hypertension most likely will affect the retina of the eye. The lens is affected with a cataract. The iris and ciliary body are not impacted.

The nurse is performing an eye assessment on a client who presents with a red eye. The nurse determines that the redness is related to bacterial conjunctivitis based on which additional symptom(s)?

Tearing, itching, and burning - Conjunctivitis causes bilateral tearing, itching, burning, foreign body sensation, and morning eyelash crusting and eye redness. Hyperacute conjunctivitis causes conjunctival redness and edema (chemosis), lid swelling and tenderness, and swollen preauricular lymph nodes. Attacks of glaucoma (increased intraocular pressure) are manifested by ocular pain, excruciating headache, blurred or iridescent vision, and corneal edema with hazy cornea, dilated (mydriasis), and fixed pupil; with repeated or prolonged attacks, the eye becomes reddened.

The nurse, working in the preoperative area, is caring for an older adult client who is scheduled to receive succinylcholine as part of general anesthesia. When collecting the nursing history, what finding should require the nurse to notify the anesthesiologist?

The client takes timolol eye drops to treat narrow-angle glaucoma. - Succinylcholine should be used with caution in clients with narrow-angle glaucoma because intraocular pressure increases. The client's recent blood donation, diabetes, and use of vitamin supplements would not have a direct bearing on the safe and effective use of succinylcholine.

A patient visits a clinic for an eye examination. He describes his visual changes and mentions a specific diagnostic clinical sign of glaucoma. What is that clinical sign?

The presence of halos around lights - Colored halos around lights is a classic symptom of acute-closure glaucoma.

The client has been ordered a beta-adrenergic blocking medication. The nurse knows that these medications are used to treat which diagnoses? Select all that apply.

cardiac arrhythmia heart failure glaucoma - Beta-adrenergic blockers are used to treat hypertension, cardiac arrhythmias, migraine headaches, heart failure, angina pectoris, and glaucoma. Beta-adrenergic blockers can have the side effects of hypotension and syncope. They are not used for glaucoma.

The ophthalmologist is performing a client's annual eye exam and notes an increase in intraocular pressure. The condition most likely is the result of:

imbalance between aqueous production and outflow. - Increases in intraocular pressure occur when there is an imbalance between aqueous production and outflow. A cell breakdown in the macula lutea results in macular degeneration. Cataracts may cause blurring of vision but do not alter pressure.

The nurse is caring for a client who has been diagnosed with both Parkinson's disease and narrow-angle glaucoma. What medication should cause the nurse concern?

levodopa - Because levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma. The other listed medications are not necessarily contraindicated.