Professional Documents
Culture Documents
History: Acuity changes, blurring, diplopia, photophobia, pain, use of gtts or other eye meds, hx of trauma, familial eye disease, occupational risks Risk Factors for Eye Disorders: Aging process, DM, HTN, HIV, +++others, Medications, Gender, Nutritional deficiencies
Glaucoma Types
Open Angle
Closed Angle Sudden onset Emergency Severe pain radiating around eyes & face Colored halos around lights
Glaucoma Assessment
Early signs = IOP, blurred vision, decreased accommodation, difficulty adjusting to darkness Later signs = loss of peripheral vision, decreased acuity (uncorrectable), halos around lights, pain
Glaucoma Interventions
Medication Rx: -Miotics -Sympathomimetic -Beta blockers -Carbonic anhydrase inhibitors -Osmotic diuretics -Prostaglandin agonist Surgical Rx: -Trabeculoplasty -Iridectomy
Glaucoma Medications
Increase Decrease Drainage of Aqueous Production of Humor Aqueous Humor Miotics Beta Blockers
Pilocarpine hydrochloride Timolol maleate (Isopto Carpine) (Timoptic)
Osmotic Diuretics
CAIs
Actetazolamide (Diamox)
Prostaglandin Agonists
Latanoprost (Xalatan)
Sympathomimetics
Dipivefrin ( Propine)
http://dmc.org/videolibrary/ek_gla ucoma.html
Cataracts Assessment
Blurred vision Decreased color perception Opacity of lens Absence of red reflex Vision better in dim light w/ pupil dilation Gradual loss of vision Painless
Cataract Interventions
Surgery = only option for Rx Surgical removal of diseased lens and replacement with silicone prosthetic lens Extracapsular procedure = most common Outpatient surgery
The client is a 62-year-old woman who works as a stockbroker. She has recently been diagnosed with bilateral cataracts. She lives in the Denver area and her hobbies include long-distance biking and downhill skiing. She has a glass or two of wine with dinner every night. She smoked when she was in college but has not smoked for more than 30 years. She is surprised by her diagnosis because she is a vegetarian and keeps herself physically fit. She also tells you that neither of her parents nor any of her four brothers and sisters have cataracts. How should you explain the influence of genetics on the development of cataracts? What factors may have influenced the development of her cataracts? What additional personal and family information should you obtain from this client?
Your 62-year-old client with bilateral cataracts is scheduled to have an extracapsular cataract removal with immediate intraocular lens implantation for her left eye (the one with the worse vision). She asks why both eyes can't be done at the same time so that she will not have to go "through all of this rigmarole twice." She also is concerned about her facial appearance after surgery and whether any bruising will be present. Should both eyes be done at the same time? Why or why not? How will her appearance be changed during the first week after surgery?
Your 62-year-old client had the cataract removed from her left eye and a multifocal lens implanted on Friday afternoon. She plans to go back to work on Monday and does not want her co-workers to know about the surgery. (She worries that people will think she is "old" and not on the cutting edge of her profession). Should she go back to work on Monday? Why or why not? What accommodations will she have to make at her workplace? What specific activities will you tell her to avoid?
Macular Degeneration
Dry (age-related) Most common Gradual Wet Sudden onset Macula = area of central vision Increased risk for smokers Antioxidant intake decreases risk and slows progression
The client is a 75-year-old man who was diagnosed with age-related "dry" macular degeneration after he was involved in a car accident in which he failed to stop at an intersection and hit another car at a low rate of speed. No injuries resulted from the car accident although the client received a citation for a moving violation. The client is very upset with the diagnosis. His wife has never driven nor has she managed the household accounts. He is concerned about "going blind" and wants to know if the LASIK procedure would restore his vision.
Can the client continue to drive? Why or why not? Will a LASIK procedure be helpful for this problem? Why or Why not? How will you address the issue of "going blind?"
Your client with macular degeneration (dry) wants to know if continuing to use his limited vision will increase the progression of the macular degeneration. He also worries that he will "lose his mind" if he has to give up all his usual activities. How will you address his concerns? How will you proceed to assist the client and his wife in maintaining independence and quality of life? LIGHTHOUSE INTERNATIONAL
Retinopathy
Hypertensive Diabetic
Retinal Detachment
Partial detachment Layers of retina separate because of fluid accumulation between them
Complete detachment if above left untreated; leads to blindness
Flashes of light ( photopsia) Floaters Blurred vision Sense of curtain being drawn Loss of portion of visual field
Emergency RX
Surgical RX
Gas / Oil inserted inside eye to compress retina. Postop position on abdomen, head turned with unaffected eye up X 1 week Scleral buckling silicone band around eye to hold choroid and retinal layers together
External Examination: Swelling, lesions, symmetry, position, external canal, odor Internal Examination: Otoscope exam: assess tympanic membrane color, intactness, bulging Assess cerumen
The client is a 52-year-old man who is the conductor of a symphony in a large city. He is admitted to the emergency department with severe dizziness and vomiting. He tells you he was eating dinner in a restaurant when his symptoms began suddenly. He has had such episodes in the past and has been diagnosed with Mnire's disease. He tells you he would rather die than lose his hearing because music is his life.
What vital signs should you take first for this client? Why? What nursing diagnoses are appropriate at this time for this client? What interventions can you initiate for the symptoms he has before he is seen by a physician? What lifestyle alterations can you suggest for his chronic condition?
Otosclerosis Etiology
Bony overgrowth around ossicles Fixation of bones Stapes fixation leads to conductive loss Inner ear involvement leads to sensorineural loss Familial tendency
Otosclerosis Assessment
Slowly progressing conductive loss Bilateral ; may be worse in one ear Ringing/roaring tinnitus Loud sounds when chewing Negative Rinne test Weber test shows lateralization of sound to ear with most conductive loss
Otosclerosis Interventions
Surgical Stapedectomy Fenestration
You are the home care nurse for a 74-year-old woman with diabetes, stasis ulcers, and rheumatoid arthritis who lives alone at home. She has had a conductive hearing loss for 10 years and has been using a hearing aid successfully for that time. She has had a kidney infection for the past 2 weeks and was seen by her internist for this problem. At first she was taking Septra orally (prescribed by her internist) for the infection but when her symptoms didn't subside, she went to an urgent care center and was started on streptomycin 8 days ago. The other drugs she takes routinely are insulin, bumetanide, and ibuprofen. She says her hearing has decreased during the last 4 days.
What questions should you ask this client? Exactly how will you test her hearing in this setting? What interventions could you perform immediately for her change in hearing? Can you determine whether she has any sensorineural hearing loss? Why or why not? What drugs or health factors could be contributing to her difficulty hearing?