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Module 18.3 Sensory
Eye injuries
| Question | Answer |
|---|---|
| What will damage an eye worse acid or alkaline substances? And why? Pg.1312 | Alkaline. Because tiny particles of the chemical may remain in the conjunctival sac, causing progressive damage. |
| What substances can cause an eye injury? Pg.1312 | Ammonia, products containing lye(oven or drain cleaners), acids from car batteries, External damage: burns by heat, radiation, explosion, chemical burns(most common) |
| What type of burn injures pose the greatest risk for thermal burns to the eye? Pg.1312 | Explosions and flash burns |
| Ultraviolet light can cause what type of damage to the eye? Pg.1312 | Can cause corneal damage ranging in severity from mild to extensive. |
| What are three types of Ultraviolet light burns? Pg.1312 | snowblindness, welder’s arc burn or flash burn |
| What is a penetrating injury to the eye? Pg.1312 | - the layers of the eye spontaneously re-approximate after entry of sharp-pointed object or small missile into the globe. |
| What is a perforating injury to the eye? Pg.1312 | layers of the eye do not spontaneously re-approximate resulting in rupture of the globe and potential loss of ocular contents. A perforating eye involves an entrance and exit wound both of which are caused by the same source. |
| What are some concerns with a penetrating injury when assessing a client? Pg.1312 | May be hidden because of tissue swelling, May be missed if client has other significant injuries, If eyelid is lacerated/puncture wound inspect eye tissue for damage |
| What are some signs of eye perforation? Pg.1312 | pain, partial or complete loss of vision, possible bleeding or extrusion of eye contents |
| What is the most common cause of a blunt trauma to the eye? Pg.1312 | Sports injury, struck by with a ball or contact sports |
| What are some alternative examples of blunt trauma to the eye? Pg. 1312 | MVA, falls, physical assault |
| What are some examples of minor blunt trauma injuries? Pg.1312 | lid ecchymosis (black eye), subconjunctival hemorrhage, hyphema, orbital blowout fracture |
| What is a subconjunctival hemorrhage? Pg.1312 | Caused by a rupture of a blood vessel in the conjunctiva, appears as a bright area of erythema, no pain/treatment, reabsorbs in 2-3weeks |
| What is a hyphema? Pg.1312 | bleeding into the anterior chamber of the eye, Client complains of eye pain, experiencing decreased visual acuity and seeing a reddish tint. Blood is visible in the anterior chamber. |
| What is enophthalmos? And when do you see it? Pg.1312 | Eye appears sunken and has limited movement, Can occur after an orbital fracture |
| What happens to the eye during an orbital fracture? Pg.1312 | Ethmoid bone on the orbital floor is the most likely site to be fractured. Orbital contents including fat, muscles, and the eye itself may herniate thru the fracture into the underlying maxillary sinus. |
| What happens when a retina detaches? Pg.1312 | Separation of the retina or sensory portion of the eye from the choroid, the pigment vascular layer. It may occur after trauma but usually occurs spontaneously. |
| What are some risk factors related to retinal detachment? Pg.1312 | Aging is a common risk factor, as are myopia, glaucoma, trauma, previous retinal detachment and aphakia, absence of the lens |
| Table. Focus on Diversity & Culture. Why are eye injuries among migrant farm workers underreported? Pg.1312 | Most migrant workers don’t have jobs that provide worker’s compensation coverage. B/c of a limited number of clinics that serve this population, many injuries go both unreported and untreated |
| Table. Focus on Diversity & Culture. What type of exposures are the migrant farm workers at risk for? Pg.1312 | chemicals, machinery, tools, and airborne soil and particulates. |
| Table. Clinical Manifestations and Therapies: Eye Injuries. What are the clinical manifestations for detached retina? Pg.1314 | floaters: irregular dark lines or spots on the field of vision, flashes of light, blurred vision, progressive deterioration of vision, sensation of a curtain or veil being drawn across the field of vision, if macula is involved, loss of central vision |
| Table. Clinical Manifestations and Therapies: Eye Injuries. What are the clinical therapies for detached retina? Pg.1314 | prompt treatment to preserve vision, proper positioning, cryotherapy, laser photocoagulation, scleral buckling and laser therapy |
| What are some Diagnostic tests you can do in clinic for a patient with an eye injury? Pg.1314 | Visual acuity, Extraocular movements, Pupil reactivity &size (PERRLA), ophthalmoscope used to examine fundus for presence of red reflex |
| What is a slit lamp and what is it used for? Pg.1314 | slit-lamp is a high-intensity light source combined with a low-power microscope can be focused to shine a blue light in a thin beam, used in conjunction with fluorescein stain, Fluorescein is orange/yellow in color appears if defect on the cornea |
| What other test can be done for the eye? Pg.1314 | Facial x-rays & CT scan used to identify orbital fractures or foreign bodies in the globe. Ultrasonography used to detect a detached retina or vitreous hemorrhage |
| What treatments of the eye would not need surgical intervention? Pg.1314 | corneal abrasion, subconjunctival hemorrhage or periorbital ecchymosis |
| What surgical interventions maybe necessary due to a severe chemical burn? Pg.1314 | debridement, tissue grafting, or even corneal transplant |
| What is considered a medical emergency in order to preserve vision? Pg.1314 | Retinal detachment is medical emergency; early diagnosis and treatment are important to preserve vision. |
| What are the three surgical treatments for retinal detachment? Pg. 1314 | Cryotherapy, Scleral buckling, Pneumatic retinopexy |
| Describe Cryotherapy and how it is used to correct retinal detachment? Pg. 1314 | uses a cooled probe or laser photocoagulation may be used to create an area of inflammation and adhesion to “weld” the layers together |
| Describe Scleral buckling and how it is used to correct retinal detachment? Pg. 1314 | Scleral buckling during which an indentation or fold is surgically created in sclera to restore contact between retina and choroid. Contact is maintained with a local implant on the sclera or an encircling strap or buckle. |
| Describe Pneumatic retinopexy and how it is used to correct retinal detachment? Pg. 1314 | air is injected into the vitreous cavity. Pt is positioned so air bubbles pushes the detached portion of the retina into contact with the choroid |
| What steps will the nurse take in order to protect the eye from further injury when penetration or perforation is suspected? Pg.1316 | Do not place any pressure on the eye itself, cover gently with sterile gauze or eye pad, if object is embedded or sticking out of eye do not attempt to remove, object should be immobilized with metal eye shield, patch unaffected eye to decrease movement |
| What interventions and instruction would an RN offer to a client with a blunt trauma to the eye? Pg.1316 | Intervention: best rest in Semi-fowler's position, use eye shield to prevent further damage, unaffected eye should be patched to reduce movement. Instruction: if healing has not occurred in 1-2weeks FU |
| How is a foreign body removed from the conjunctiva? Pg.1316 | Irrigation, sterile cotton-tipped applicator, sterile needle, or other instrument |
| How do you position a client with a detached retina if an ophthalmologist is not readily available? Why might this position not be tolerated by some? Pg.1316 | lay client flat with head midline. Position may not be tolerated by clients with cardiorespiratory diseases. |
| What are some appropriate Nursing diagnosis for a client with an eye injury? Pg.1316 | Impaired tissue integrity: ocular, Acute pain, Anxiety, Ineffective tissue perfusion: retinal |
| During the implementation process how will the RN Reduce the risk for impaired vision? Pg.1316-1317 | Assess vision with & w/o corrective lenses upon initial assessment, Inspect eye carefully, burn/foreign body present admin anesthetic drops, Remove any loose foreign bodies, rest/stabilize for severe injury |
| After an injury what topic would the RN discuss with the client & caregivers? Pg.1317 | Prescribed meds & possible adverse effects, strategies to prevent further trauma, Application of eye pad/shield, Avoid activities that increase IOP, Importance of activity restriction |
| What are the interventions for retinal detachment? Pg.1317 | Notify physician & ophthalmologist immediately, Lie pt flat & turn head to affected side, Maintain calm environment, Reassure pt in most cases detachments can be treated, explain the procedure thoroughly, Allow family/friends to remain with pt |
| During the evaluation phase for a client with an eye injury, what would be considered a successful resolution? Pg.1317 | Client maintains optimal vision following injury, Experiences no loss of vision as result of preventable complications, Reports pain management to acceptable levels |
Created by:
Studying_Nurse
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