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Nsg 230 Eye
| Question | Answer |
|---|---|
| What four things does light pass through before striking the retina? | 1. cornea 2. aqueous humor 3. lens 4. vitreous humor |
| These 2 things encode data about the intensity and wavelenght of light- One is for fine discrimination and color vision, the other is for peripheral vision and function best in dim light | Rods and cones Rods- peripheral vision, dim light Cones- fine discrimination, color vision |
| Before the light arrives at the visual cortex, it must be processed and transmitted through nerve cells of the _______, _____ _____, and ____________. | nerves of retina, optic nerve, and thalamus |
| External structures of eye that protects eye from foreign particles | eyelids and eyelashes |
| What is the conjunctiva? | thin, transparent layer of mucous membrane that lines eyelids and covers the eyeball |
| This external structure of the eye produces tears to lubricate the eye and moisten the cornea: tears drain into the nasolacrimal duct, which empties into the nasal cavity | lacrimal apparatus |
| muscles that control the movement of the eye | extraocular muscles |
| Which internal structure of the eye covers entire eyeball and is a tough, white connective tissue | sclera |
| What is the cornea and what does it do? | transparent avascular tissue through which light enters the eye. Acts to bend and direct rays of light to the retina |
| Highly vascular layer of eye that nourishes the retina and is located posteriorly | choroid |
| Which internal structure produces and secretes aqueous humor? The muscles also help change the shape of the lens. | ciliary body |
| Colored part of eye- pupil in center, constricts and dilates to regulate amount of light entering the eye | iris |
| What is the retina? | thin layer of nerve tissue which forms the innermost lining of the eye. Contains all the sensory receptors for the transmission of light and is actually part of the brain. Composed of rods and cones. |
| What is defected if a person is colorblind? | Cones |
| Blind spot of the eye, located in retinal for entrance of optic nerve, no photoreceptors | optic disk |
| Transparent body that focuses image on the retina. 4 mm thich and 9 mm in diameter. Sole purpose is to focus light on the retina. Elasticity of this structure allows for focusing on nearby or distant objects. Surrounded by capsule. | Lens |
| Clear, watery fluid in anterior and posterior chambers in anterior part of eye, serves as refracting medium and provides nutrients to lens and cornea, contributes to maintenance of intraocular pressure | aqueous humor |
| Where is the anterior chamber? | between the iris and posterior surface of cornea |
| Where is the posterior chamber? | between the anterior surface of the lens and posterior surface of the iris |
| Clear, viscous material, fills the largest cavity of the eye accounting for 2/3 of its volume. helps maintain shape and transparancy of the eye. | vitreous humor |
| Where are the visual impules generated? | in the rods and cones of retina |
| How do visual impulses leave the eye? | in axons that form the optic nerve |
| What is the optic chiasma? | Axons from medial portion of each retina cross over to the optic tract on the opposite side- Right side of brain lets you see your Left visual field. |
| Where do the optic tracts lead? | to the thalamus |
| Where do optic radiations go? From the ______ to the _______ ______. | thalamus to the occipital lobe |
| Where are the visual impulses interpreted? | occipital lobe |
| Where is the only place we can see blood vessels in the eye? | the retina |
| What types of things are you looking at in an initial observation of an eye patient? | colors they are wearing, if they are holding their head a certian way, do they have scanning vision, shake their hand to see their depth perception, etc. |
| What should always be done with an eye patient, for both legal and medical reasons | visual acuity, the Snellen chart, stand 20 ft away, note smallest line they can read with 2 or fewer errors. |
| How is right eye, left eye, and both eyes documented? | right eye- OD left eye- OS both eyes- OU |
| What visual acuity is considered legally blind? | corrected vision of 20/200 or less |
| If patient can't see the 20/400 letter, you can do what to test the visual acuity? | finger count, document as FC at 3ft. |
| If patient can't do a finger count, how else can you test their visual acuity? | ask if they can see your hand move in front of their face, recored as HM. |
| If only light can be seen during a visual acuity assessment, how is it documented? | LP (light projection) |
| What does it mean if a person has 20/40 vision? | they see at 20 ft what others see at 40 ft |
| How are the extraocular muscles tested? | check for 6 cardinal positions by having them follow your finger in all directions |
| Which cranial nerves are used for eye movement? | trochlear, oculomotor, and abducens |
| How should the optic disk look when you look into a patients eye? | well rounded, nice clear margins. If it is not well rounded, could mean increased intraocular pressure |
| Normal physical assessment of visual system | *20/20 OU, no diplopia *external eye structures symmetric, no lesions or deformities *lacrimal aparatus nontender w/o drainage *conjuctiva clear, sclera white *PERRLA *lens clear *Extraocular movements intact *disc margins sharp *retinal vessel |
| diagnostic study- multiple lenses are on rotating wheels, patient looks at snellen chart and choose which lens they see out of best- will have cycloplegic drugs, dilation may last 3-4 hours | refractometry |
| diagnostic study- detailed imaging and recording of ocular circulation by series of photos after dye is injected into AC or other vein. Assess for allergies, informed consent. Mydriatic drops instilled 1 hour before exam | fluorescein angiography- dye may cause skin to appear yellow for several hours after the test, eliminated in urine. Drink fluids after exam, urine will be bright green. Avoid sunlight for few hours after test. Dye may cause N&V. |
| Cornea is numbed, probe is used against cornea for axial length measurment and against closed lid for diagnosis of foreign bodies, tumors, vitreous opacities, and retinal detachments | ultrasonography |
| What test would be used to test for diabetic neuropathy/ sclerosis? | fluorescein angiography |
| How is corneal staining done and what is it used for? | Instil topical dye into conjuctiva to outline irregularities of corneal surface. Eye is viewed through a blue filter, and bright green color indicates nonintact cornal epithelium- looking for scratches of cornea |
| What is the tonometry test and what is it used for? | Puff of air into each eye, measuring pressure- used to assess for an increase in intraocular pressure. Normal is 10-22. Pressure is highter in the morning. |
| What can increased intraocular pressure lead to? | glaucoma |
| Most common type of visual problems | refractive errors- light is bent as it passes through cornea and lens of eye. refractive errors exist when light rays are not focused apropriately on the retinal of they eye |
| What is myopia? near sightedness or far sightedness? | nearsighted- cannot see far away- fix with concave lense, - lense numbers. Eyeball is longer than normal, may be familial. |
| What is hyperopia? near or far sightedness? | farsighted- cannot see up close- fix with convex lense, + lense numbers. Eyeball is shorter than normal, or cornea has less curvature than normal |
| What is astigmatism? | refractive condition in which rays of light are not bent equally by the cornea in all directions, so the point of focus is not attained. Caused by curvature of cornea not perfectly spherical. Poor vision near and far away. Correction- cylindrical lenses |
| Loss of accommodation because of age- crystalline lens becomes larger, firmer, and less elastic. Usually occurs around the age of 40. | presbyopia |
| Procedure in which an extremely thin layer of the cornea is peeled back for the laser reshaping of the middle layer of the cornea and then put back in place. | LASIK |
| In this procedure, the central cornea is flattened for myopia or steepened for hyperopia. | photorefractive keratectomy (PRK) |
| What to expext after a laser eye surgery | *eye is treated with steroid drops to suppress scarring *watering of eye and minimal pain is reported *refraction slowly stabalizes after surgery *daytime glare is common and reduced contrast sensitivity in night vision is common |
| What is the difference between total and functional blindness and legally blind. | Total and functional blindness have no usable vision |
| Total blindness | no usable visiona and no light perception |
| Functional blindness | some light perception but no usable vision |
| which type of blindness? has some usable vision, best visual acuity with corrective lenses is 20/200 or less | legally blind |
| Nursing care of a pt who is blind | *use normal tone of voice *alert when approaching *orient to environment *use focal point to orient *allow client to touch items *use clock for placement of food on plate *promote independance *voice clock, braille watch |
| Correct way to ambulate a pt who is blind | Allow to grasp on to arm at the elbow. Keep your arm close to the body so the pt can detect direction of movement. Instruct to stay one step behind you. Cane is held in dominant hand several inches off floor. |
| Bleeding into the anterior chamber of the eye, secondary to blund trauma | hyphema- blood vessels of iris break and leak into the clear aqueous fluid of the anterior chamber |
| Manifestations of hyphema | *pain due to increased intraocular pressure *photophobia *blurred vision *can see blood in chamber *suspect concurrent head injury of altered LOC |
| Medical management for hyphema | *quiet activity or bedrest *HOB 30 to 45 degrees *if noncompliant, hospitalize *avoid sudden eye movement for 3-5 days- bilateral eye patch *beta blockers *mydriatic agents *steroids *antifibrinolytic *antiemetics |
| Nursing management for hyphema | *monitor for rebleeding- most common complication w/in 2-5 days *monitor for nausea *encourage compliance |
| Management for a client with a foreign object in their eye | *locate object and remove it(medical) *local anesthetic *evert eyelid with a cotton tipped swab, irrigating with normal saline, and gently remove foreign body with moist swab *swab lower lid with moistened swab *examine for abrasion- corneal staining |
| Nursing and medical management for a client with a penetrating object in their eye | *cover object with cup or tape in place *do not allow pt to bend *do not place pressure on eye *EMERGENCY- physician see immediately *patch other eye to decrease eye movement |
| What is the most urgent of all ocular emergencies | chemical burns- alkaline burns are worse- will burn eye until you get the chemical out |
| Medical/nursing management for a chemical burn | *numb eye, then copious irrigation with NS- minimum of 30 min with 2L of fluid, irrigate until Ph is 7, and solution is directed across cornea toward lateral canthus *visual acuity assessment *antibiotic ointment *cover eye as prescribed |
| Most common extraocular disorder, inflammation of the conjuctiva most commonly caused by S. aureus, strep, or heamophilius influenza. Occurs most commonly in children due to poor hygiene | bacterial conjuctivitis (pinkeye) |
| Manifestations of pinkeye | *irritation *tearing *redness *mucopurlent drainage- yellow green color, eye matted shut in morning *occurs in one eye but rapidly spreads to other eye- VERY CONTAGIOUS |
| Management of pinkeye | self limiting *antibiotic drops shorten course *careful handwashing and disposable towels *warm/cold compresses *darken room *analgesics |
| What are cataracts most commonly caused by? | UV light exposure |
| An opacity of the lens | cataract |
| What congenital factors can be causes of cataracts? | *maternal rubella *mumps *chickenpox All during 1st trimester of pregnancy |
| Difference between mature or ripe cataract and an immature cataract | immature- not completely opaque, some light is still transmitted, have useful vision mature or ripe- completely opaque, vision is significantly reduced, whole lens is scarred |
| Manifestations of cataracts | *opaque or cloudy white lens *gradual loss of vision *cloudy vision or glare *blurred vision *photophobia *decreased color perception *vision better in dim light *absence of red reflext with opthalmoscope |
| Medical management for cataracts | No medical tx- may change glasses prescription, use magnifiers, drive during daylight because glare is too bad at night. Only option is surgery to remove lens |
| Preop care for a pt getting cataract surgery | *physical exam *antibiotic eye drops, mydriatic or cycloplegic drops, NSAID drops *antianxiety meds |
| What should you do if a patient c/o their mydriatic or cycloplegic drops stinging and buring their eyes? | nothing, this is normal |
| Surgery for cataracts in which the entire lens is removed with the capsule intact | itracapsular extraction |
| Surgery for cataracts in which the anterior capsure is opened, the lens is removed, and the capsular bag is left intact | extracapsular extraction |
| What is applied to the eye intraoperativeley? | antibiotic and corticosteriod ointment and an eye patch |
| Postop care for intra or extracapsular extraction | *antibiotic and corticosteriod eye drops *may have activity restriction *Eye sheild at night for 1st week *Do not lay on operative side *Don't rub eye *report unrelieveable pain *wait 6-12 wks before becoming concerned about vision |
| What does RSVP stand for when telling a patient what to report after eye surgery | Redness, Swelling, Visual Problems, Pain |
| What do you teach a patient if they have had cataract surgery and 4 mos later cannot see very well again? | Go to opthamologist, may be film over the capsule, can be lasered in the office |
| Post op teaching after cataract surgery | *wear wrap around sunglasses *avoid radiation *maintain intake of vitamins and good nutrition *will have photophobia after instilling drops *drops will sting and burn *Use puntual occlusion when administering eye drops |
| What symptoms should cause the patient who is post op cataract surgery to report to the dr immediately? | blurred or cloudy vision, halos around lights, severe and unrelieved pain, nausea, vomiting, bleeding |
| What is the term for a client who has no lens implant? | aphakic, will have very thick eyeglasses- look through center to see best |
| Detachment or seperation of the retina from the pigment epithelium, with fluid accumulation between the two layers | Retinal detachment |
| Risk factors for retinal detachment | *older than 40- mostly between 50 and 70 *cataract extraction, trauma, previous detachment in other eye, family history *holes occur spontaneously *retinal tears can occur when the vitreous houmor shrinks during aging and pulls on the retina |
| Patho of retinal detachment | Break in the retina allows liquid vitreous to enter subretinal space causing detachment. Retina is pulled away from choroid blood supply and will die if not repaired. (w/in 24-48 hrs) |
| Manifestations of what? shadow or curtain falling accross field of vision, floaters, flashing lights, bursts of black spots, painless sudden loss of vision (usually only half of vision) | retinal detachment |
| How is retinal detachment diagnosed? | visual acuity measurement, visualization of detachment with opthalmoscope |
| What is the tx for retinal detachment? | Some breaks are not likely to lead to detachment, therefore dr will watch and give signs of detachment. *Cryopexy(freezing) or laser photocoagulation can seal hole with inflammation and scarring |
| Scleral bluckling is a procedure to tx what? | retinal detachment |
| Describe scleral buckling | Sclera is pressed in from the outside by a band and sutured in place permanently to push the retina back against the choroid layer for nourishment. Subretinal fluid is drained. May have intraocular injection of air bubble |
| If a client has an intraocular injection of air or gas bubble, what teaching will be involved post op? | Client may have to hold head a certian way for weeks to hold bubble in right spot |
| Pre op management of a client going for scleral buckling | *bed rest *patch both eyes to prevent further detachment *avoid jerky head movements |
| Post op management of a client who had scleral buckling | *narcotics 1st 24 hrs as ordered- very painful! *manage N and V *Diamox iv to reduce IOP *activity restrictions *head down and to one side for several days if gas injected *warm moist soaks to eye *cycloplegic drops *eye patch removed next morning |
| A retinal degenerative process that affects the macula(tightly packed cones) and surround tissue, resulting in central visual deficits and fine discriminate vision loss | Age related macular degeneration (AMD) |
| Etiology and patho of AMD | *aging *maybe hereditary *usually bilateral and progressive *abnormal accumulation of waste material in retinal epithelium *smoking |
| Hallmark sign of AMD | yellowing exudates beneath retinal pigment epithelium (drusen spots) |
| blurred, wavy distortion of vision related to AMD | metamorphopsia |
| island like blind spots related to AMD | scotomas |
| Diagnostics for AMD | visual acuity and opthalmoscope |
| Which type of AMD? exudate gets under macula, starts to lift up, slower progression, no tx, drusen spots | Dry AMD |
| Which type of AMD? rapid onset, can lose vision, new vessels growing, can tx with eye injections of lucentis(decreases growth of new vessels) | Wet AMD |
| Management of AMD | *Can use photocoagulation to prevent further damage, but will have blind spots *magnifying glasses, bright lighting *focus on vision they have left, not on what they have lost! |
| Group of disorders characterized by increased IOP, optic nerve atrophy, and peripheral vision loss | Glaucoma |
| Leading cause of blindness in african americans | glaucoma |
| Can blindness be prevented in glaucoma? | yes, if tx is caught early enough |
| Risk factors for glaucoma | *over age 40, diabetes, HTN, heredity, previous eye surgery, trauma, inflammation, long term use of steriods |
| When aqueous fluid builds up in the eye, due to increased production or obstruction of outflow, increased pressure inhibits blood supply to optic nerve and retina causing them to become ischemic- which condition? | Glaucoma |
| Most common type of glaucoma, gradually occuring, bliateral, slow progressing. Trabecular meshwork is clogged, causing reabsorption of aqueous humor to be slowed or stopped. | Primary open-angle glaucoma |
| Less common type of glaucoma, sudden onset, medical emergency. Displacement of iris against cornea narrows or closes angle, obstructing outflow of aqueous fluid. Lens could be bulging forward due to aging, or pupil could be caused by pupil dilation | angle closure glaucoma (closed-angle, narrow-angle, acute glaucoma) |
| Increased IOP results from other conditions that may block outflow of channels. What type of glaucoma? | secondary glaucoma |
| What type of glaucoma can occur when there is an abnormal formation of the angle or iris? | congenital glaucoma |
| Manifestations of Primary Open-angle Glaucoma | *gradual loss of visual fields, peripheral *eventually develop tunnel vision *LATE- decreased visual acuity not correctable with glasses *LATE- Halos around lights *Increased IOP- 22-32 |
| Manifestations of Acute Closed-angle glaucoma | *Sudden, excrutiating pain in or around eye *N and V *colored halo arund lights *blurred vision *ocular redness *IOP may be 50 or higher |
| Diagnostic studies for glaucoma | *Opthalmascope may reveal atrophy(pale color) and cupping(indentation) of optic disk *loss of peripheral vision *increased IOP |
| Primary focus for management of glaucoma | keep IOP low enough to prevent patient from developing optic nerve damage- can be done with lifelong tx of eye drops, close monitoring, and follow-up care |
| 1st choice of eye drops used in glaucoma | Prostaglandin analog drugs- prost drugs |
| 2nd choice of eye drops used in gluacoma | Beta blockers- LOL drugs- be careful with patients with cardiac problems, be sure to teach to occlude lacrimal duct when applying to avoid systemic effects |
| If allergic to sulfa drugs, which tx of glaucoma should be questioned? | Diamox |
| Laser surgery for glaucoma- procedure and post op care | *laser surgery, scar meshwork to tighten and increase size between fibers for POAG, also used for Acute closed-angle glaucoma- make hole near edge of iris -post op- measure IOP after 1 hour, may be on ocular steriod |
| Standard surgical therapy for glaucoma- procedure and post op care | *surgery creates new drainage channel or destroys structure responsible for its production *peripheral iridectomy- portion of iris is excised to facilitate drainage -post op- eye sheild, antibiotic/steroid ointment, avoid aspirin, report pain or nausea |
| Most serious complication of glaucoma correction surgery | choroidal hemorrhage- if IOP drops too low, fluid may enter the subarachnoid space and cause a choroidal detachment. Blood vessels may break- symptoms- acute pain deep in eye, decreased vision, vital sign changes |
| Management of a client with glaucoma | *teach how to administer eye drops *teach to avoid stooping, heavy lifting, pushing, emotional upsets, excessive fluid intake, constrictive clothing around neck *avoid use of antihistamines or sypathomimetic drugs in closed angele, may cause mydriasis |
| Term used for removal of eye | enucleation |
| Why would a client have enucleation done? | *painful, blind *ocular malignancies *sympathetic opthalmia- untraumatized eye attacks good eye- inflammatory response |
| After an enucleation, what should the patient be monitored for? | *excessive bleeding or swelling *increased pain *displacement of implant *temp elevation |
| Care of client after enucleation | antibiotic/steriod ointment inserted into culdesac once a day until prosthesis is fitted (usually 1 month after surgery) |
| Degeneration of cornea | keratoconus |
| inflammation of cornea due to irritation or infection | keratitis |
| term for corneal transplant | keratoplasty- surgical removal of diseased cornea and replacement with donor cornea |
| Post-op care for a keratoplasty (corneal transplant) | *subconjuctival antibiotic injection and antibiotic ointment *pressure patch and sheild *dsg left in place until next day *lie on nonoperative side *wear shield at night for 1st month and when around children or pet |
| Teaching after a keratoplasty (corneal implant) | *teach about complications- bleeding, wound leakage, infection, graft rejection *report changes in vital signs or drainage on dressing *teach signs of graft rejection- RSVP |
| Nsg care for corneal donor BEFORE surgery | *HOB 30 degrees *antibiotic drops *close eyes with small ice pack |
| After corneal transplant, vision will be perfect immediately after surgery. T or F? | False, may not have good vision for 6 months |
| During an enucleation procedure, what is important to teach patient about when the optic nerve is clipped from eye being removed? | Client will have temporary blindness until brain readjusts, also may have trouble opening other eye |
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