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IOP

IOP

Patho

• Increase pressure in the eye

Causes 

• Strain 

• Pressure on head 

• Injury to eye  

• Lifting objects 

• Tight skirts 

Blindness

• Legal blindness is BCVA that does not exceed 20/200 in better eye or widest filed of vision is 20 degree or less

Emmetropia

Normal vision

Myopia

Nearsighted

Hyperopia

Farsighted

Astigmatism

Distortion due to irregularity of cornea

Glaucoma

Aqueous production and drainage not working, causes extra pressure in eye 

Types 

• Open angle (chronic) 

  • Develops slowly 

  • CM

    • Eyes tire easily 

    • Gradual loss of peripheral vision(tunnel) 

• Closed angle (acute) 

  • Develops quickly 

  • Noticeable symptoms 

  • CM

    • Pain around eye

    • Nausea vomiting 

    • Colored halos 

    • IOP 30+

• RF

  • Family history 

  • African american 

  • Migraine syndrome 

  • Eye trauma 

• Dx

  • Tonometry to assess IOP 

  • Gonioscopy 

  • Eye redness 

• NC

  • No cure lifelong medication 

  • Miotics

  • Beta-blockers- Decrease aqueous→ makes eyes dry→  punctual occlusion blocks the tear ducts→ tears go to the eye 

  • Steroids 

  • Prostaglandin

Cataracts

Patho 

• Degenerative opacification of the crystalline lens of the eye 

RF

• Age 

• Other eye disease 

• Toxic 

S_/s

• painless , blurred vision 

• Loss of red reflex 

• Cloudy, opaque lens 

Dx

• Decrease visual acuity and opacity 

NC

• Removal of lens with lens implant 

• Cataract extraction pre and post operative care; 

Pre

• Prepare for surgery 

• Give medication

• Avoid glare 

Post 

• Abx and steroid with eye patch 

• Cool compress, mild analgesics avoid asa 

• Avoid IOP, on side, light, 

• Normal: mild itchy, bloodshot, red eye discomfort, crusty drainage, will clear over days 

• Abnormal: more swelling, redness or bruising, yellow green drainage 

Retinal detachment

Patho 

• Sensation of a shade or curtain coming across the vision of one eye, bright flashing lights 

Dx

• Assess visual acuity

• surg 

pre 

• Surgical scleral buckling and vitrectomy 

• Eye patch to the affected area 

Post

• Prone position with head turned and affected eye facing up

• Report nausea and IOP activities

Hyphema

Hemorrhage in the anterior chamber, semi fowlers, ASA avoid 

Contusion

Blunt injury ,Ice application in the early phase; hematomas causing increased orbital pressure may be surgically evaluated.

Lacerations

an emergency; eye was cut, do not remove penetrating object; IV antibiotics and surgery.

Penetrating injuries

Poor chance to regain vision; avoid MRI; IV antibiotics, corticosteroids and surgery.   

Orbital fractures

Orbital roof fractures are dangerous. Surgery is usually non-emergent within 10-14 days.

Foreign bodies 

Ocular irrigation for 20 minutes  with tap water or normal saline for chemical burn or splash injuries

Mitotic Meds

Little pupil, Cholinergic drugs—>constriction of pupil—> see less—> fall risk

Mydriatic Meds

Make the pupil larger (epi)

Cycloplegic drops

 No driving no operating machinery 

Meniere’s disease

Patho 

• Attacks of vertigo, tinnitus 

S/S

• Tinnitus 

• One sided hearing loss

• Vertigo 

• Depression 

RF

• Head trauma 

• Allergic reaction 

• Salt intake 

Herpes

Types 

• HSV-1: classic recurring cold sore 

• HsV-2: gential herpes 

• Herpes zooster: acute inflammation of nerve root 

  • Cause by reactivation of the dormant varicella-zoster virus (chickenPox) 

  • Patho 

    • Lesion across the body 

    • Unilateral pain, itching, nursing, tingling Dermatome 

  • NI

    • Pain management with pentin 

    • Antiviral medication 

    • Lesion care 

    • Hand hygiene 

• NI 

  • Contagious to people who have not haf chickenpox 

  • Contact precaution 

  • Zostavax for 50

Psoriasis

Patho 

• Chronic autoimmune: trig by stressors 

S/S

• Chronic recurrent thick itchy erythematous plaques 

• Silvery colored- scalp knee slbows 

• Pitting crumbling beneath the nails 

NI 

• Bath soak in oil or coal tar prep 

• Soft brush on plaque 

• Sterious 

• UV light 

• Avoid stressors and picking at scabs 

• assess joints for RA 

Cellulitis

General infection involving the deeper connective tissue 

• PPE if wound open

1st Degree Burn

Superficial burn

2nd Degree Burn

Superficial partial thickness

Deep partial thickness

3rd Degree Burn

Full thickness

4th Degree Burn

Deep full thickness

Burn Classification 

• Depth 

• Extent 

• Location 

• RF

Thermal burn

Patho 

• Flame flash scald hot 

NI 

• Large

  • Don't use water, wrap in sheet, remove cloths

• Small  

  • Sover with clean, cool, tap water-damp towel

Chemical burn

Patho 

• ACID 

NI 

• Damage continues after the alkali neutralizer–72 HR 

• Skin, eyes resp, liver and kidney all affected 

• Quickly remove 

• Slothing removed

Electrical burn

Patho  

• Amount of voltage, tissue resistance, current pathway, surface area, duration 

• Beneath skin 

• Put a patient at risk for dysrhythmias metabolic acidosis 

NI 

• Remove from source 

Smoke inhalation 

Patho 

• Gas

• Burns in a closed area often have resp involved 

• Productive cough/raspy in nature 

• Dyspnea 

• Singed nasal hairs 

Types 

• Carbon monoxide-cherry red 

• Inhalation injury above glottis (burn to face )

• Inhalation injury below  glottis 

Carbon monoxide

• Cherry red 

• Treat with 100% humid O2

• Can happen without skin involved 

Inhalation injury above glottis

• Burn to face

  • Presence of facial  burns 

  • Signed nasal hairs 

  • Hoarness 

Inhalation injury below  glottis 

• Length of exposure to smoke or toxic fumes 

• PE might appear after 

Compensatory Stage of Shock

• Vasoconstriction→Inc HR→cool clammy skin BP normal 

• Acidosis occurs from anaerobic metabolism→Resp Inc 

• Give fluids

Progressive Stage of Shock

• BP and MAP decrease 

• All organs suffer from hypo-perfusion 

• Lungs fail→ dysrhythmia→ Mental status deteriorates from decreased cerebral perfusion 

Irreversible Stage of Shock

• Lungs begin to fail, decreased pulmonary blood flow, inadequate perfusion of heart leads to dysrhythmias, ischemia, liver function

• Organ damage so severe that pt does not respond to treatment

Low Blood flow

• Hypovolemic shock

• Cardiogenic

Hypovolemic shock

Patho

• Loss of blood flow→ due to bleeding or severe dehydration 

Dx

• pH PaO2 -decrease 

• K increase 

• Blood Count 

• K+

S/S

• tachycardia 

• Hypotension 

• SOB

• Alter mental 

• Dyspnea 

NC 

• Trendelenberg helps redistrub fluid 

• Treatment of the underlying cause→Fluid and blood replacement 

Cardiogenic shock

shock state resulting from impairment 

• Pump failure, MI, Cardiac amyloidosis 

• NC

  • Correction of underlying causes 

  • Initiation of first line treatment; O2, pain, fluid, 

  • Nitro, vasoactive medication→extravasation cause extensive tissue

Distributive Shock

• Anaphylactic shock 

• Septic shock 

• Neurogenic shock

Neurogenic shock

Patho 

• Spinal shock 

• After injury 

• Pooling of blood in vessels 

S/S

• Bradycardia→ decreased bowel 

• Hypotension 

• Skin- cool clammy to cyanosis 

NI

• Elevate HOB 

• Support CV and neuro function

• Assessment must be done within 3 hour 

Autonomic dysrelefixa happens after the resolution of ^  can cause stroke

Septic Shock

Patho/RF

• Life threatening organ dysfunction caused by bacteria or virus in blood stream 

• Malnutrition, Immunosuppression, Gi ischemia 

Dx

• SEPSIS 

  • S-SOFA score ( sequential organ failure assessment in ICU) 

  • E- Early recognition 

  • P- Proteoctols Follow them 

  • S-Start treatment right away 

  • I-Improve outcomes 

  • S-Share results 

S/S

• DIC: petechiae, blood oozing from the gum, mucous membranes, venipuncture sites & IV site 

NI

• 3 hr must assess→Obtain culture before admin antibiotics, fluid resuscitation      

• 6 hours  assess  → noriepi is the initial vasopressor     

Anaphylactic shock 

• Allergic: food, meds 

• Venom bites

Black Tag

Dead or requires to much work at emergency time

Red Tag

Highest priority get to work

Yellow Tag

Moderate, delayed but urgent

Green Tag

Pt is fine

Emergent phase (resuscitative)-

24-48hr after burn 

• Airway management(intubation, bronchoscopy),

• Infection:infection from own flora, wound,  nutrition 

• Cardiovascular: dysrhythmias, hypovolemic shock, edema, necrosis, 

• Fluid resuscitation because of fluid shift 

• Burns of >15% of tbsa(burn) and over 10% in children (4mLxTBSAxkgs= mL fluid then divide in 2)

Acute Phase

48-72hr

• begins when fluid resuscitation is finished healing, diuresis phase

Rehabilitation Phase

• Healing from the burns

Conjunctival Hemorrhage 

Bright red eye, no pain, no visual 

Conjunctival Trachoma

• Chronic conjunctivitis by chlamydia trachomatis,  both eyes

Conjunctival Conjunctivitis

• Inflammation or infection of conjunctiva 

• Viral is not responsive, very contagious 

Urticaria

• Avoid overexertion, alc hives, antihistamine

Impetigo

• contagious skin infection 

• Don't pop or squeeze boils 

• Yellow golden crust

Tinea

• hair loss, ring worm, athletes foot

Candida albicans

•  Thrush, skinfold clean, watch for fungal infection, airflow 

Steven Jonson syndrome 

• Most commonly by medications

• Supportive, isolation precaution, hypovolemia 

Minior burns

• Less then 10% body 

• Check for tetanus imz and admin

Vertigo

Patho/CM

• Dizzy 

NC

• Move slow and have stablize 

• Fall risk precaution

Severe burn

• 20% or more

Moderate Burns

• 10-20

• Inhalation injury

Penetrating keratoplasty (PKP) 

• Cadaver corneal transplantation/grafting) 

• Postoperatively 

  • Apply pressure eye patch (during the day for the first 3-5 days) and eye shield (at night for the first month). 

PTK

laser procedure used to treat diseased corneal tissue by removing or reducing corneal opacities) 

• Post-operative care: 

  • Oral analgesics  

  • Apply a pressure patch or therapeutic soft contact lens. 

  • Antibiotic, corticosteroids ointments, NSAIDs