Visual problems

Assessment and Evaluation of Vision

•Ocular history

•Visual acuity

•Snellen chart

•Record each eye

•20/20 means the patient can read the “20” line at a distance of 6.1 m (20 feet )

•Finger count or hand motion

Visual Problems

•Loss of some or all vision loss:

•doubles the difficulties associated with activities of daily living.

•Affects social functioning.

•doubles the risk of falls and mortality rates.

•triples the risk of depression.

quadruples the risk of hip fractures.

Visual problems

Can be corrected by lenses that focus light rays on  retina

Myopia:

nearsightedness

Hyperopia:

farsightedness

Astigmatism:

distortion owing to irregularity in the curvature of the cornea

Assessment

History

•Examination of distance and near visual acuity, visual field, contrast sensitivity, glare, colour perception, and refraction

•Special charts may be used for low vision

•Nursing assessment  includes functional ability and coping

•Personal meaning client attaches to visual impairment?

•Nursing assessment For visual impairment

How long has the patient had visual impairment?

How does the patient’s visual impairment affect normal functioning?

What is the personal meaning the patient attaches to visual impairment?

Nursing Management:Visual Impairment

Support coping strategies, grief processes, and acceptance of visual loss

Strategies for adaptation to the environment

Placement of items in room

“Clock method” for trays

Communication strategies

Collaboration with low vision specialist, occupational therapy, or other resources

Braille or other methods for reading and communication

Use of service animals

Active listening and facilitating ,Allowing expression of anger/grief,Helping identify fears

Nursing diagnoses for visual impairment

•Potential for injury

•Reduced self-care

•Preparedness for intensified self-care

•Potential for grieving

Planning of visual impairment

•Goals

•Successful adjustment

•Verbalization of feelings related to the loss

•Identification of personal strengths and external support systems

•Use of appropriate coping strategies

Nursing implementation

•Ambulatory and home care

•Optical devices for vision enhancement

•Nonoptical methods for vision enhancement

•Evaluation

•Expected outcomes

•Have no further loss of vision

•Be able to use adaptive coping strategies.

•Not experience a decrease in self-esteem or social interactions

•Function safely within her or his own environment.

Age-Related Considerations:

Visual Impairment

•Older clients are at increased risk for vision loss caused by eye disease.

•Other deficits (e.g., cognitive impairment, limited mobility) may further affect ability to function.

•Financial resources may be inadequate.

•Older client may become confused or disoriented when visually compromised.

•Increases the risk of falls

Eye Trauma

One of the leading causes of vision impairment in Canada

Ocular injuries can involve

•ocular adnexa.

•superficial

deeper ocular structures.

•Types of ocular trauma include

•blunt injuries.

•penetrating injuries.

chemical exposure injuries

•Causes of ocular injuries include

•automobile accidents.

•falls.

•sports and leisure activity injuries.

•assaults.

work-related situations

Trauma

•Prevention of injury

•Pt and public education

•Emergency tx.

•Flush for all chemical injuries

•Do not try to  remove foreign objects

•Protect using metal shield or cup

Potential for sympathetic ophthalmia, causing blindness in the uninjured eye with some injuries

ocular adnexa 

refers to accessory structures that support, protect the functioning of the eye

Nystagmus

is an involuntary, rapid, and repetitive movement of one or both eyes,

described as shaking causes reduced vision, dizziness, and depth perception. Treatments include glasses, contacts, surgery

•Ptosis

•drooping eyelid

Examination of the External Structures

•Note any evidence of irritation, inflammatory process, discharge, etc.

•Assess eyelids and sclera

•Assess pupils and pupillary response in a darkened room

•Note gaze and position of eyes

•Assess extraocular movements

•Ptosis: drooping eyelid

•Nystagmus: oscillating movement of eyeball

Uveitis

•Inflammation of uveal tract, retina, vitreous body, or optic nerve

Cytomegalovirus retinitis:

Opportunistic infection occurring in patients more common with AIDS in r immunosuppressed patients

Endophthalmitis

Intraocular inflammation of vitreous cavity

Panophthalmitis

All layers of eye inflamed

Treatment for Intraocular Inflammation &

•Antimicrobial medications

Anti-inflammatory medications

Nursing Management:

Inflammation and Infection

•Nursing assessment

•Assess ocular changes (e.g., edema, redness, decreasing visual acuity, feeling  foreign body is present, or discomfort) and document findings.

•Assess psychosocial aspects of the client’s condition.

•Nursing diagnoses

•Acute pain related to biological injury pathogen (infection)

•Anxiety related to major change (health/ vision status)

•Planning

•Goals

•Avoid spread of infection.

•Maintain acceptable level of comfort and functioning during course of problem.

•Maintain or improve visual acuity.

•Comply with the prescribed therapy.

•Promote appropriate health-seeking behaviours.

Nursing Management: Inflammation and Infection

•Nursing implementation

•Health promotion

•Careful asepsis and frequent, thorough handwashing to prevent spread of infection

•Dispose of contaminated dressings properly

•Inform client if infective disorder can be transmitted sexually.

•Acute intervention

•Comfort measures (e.g., warm or cool compresses, analgesics, darkening the room)

•Eye drops

• Ambulatory and home care

•Information about required care

•Evaluation

•Overall expected outcomes

•Client will cooperate with the treatment plan.

•Client will experience relief of ocular discomfort.

•Client will effectively cope with functional changes if visual acuity is decreased.

•Client will obtain specific information to prevent recurrent disease.

Keratoconjunctivitis sicca

(dry eyes)

Dry Eye Disorders

•Keratoconjunctivitis sicca (dry eyes)

•Common in older adults and those with certain systemic diseases

•â quality or quantity of tears

•Irritation or sensation of sand in eye worsens through the day.

Treatment of underlying cause

Cataracts

An opacity or cloudiness of the lens

Cataracts

•An opacity or cloudiness of the lens

•A leading cause of disability in older adults in Canada

Cataract surgery most common  in Canada

Surgical management for cataract

•If reduced vision does not interfere with normal activities, surgery is not needed

•

•Surgery is performed on an outpatient basis with local anesthesia

•

•Preoperatively, assess level of comfort & ability to follow the post-op regimen.

•

•Surgery usually takes less than 1 hour and patients are discharged soon afterward

•

Complications are rare but may be significant

Nursing Management: Cataracts

•Nursing assessment

•Assess distance and near visual acuity

•Note visual acuity in nonoperative eye to determine how visually compromised

•Assess psychosocial impact of patient’s visual disability and patient’s understanding of disease process and therapeutic options

 

•Postoperatively, assess level of comfort and ability to follow postoperative regimen

 

•Nursing diagnoses

•Reduced self-care resulting from perceptual disorders

•Anxiety

Nursing Management: Cataracts

•Planning

•Preoperative goals for patient

•Make informed decisions regarding therapeutic options

•Experience minimal anxiety

•Postoperative goals for patient

•Understand and adhere to postoperative therapy

•Maintain acceptable level of physical and emotional comfort

Remain free of infection and other complications

Nursing management

•Preoperative care

•Usual preoperative care for ambulatory surgery

•Before surgery, patients with dark irides may need larger dose of topical medications for pupil dilation.

•Contraindicated in patients with narrow-angle glaucoma

•Mydriatic medications can produce significant cardiovascular effects

•Postoperative care: ensure client’s have prescriptions and instructions

•Provide written and verbal instructions

Instruct patient to call physician immediately if vision changes; continuous flashing lights appear; redness, swelling, or pain increases; type and amount of drainage increases; or significant pain is not relieved by acetaminophen