CCAH chap 39 EENT eyes

eye condition priorities: 3

sensory perception, pain, safety

layers of the eye: 4

sclera, uvea, retina, optic fundus

refractive structures and media of eye: 4

cornea, aqueous humor, lens, vitreous body

external structures of eye: 3

canthus, conjunctivae, lacrimal gland

functions that produce clear vision: 4

refraction, pupillary constriction, accommodation, convergence

what is eye convergence?

eyes turn inward to see something up close

what is accommodation in vision?

being able to look and focus on something up close after looking far away

how can a nurse verify accomodation?

watch for pupil constriction

what is miosis?

constrition

what is mydriasis?

dilation

what is hyperopia?

farsightedness

what is myopia?

nearsightedness

natural decrease in visual acuity with age is called:

presbyopia

what is fatty deposits around cornea called?

arcus senilis

what is arcus senilis?

fatty deposits around cornea

what is yellowing sclera caused by?

fatty deposits

patients >40 y/o with DM/HTN need:

annual eye exams

eye changes with aging: 8

decreased visual acuity, decreased eye muscle tone, arcus senilis, yellowing sclera, lens hardens/shrinks, narrowing vision field, decreased color perception, increased IOP

what should the nurse think when they hear increased IOP:

glaucoma

normal IOP is:

10-20

retinal detachment is more common in:

men

patients with DM/HTN are at risk for:

diabetic retinopathy

nutrition: what deficiency can cause dry eyes?

vitamin A

severe vitamin A deficiency can cause:

blindness

family history that can be genetic: 4

HTM, glaucoma, cataracts, macular degeneration

medications that cause cause pupil restriction and dry eyes:

anticholinergics, antihistamines

what is it called wehn there is protrusion of the eyes?

exophthalmos

what can exophthalmos indicate?

graves disease

how to test visual acuity:

snellen chart

what does slit-lamp test look for?

cornea/lens abnormality

what does corneal staining check for? 2

trauma, abrasions

what to know about fluorescein/dye: 2

can stain yellow around eyes, urine

diagnostic tools to look at back structures of eyes: 4

CT, MRI, US, radioisotope scoping

what does tonometry measure?

IOP

what should IOP be?

10-20 mmhg

what does ophthalmoscopy look at? 4

external eye, interior structures, red reflex, tumors/cataracts

what does fluorescein angiography check for?

retinal circulation

before fourescein angiography is performed, what should the nurse ensure? 4

informed consent, mydriatic eye drops 1hr before exam, wear dark glasses, find driver

what does electroretinography check for?

retinas response to light stimulation

what does gonioscopy determine?

open angle or closed angle glaucoma

what is optical cogerence tomography?

US of retina/optic nerve

what are cataracts?

change in lens opacity

what causes cataracts? 5

aging, trauma, toxin exposure, UV light, chronic conditions

1st sign of cataracts: 2

blurry vision, decreased color perception

symptoms of cataracts: 3

cloudy lens, blurred/double vision, difficulty seeing at night

with cataracts, overtime there is a decrease in:

peripheral/central vision

cataracts can progress to _______ if not surgically treated

blindness

what is the cure to cataracts?

surgery

preop cataract care: 3

teach, stop aspirin/NSAIDs, arrangements for care outside hospital

when does best vision come back after cataract surgery?

4-6 weeks

cataract surgery is usually performed in ________

outpatient

what is given during operation for cataracts? 3

sedative, series of mydriatic/paralytic/vasoconstricting eye drops, local anesthetic

cataracts post op care: 6

no water 3-7 days, patch while sleeping, watch for infection, avoid coughing/sneezing, dark glasses outdoors, cool compress

when administering eye drops, how long should the nurse wait before between administration?

5-10 minutes

what condition is the most common cause of blindness?

glaucoma

glaucoma is caused by:

increased IOP

glaucoma has no known _______

prevention

what type of glaucoma is the most common and develops slowly?

open angle glaucoma

OAG symptoms: 3

mild headache, seeing halos, loss of peripheral vision

OAG tonometry reading:

22-32 mmhg

ACG is a:

medical emergency

ACG characteristics:

displacement of iris pressing cornea causing no flow of humor

ACG tonometry reading:

>30 mmhg

secondary glaucoma characteristics: 4

neovascular, steroid induced, trauma, uveitis

glaucoma ophthalmoscope exam will show: 4

widening, deepening, gray, atrophy of optic disc

OAG assessment data: 6

gradual loss of peripheral vision, unaffected central vision, foggy vision, reduced accommodation, mild aching in eye/head, frequent eyeglass prescription changes

ACG assessment data: 9

acute onset, sudden/severe pain around eyes that radiates through face, headache, n/v, colored halos around lights, sudden blurred vision, red sclera, foggy cornea, dilated/nonreactive pupil

drug classifications that dilate vlood vessels to increase aqueous humor reabsorption: 2

prostaglandin agonists, cholinergic agonists

prostaglandin agonist examples: 3 (generic/brand)

bimatoprost/Lumigan, latanoprost/Xalatan, travaprost/Travatan

cholinergic agonist examples: 4 (generic/brand)

carbichol/Isopto carbichol, echothiophate/Phospholine iodide, pilocarpine/Piloptic

drug classification tha reduce aqueous humor production: 3

adrenergic agonists, beta blockers, carbonic anhydrase inhibitors

adrenergic agonist examples: 3 (generic/brand)

apraclonidine/Loidine, brimonidine/Alphagan, dipivefrin hcl/Propine

beta blockers examples: 4 (generic/brand)

betaxolol/Betopic, carteolol/Cartrol, levobunolol/Betagan, timolol/Timoptic

carbonic anhydrase inhibitors examples: 2 (generic/brand)

brinzolamide/Azopt, dorzolamide/Trusopt

for drugs that reduce aqueous humor production, what should be monitored?

HR, HTN

what systemic osmotic drugs are given for ACG?

oral glycerin, IV mannitol

what does mannitol do?

can rapidly dehydrate cells

the goal for eye condition is:

not to cure but to slow damage

surgical management for OAG: 3

laser trabeculoplasty, tube shunt, cyclophotocoagulation

surgery for ACG:

laser peripheral iridotomy

glaucoma surgery complications: 2

choroidal hemorrhage, choroidal detachment

what is the biggest issue with corneal damage?

cornea has no separate blood supply and can rapidly impair vision

corneal damage symptoms:

pain reduced vision, photophobia, eye secretions

corneal damage diagnostics: 3

fluorescein stain, slit lamp, corneal scrapings/culture

corneal damage warnings: 2

do not cross contaminate eye drops, do not year wear contact lenses until infection is gone/ulcer clears

what is keratoconus?

degeneration of corneal tissue causing permanent loss of shape

keratoplasty (corneal transplant) postop care: 7

antibiotics, eye patch, lie on nonop side to reduce IOP, watch bleeding/infection/graft rejection, corticosteroids/immunosuppressants, IOP restrictions, NO ice packs

dry macular degeneration characteristics: 3

common, slow progression, over time central vision is lost

wet macular degeneration characteristics: 2

quick onset, sudden decrease in vision

how to reduce risk of macular degeneration with dietary intake of: 4

lutein, zeaxthin, vit C/E, zinc

macular degeneration is mostly caused by _________

genetics

posterior vitreous detachment (PVD) characteristics: 4

small flashes of light in one eye with floaters, painless, photopsia, part vision looks as if curtain is pulled over

what is photopsia?

birght flashes of light

PVD op education: 5

restrict activity/head movement, eye patch, general anesthesia, IOP restrictions, avoid close vision 1 week postop

what is myopia?

over refaction of light

how is myopia treated? 2

concave lens, lasik

what is hyperopia/hypermetropia?

weak refraction

how is hyperopia/hypermetropia treated? 2

convex lens, lasik

what is presbyopia? 2

loss of elasticity, difficulty changing shape to view close objects

what is astigmatism? 2

unequal refraction, images cannot focus