Care of the patient with vision problems

• What are age related structural changes?

• Decreased eye muscle tone

• Ectropion and dry eye

• Arcus senilis

• Yellowing of sclera

  • From fatty deposits

• Less ability to dilate pupil

  • Difficulty seeing in dark environments

  • More light needed for reading

• What are age related functional changes?

• Lens will yellow, harden, lose elasticity

• Accommodation is gradually lost

• Presbyopia

  • Images must be placed farther away to see clearly

• Color perception decreases

• IOP increases

• What are laboratory assessments for eyes?

• Culture

• Conjunctival swabs

• What are imaging assessments for eyes?

• CT

• MRI

• Radioisotope scanning

• What is tonometry used for?

• To check pressure to see if you have glaucoma

• What is a tonometry

• Applies pressure to outside of eye until it equals pressure inside the eye

• What is normal eye pressure?

• 10 to 20 mmHg

• What is gonioscopy used for?

• Determines is open angle or closed angle glaucoma

• What is a gonioscopy

• Completed when client has high IOP

• Visualizes angle where iris meets cornea

• What is glaucoma?

• It is increased intraocular pressure

• What are the types of glaucoma?

• Primary open-angle

• Primary angle closure

• What is primary angle closure glaucoma?

• Displacement of iris, immediate

• What is primary open angle glaucoma?

• Gradual onset

• Both eyes

• What are symptoms of glaucoma?

• Headache or brow pain

• Nausea/vomiting

• Colored halos around lights

• Sudden blurred vision

What do you notice in a client who has glaucoma in an eye examination?

• Cupping and atrophy of optic disc

• Mainly looking at optic nerve

• Sclera appears reddened

• Cornea is foggy

• Non Reactive dilated pupil

• Cloudy aqueous humor

• What is the diagnostic test for glaucoma?

• Tonometry

• Perimetry

  • Visual field testing

• Gonioscopy

• Optic nerve imagine

  • Determines optic nerve damage

• What is patient teaching for glaucoma and cataracts?

• Adhere to eyedrop schedule

• Punctal occlusion

• Good hand washing

• How to put eyedrops in?

• Keep eye drop tip clean

• Avoid touching tip to eye

• If multiple medications wait 5 to 10 minutes

• What are some things to do if a client has reduced vision?

• Announce entrance

• Ensure impairment is on EHR

• Determine the degree they can see

• Orient the patient to room

• Do not move objects around

• Remove all clutter

• Ask what assistance they need

• Describe food placement

• Open food and condiments

• Use normal tone of voice

• Offer an arm when walking

• What are cataracts?

• Clouding and blurring of lens

• What do cataracts look like?

• Opacity makes it difficult to focus image on retina

• Visual acuity restricted

• No pain or eye redness

• Usually age related or caused by trauma

• How to prevent cataracts from happening?

• Avoid heavy sun or UV light exposure

• Wear sunglasses

• Wear eye protection

• Stop smoking

• Glaucoma is fixed by?

• Medicine

• Cataract is fixed by?

• Surgery

• What is the preoperative stage of surgery for cataracts?

• Assess ability to instill eye drops

• Assess what medications were taken

• Instil eye drops to dilate pupils

• What is the operative stage of surgery for cataracts?

• Phacoemulsification

  • Sound waves break apart lens removed by suction

  • Replacement lens placed

• What is the postoperative stage of surgery for cataracts?

• Antibiotic and steroid ointment

• Discharge same day

• What is patient education for after cataract surgery?

• Wear dark glasses outside or near bright lights

• Educate in proper ways to instill eye drops

• Crease a schedule for eye drop for 2 to 4 weeks

• Do not drive until ointment is gone

• Mild itching swelling bloodshot appearance is NORMAL

• Avoid activities the increase IOP

• Best vision is 4 to 6 weeks after surgery

• What are activities that increase IOP?

• Bending from the waist

• Lifting objects more than 10 pounds

• Sneezing 

• Coughing

• Blowing nose

• Starting to have bowel movement vomiting

• Having sexual intercoarse

• What are the complications to report for cataracts?

• Sharp sudden pain

• Green or yellow thick discharge

• Reappearance of bloodshot sclera

• Bleeding or increased discharge

• Severe swelling

• Floaters