chapter 46 Coordination Care for Patients with Visual Disorders

Learning Outcomes

• Understanding the epidemiology, pathophysiology, clinical manifestations, diagnostics, management, complications, and nursing care planning for patients with visual disorders.

Key Concepts

• Caring: The importance of compassionate care in managing visual disorders.
• Comfort: Providing pain control and relief from discomfort related to eye conditions.
• Infection and Inflammation: Recognizing and managing infections and inflammatory conditions that affect the eyes.
• Medication: Understanding pharmacologic interventions for eye disorders.
• Perioperative Care: Recognizing the special considerations required for patients undergoing eye surgery.
• Sensory Perception: Assessing the impact of visual disorders on sensory perception.

Essential Terms

• Amsler Grid: A tool used to assess visual changes associated with macular degeneration.
• Drusen Bodies: Yellow deposits in the retina associated with age-related macular degeneration.
• Photorefractive Keratectomy (PRK): A surgical solution for refractive errors in the eye.
• Phacoemulsification: A procedure for cataract removal involving ultrasonic waves to break up the lens.

Visual Acuity Disorders

• Refractive Errors: Include myopia (nearsightedness), hyperopia (farsightedness), astigmatism (irregularities in the cornea), and presbyopia (age-related loss of lens elasticity).
  • Myopia: Eyeball too long; distant objects are blurry.
  • Hyperopia: Eyeball too short; near objects are blurry.
  • Astigmatism: Distorted images due to uneven cornea.
  • Presbyopia: Age-related difficulty seeing close objects.

Epidemiology of Visual Disorders

• Approximately one-third of people over 40 years experience some form of refractive error.
• Myopia affects about 25% of the U.S. population; hyperopia also affects 25%.

Clinical Manifestations

• Myopia: Blurry distance vision.
• Hyperopia: Blurry near vision.
• Astigmatism: Wholesome vision distortions leading to headaches and squinting.
• Presbyopia: Difficulty focusing on close objects; require reading glasses.

Diagnostic Approach

• Use of Snellen charts for visual acuity assessment; referral to optometrist or ophthalmologist for detailed evaluation if abnormalities are found.

Interprofessional Management

Medical Management

• Focus on maximizing sight via corrective lenses; options include eyeglasses, contact lenses, and surgical interventions.
• Orthokeratology: Contact lenses reshape the cornea to correct myopia.

Surgical Management

• Common surgical procedures include:
  • Radial Keratotomy: Incisions made to flatten the cornea.
  • LASIK: Laser reshapes the cornea.
  • Keratoplasty: Replacement of corneal tissue.

Nursing Management

Assessment and Diagnosis

• Assess visual acuity with tools such as the Snellen chart, monitor signs of infection or complications, and assess patient comfort.

Nursing Diagnoses

• Disturbed sensory perception related to visual disorders.
• Risk for injury due to compromised vision quality.
• Potential for anxiety related to the diagnosis and treatment.

Nursing Interventions

• Ensure proper use of corrective lenses.
• Educate patients on the importance of follow-up appointments.
• Provide comfort measures such as adequate lighting and eye protection.

Other Visual Disorders

Endogenous Endophthalmitis

• Related to opioid use; can lead to blindness due to infection.
  • Presentation: Red, painful eye, photophobia, floaters.
  • Management: Prompt administration of antibiotics and potential hospitalization.

Conjunctivitis (Pink Eye)

• Caused by allergies, bacteria, or viruses; presents with redness, itching, watering, and discharge.
  • Treatment: Depends on etiology; includes antihistamines, antibiotics, or supportive care.

Corneal Abrasion

• Superficial scratch or scrape on the cornea; very painful and requires management with antibiotics and eye drops.

Cataracts

• Clouding of the lens leads to decreased vision, managed through surgical lens replacement.

Glaucoma

• Increased intraocular pressure leading to optic nerve damage; various types including open-angle and angle-closure glaucoma.
  • Medical and surgical treatments focus on lowering intraocular pressure.

Macular Degeneration

• Age-related condition affecting central vision; can progress from dry to wet forms.
  • Management includes laser treatments and dietary interventions.

Retinal Detachment

• Medical emergency characterized by separation of the retina; requires immediate surgical intervention.

Eye Trauma

• Includes both blunt and penetrating injuries; management focuses on stabilization and preventing further damage.

Teaching Plans for Patients

• Importance of compliance with follow-up visits, proper lens use, and recognizing complications.
• Education around visual changes and when to seek medical help is crucial in all visual disorders to maintain eye health.