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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e. Chapter 42: Caring for Clients with Eye Disorders. Approximately 18 million people in the United States have some degree of visual impairment – which include approx 1 million who are legally. BLIND. Refractive Errors.

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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

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  1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 42: Caring for Clients with Eye Disorders

  2. Approximately 18 million people in the United States have some degree of visual impairment – which include approx 1 million who are legally BLIND

  3. Refractive Errors • Emmetropia: Normal vision • Myopia • Hyperopia • Presbyopia • Astigmatism • Box 42-1 pg 607 Figure 42-1 pg 607 Eyeball shape affects visual acuity in some refractive errors.

  4. Refractive Errors • Pathophysiology, Etiology • Etiology - Inherited; Surgical error • Presbyopia: Natural degenerative changes • Assessment Findings: Blurred vision; Recurrent headaches • Diagnostics: Snellen, Jaeger charts; Retinoscopy • Medical Management: Eyeglasses; Contact lenses • Surgical Management: RK; LASIK; PRK; ICRS; IOLs; CK • Nursing Management

  5. Blindness, Visual Impairment • BCVA ≤20/200, even with corrective lenses • Visual Impairment: BCVA between 20/70 and 20/200 (in better eye with glasses) • Causes: Congenital; Injury; Optic nerve damage; Disorders; Tumors • Medical Management: Corrective lenses; Rehabilitation; Independent living skills • Nursing Management • REVIEW: Client & Family teaching: 42-1 & 42-2, pg 608 • REVIEW: Gerontologic Considerations, pg 609 • REVIEW: Nursing Process for Blind Client, pg 609 - 610

  6. Eye Trauma • Pathophysiology, Etiology • Weather; Chemicals; Injury; Endophthalmitis • Assessment Findings: Signs and Symptoms • Pain; “Gritty” feeling; Tearing; Blurred vision; Asymmetric eyes; Diplopia; Edema; Bleeding; Purulent drainage • Diagnostic Findings • Fluorescein dye; Slit-lamp examination • Radiography; CT scan

  7. Eye Trauma • Medical, Surgical Management • Emergency first aid; Antibiotic ointment or drops; Eye patch placement • Hospitalization • Surgical repair • Nursing Process for Eye Trauma, pg 611 - 612 • Client & Family Teaching 42-3, Instilling eye meds • REVIEW: Stop, Think and Respond 42-1 pg 612 Figure 42-2 pg 611 Everting the eyelid

  8. Conjunctivitis • Pathophysiology, Etiology: Bacterial,Viral; Rickettsial infection • Easily transmitted; Can lead to blindness • Assessment Findings: Redness; Tearing; Burning; Itching; Purulent drainage; Enlarged lymph nodes • Medical Management: Antibiotic, antiviral meds; Warm soaks, irrigations; Decongestants; Antihistamines • Nursing Management: Read bullet points pg 612-613

  9. Uveitis • Pathophysiology, Etiology: Inflammatory changes • Identified with specific diseases or autoimmune disorders • Assessment Findings: Blurred vision; Photophobia; Eye pain; Red, congested eye; Pupil reacts poorly to light • Diagnostic Findings: Slit-lamp examination • Medical Management: Oral, topical corticosteroids; Mydriatic, antibiotic eyedrops; Analgesics; Sunglasses • Nursing Management

  10. Keratitis, Corneal Ulcer • Pathophysiology, Etiology: Corneal trauma; Infectious agents • Assessment Findings: Pain; Photophobia; Blurred vision; Tearing; Purulent discharge; Redness • Diagnostic Findings: Flashlight illumination; Slit-lamp exam; Fluorescein drops, strips • Medical, Surgical Management: Topical anesthetics; Mydriatics; Antibiotics; Keratoplasty • Nursing Management: no contact lens, keep eye clear of exudate

  11. Blepharitis • Pathophysiology, Etiology: Hypersecretion; Infectious agents • Assessment Findings: Inflamed lid margins; Patchy flakes; Missing eyelashes; Purulent drainage • Diagnostic Findings: Scraping lid margins; Microscopic examination • Medical Management: Topical antibiotic; Cleansing: Eye, face, and hair • Nursing Management

  12. Hordeolum (Sty) • Pathophysiology, Etiology: Staphylococcus aureus • Assessment Findings: Tender, swollen, red pustule • Medical, Surgical Management: Warm soaks; Topical antibiotic • Severe cases: Incision; Drainage • Diagnostic Findings: Exudate culture identifies pathogen (seldom used) • Nursing Management: separate towels, cleanliness

  13. Chalazion (cyst) • Pathophysiology, Etiology: meibomian gland becomes obstructed and the release of sebaceous secretions is blocked; cyst • Assessment Findings: swollen, hard, can block vision if too large • Medical, Surgical Management: Warm soaks; massage • Severe cases: excision • Nursing Management: review bullet points on pg 614

  14. Macular Degeneration • Pathophysiology, Etiology: breakdown of or damage to the macula • Dry: Gradual onset; Wet: Abrupt onset • Leading cause of vision loss in clients >60 yrs • Assessment Findings • Dry: Blurred vision; Central vision affected • Wet: Vision distortion; Central vision affected • Medical Management: Laser photocoagulation; Photodynamic therapy; Intravitreal injection; Macular translocation (new); Diet, vitamins • Nursing Management

  15. Glaucoma • Pathophysiology, Etiology: Aqueous fluid imbalance; Elevated IOP • Assessment Findings: Signs and Symptoms • Open-angle: May be asymptomatic, Eye discomfort; Temporary blurred vision; Halos; Reduced peripheral vision • Acute angle-closure: Hard, painful, sightless eyes; N/V; Red conjunctiva; “Steamy” cornea • Diagnostic Findings: Optic disc visualization; Anterior chamber inspection; Tonometry; Visual field exam

  16. Glaucoma • Medical, Surgical Management: Medications; Miotics; Analgesics; Complete rest; Laser, surgical iridectomy; Laser trabeculoplasty; Corneal trephine • REVIEW: Drug Therapy Table 42-1, pg 618 • Nursing Management: meds are lifelong - if doctors orders followed, glaucoma can be controlled • REVIEW: Stop, Think, Respond, 42-2, pg 619

  17. Cataracts • Pathophysiology, Etiology: Aging process; Congenital; Lens injury; Secondary condition • Assessment Findings: Halos; Difficulty in reading; Color vision changes; Reduced, distorted vision • Diagnostic Findings: Snellen chart; Ophthalmoscopic and slit-lamp examination; Tonometry

  18. Cataracts • Surgical Management: Intracapsular or extracapsular extraction; Phacoemulsification • Post-op vision restoration: Corrective glasses; Contact lens; IOL implant • Nursing Management: Review bullet points, pg 620; Review Nutritional Notes 42-2 pg 620 • REVIEW: Nursing Care Plan 42-1 pg 621 & 622 X

  19. Retinal Detachment • Pathophysiology, Etiology: Retinal stretching; Degenerative changes; Injury; Eye surgery; Figure 42-8, pg 622 • Assessment Findings: Signs and Symptoms • Blind spots; Flashes of light; Floaters; Complete vision loss • Diagnostic Findings: Ophthalmoscope • Surgical Management: Laser surgery; Cryopexy; Diathermy; Retinopexy; Scleral buckling; Pneumatic retinopexy • Nursing Management

  20. Enucleation • Surgical Removal of an Eye due to • Injury; Disease • Tumor; Severe pain (damaged, sightless eye) • Medical, Surgical Management • Metal or plastic ball in capsule of connective tissue • Pressure dressing; Shell-shaped prosthesis • Nursing Management: Watch for hemorrhage, infection

  21. End of Chapter

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