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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/20 Pg 606

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/20 Pg 606. Chapter 42: Caring for Clients with Eye Disorders By: P.K. Williams, RN. 23 Words to Know 02/20 Pg 606. Astigmatism Cataract Diplopia

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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/20 Pg 606

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  1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/20 Pg 606 Chapter 42: Caring for Clients with Eye Disorders By: P.K. Williams, RN

  2. 23 Words to Know 02/20 Pg 606 • Astigmatism Cataract Diplopia • Corneal Transplantation Corneal trephine Emmetropia • Edophtalmitis Enucleation Glaucoma • Hordeolum Hyperopia Iridectomy • Keratitis Keratoplasty Myopia • Intraocular lens implant Photophobia • Macular degeneration Retinal detachment Uvetitis • Trabeculoplasty Visually impaired

  3. 15 Learning Objectives 03/20 Pg 606 On completion of this chapter, you will be able to: 01 Explain the different types of refractive errors. 02 Differentiate the terms blindness and visually impaired. 03 Identify appropriate nursing interventions for a blind client. 04 Discuss the nursing management of clients with eye trauma. 05 Describe the technique for instilling ophthalmic medications. 06 Explain how different infectious and inflammatory eye disorders are acquired. 07 Specify the visual changes that result from delayed or unsuccessful treatment of macular degeneration.

  4. 15 Learning Objectives 04/20 Pg 606 08 Differentiate between open-angle and angle-closure glaucoma. 09 Distinguish categories and mechanisms of actions of medications used to control intraocular pressure. 10 Identify a category of drugs contraindicated in clients with glaucoma. 11 Name activities clients with glaucoma should avoid because they elevate intraocular pressure. 12 Describe methods for improving vision after a cataract is removed. 13 Discuss postoperative measures that help prevent complications after a cataract extraction. 14 Give classic symptoms associated with a retinal detachment. 15 Discuss the care and cleaning of an eye prosthesis.

  5. Refractive Errors 05/20 Pg 606 • Emmetropia: *** Normal vision • Myopia;*** • Hyperopia;*** • Presbyopia;*** • Astigmatism;*** Figure 42-1 Eyeball shape affects visual acuity in some refractive errors.

  6. Refractive Errors 06/20 Pg 606 • Pathophysiology, Etiology • Inherited; Surgical treatment result • 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

  7. Blindness, Visual Impairment 07/20 Pg 608 • BCVA≤20/200, even with corrective lenses [Best Corrected Visual Acuity] • 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

  8. Eye Trauma*** 08/20 Pg 607 • 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

  9. Eye Trauma 09/20 Pg 610 • Medical, Surgical Management • Emergency first aid; Antibiotic ointment or drops; Eye patch • Hospitalization • Surgical repair • Nursing Management Figure 42-2 Everting the eyelid

  10. Conjunctivitis 10/20 Pg 612 • 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

  11. Uveitis11/20 Pg 613 • 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

  12. Keratitis, Corneal Ulcer 12/20 Pg 613 • 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

  13. Blepharitis 13/20 Pg 613 • 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

  14. Hordeolum (Sty)***14/20 Pg 614 • Pathophysiology, Etiology: Staphylococcus aureus[infected make up] • 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

  15. Macular Degeneration*** 15/20 Pg 614 • Pathophysiology, Etiology: Types • Dry: Gradual onset; Wet: Abrupt onset • Assessment Findings • Dry:Blurred vision; Central vision affected • Wet:Vision distortion; Central vision affected • Medical Management: Laser photocoagulation; Photodynamic therapy; Intravitreal injection; Macular translocation; Diet, vitamins • Nursing Management

  16. Glaucoma***16/20 Pg 616 • Pathophysiology, Etiology: Aqueous fluid imbalance; Elevated IOP • Assessment Findings: Signs and Symptoms • Open-angle: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 • Medical, Surgical Management: Medications; Miotics; Analgesics; Complete rest; Laser, surgical iridectomy; Laser trabeculoplasty; Corneal trephine • Nursing Management

  17. Cataracts***17/20 Pg 619 • 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 • Surgical Management: Intracapsular or extracapsular extraction; Phacoemulsification • Post-op vision restoration: Corrective glasses; Contact lens; IOL implant • Nursing Management

  18. Retinal Detachment***18/20 Pg 620 • Pathophysiology, Etiology: Retinal stretching; Degenerative changes; Injury; Eye surgery • 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

  19. Enucleation***19/20 Pg 623 • 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 • A shell-shaped prosthesis [painted to match the remaining eye • Nursing Management

  20. End of Presentation Now NCLEX By: P.K. Williams, RN20/20 Pg 606 pkwilliams@DNI.edu

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