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Eye Trauma & Disorders

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olanjones's version from 2017-03-17 17:15

Eye Trauma

Question Answer
Eye trauma assessment findingsphotophobia, redness, swelling, ecchymosis, tearing, blood in anterior chamber, absent eye movements, fluid from eye (CSF, blood, aqueous humor), abnormal or ↓ vision; prolapsed globe
Initial interventionsABCs; assess for other injuries; check for chemical exposure (begin irrigation asap with saline if available); stabilize foreign objects; cover eye with dry, sterile patches & protective shield; do not give pt. food or fluids; HOB @ 45; do not put meds in eye unless ordered
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Eye Disorders

Question Answer
Hordeolumaka as a "sty" is an infection of sebaceous glands in lid margin usually d/t staph aureus
Hordeolum intervention/pt. teachingapply warm, moist compresses at least 4x/day until it improves, if reoccurring, may need antibiotic ointments
Chalazionchronic inflammatory granuloma of meibomian (sebaceous glands) that could evolve from a hordeolum or in response to the material released into the lid with a blocked gland ruptures
Chalazion characteristicsappears on upper lid as a swollen, tender, reddened area that may be painful.
Tx chalazionwarm compress 4x/day, if ineffective may need to be removed surgically
Blepharitiscommon bilateral inflammation of lid margins, pt. may complain of itching but also burning, irritation & photophobia with conjunctivitis
If blephartis is caused by a staph infection, what CC is initiated?Antibiotic ointment
Conjunctivitisinfection or inflammation of conjunctiva, caused by bacterial or viral orgs.
Keratitisinflammation or infection of cornea
HSV keratitismost frequently occurring infectious cause of corneal blindness in Western Hemisphere
Corneal Ulcertissue loss caused by infection of corneal, if untreated could result in scarring & perforation of cornea
Overall Nursing goals for eye inflammation & infectionavoid spread of infection; maintain acceptable level of comfort & functioning during course of specific ocular problem; maintain or improve visual acuity; comply with prescribed therapy; engage in appropriate health-seeking behaviors
Keratoconjunctivitis sicca dry eyes, usually with elderly & ppl with systemic conditions such as lupus
dry eye txartificial tears or ointments; if severe, may need to close off lacrimal puncta
Strabismuscondition in which patient cannot consistently focus two eyes on same object
penetrating keratoplastycorneal transplant for scars & opacities. surgeon removes full thickness of pt's cornea & replaces it with a donor cornea that is sutured into place
keratoconusnon-inflammatory, usually bilateral disease that has a familial tendency. Can be associated with Down Syndrome, Marfan's, atopic dermatitis.
keratoconus characteristicsanterior cornea thins & protrudes forward, taking on a cone shape, only sx is blurred vision
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Cataracts

Question Answer
What is a cataract?an opacity within the lens, pt. may have in one or both eyes
Etiology & pathomost are age-related (senile cataracts); can be from many other factors. Development is mediated by a # of factors in which altered metabolic processes w/in the lens cause accumulation of water & alterations in the lens fiber structure. These changes affect lens transparency, causing vision changes.
Manispt. complains of ↓ vision; abnormal color perception & glare
Dx studiesbased on decreased visual acuity, opacity is observable
Nonsurgical therapyNo "cure" to cataracts. Preventative measures to ↓ strain on eyes (don't drive at night, use good glasses, sunglasses, reading light)
Surgical therapyremoval of cataract when ↑ IOP is causing visual problems
Preoperative phase interventionsmydriatic, cycloplegic agents; NSAIDs; topical antibiotics; anti-anxiety meds
Surgeryremoval of lens: phacoemulsification (nucleus is fragmented by vibration & aspirated in capsular bag), extracapsular extraction (scooping out lens nucleus); correction of surgical aphakia; intraocular lens implantation; contact lens
Post optopical antibiotic; topicla corticosteroid or other anti-inflammatory agent; mild analgesia if needed; eye shield
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Glaucoma

Question Answer
Definitionnot one disease, but is a group of disorders characterized by ↑IOP & pressure, optic nerve atrophy & peripheral visual field loss
Primary open angle glaucomamore common, drainage channels clog damaging optic nerve. Develops slow w/o sx's Eventually gets "tunnel vision"
Primary angle-closure glaucomalens bulges forward d/t aging or pupil dilation (drugs, including prescription/OTC); causes definite symptoms: excruciating pain, n/v, colored halos around lights, blurred vision & ocular redness, ↑IOP=edema (frosted appearance)
Collaborative care, primary focuskeep IOP low enough to prevent pt from damaging optic nerve.
Drugs for Chronic open-angle glaucomaB-adrenergic blockers; a-adrenergic blockers; cholinergic agents (miotics); carbonic anhydrase inhibitors)
Surgical Therapy chronic open-angleargon laser trabeculoplasty; trabectomy
Acute angle-closure glaucoma txtopical cholinergic agent, hyperosmotic agent, laser peripheral iridotomy, surgical irdectomy
Nursing interventions non-pharmacologic for acute angle-closuredarken env't; cool compress to pt's forehead; quiet & private space for pt.
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Age-Related Macular Degeneration (AMD)

Question Answer
AMD divided into 2 formsnonexudative (dry) and exudative (wet) *Dry is more common @ 90%, but we is more severe and accounts for 90% of the AMD-related blindness
Manisblurred & darkened vision, blind spots in visual field, distortion of vision
Dx studiesprimary is opthalmoscopy & examiner looks for fundus changes
Collaborative carevision usually does not improve, limited tx options for wet AMD
Drug class injected into virtreous cavityselective inhibitors of endothelial growth factor, helping to slow vision loss in wet AMD SE: blurred vision, eye irritation, eye pain, photosensitivity, given at 4-6 wk intervals
Photodynamic therapyuses verteporfin IV & a "cold" laser to excite the dye...destroys abnormal blood vessels w.o damaging other cells.
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