Adult I Eye

Front 1

What are some assessment questions you may ask regarding the eye?

Back 1

blurred vision? double vision? pain? headache? foreign body? difficulty driving at night? or at all?

family history? recent infection? eye injury? medical history of diabetes, hypertension, arthritis, or allergies?

Front 2

Cataract

Back 2

a clouding of the eye's natural lens in which light is scattered

Front 3

Definition of cataract

Back 3

gradual progressive opacity of the lens or lens capsule that leads to visual loss

Front 4

What are some causes of cataracts?

Back 4

aging (most common), trauma, drugs, chemical toxicity, secondary effects

Front 5

What are the early signs of cataracts

Back 5

blurred vision and decreased color perception

Front 6

What occurs in cataracts (pathophys)

Back 6

lens is made of water and proteins and due to aging, the proteins clump together and cloud a small area of the lens. light rays cannot pass through, causing vision loss

Front 7

Do cataracts develop bilaterally or unilaterally?

Back 7

bilaterally, but progresses different in each eye

Front 8

What is the treatment for cataracts?

Back 8

removal and replacement of the lens

Front 9

What are signs and symptoms of cataracts?

Back 9

hazy or blurred vision, dimmed colors, light appearing too bright or glaring, gradual and painless loss of vision, pupil may appear milky or white

Front 10

What are some risk factors for cataracts?

Back 10

age (increased), smoking, steroids, eye injury, diabetes, obesity, exposure to light, alcoholism, family history

Front 11

What are some complications of cataracts?

Back 11

impaired vision, blindness, and rarely, glaucoma

Front 12

What is the management and tx of cataracts

Back 12

unilateral- can continue w/o surgery
bilateral- surgery recommended
there is no medical tx available

Front 13

What are some pre-op considerations for the eye?

Back 13

assess knowledge regarding procedure, assess fear and anxiety levels, discontinue anticoagulants, lab values, dilating drops (every 10 minutes x 4 up to 1 hour)

Front 14

What are some post-op considerations for the eye?

Back 14

precautions to prevent increased IOP and injury

Front 15

What are some ways to prevent increased IOP post op cataracts?

Back 15

positioning, stool softener, avoid sneezing or coughing, antiemetic, hair care, excessive exertion (lifting)

Front 16

What are some ways to prevent injury post op for cataracts?

Back 16

report any sharp pain or feelings of IOP, assist with ambulation as needed, prevent sensory deprivation, promote adequate nutrition, teach self care measurements, orientating, needed items within reach, bed in low position, adequate lighting, assist with ambulation, keep hands away from face, comfort measures

Front 17

What do you assess for post op in the eye?

Back 17

pain for sudden onset, severe pain followed by n/v, visual acuity in the eye, signs and symptoms of infection, level of independence

Front 18

What may sudden pain after eye operation signal

Back 18

hemorrhage

Front 19

What may severe pain followed by n/v indicate post op?

Back 19

increased IOP

Front 20

What are some eye post op complications?

Back 20

pain from inflammation of various eye structures, suture problem (broken or loose), infection, malposition or dislocation of lens

Front 21

What is the MOA of a direct acting miotic?

Back 21

results in miosis and contraction of the ciliary muscle, opens the angle to improve aqueous outflow

Front 22

What is the primary use of direct acting miotics?

Back 22

glaucoma or to counteract mydriatics (usually narrow angle)

Front 23

What are some direct acting miotics?

Back 23

acetylcholine, carbachol, pilocarpine

Front 24

What is the MOA of cholinesterase inhibitor miotics?

Back 24

inhibit cholinesterase, causing intense miosis and contraction of ciliary muscle; decrease in IOP due to increased aqueous outflow

Front 25

What is the use of cholinesterase inhibitor miotics?

Back 25

open angle glaucoma

Front 26

What is the MOA of beta adrenergic blockers

Back 26

act on beta receptors and decrease the formation of aqueous humor, cauinsg a slight increase in outflow

Front 27

What is the use of beta adrenergic blockers

Back 27

increased IOP

Front 28

What are some examples of cholinesterase inhibitor miotics?

Back 28

demecarium bromide (humorsol), floropryl, isopto eserine

Front 29

What are some examples of beta adrenergic blockers

Back 29

betoptic, betagan, timoptic, ocupress

Front 30

What is the use of osmotic diuretics?

Back 30

IV used for reduction of IOP in acute attack of glaucoma or before ocular surgery where preop reduced IOP is indicated

Front 31

What is the use of mydriatics

Back 31

result in dilation of pupil, vasoconstriction, and an increase in the outflow of aqueous humor; used for pupillary dilation or surgery and examination

Front 32

What are some osmotic diuretics?

Back 32

osmitrol and glycerol

Front 33

What are some mydriatics?

Back 33

phenylephrine

Front 34

What is used for pupillary dilation for surgery and examination?

Back 34

mydriatics (phenylephrine)

Front 35

What is used for pre-op reduction of IOP or attack of acute glaucoma?

Back 35

osmotic diuretics

Front 36

What decreases aqueous humor production?

Back 36

beta-adrenergic blockers

Front 37

What can mydriatics and cycoplegics used together cause

Back 37

max dilation for 3 hours for surgery, fundus exams, or viewing internal structures of eye

Front 38

What are effects of mydriatics?

Back 38

glare, inability to focus, read, drive

can affect CNS, and effects children more often

Front 39

What do you assess for closely with mydriatrics and cycoplegics?

Back 39

rise in BP, dizziness, confusion, hallucinations, tachycardia, ataxia, disorientation, incoherent speech

Front 40

What is macular degeneration?

Back 40

disease associated with aging that gradually destroys the central vision and it affects the macula

Front 41

What is central vision needed for?

Back 41

seeing objects clearly, fine detailed sight, reading, driving

Front 42

What are some causes of macular degeneration?

Back 42

aging

Front 43

What are some risk factors for macular degeneration

Back 43

smoking, obesity, race (more in caucasians), family history, gender

Front 44

What are the stages of AMD

Back 44

early, intermediate, and advanced

Front 45

What is the early stage of macular degeneration (AMD)?

Back 45

several small drusen, but no vision loss

Front 46

What is the intermediate stage of macular degeneration?

Back 46

medium sized drusen or one of more large drusen; blurred spot in the center of vision

Front 47

What is the advanced stage of AMD?

Back 47

breakdown of light sensitive cells and tissue in the retina; blurred spot gets bigger and darker

Front 48

What is wet macular degeneration (AMD)

Back 48

abnormal blood vessels behind the retina start to grow under the macula and new vessels are fragile and they leak blood and fluid, which damages the macula rapidly

Front 49

What is dry macular degeneration (AMD)

Back 49

light sensitive cells in the macula slowly break down, central vision is blurred in teh affected eye, and the blurred spot in center of vision occurs as AMD gets worse
over time, central vision is gradually lost

Front 50

What occurs in dry AMD

Back 50

aging and thinning of macular tissues, depositioning of pigment in the macula, can be a combination of both

Front 51

What occurs in wet AMD

Back 51

abnormal blood vessel growth, attempting to supply more nutrients and oxygen to the retina, creates scarring

Front 52

What are signs and symptoms of dry macular degeneration?

Back 52

slightly blurred vision, difficulty recognizing faces, more light for reading, development of drusen

Front 53

What is wet macular degeneration?

Back 53

straight lines appear wavy

Front 54

What are some complications of AMD

Back 54

central vision loss, vitreous hemorrhage

Front 55

What must you have first: wet or dry?

Back 55

dry

Front 56

How do you administer eye drops?

Back 56

pull lower lid down to expose conjunctiva, have patient look up and away, squeeze drops in, release eyelid, have pt blink

Front 57

How do you install eye ointment?

Back 57

lay a thin strip of med along conjunctival sac from inner to outer canthus; avoid touching tip of tube to eye, release eyelid, have patient roll eye behind closed lips to distribute

Front 58

If giving eye drops and ointment, which do you instill first?

Back 58

drops

Front 59

What do you do for eye meds that can be absorbed systemically?

Back 59

press thumb on inner canthus for 1-2 minutes after instillation while patient closes eyes

Front 60

How many patients should receive eye meds from the same tube?

Back 60

just one

Front 61

How much time do you put in between eye drops if you have more than one?

Back 61

5 minutes

Front 62

When should you apply pressure to eye?

Back 62

when ordered

Front 63

When do you change eye shield

Back 63

only with order

Front 64

When do you change eye patch

Back 64

only with order

Front 65

What are some psychological implications with eye problems

Back 65

coping difficulties (unknown prognosis, chronic or long term condition), self concept changes (related to altered body image, blindness, need for glasses, possible loss of independence), lifestyle changes (role change, job duties, loss of job, self care deficit), social interaction pattern changes (depression, isolation)

Front 66

What must you remember in patients with eye problems?

Back 66

safety (orient, meds, mobility/independence), alteration in mood and mental status, safety (falls, side rails, call light, adequate lighting, room orientation, assess home environment, call for help)

Front 67

What is a group of conditions associated by abnormally elevated IOP which can damage the optic nerve

Back 67

glaucoma

Front 68

What are 2 types of glaucoma

Back 68

acute closed angle and chronic open angle

Front 69

What is IOP determined by?

Back 69

rate of aqueous production

Front 70

What is IOP

Back 70

resistance encountered by the aqueous humor as it flows out of the passages

Front 71

What is normal IOP

Back 71

10-21 mmHg

Front 72

When does IOP increase

Back 72

when aqueous fluid is inhibited from flowing out

Front 73

What is the main focus of treatment for increased IOP and glaucoma

Back 73

prevent optic nerve damage!!!*

Front 74

What are some incidence of glaucoma?

Back 74

congenital, hereditary

Front 75

What are some risk factors for glaucoma?

Back 75

family history, African American, age, diabetes, CV disease, migraine syndromes, nearsightedness, eye trauma, prolonged use of steroids

Front 76

What are some early signs of glaucoma

Back 76

decreased accommodation and increased IOP

Front 77

What are some late signs of glaucoma

Back 77

loss of peripheral vision, decreased visual acuity, halos around lights

Front 78

What are some complications of glaucoma

Back 78

optic nerve damage (can lead to blindness), blindness, motor vehicle accidents (loss of peripheral vision)

Front 79

What occurs in acute angle glaucoma?

Back 79

mechanical blockage of anterior chamber angle; angle closure from pupillary dilation, sudden elevation of IOP, permanent eye damage without hours if untreated

Front 80

What type of glaucoma can cause permanent eye damage within hours if untreated?

Back 80

acute closed angle glaucoma

Front 81

What occurs in acute angle glaucoma?

Back 81

scar tissue forms between iris and cornea, iris and ciliary body start to atrophy, cornea degenerates due to edema, optic nerve begins to atrophy

Front 82

What are some assessment findings in acute glaucoma?

Back 82

rainbow of color (halos) around lights, reddened eye with excruciating pain, pupil mid-dilated and fixed, hazy looking cornea, due to corneal edema, headache, N/V, sudden onset of blurred vision, profuse lacrimation

Front 83

What are some reasons for meds for glaucoma?

Back 83

needed to decrease eye pressure before surgery, prescribed at discretion of the MD

Front 84

What is a medical emergency glaucoma?

Back 84

acute closed-angle glaucoma

Front 85

What are some interventions for acute glaucoma?

Back 85

relieve pain, relieve fear, use of medications, follow up visits, seek med attention immediately if needed, avoid meds that may raise iop

Front 86

What is the pathophys of chronic open angle glaucoma?

Back 86

obstruction to outflow of aqueous humor through the trabecular meshwork to canal of Schlemm which causes IOP and it's usually bilaterally

Front 87

what increases the risk of eye damage with chronic open angle glaucome?

Back 87

age, family history

Front 88

What are some interventions for chronic open angle glaucoma?

Back 88

provide information, continue to take meds as ordered, follow up is VITAL!, discuss visual defects and how to compensate, permanent vision loss, and treatment aimed at stopping progression

Front 89

What is a sign of chronic open angle glaucoma?

Back 89

halo vision

Front 90

What are some parts to patient education for chronic open angle glaucoma?

Back 90

IOP can be elevated, through asymptomatic, ongoing use of meds and follow up, glaucoma cannot be cured, can be controlled, avoid circumstances that can increase IOP, recommend the daily use of eye meds, moderate use of the eyes, wear medi-alert tag, adequate administration, teach about med

Front 91

Can glaucoma be cured?

Back 91

no

Front 92

What should you recommend with chronic open angle glaucoma?

Back 92

daily use of eye meds, moderate use of eyes

Front 93

What should the pt do after you provide demonstration of meds?

Back 93

return demonstration

Front 94

What are some meds for chronic open angle glaucoma

Back 94

timolol (timoptic), pilocarpine (pilocar), acetozolamide, methazolamide

Front 95

What are some parts to assessment findings for chronic open angle glaucoma?

Back 95

no early symptoms, insidious visual impairment, blurring, foggy vision, diminished accommodation, gradual loss of peripheral vision, mild aching eyes, halos around lights later with increased IOP

Front 96

How should you position a patient post op for chronic open angle glaucoma?

Back 96

HOB 30 degrees to help drain aqueous humor

Front 97

How do they manage chronic open angle glaucoma?

Back 97

commonly treat a combo of topical miotic agents and a local carbonic anhydrase inhibitors and beta adrenergic blockers; follow up at 3-6 mo, surgery may be required

Front 98

What are the adverse effects of using timoptic and betoptic?

Back 98

headche, eye irritation, decreased corneal sensitivity, blurred vision, bradycardia, palpitations, bronchospasm, hypotension, tachycardia, heart failure

Front 99

What are some adverse effects of pilocarpine?

Back 99

eye irritation, blurring and redness, headache, pupil constriction, poor vision in dim light, possible hypertension, and tachycardia
rare: retinal detachment and lens opacity

Front 100

What are some adverse effects of azetazolamide (diamox) and neptazane?

Back 100

drowsiness, anorexis, paresthesia, stomach upset, tinnitus, fluid and electrolyte imbalance

rare: kidney and liver dysfunction