Med/surg Sensory Unit

Front 1

Assessment & Eval of Vision- Ocular Hx

Back 1

Visual acuity, pain, interference with ADLs,

Genetic components

Front 2

Assessment & Eval of Vision- Visual acuity

Back 2

Snellen chart, Record each eye (20/20 means pt can read the '20' line at a distance of 20 ft)

*Finger count or hand motion

Front 3

Examination of the external structures

Back 3

Note any evidence of irritation, inflammatory process, discharge, etc.

Assess eyelids and sclera

Assess pupils and pupillary response (use darkend room!)

Note gaze and position of eyes

Assess extraocular movements

Front 4

Definition of Ptosis

Back 4

drooping eyelid

Front 5

Definition of Nystagmus

Back 5

oscillating movement of the eyeball

Front 6

Dx Evals- Opthalmoscopy

Back 6

Examines the cornea, lens and retina

Color Vision testing, Amsler grid (macular degeneration), Ultrasonography

Front 7

Dx Evals- Tonometry

Back 7

Measures IOP (intra-ocular pressure)

Front 8

Dx Evals- Perimetry testing

Back 8

Evaluates the field of vision; identifies scotomas: blind areas in the visual field

Front 9

Refractive errors- how can they be corrected?

Back 9

Corrected by lenses which focus light rays on the retina

*refractive errors- eyeball shape

Front 10

Definition of Emmetropia

Back 10

normal vision

Front 11

Definition of Myopia

Back 11

nearsighted

Front 12

Definition of Hyperopia

Back 12

farsighted

Front 13

Definition of Astigmatism

Back 13

distortion due to irregularity of the cornea

Front 14

Refractive Error CMs- Myopia

Back 14

the person can see nearby objects clearly but distant objects appear blurred

Front 15

Refractive Error CMs- Hyperopia

Back 15

the person can see distant objects clearly but nearby objects appear blurred

Front 16

Refractive Error CMs- Astigmatism

Back 16

Sometimes can give you HAs or eyestrain and distort or blur your vision at all distances

Front 17

Definition of Glaucoma

Back 17

A group of ocular conditions in which damage to the optic nerve is r/t increased IOP caused by congestion of the aqueous humor

Front 18

What is the leading cause of blindness in adults in the US?

Back 18

Glaucoma

Front 19

RFs for Glaucoma

Back 19

*Incidence increases with age!

Age over 40, male, African American race

Front 20

CMs of Glaucoma

Back 20

'Silent theif'

Unaware of the condition until there is a significant vision loss

Peripheral vision loss

Blurring

Halos

Difficulty adjusting eyes to low lighting

Difficulty focusing

Aching or discomfort around eyes or HA

Front 21

What Dx evals would you use for a pt diagnosed with Glaucoma?

Back 21

Visualize optic nerve with opthalmoscope

Tonometry- assess IOP

Gonioscopy- assess angle of the ant chamber

Perimetry- assess vision loss

Front 22

Tx for Glaucoma

Back 22

Goal: prevent further optic nerve damage

Maintain IOP within a range unlikely to cause damage

Pharm therapy- topical Beta Blocker first

Surgery- improve drainage

Front 23

Surgery to improve drainage for pt diagnosed with Glaucoma

Back 23

Laser trabeculoplasty

Traibeculectomy

Laser iridotomy

Filtering procedures

Drainage implants/shunts

Front 24

NRSG MGMT & Pt education for Glaucoma

Back 24

Therapeutic regimen for lifelong control

Use and effects of medicine

Meds used for glaucoma may cause vision alterations and other side effects

Support and interventions to aid the pt in adjusting

Front 25

Definition of Cataracts

Back 25

An opacity or cloudiness of the lens

Front 26

What is the increased incidence with aging for Cataracts?

Back 26

By age 80 more than half of all Americans have cataracts

*A leading cause of disability in the US

Front 27

RFs for Cataracts

Back 27

Aging, chemicals, nutrition, dehydration, UV light, trauma, other disorders

Front 28

CMs of Cataracts

Back 28

Painless

Blurry vision

Reduced visual acuity

Other effects- during exam: decreased visual acuity, opacity of the lens

Front 29

Sugical MGMT for Cataracts

Back 29

If reduced vision does not interfere with normal activities, surgery is not needed

Surgery is performed outpatient

Local anesthesia

Surgery usually takes less than 1 hour

Patients are discharged soon afterward

Complications are rare but may by significant

Front 30

Types of Cataract Surgery- Intracapsular Cataracts Extraction (ICCE)

Back 30

removes entire lens

Front 31

Types of Cataract Surgery- Extracapsular cataract extraction (ECCE)

Back 31

maintains the posterior capsule of the lens

Front 32

Types of Cataract Surgery- Phacoemuslification

Back 32

An ECCE uses an ultrasonic device to suction the lens out

Incision is smaller

Front 33

Types of Cataract Surgery- Lens replacement

Back 33

IOL- intraocular lens implant

Front 34

NRSG MGMT for Cataract surgery

Back 34

Preop care for ambulatory surgery

Dilate eye drops or other meds as ordered

Postop Care

Written and verbal instructions

Front 35

What is Retinopathy? (CMs and RFs)

Back 35

Damage to the retina

Inflammation, vascular remodeling

HTN, DM, prematurity, trauma, sunlight, radiation

Prevention is key!

Front 36

Diabetic Retinopathy- Surgical MGMT

Back 36

Treat the current condition- does not reverse the loss of vision that has already occurred

Front 37

Definition of Photocoagulation

Back 37

high energy laser beam, seals the leaking

this causes the blood vessels to shrink and disappear

Front 38

Diabetic Retinopathy NRSG Dx

Back 38

Disturbed Sensory Perception

Knowledge Deficit r/t the importance of keeping the BG within norm limits to prevent diab retinopathy

Front 39

Definition of Retinal Detachment

Back 39

Separation of the sensory retina and the retinal pigment epithelium

Front 40

CMs of Retinal Detachment

Back 40

Sensation of shade or curtain coming across the vision of the eye

Bright flashing lights

Sudden onset of floaters

Front 41

Dx Findings of Retinal Detachment

Back 41

Assess visual acuity

Assessment of retina by indirect opthalmoscope

Slit-lamp

Stereo fundus photography

Fluorescein angiography

Tomography

UA

Front 42

Surgical Tx of Retinal Detachment

Back 42

Goal- reattach!

Scleral buckle

Pars plana vitrectomy

Pneumatic retinoplexy

Postop positioning is crucial!

Front 43

Definition of Pneumatic retinoplexy

Back 43

Injected gas bubble, liquid or oil is used to flatten the sensory retina against the RPE

Front 44

What does a Sclera Buckle do?

Back 44

Encircles the globe

Holds sclera against the retina

Repairs tear

Front 45

NRSG MGMT for eye surgery

Back 45

PT teaching- eye surgery is mostly an outpatient procedure- education is vital!

S/S of complications- especially increased IOP and infection

Promote comfort

Pt may need to lie in a special position with pneumatic retinoplexy

Front 46

Definition of Macular Degeneration

Back 46

Age-related Macular Degeneration (AMD) is the most common cause of vision loss in persons older that age 60

2 types- Dry and Wet

Front 47

Dry- Macular Degeneration

Back 47

Most common 85-90%

Slow breakdown of the layers of the retina with appearance of drusen

Front 48

Wet- Macular Degeneration

Back 48

Vessels beneath retina leak fluid and elevate the retina

Front 49

Photodynamic therapy for slowing progression of AMD

Back 49

Light sensitive verteporfin dye is injected into vessels

Laser activates the dye- shutting down vessels without damaging the retina

The result is to slow or stabilize vision loss

Pt must avoid exposure to sunlight or bright light for 5 days after treatment to avoid activation of dye in vessels near the surface of the skin

Front 50

Trauma of the Eye- emergency tx

Back 50

Flush chemical injuries

Do not remove foreign objects

Protect using metal shield or paper cup

*Potential for sympathetic opthalmia causing blindness in the uninjured eye with some injuries

Front 51

Infectious and Inflammatory disorders- Conjunctivitis

Back 51

Pink Eye

Classified by cause- bacterial, viral, fungal, parasitic, allergic, toxic

Viral is contagious

(other disorders include Uveitis and orbital cellulitis)

Front 52

Menieres Disease- Def and CMs

Back 52

Abnormal inner ear fluid balance- malabsorption of the endolymphatic sac or blockage of the endothelium

CMs- hearing loss, tinnitus, feeling of pressure, vertigo, nausea, vomiting

Front 53

Tx for Meniered Disease

Back 53

Low sodium diet

Meclizine (antivert)

Tranquilizers

Antiemetics and diuretics

Surg MGMT- endolymphatic sac decompression, middle and inner ear perfusion, catheters and vestibular nerve sectioning