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SENSORY/PERCEPTUAL

SENSORY/PERCEPTUAL. EYE ALTERATIONS. REFRACTIVE ERRORS. OVERVIEW A. THE ABILITY OF THE EYE TO FOCUS ON THE RETINA DEPENDS ON THE LENGTH OF THE EYE FROM FRONT TO BACK & THE REFRACTIVE POWER OF THE LENS SYSTEM B. REFRACTION IS THE BENDING OF LIGHT RAYS

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SENSORY/PERCEPTUAL

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  1. SENSORY/PERCEPTUAL EYE ALTERATIONS

  2. REFRACTIVE ERRORS OVERVIEW A. THE ABILITY OF THE EYE TO FOCUS ON THE RETINA DEPENDS ON THE LENGTH OF THE EYE FROM FRONT TO BACK & THE REFRACTIVE POWER OF THE LENS SYSTEM B. REFRACTION IS THE BENDING OF LIGHT RAYS C. PROBLEMS IN EITHER EYE LENGTH OR REFRACTION CAN RESULT IN REFRACTIVE ERRORS

  3. REFRACTIVE ERRORS TYPES STRABISMUS (Eye Deviation) May lead to Amblyopia Common test to detect the disorder • Corneal Light Reflex • Cover Test If uncorrected leads to blindness

  4. REFRACTIVE ERRORS TYPES MYOPIA A. ALSO REFERRED TO AS – NEARSIGHTNESS B. THE REFRACTIVE ABILITY OF THE EYE IS TOO STRONG FOR THE EYE LENGTH C. IMAGES ARE BENT & FALL IN FRONT OF, NOT ON, THE RETINA

  5. REFRACTIVE ERRORS TYPES HYPEROPIA A. ALSO REFERRED TO AS – FARSIGHTEDNESS B. THE REFRACTIVE ABILITY OF THE EYE IS TOO WEAK C. IMAGES ARE FOCUSED BEHIND THE RETINA D. A SHORTER LENGTH OF THE EYE MAY CONTRIBUTE TO THE DEVELOPMENT OF HYPEROPIA

  6. REFRACTIVE ERRORS TYPES PRESBYOPIA A. AS PEOPLE AGE THE CRYSTALLINE LENS LOSES ITS ELASTICITY & IS LESS ABLE TO ALTER ITS SHAPE TO FOCUS THE EYE FOR CLOSE WORK B. IMAGES FALL BEHIND THE RETINA C. PRESBYOPIA USUALLY OCCURS IN PEOPLE IN THEIR 30’s & 40’s

  7. REFRACTIVE ERRORS TYPES ASTIGMATISM A. OCCURS WHEN THE CURVE OF THE CORNEA IS UNEVEN B. BECAUSE LIGHT RAYS ARE NOT REFRACTED EQUALLY IN ALL DIRECTIONS A FOCUS POINT ON THE RETINA IS NOT ACHIEVED

  8. EYE DISORDERS BLINDNESS • LEGALLY DEFINED AS VISION < 20/200 W/ THE USE OF CORRECTIVE LENSES OR A VISUAL FIELD OF NO GREATER THAN 20 DEGREES. • GREATEST INCIDENCE AFTER AGE OF 65 • RISK FACTORS A. GLAUCOMA B. CATARACTS C. DIABETIC RETINOPATHY D. ATHEROSCLEROSIS E. TRAUMA

  9. EYE DISORDERS BLINDNESS ANALYSIS / NURSING DIAGNOSIS A. VISUAL SENSORY/PERCEPTUAL ALTERATION R/T BLINDNESS B. IMPAIRED SOCIAL INTERACTION R/T LOSS OF SIGHT C. RISK FOR INJURY R/T VISUAL IMPAIRMENT D. SELF-CARE DEFICIT R/T VISUAL LOSS

  10. EYE DISORDERS BLINDNESS NURSING CARE PLAN / IMPLEMENTATION A. GOAL: PROMOTE INDEPENDENCE & PROVIDE EMOTIONAL SUPPORT 1. FAMILIARIZE W/ SURROUNDINGS & ENCOURAGE USE OF TOUCH 2. ESTABLISH COMMUNICATION LINES & ANSWER QUESTIONS 3. DEAL W/ FEELINGS OF LOSS & OVERPROTECTIVENESS BY FAMILY MEMBERS

  11. EYE DISORDERS BLINDNESS 4. PROVIDE DIVERSIONAL ACTIVITIES, ie: A. RADIO B. TALKING BOOKS, TAPES, RECORDS 5. ENCOURAGE SELF-CARE ACTIVITIES 6. ALLOW VOICING OF FRUSTRATIONS WHEN ACTIVITY IS NOT DONE TO SATISFACTION – TO DECREASE ANGER & DISCOURAGEMENT

  12. EYE DISORDERS BLINDNESS NURSING CARE PLAN / IMPLEMENTATION B. GOAL: FACILITATE ACTIVITIES OF DAILY LIVING 1. EATING: A. ESTABLISH ROUTINE PLACEMENT FOR TABLEWARE, ie: PLATES B. HELP PERSON MENTALLY VISUALIZE THE PLATE AS A CLOCK / COMPASS C. TAKE PERSON’S HAND & GUIDE THE FINGERTIPS TO ESTABLISH SPATIAL RELATIONSHIP

  13. EYE DISORDERS BLINDNESS NURSING CARE PLAN / IMPLEMENTATION B. GOAL: FACILITATE ACTIVITIES OF DAILY LIVING 2. WALKING: A. HAVE PERSON HOLD YOUR FOREARM & WALK HALF A STEP IN FRONT B. TELL THE PERSON WHEN APPROACHING STAIRS, CURB, etc.

  14. EYE DISORDERS BLINDNESS NURSING CARE PLAN / IMPLEMENTATION B. GOAL: FACILITATE ACTIVITIES OF DAILY LIVING 3. TALKING: A. SPEAK WHEN APPROACHING PERSON & TELL THEM BEFORE YOU TOUCH THEM B. TELL THEM WHO YOU ARE & WHAT YOU WILL BE DOING C. DO NOT AVOID USING WORDS SUCH AS “SEE” / DISCUSSING THE APPEARANCE OF THINGS

  15. EYE DISORDERS BLINDNESS NURSING CARE PLAN / IMPLEMENTATION C. GOAL: HEALTH TEACHING 1. ACCIDENT PREVENTION IN THE HOME 2. COMMUNITY RESOURCES A. VOLUNTARY AGENCIES * American Foundation for the Blind * Nat’l. Society for the Prevention of Blindness B. GOVERNMENT AGENCIES * Social & Rehabilitative Service * Veteran’s Administration c.CARE OF ARTIFICIAL EYE

  16. CARING FOR AN ARTIFICAL EYE • W/ GLOVED HAND PULL LOWER EYELID DOWN OVER THE INFRAORBITAL BONE & EXERT PRESSURE BELOW THE EYELID • PRESSURE WILL MAKE THE EYE POP OUT • HANDLE EYE PROSTHESIS CAREFULLY • USING ASEPTIC TECHNIQUE, CLEANSE SOCKET W/ SALINE-MOISTENED GAUZE – STROKING FROM THE INNER TO OUTER CANTHUS • WASH THE PROSTHESIS IN WARM NORMAL SALINE • TO REINSERT – GENTLY PULL THE PATIENT’S LOWER LID DOWN, RAISE THE UPPER LID IF NECESSARY, SLIP THE SALINE-MOISTENED EYE PRSOSTHESIS GENTLY INTO THE SOCKET, & RELEASE THE LIDS

  17. EYE DISORDERS BLINDNESS EVALUATION / OUTCOME CRITERIA A. ACCEPTANCE OF DISABILITY * PARTICIPATES IN SELF-CARE ACTIVITIES * REMAINS SOCIALLY INVOLVED B. REGAINS INDEPENDENCE W/ REHABILITATION

  18. TRAUMA • Hematoma • Chemical burns • Corneal abrasions • Penetrating/Non-penetrating wounds • Foreign bodies

  19. EYE DISORDERS INFLAMMATION & INFECTIONS • BLEPHARITIS 1. AN INFLAMMATION OF THE EYELID EDGES 2. MOST COMMON IN THE OLDER ADULT 3. OFTEN ASSOCIATED W/ DRY EYE SYNDROME 4. LACK OF SUFFICIENT TEARS W/ THIS DX. MAY LEAD TO BACTERIAL INVASION OF THE EYE STRUCTURES, BECAUSE TEARS ARE BACTERIOSTATIC 5. SX.& SX. – ITCHY, RED & BURNING EYES W/ SEBORRHEA OF THE EYEBROWS & EYELIDS 6. TREATMENT – EYELID CARE OF WARM, MOIST COMPRESSES FOLLOWED BY GENTLE SCRUBBING W/ BABY SHAMPOO

  20. EYE DISORDERS INFLAMMATION & INFECTIONS • CHALAZION 1. A STERILE INFLAMMATION OF A SEBACEOUS GLAND IN THE EYELID 2. SX. & SX. - BEGINS W/ AN INFLAMMATION & TENDERNESS , FOLLOWED BY A GRADUAL PAINLESS SWELLING @ THE GLAND 3. IN ITS FULLY DEVELOPED STATE NO SX. OF INFLAMMATION ARE PRESENT 4. C/O EYE FATIGUE, SENSITIVITY TO LIGHT, POSSIBLEY EXCESSIVE TEARING 5. TREATMENT – USE OF WARM COMPRESSES FOR 15’ QID, FOLLOWED BR INSTILLATION OF AN ANTI-INFECTIVE OPHTHALMIC OINTMENT 6. M.D. MAY EXCISE CHALAZION IF IT INTERFERES W/ VISION

  21. EYE DISORDERS INFLAMMATION & INFECTIONS • CONJUNCTIVITIS 1. AN INFLAMMATION / INFECTION OF THE CONJUNCTIVA 2. INFLAMMATORY CONJUNCTIVAITIS RESULTS FROM EXPOSURE TO ALLERGENS / IRRITANTS & IS NOT CONTAGIOUS 4. SX. & SX. – CONJUNCTIVAL EDEMA, BURNING SENSATION, EXCESSIVE TEARING , ITCHING & VASCULAR ENGORGEMENT W/ BLOODSHOT APPEARANCE OF EYE/S 5. TREATMENT – INSTILLATION OF VASOCONSTRICTORS & CORTICOSTEROIDS EYEDROPS AS WELL AS INSTRUCTION FOR THE CLIENT TO AVOID USING EYE MAKE-UP UNTIL CONDITION SUBSIDES

  22. EYE DISORDERS INFLAMMATION & INFECTIONS CONJUNCTIVITIS -- CONT’D 1. AN INFLAMMATION / INFECTION OF THE CONJUNCTIVA 2. INFECTIOUS CONJUNCTIVITIS OCCURS AS A RESULT OF BACTERIAL / VIRAL INFECTION & IS CONTAGIOUS 3. ALSO KNOWN AS BACTERIAL CONJUNCTIVITIS / “PINK EYE” 3. SX. & SX. – BLOOD VESSEL DILATION, CONJUNCTIVAL EDEMA, TEARING & DISCHARGE 4. DISCHARGE IS USUALLY WATERY @ FIRST THEN BECOMES THICKER, W/ SHREDS OF MUCUS 5. TREATMENT – AIMED @ CONTOLLING THE INFECTION W/ C&S DONE OF DRAINAGE FOR APPROPRIATE ANTI- INFECTIVE – HYGIENE INSTRUCTION GIVEN – ISOLATE LINENS & OTHER CLOTHING TO PREVENT SPREAD

  23. EYE DISORDERS INFLAMMATION & INFECTIONS HORDEOLUM 1. ALSO KNOWN AS A “STYE” 2. THIS “STYE” CAN BE INTERNAL / EXTERNAL 3. USUALLY AFFECTS ONLY ONE EYE @ A TIME W/ NO VISION IMPAIRMENT 3. EXTERNAL STYE IS AN INFECTION OF THE SWEAT GLANDS IN THE EYELID, OCCURING NEAR THE EMERGENCE OF THE EYELASHES FROM THE EYELID 5. INTERNAL STYE IS CAUSED BY AN INFECTION OF THE EYELID SEBACEOUS GLAND 4. SX. & SX. – A RED, SWOLLEN, TENDER AREA IS NOTED ON THE SKIN SURFACE SIDE OF THE EYELID & PAIN IS PRESENT R/T PURULENT DSCHG IN STYE 5. TREATMENT - WARM COMPRESSES – QID, & ANTI- INFECTIVE OINTMENT

  24. EYE DISORDERS GLAUCOMA PATHOPHYSIOLOGY A. ACUTE (CLOSED ANGLE) IMPAIRED PASSAGE OF AQUEOUS HUMOR INTO THE CIRCULAR CANAL OF SCHLEMM DUE TO CLOSURE OF THE ANGLE BETWEEN THE CORNEA AND THE IRIS. ** MEDICAL EMERGENCY -- REQUIRES SURGERY

  25. EYE DISORDERS GLAUCOMA -- CONT’D PATHOPHYSIOLOGY B. CHRONIC (OPEN-ANGLE) LOCAL OBSTRUCTION OF AQUEOUS HUMOR BETWEEN THE ANTERIOR CHAMBER AND THE CANAL.. MOST COMMONLY TREATED WITH FOLLOWING MEDICATION : 1. MIOTICS 2. CARBONIC ANHYDRASE INHIBITORS

  26. EYE DISORDERS GLAUCOMA -- CONT’D PATHOPHYSIOLOGY C. GLAUCOMA (UNTREATED) IMBALANCE BETWEEN RATE OF SECRETION OF INTRAOCULAR FLUIDS AND RATE OF ABSORPTION OF AQUEOUS HUMOR > INCREASED INTRAOCULAR PRESSURE > DECREASED PERIPHERAL VISION > CORNEAL EDEMA > HALOS AND BLURRING VISION > BLINDNESS

  27. EYE DISORDERS GLAUCOMA -- CONT’D RISK FACTORS *UNKNOWN, BUT ASSOCIATED WITH: 1. EMOTIONAL DISTURBANCES 2. HEREDITARY FACTORS 3. ALLERGIES / AGE 4. VASOMOTOR DISTURBANCES 5. NEARSIGHTNESS (MYOPIA) 6. EYE TRAUMA / SYSTEMIC CORTICOSTEROIDS 7. CV DISEASE & DIABETES 8. MIGRAINE SYNDROMES 9. AFRICAN AMERICAN / ASIAN MALES

  28. EYE DISORDERS GLAUCOMA -- CONT’D ASSESSMENT SUBJECTIVE DATA A. ACUTE (CLOSED-ANGLE) 1. PAIN: SEVERE, IN & AROUND EYE 2. HEADACHE 3. RAINBOW HALOS AROUND LIGHTS 4. BLURRING OF VISION 5. N & V B. CHRONIC (OPEN-ANGLED) 1. EYES TIRE EASILY 2. LOSS OF PERIPHERAL VISION

  29. EYE DISORDERS GLAUCOMA -- CONT’D ASSESSMENT OBJECTIVE DATA 1. CORNEAL EDEMA 2. DECREASED PERIPHERAL VISION 3. INCREASED CUPPING OF OPTIC DISC 4. TONOMETRY - PRESSURES > 22mmHg 5. PUPILS DILATED 6. REDNESS OF EYE

  30. EYE DISORDERS GLAUCOMA -- CONT’D NURSING DIAGNOSES A. VISUAL SENSORY/ PERCEPTUALALTERATIONSR/T INCREASED INTRAOCULAR PRESSURE B.PAIN R/T SUDDEN INCREASE IN INTRAOCULAR PRESSURE C.RISK FOR INJURYR/T BLINDNESS D.IMPAIRED PHYSICAL MOBILITYR/T IMPAIRED VISION

  31. 1. REDUCE IOP ACTIVITY: BEDREST POSITION: SEMI-FOWLER’S MEDS AS ORDERED: A. MIOTICS B. CARBONIC ANHYDRASE INHIBITORS C. ANTICHOLINESTERASE D. OPHTHALMIC EYE DISORDERS GLAUCOMA -- CONT’DGOALS & IMPLEMENTATIONS

  32. EYE DISORDERS GLAUCOMA MEDICATIONS 1. MIOTICS (PILOCARPINE & CARBACHOL) * USED TO LOWER THE IOP > INCREASED BLOOD FLOW TO THE RETINA & DECREASED RETINAL DAMAGE AND LOSS OF VISION * MIOTICS CAUSE A CONTRACTION OF THE CILIARY MUSCLE & WIDENING OF TRABECULAR MESHWORK *PILOCARPINE PRODUCES MIOSIS & DECREASES IOP

  33. EYE DISORDERS GLAUCOMA MEDICATIONS 2. CARBONIC ANHYDRASE INHIBITORS (acetazolamide) * INTERFERE WITH PRODUCTION OF CARBONIC ACID, WHICH LEADS TO DECREASED AQUEOUS HUMOR FORMATION & DECREASED IOP * USED FOR LONG-TERM TREATMENT OF OPEN-ANGLE GLAUCOMA * RECOMMENDED ONLY AFTER PILOCARPINE, BETA BLOCKERS, EPINEPHRINE, & CHOLINESTERASE INHIBITORS ARE INEFFECTIVE

  34. EYE DISORDERS GLAUCOMA MEDICATIONS 3. ANTICHOLINESTERATE * FACILITATES OUTFLOW OF AQUEOUS HUMOR SHORT-ACTING (PHYSOSTIGMINE SALICILATE) LONG-ACTING(DEMECARIUM BROMIDE )

  35. EYE DISORDERS GLAUCOMA MEDICATIONS 4. OPHTHALMIC: BETA-ADRENERGIC BLOCKERS * (BETAXOLOL) BETOPTIC - USED TO DECREASE ELEVATED IOP IN CHRONIC OPEN-ANGLE GLAUCOMA & OCULAR HYPERTENSION * (TIMOLOL MALEATE) TIMOPTIC - REDUCES PRODUCTION OF AQUEOUS HUMOR

  36. 2. PROVIDE EMOTIONAL SUPPORT PLACE PERSONAL OBJECTS WITHIN FIELD OF VISION ASSIST WITH ACTIVITIES ENCOURAGE VERBALIZATION OF CONCERNS, FEARS OF BLINDNESS, LOSS OF INDEPENDENCE EYE DISORDERS GLAUCOMA -- CONT’DGOALS & IMPLEMENTATIONS

  37. 4. HEALTH TEACHING A. PREVENT > IOP BY AVOIDING: 1. ANGER, EXCITEMENT, WORRY 2. CONSTRICTIVE CLOTHING 3. HEAVY LIFTING 4. EXCESSIVE FLUID INTAKE 5. STRAINING @ STOOL 6. EYE STRAIN 7. ATROPINE, OR OTHER MYDRIATICS WHICH CAUSE DILATION EYE DISORDERS GLAUCOMA -- CONT’DGOALS & IMPLEMENTATIONS

  38. 4. HEALTH TEACHING B. RELAXATION & STRESS MANAGEMENT TECHNIQUES C. PREPARE FOR SURGERY, IF ORDERED * LASER TRABECULOPLASTY * TRABECULECTOMY (FILTERING) D. ACTIVITY ALLOWED: * MODERATE EXERCISE - WALKING EYE DISORDERS GLAUCOMA -- CONT’DGOALS & IMPLEMENTATIONS

  39. 4. HEALTH TEACHING E. SAFETY MEASURES: 1. EYEPROTECTION -SHIELD/GLASSES 2. Medic Alert BAND/TAG 3. AVOID DRIVING 1-2 HR. AFTER INSTILLING MIOTICS F. MEDICATIONS: 1. PURPOSE, DOSAGE & FREQUENCY 3. EYEDROP INSTILLATION G. COMMUNITY RESOURCES, AS NEEDED EYE DISORDERS GLAUCOMA -- CONT’DGOALS & IMPLEMENTATIONS

  40. EVALUATION/OUTCOME CRITERIA A. EYESIGHT PRESERVED, IF POSSIBLE B. IOP LOWERED ( < 22 mm Hg ) C. CONTINUES MEDICAL SUPERVISION FOR LIFE -- REPORTS REAPPEARANCE OF SYMPTOMS IMMEDIATELY EYE DISORDERS GLAUCOMA -- CONT’D

  41. EYE DISORDERS -- CATARACTS PATHOPHYSIOLOGY/ETIOLOGY * DEVELOPMENT or DEGENERATIVE OPACIFICATION OF THE CRYSTALLINE LENS * CATARACTS CAN DEVELOP @ ANY AGE * THEY MAY BE DUE TO A VARIETY OF CAUSES * MOST COMMON IN LATER LIFE & ASSOCIATED WITH AGING * CAN DEVELOP IN BOTH EYES -- USUALLY ONE EYE IS MORE COMPROMISED * VISUAL IMPAIRMENT USUALLY PROGRESSES @ SAME RATE IN BOTH EYES

  42. EYE DISORDERS -- CATARACTS RISK FACTORS * AGING (MOST COMMON) * TRAUMA * TOXINS * CONGENITAL DEFECTS * ASSOCIATED OCULAR CONDITIONS * NUTRITIONAL FACTORS * PHYSICAL FACTORS * SYSTEMIC DISEASES & SYNDROMES

  43. EYE DISORDERS -- CATARACTS ASSESSMENT SUBJECTIVE DATA *VISION (DIMMING ) *BLURRING (PAINLESS ) *LOSS OF ACUITY (SEE BEST IN LOW LIGHT) * DISTORTION * DIPLOPIA *PHOTOPHOBIA *SENSITIVITY TO GLARE

  44. EYE DISORDERS -- CATARACTS ASSESSMENT OBJECTIVE DATA * BLINDNESS A.UNILATERAL B.BILATERAL( PARTICULARLY, IN CONGENITAL CATARACTS) * LOSS OF RED REFLEX *GRAY OPACITY OF LENS *MYOPIC SHIFT& COLOR SHIFT *ASTIGMATISM * REDUCED LIGHT TRANSMISSION

  45. EYE DISORDERS -- CATARACTS ANALYSIS / NURSING DIAGNOSES A. VISUAL SENSORY/PERCEPTUAL ALTERATIONS R/T OPACITY OF LENS B.RISK FOR INJURY R/T ACCIDENTS C.SOCIAL ISOLATION R/T IMPAIRED VISION

  46. EYE DISORDERS -- CATARACTS CATARACT REMOVAL * REMOVAL OFOPACIFIED LENS BECAUSE OF LOSS OF VISION A. EXTRACAPSULAR CATARACT EXTRACTION(ECCE ) FOLLOWED BY INTRAOCULARLENS ( IOL )INSERTION B. PHACOEMULSION - USES AN ULTRASONIC DEVICE THAT LIQUEFIES THE NUCLEUS & CORTEX WHICH ARE THEN SUCTIONED OUT THROUGH A TUBE

  47. GOALS & IMPLEMENTATIONS PREOPERATIVE CARE 1. ANTIBIOTIC DROPS/OINTMENT, AS ORDERED 2. MYDRIATICEYEDROPS,AS ORDERED (NOTE DILATATION OF PUPILS) 3. AVOID GLARING LIGHTS 4. SURGERY OFTEN DONE UNDER LOCAL ANESTHESIAWITH SEDATION 1.PREPARE FOR SURGERY EYE DISORDERS -- CATARACTS

  48. 2. HEALTH TEACHING PRE-OP. GOALS & IMPLEMENTATIONS PREOPERATIVE CARE 1. DO NOTRUB , TOUCH, or SQUEEZEEYES SHUT AFTER SURGERY 2. EYE PATCH WILL BE ON AFFECTED EYE 3. ASSISTANCE WILL BE GIVEN FOR NEEDS 4. OVERNIGHT HOSPITALIZATION NOT REQUIRED,UNLESS COMPLICATIONS OCCUR 5. MILD IRITITIS USUALLY OCCURS EYE DISORDERS -- CATARACTS

  49. 1. REDUCE STRESS ON THE SUTURES & PREVENT HEMORRHAGE GOALS & IMPLEMENTATIONS POSTOPERATIVE CARE A. ACTIVITY: 1. AMBULATE , AS ORDERED, SOON AFTER SURGERY 2. USUALLY DISCHARGED 5-6 HRS AFTER SURGERY B.POSITION: 1. FLAT or LOW FOWLER’S 2. LIE ON BACK or TURN TO UNOPERATIVE SIDE EYE DISORDERS -- CATARACTS

  50. 1. REDUCE STRESS ON THE SUTURES & PREVENT HEMORRHAGE GOALS & IMPLEMENTATIONS POSTOPERATIVE CARE C. AVOIDACTIVITIES THAT > IOP: 1. STRAINING @ STOOL 2. VOMITING, COUGHING, SHAVING 3. BRUSHING TEETH or HAIR 4. LIFTING OBJECTS > 20lb. 5. BENDING or STOOPING 6. WEAR GLASSES / SHADED LENS DURING DAY 7. WEAR EYESHIELD @ NIGHT EYE DISORDERS -- CATARACTS

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