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Eye Disorders. Metropolitan Community College NURS 1110 Adult Nursing I. Objective 1: Describe the normal structure and functions of the eye, and identify structures which help protect the eye. Review A&P from A&P class, and Linton.
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Eye Disorders Metropolitan Community College NURS 1110 Adult Nursing I
Objective 1: Describe the normal structure and functions of the eye, and identify structures which help protect the eye. • Review A&P from A&P class, and Linton
Objective 2: Identify the principles of providing basic eye care which should be taught to all clients with eye disorders.
Good lighting • Rest eyes on distant object • Meds only by MD; discard old meds; maintain sterility • Avoid bright light exposure • Goggles • Do NOT share eye make up
Don’t rub eyes • Under 40, test every 3-5 yrs; over 40, every 2 years • Report to MD: sudden sharp eye pain, deep eye pain; photophobia; blurred or double vision; loss of part of visual field; halos around lights; floaters; excess tearing; drainage from eye
Clean eye from inner to outer canthus • Vitamins A & B are important • Wear contacts appropriately
Objective 3: Explain the basic principles to be practiced when providing care to a visually impaired client.
Client is blind, not deaf • Treat as adults • Speak when entering or leaving room • Inform before touching
Determine amount of help needed • Let person take your arm when walking • Independence fostered by: • Braille • Special cane • Seeing eye dog
Keep bed low position • Eliminate noise • Room free of clutter • Reduce glare
Objective 4: Name five diagnostic tools commonly used to diagnose eye disease
Ophthalmoscopy • Look into eye-see retina, optic disk, blood vessels • May see changes with eye disorders • May see changes with diabetes mellitus
Refraction • Look into series of refractors-lenses • Client chooses the clearest vision
Tonometry • Measures eye pressure • Pneumotonometer uses puff of air • Normal pressure 12-21 mm Hg
Visual field • Peripheral vision • Important in some eye diseases
Snellen eye chart • Visual acuity • Normal is 20/20 • Example: 20/30—the person sees at 20 feet what a person with normal vision sees at 30 feet • 20/70 is visual impairment • 20/200 is legally blind
Objective 5: Describe the nursing assessments made when examining a client with any eye problem.
Assessments • Eye lid, conjunctiva, sclera • Any discharge, signs of inflammation or infection • Visual acuity • PERLA
Current and past medical Hx RT eyes • Dry, red, edema
Change from medical problems • Diabetes mellitus • Neurological damage • Hypertension • Eye injury • Family history • Corticosteroid use • Occupation
Objective 6: Describe four major external eye disorders and their treatment.
Keratitis • Inflammation of cornea • From infection, irritation, injury, allergy • Symptoms: severe eye pain, red watery eye, photophobia
May cause reduced vision, rash • Treatment: anesthetics, mydriatics, dark glasses, antibiotics
Stye or hordeolum: pustular inflammation of eyelash follicle or sebaceous gland on lid margin • Staphylococcal organism
Symptoms: pain, redness, swelling • Treatment: warm compress; topical antibiotic • May need I&D if severe
Chalazion • Cyst of meibomian glands • Hard, filled with fatty material • Painless • Develops over weeks • Treatment: surgical excision if infected, interferes with sight
Blepharitis • Inflammatory condition of lash follicles meibomian glands of eyelids • Swelling, redness, crusts
Conjunctivitis • Inflammation of conjunctiva from bacteria, virus, ricketsia, allergen, irritant • Symptoms: burning, itching eyes, discharge, edema, pain, redness
Treatment: WMC, antibiotic, antiviral ointments; if allergy, treat allergy • Is contagious-use infection control measures
Objective 7: Define the following refractive errors: myopia, hyperopia, astigmatism, presbyopia.
Myopia: nearsightedness • Light focuses on front of retina • Starts with children • Hyperopia: farsightedness. Light focuses behind the retina
Astigmatism: hard to see small objects. Light rays distorted • Presbyopia: poor accommodation
Objective 8: describe the pre and postoperative care for a client having eye surgery
Preoperatively • Orient to room if bilateral eye patch, very important • Consent form • NPO • Expectations postoperatively • Eye drops • Report any S/S of infections
Postoperatively • Safe environment • HOB up 30-45 degrees • NO cough, lifting, stooping over, straining, laying on affected side • If nausea, get antiemetic order • Avoid constipation • Eye shield, esp. at night
Report any eye pain STAT • Report any bloody drainage • PO meds for mild to moderate pain
Objective 9: Review how to instill eye drops, ointments, and perform eye irrigation. • Review from NURS 1510
Objective 10: discuss drugs used to treat eye disorders • Drugs will include • Anticholinergics, mydriatics, cycloplegics
Mydriatics: dilate the pupil • Cycloplegics: paralyze muscles of accommodation • Both used in diagnostic eye procedures, eye surgery
Anticholinergics: dilate the pupil; paralyze muscle of accommodation • Relax ciliary & dilator muscles by blocking acetylcholine
Examples: Atropine sulfate (cycloplegic); Propine for open angle glaucoma; epinephrine for eye surgery or open angle glaucoma
Objective 11: define the following diseases and explain the treatment and nursing interventions for each: • Cataract • Retinal detachment • Glaucoma • Macular degeneration
Cataract disease • Opacity or clouding of lens • Congenital, chemical, traumatic, mechanical, or degenerative • Assessment: subjective—C/O cloudy vision, seeing spots or ghost images; floaters • Gradual loss of vision • Advanced: can see milky white lens
Cataract treatment • Extract lens, implant new one • Outpatient status, go home 2-3 hrs. post op
Mild sedative, local anesthesia • Preop: mydriatic, cycloplegic • Post op: avoid increasing IOP • Do not drive car until released to do so • Wear dark glasses
Retinal detachment • Separation of retina from choroid layer • Collection of fluid between sensory and pigmented layer
From: trauma, degenerative changes; secondary to other surgeries • Myopic clients at more risk • Assessment: C/O flashes of bright lights or floaters