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Chapter042

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  • 1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 42: Caring for Clients with Eye Disorders Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. Refractive Errors • Emmetropia: Normal vision • Myopia; Hyperopia; Presbyopia; Astigmatism Figure 42-1 Eyeball shape affects visual acuity in some refractive errors. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. Refractive Errors • Pathophysiology, Etiology – Inherited; Surgical treatment result – Presbyopia: Natural degenerative changes • Assessment Findings: Blurred vision; Recurrent headaches • Diagnostics: Snellen, Jaeger charts; Retinoscopy • Medical Management: Eyeglasses; Contact lenses • Surgical Management: RK; LASIK; PRK; ICRS; IOLs; CK • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 4. Blindness, Visual Impairment • BCVA ≤20/200, even with corrective lenses • Visual Impairment: BCVA between 20/70 and 20/200 (in better eye with glasses) • Causes: Congenital; Injury; Optic nerve damage; Disorders; Tumors • Medical Management: Corrective lenses; Rehabilitation; Independent living skills • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. Eye Trauma • Pathophysiology, Etiology – Weather; Chemicals; Injury; Endophthalmitis • Assessment Findings: Signs and Symptoms – Pain; “Gritty” feeling; Tearing; Blurred vision; Asymmetric eyes; Diplopia; Edema; Bleeding; Purulent drainage • Diagnostic Findings – Fluorescein dye; Slit-lamp examination – Radiography; CT scan Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Eye Trauma • Medical, Surgical Management – Emergency first aid; Antibiotic ointment or drops; Eye patch – Hospitalization – Surgical repair • Nursing Management Figure 42-2 Everting the eyelid Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 7. Conjunctivitis • Pathophysiology, Etiology: Bacterial; Viral; Rickettsial infection – Easily transmitted; Can lead to blindness • Assessment Findings: Redness; Tearing; Burning; Itching; Purulent drainage; Enlarged lymph nodes • Medical Management: Antibiotic, antiviral meds; Warm soaks, irrigations; Decongestants; Antihistamines • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 8. Uveitis • Pathophysiology, Etiology: Inflammatory changes – Identified with specific diseases or autoimmune disorders • Assessment Findings: Blurred vision; Photophobia; Eye pain; Red, congested eye; Pupil reacts poorly to light • Diagnostic Findings: Slit-lamp examination • Medical Management: Oral, topical corticosteroids; Mydriatic, antibiotic eyedrops; Analgesics; Sunglasses • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 9. Keratitis, Corneal Ulcer • Pathophysiology, Etiology: Corneal trauma; Infectious agents • Assessment Findings: Pain; Photophobia; Blurred vision; Tearing; Purulent discharge; Redness • Diagnostic Findings: Flashlight illumination; Slitlamp exam; Fluorescein drops, strips • Medical, Surgical Management: Topical anesthetics; Mydriatics; Antibiotics; Keratoplasty • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 10. Blepharitis • Pathophysiology, Etiology: Hypersecretion; Infectious agents • Assessment Findings: Inflamed lid margins; Patchy flakes; Missing eyelashes; Purulent drainage • Diagnostic Findings: Scraping lid margins; Microscopic examination • Medical Management: Topical antibiotic; Cleansing: Eye, face, and hair • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Hordeolum (Sty) • Pathophysiology, Etiology: Staphylococcus aureus • Assessment Findings: Tender, swollen, red pustule • Medical, Surgical Management: Warm soaks; Topical antibiotic – Severe cases: Incision; Drainage • Diagnostic Findings: Exudate culture identifies pathogen (seldom used) • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. Macular Degeneration • Pathophysiology, Etiology: Types – Dry: Gradual onset; Wet: Abrupt onset • Assessment Findings – Dry: Blurred vision; Central vision affected – Wet: Vision distortion; Central vision affected • Medical Management: Laser photocoagulation; Photodynamic therapy; Intravitreal injection; Macular translocation; Diet, vitamins • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 13. Glaucoma • Pathophysiology, Etiology: Aqueous fluid imbalance; Elevated IOP • Assessment Findings: Signs and Symptoms – Open-angle: Eye discomfort; Temporary blurred vision; Halos; Reduced peripheral vision – Acute angle-closure: Hard, painful, sightless eyes; N/V; Red conjunctiva; “Steamy” cornea • Diagnostic Findings: Optic disc visualization; Anterior chamber inspection; Tonometry; Visual field exam • Medical, Surgical Management: Medications; Miotics; Analgesics; Complete rest; Laser, surgical iridectomy; Laser trabeculoplasty; Corneal trephine • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 14. Cataracts • Pathophysiology, Etiology: Aging process; Congenital; Lens injury; Secondary condition • Assessment Findings: Halos; Difficulty in reading; Color vision changes; Reduced, distorted vision • Diagnostic Findings: Snellen chart; Ophthalmoscopic and slit-lamp examination; Tonometry • Surgical Management: Intracapsular or extracapsular extraction; Phacoemulsification – Post-op vision restoration: Corrective glasses; Contact lens; IOL implant • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 15. Retinal Detachment • Pathophysiology, Etiology: Retinal stretching; Degenerative changes; Injury; Eye surgery • Assessment Findings: Signs and Symptoms – Blind spots; Flashes of light; Floaters; Complete vision loss • Diagnostic Findings: Ophthalmoscope • Surgical Management: Laser surgery; Cryopexy; Diathermy; Retinopexy; Scleral buckling; Pneumatic retinopexy • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 16. Enucleation • Surgical Removal of an Eye due to – Injury; Disease – Tumor; Severe pain (damaged, sightless eye) • Medical, Surgical Management – Metal or plastic ball in capsule of connective tissue – Pressure dressing; Shell-shaped prosthesis • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 17. End of Presentation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins