1Vision in Older AdultsNURS 4100 Care of the Older AdultFall 2013Joy A. Shepard, PhD(c), MSN, RN, CNE
2Objectives Describe assessment of vision in the older adult Explain the importance of sensory function and the impactof...
3Key Terms Cataracts - Opacity of eye lens that reduces visual acuity Glaucoma – Eye disorder characterized by increased...
4Anatomy of the EyeAnatomy of the Eye Video
5Introduction: Sensory FunctionTaken for grantedProtection from harmAccurate perception of environmentEssential to com...
6Sensory Dysfunction: PersonalCostFunctional impairmentLoss of independenceInjurySocial isolationDepressionDecreased...
7Assessment of Vision
8Assessing Sensory ProblemsSkilled assessment of sensory functionAssessment Guide 26-1 (pp. 362-363):Sensory FunctionSen...
9Assessment of VisionAppearance?ClothingCleanlinessSelf-careBumps and bruises
10InterviewAdequacy of visionRecent changes visionDate of last examInspectionMovement of eyelidsAbnormally colored s...
11Interview – Visual Problems Red eye Excessive tearing/ discharge Foreign body sensation Headache, eyestrain when rea...
12VisionSnellen chart orreading from printVisual field testingExtraocularmovements
13Eye ExaminationsHealthy older adultsComplete eye examination everyyearVisual acuityRetinaIntraocular pressure (IOP)
14Normal Visual Changes withAging
15Normal Age-Related Changes ofthe EyeChanges are gradualOver time can limit functionalabilityCommon eye disorders in t...
16Normal Age-Related Changes of theEye: External Changes Graying and thinning  eyebrowsand eyelashes Subcutaneous tissu...
17Normal Age-Related Changes of theEye: Internal Changes Reduced elasticity of lens; decreased ability of the lensto acco...
18Changes During Accommodation
19Presbyopia: Normal ChangeFlexible lens of eye gradually loses elasticity,affecting ability to change shape to focus on ...
20Normal Age-Related Changes of theEye: Internal Changes Decreased pupil size, decreased retinal illumination Decreased ...
21Internal Changes: Cornea & Lens Lipid deposits aroundperipheral cornea arcus senilis (normalchange) Lenses thicken/ h...
22Normal Age-Related Changes of theEyeVisual acuity (sharpness of vision)Diminishes gradually after age 50Decreases rap...
23Clinical Implications Difficulty reading small print Narrowing of field of vision Decreased light to retina Sensitiv...
24Visual Impairments with Aging
25Visual ImpairmentVisual impairment = visual acuity 20/40 by Snellenchart at 20 feetIncreases with ageCommon visual di...
26Legal blindnessVisual acuity20/200 by Snellenchart at 20 feetIncreases withagePeaks at 85 years
27Question The nurse is assessing a patient who has just beentested for visual acuity and was told his vision is 20/50.Th...
28Diseases Affecting Vision
29Cataracts
30Cataracts NOT a normal part of aging process(though very common with aging) Most cataracts are related to aging Lens ...
31Cataracts: SignsYellowing of lensPupil changes colorto cloudy white orgray
32Cataracts: Symptoms No pain or discomfort Hazy or blurred vision (mostlikely) Glare, photosensitivity Halos around o...
33
34Cataracts: Blurry Vision
35Cataracts: Yellowing of Images
36Cataracts: Decrease in ColorIntensity
37Cataracts: Risk FactorsIncreased ageSmoking and alcoholDiabetes, hyperlipidemiaTrauma to the eyeExposure to the sun...
38A. Simulated vision with cataracts.B. Normal vision.(From National Eye Institute, National Institutes of Health, 2004.)
39Cataracts: Tx & NursingStrategiesSurgery only cureOutpatient procedure: relatively fewcomplicationsRemoval of lensIn...
40Cataract Surgery (Outpatient):Intraocular LensLearn About Cataract Surgery - Very graphic!Say Good-Bye to Cataracts & Gl...
41Cataract Surgery – PostoperativeInstructions Day of surgery Eye shield First 2 weeks HOB 30°, lie on back orunaffect...
42Cataract Surgery – PostoperativeInstructions Symptoms to report Pain not relieved by Tylenol Changes in vision Decre...
43Education Regarding CataractPreventionWearing hats andsunglasses when insunSmoking cessationAvoid steroidsLow-fat di...
44QuestionWhich of the following statements indicates thatthe client has understood home care instructionsfollowing catar...
45Glaucoma
46GlaucomaDegenerative eye diseaseSecond leading cause of blindness in U.S.10% vision loss in U.S.Primary cause of bli...
47GlaucomaOptic nerve damaged by pressureIncrease in intraocular pressure (IOP)  opticnerve damage  peripheral vision ...
48
49Aqueous Humor
50(From National Eye Institute, National Institutes of Health, 2004.)Simulated Vision with Glaucoma
51Chronic (Open-Angle) vs Acute(Angle-Closure) GlaucomaChronic (also called open-angle)More common than acute, 90%Slowe...
52Chronic (Open-Angle) Glaucoma
53Chronic (Open-Angle) Glaucoma
54Chronic Glaucoma
55Chronic Glaucoma: S/SPeripheral vision slowly impairedTired eyesHeadachesMisty visionColored rings/ halos around li...
56
57Chronic: Tx & Nursing Strategies Diagnosis and Treatment Dx: tonometry; gonioscopy Treatment (Care Plan 26-1; pp. 366...
58Tonometry & Gonioscopy
59Topical Eyedrops Beta-blockers (Betagan, Timoptic, Ocupress) – Bottleswith blue or yellow caps 1st line therapy for gl...
60Topical EyedropsAlpha-Adrenergic Agonists (Iopidine,Alphagan, Epinal) – Bottles with purple capsLowers IOP by decreasi...
61Topical EyedropsMiotics/ cholinesterase inhibitors (pilocarpine,Humorsol) – Bottles with green capsFacilitates outflow...
62Question A client with open-angle glaucoma is receivingbrinzolamide (Azopt) for treatment. When assessing theclient’s r...
63Acute (Angle-Closure) Glaucoma Acute (angle-closure, closed-angle, narrow-angle) Not as common Angle of iris obstruct...
64Acute (Angle-Closure) Glaucoma
65Acute Glaucoma: S/SSevere unilateral eye pain or headacheBlurred visionNausea and vomitingPhotophobiaColored halos ...
66Acute Glaucoma Sudden S/S: eye pain,HAs, halos around lights,dilated pupils, vision loss,red eyes, N & V May last for ...
67Acute Glaucoma: Tx & NursingStrategies Diagnosis Tonometer to measure IOP Normal IOP is 20 mm Hg or below Gonioscopy...
68Risk Factors for GlaucomaIncreased intraocular pressureOlder than 60 years of ageFemale genderFamily history of glau...
69Education Regarding GlaucomaScreeningComplete ophthalmic examinationAdults 65+ should be evaluatedannuallyEvery 6 mon...
70Glaucoma: ContraindicatedMedications Cold remedies with Pseudoephedrine or Phenylephrine(Neo-Synephrine) Antihistamine...
71QuestionIs the following statement true or false?Patient adherence with treatment for glaucomacan be a problem in the ...
72Age-Related MacularDegeneration (ARMD)
73Age-Related MacularDegeneration (ARMD) Most common cause ofblindness adults > 65 Degeneration of macula,(sharpest cent...
74ARMD: Symptoms Painless More light required forreading Central scotomas – blindspots Blurry Bent, warped images Da...
75A. Simulated loss of vision with age-related maculardegeneration (AMD). B. Normal vision.(From National Eye Institute, N...
76Macular degeneration: distortion ofcenter vision; normal peripheral visionAmsler Grid
77ARMD: Two Types –Dry & Wet Dry (atrophic,nonexudative form) 10-20% severe vision loss Atrophy Retinal pigmentdegener...
78ARMD: Two Types –Dry & Wet Wet (Neovascular exudates) Blood or serum leak from newlyformed blood vessels beneathretina...
79Normal Macula vs Dry & WetARMD
80Risk Factors for ARMD Age (above 50) Female gender Caucasian race and light (blue) colored eyes Family history of AR...
81ARMD: TxNo cure at presentNew research:Photodynamic therapy uses a special laser to sealleaking blood vessels in the ...
82Age-Related Macular Degeneration(ARMD) Preventive MeasuresNurses should encourageRoutine ophthalmic examinationsWeari...
83ARMD: Nursing Strategies(p.365, Box 26-2) Magnifying glasses Reading lamps Low-vision assistive devices Modify envir...
84QuestionWhich type of visual problem isassociated with macular degeneration?A. Loss of peripheral visionB. Loss of ce...
85Detached Retina
86Detached Retina Forward displacement of retina Gradual or sudden Risk factors: nearsightedness (myopia), cataract sur...
87Posterior Vitreous Detachment
88Retinal Detachment
89Detached Retina: Tx & NursingStrategiesPrompt treatmentBed rest, bilateral eye patchesReason: Reduce rapid eye moveme...
90Promoting Visual Safety
91Promoting Visual Safety in Home Provide adequate lighting in high-traffic areas Stair rails, non skid surfaces Use co...
92Nursing Diagnoses
93Nursing Diagnoses Associated withVisual Impairment (Table 26-1)Sensory/Perceptual Alterations: Visual with avariety of ...
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Vision in older adults fall 2013 abridged

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Vision in older adults fall 2013 abridged

  1. 1. 1Vision in Older AdultsNURS 4100 Care of the Older AdultFall 2013Joy A. Shepard, PhD(c), MSN, RN, CNE
  2. 2. 2Objectives Describe assessment of vision in the older adult Explain the importance of sensory function and the impactof sensory deficits on older adults Describe the effects of aging on visual function List measures to promote healthy visual function in olderadults Identify signs and symptoms and nursing interventions forolder adults with cataracts, glaucoma, maculardegeneration, and detached retina
  3. 3. 3Key Terms Cataracts - Opacity of eye lens that reduces visual acuity Glaucoma – Eye disorder characterized by increasedintraocular pressure; can lead to irreversible damage tooptic nerve with loss of peripheral vision Macular Degeneration- Atrophy of cells in central macularregion of retina Presbyopia - Universal age-related change in lens of eyeinvolving loss of accommodation. Objects held closer than1 or 2 ft become difficult to see
  4. 4. 4Anatomy of the EyeAnatomy of the Eye Video
  5. 5. 5Introduction: Sensory FunctionTaken for grantedProtection from harmAccurate perception of environmentEssential to communicationSensory deficits compound other problems thatthreaten health, well-being, and independence
  6. 6. 6Sensory Dysfunction: PersonalCostFunctional impairmentLoss of independenceInjurySocial isolationDepressionDecreased quality of life
  7. 7. 7Assessment of Vision
  8. 8. 8Assessing Sensory ProblemsSkilled assessment of sensory functionAssessment Guide 26-1 (pp. 362-363):Sensory FunctionSensory Function (Review!)Assistive techniques: Correctimplementation to promote sensory function
  9. 9. 9Assessment of VisionAppearance?ClothingCleanlinessSelf-careBumps and bruises
  10. 10. 10InterviewAdequacy of visionRecent changes visionDate of last examInspectionMovement of eyelidsAbnormally colored scleraUnequal or absent pupillaryresponse
  11. 11. 11Interview – Visual Problems Red eye Excessive tearing/ discharge Foreign body sensation Headache, eyestrain when reading ordoing close work New onset Double vision, rapid deterioration visual acuity Haziness, flashing lights, moving spots Loss central/ peripheral vision Trauma or eye injury
  12. 12. 12VisionSnellen chart orreading from printVisual field testingExtraocularmovements
  13. 13. 13Eye ExaminationsHealthy older adultsComplete eye examination everyyearVisual acuityRetinaIntraocular pressure (IOP)
  14. 14. 14Normal Visual Changes withAging
  15. 15. 15Normal Age-Related Changes ofthe EyeChanges are gradualOver time can limit functionalabilityCommon eye disorders in theelderly are NOT normal:cataracts, glaucoma, maculardegeneration, & retinopathy
  16. 16. 16Normal Age-Related Changes of theEye: External Changes Graying and thinning  eyebrowsand eyelashes Subcutaneous tissue atrophy wrinkling + thinning of skin around eyes Decreased orbital fat  sunken eyeappearance + sagging eyelids Atrophy lacrimal glands  Dry eyes(saline drops)
  17. 17. 17Normal Age-Related Changes of theEye: Internal Changes Reduced elasticity of lens; decreased ability of the lensto accommodate Decreased ability to focus on close objects (presbyopia) Accommodation is the process by which the eye changesoptical power to maintain a clear image (focus) on an objectas its distance changes
  18. 18. 18Changes During Accommodation
  19. 19. 19Presbyopia: Normal ChangeFlexible lens of eye gradually loses elasticity,affecting ability to change shape to focus on closeobjects
  20. 20. 20Normal Age-Related Changes of theEye: Internal Changes Decreased pupil size, decreased retinal illumination Decreased visual acuity (sharpness of vision) Decreased light sensitivity (difficulty seeing in dim areas/ atnight) Dark and light adaptation takes longer Distortion in depth perception Lens: Yellowed/ Slightly cloudy (opacification) Increased difficulty in distinguishing between blue, green, & violet Increased sensitivity to glare
  21. 21. 21Internal Changes: Cornea & Lens Lipid deposits aroundperipheral cornea arcus senilis (normalchange) Lenses thicken/ hardenYellowish appearance +opacityCataracts (not a normalchange)
  22. 22. 22Normal Age-Related Changes of theEyeVisual acuity (sharpness of vision)Diminishes gradually after age 50Decreases rapidly after age 70Light sensitivity declinesBrightness contrastDark adaptationRecovery from glare
  23. 23. 23Clinical Implications Difficulty reading small print Narrowing of field of vision Decreased light to retina Sensitivity to glare Decreased night vision Difficulty with depthperception (going down stairs) Increased risk for FALLS!
  24. 24. 24Visual Impairments with Aging
  25. 25. 25Visual ImpairmentVisual impairment = visual acuity 20/40 by Snellenchart at 20 feetIncreases with ageCommon visual disturbances in older adults: Presbyopia Age-Related Macular Degeneration Cataracts GlaucomaWill affect 70 million Americans by 2030
  26. 26. 26Legal blindnessVisual acuity20/200 by Snellenchart at 20 feetIncreases withagePeaks at 85 years
  27. 27. 27Question The nurse is assessing a patient who has just beentested for visual acuity and was told his vision is 20/50.The patient asks what this means, and the nurseanswers: A. “You can see approximately 2/5 as well as the normal person.” B. “You can see at 20 feet what a person with normal vision sees at 50feet.” C. “Your vision is the same as a 20-year-old man, even though you are50.” D. “You can see at 50 feet what a person with normal vision can see at20 feet.”
  28. 28. 28Diseases Affecting Vision
  29. 29. 29Cataracts
  30. 30. 30Cataracts NOT a normal part of aging process(though very common with aging) Most cataracts are related to aging Lens clouding  decreased light toretina  limited vision Oxidative damage or cross linking Slow and painless Leading cause of low vision in olderadults > 50% of adults > 65 years havecataracts  visual problems
  31. 31. 31Cataracts: SignsYellowing of lensPupil changes colorto cloudy white orgray
  32. 32. 32Cataracts: Symptoms No pain or discomfort Hazy or blurred vision (mostlikely) Glare, photosensitivity Halos around objects Double vision Lack of color contrast orfaded colors Poor night visionThe Symptoms of Cataracts
  33. 33. 33
  34. 34. 34Cataracts: Blurry Vision
  35. 35. 35Cataracts: Yellowing of Images
  36. 36. 36Cataracts: Decrease in ColorIntensity
  37. 37. 37Cataracts: Risk FactorsIncreased ageSmoking and alcoholDiabetes, hyperlipidemiaTrauma to the eyeExposure to the sun and UVB raysCorticosteroid medicationsRisks of Cataracts
  38. 38. 38A. Simulated vision with cataracts.B. Normal vision.(From National Eye Institute, National Institutes of Health, 2004.)
  39. 39. 39Cataracts: Tx & NursingStrategiesSurgery only cureOutpatient procedure: relatively fewcomplicationsRemoval of lensInsertion of intraocular lens implant (distortsvision less than special cataract glasses do)Cataracts Treatment
  40. 40. 40Cataract Surgery (Outpatient):Intraocular LensLearn About Cataract Surgery - Very graphic!Say Good-Bye to Cataracts & Glasses
  41. 41. 41Cataract Surgery – PostoperativeInstructions Day of surgery Eye shield First 2 weeks HOB 30°, lie on back orunaffected side Eye shield at night Eye drops Mild aches, scratchiness,itchiness Tylenol; NO aspirin, ibuprofen Do not rub, touch area Avoid bright sunlight Wrap-around sunglasses Avoid activities ↑ IOP Sneezing, coughing, vomiting,straining, bending, lifting > 5 lbs Prevent constipation (fiber,fluids, mobility, stool softener) Avoid heavy work, such asgardening, mowing the lawn, ormoving furniture Avoid water in eye (tap water,shower, tub, etc)Caring for Eyes after Cataract Surgery
  42. 42. 42Cataract Surgery – PostoperativeInstructions Symptoms to report Pain not relieved by Tylenol Changes in vision Decreased vision, redness, cloudiness, drainage, floaters or light flashes,curtain over vision, severe eye pain or pressure Complications Infection Wound dehiscence Hemorrhage Severe pain Uncontrolled, elevated intraocular pressureCataracts Surgery Complications
  43. 43. 43Education Regarding CataractPreventionWearing hats andsunglasses when insunSmoking cessationAvoid steroidsLow-fat dietAvoid ocular injuryHow to Prevent Cataracts
  44. 44. 44QuestionWhich of the following statements indicates thatthe client has understood home care instructionsfollowing cataract surgery? A. “I should not bend over to pick up objects from the floor.” B. “I can sleep on whichever side I want as long as my headis raised.” C. “I may not watch television for 6 weeks.” D. “I should keep the protective eye shield in place 24 hoursa day.”
  45. 45. 45Glaucoma
  46. 46. 46GlaucomaDegenerative eye diseaseSecond leading cause of blindness in U.S.10% vision loss in U.S.Primary cause of blindness among AAGlaucoma PrevalenceWhat is Glaucoma
  47. 47. 47GlaucomaOptic nerve damaged by pressureIncrease in intraocular pressure (IOP)  opticnerve damage  peripheral vision lossIOP > 21 mm Hg“Sneaky thief of sight”Causes of Glaucoma
  48. 48. 48
  49. 49. 49Aqueous Humor
  50. 50. 50(From National Eye Institute, National Institutes of Health, 2004.)Simulated Vision with Glaucoma
  51. 51. 51Chronic (Open-Angle) vs Acute(Angle-Closure) GlaucomaChronic (also called open-angle)More common than acute, 90%Slowed flow of aqueous humor through trabecularmeshwork  build up increased IOP  damageto optic nerve  loss of visionPainless vision loss Peripheral visual field lossTypes of Glaucoma
  52. 52. 52Chronic (Open-Angle) Glaucoma
  53. 53. 53Chronic (Open-Angle) Glaucoma
  54. 54. 54Chronic Glaucoma
  55. 55. 55Chronic Glaucoma: S/SPeripheral vision slowly impairedTired eyesHeadachesMisty visionColored rings/ halos around lightsWorse symptoms in morningUsually involves one eye, but may be bothGlaucoma Symptoms
  56. 56. 56
  57. 57. 57Chronic: Tx & Nursing Strategies Diagnosis and Treatment Dx: tonometry; gonioscopy Treatment (Care Plan 26-1; pp. 366-368): No cure, requires life-long management Reduce IOP Medications to decrease IOP (topical eyedrops) Avoid stress, coughing, sneezing, bending over, or straining with bowelmovements Laser trabeculoplasty, Surgery – trabeculectomyGlaucoma TreatmentsGlaucoma Treatment DevelopmentsGlaucoma Laser
  58. 58. 58Tonometry & Gonioscopy
  59. 59. 59Topical Eyedrops Beta-blockers (Betagan, Timoptic, Ocupress) – Bottleswith blue or yellow caps 1st line therapy for glaucoma Lowers IOP by decreasing formation of aqueous humor SEs: Bradycardia, hypotension, bronchospasm, confusion Prostaglandin analogues (Xalatan, Lumigan) Increases outflow of aqueous humor SEs: Stinging, burning, darkening of eyeGlaucoma Help In A Drop
  60. 60. 60Topical EyedropsAlpha-Adrenergic Agonists (Iopidine,Alphagan, Epinal) – Bottles with purple capsLowers IOP by decreasing formation ofaqueous humorAvoid use in acute angle-closure glaucomaSEs: Palpitation, hypertension, tremor,sweating
  61. 61. 61Topical EyedropsMiotics/ cholinesterase inhibitors (pilocarpine,Humorsol) – Bottles with green capsFacilitates outflow of aqueous humorSEs: Decreased night vision, bronchospasm,sweating, salivation, lacrimation, diarrheaCarbonic anhydrase inhibitors (Trusopt, Azopt) –Bottles with orange capsDecreased formation of aqueous humor
  62. 62. 62Question A client with open-angle glaucoma is receivingbrinzolamide (Azopt) for treatment. When assessing theclient’s response to the medication, the nurse expectstherapeutic effects to be the result of the following? A. A decrease in the outflow of aqueous humor B. An increase in the outflow of aqueous humor C. A decrease in aqueous humor production D. An increase in aqueous humor production
  63. 63. 63Acute (Angle-Closure) Glaucoma Acute (angle-closure, closed-angle, narrow-angle) Not as common Angle of iris obstructs drainageof aqueous humor throughtrabecular meshwork increased IOP  visualchanges May occur suddenly Ophthalmic emergency!
  64. 64. 64Acute (Angle-Closure) Glaucoma
  65. 65. 65Acute Glaucoma: S/SSevere unilateral eye pain or headacheBlurred visionNausea and vomitingPhotophobiaColored halos around lightRed eye
  66. 66. 66Acute Glaucoma Sudden S/S: eye pain,HAs, halos around lights,dilated pupils, vision loss,red eyes, N & V May last for a few hours,return again Each attack takes part offield of vision
  67. 67. 67Acute Glaucoma: Tx & NursingStrategies Diagnosis Tonometer to measure IOP Normal IOP is 20 mm Hg or below Gonioscopy (direct exam) Medications (to decrease pressure) Permanent vision loss within 2 – 5 days if untreated Surgery: iridotomy (lowers IOP) to prevent futureepisodes
  68. 68. 68Risk Factors for GlaucomaIncreased intraocular pressureOlder than 60 years of ageFemale genderFamily history of glaucomaPersonal history of myopia, diabetes,hypertension, or migrainesAfrican American ancestryWhos at Risk of Developing Glaucoma
  69. 69. 69Education Regarding GlaucomaScreeningComplete ophthalmic examinationAdults 65+ should be evaluatedannuallyEvery 6 months with glaucomacontrolled by medication
  70. 70. 70Glaucoma: ContraindicatedMedications Cold remedies with Pseudoephedrine or Phenylephrine(Neo-Synephrine) Antihistamines such as Chlorpheniramine (Chlor-Trimeton) or Diphenhydramine (Benadryl) Overactive bladder remedies – Tolterodine tartrate(Detrol) Tricyclic antidepressants – Amitriptyline (Elavil) Cyclobenzaprine (Flexeril)
  71. 71. 71QuestionIs the following statement true or false?Patient adherence with treatment for glaucomacan be a problem in the older adult population.
  72. 72. 72Age-Related MacularDegeneration (ARMD)
  73. 73. 73Age-Related MacularDegeneration (ARMD) Most common cause ofblindness adults > 65 Degeneration of macula,(sharpest central vision) Scotoma – central vision Visual acuity Central vision Seeing objects clearly Common daily tasks (readingand driving)Managing Macular Degeneration
  74. 74. 74ARMD: Symptoms Painless More light required forreading Central scotomas – blindspots Blurry Bent, warped images Dark, foggy or light spots Words on a page mayappear distorted orincomplete Metamorphopsia –images look smaller(micropsia) or larger(macropsia) than theyactually areThe Signs of AMD
  75. 75. 75A. Simulated loss of vision with age-related maculardegeneration (AMD). B. Normal vision.(From National Eye Institute, National Institutes of Health, 2004.)Helping Macular Degeneration
  76. 76. 76Macular degeneration: distortion ofcenter vision; normal peripheral visionAmsler Grid
  77. 77. 77ARMD: Two Types –Dry & Wet Dry (atrophic,nonexudative form) 10-20% severe vision loss Atrophy Retinal pigmentdegeneration Drusen accumulations 90% ARMD this type Better prognosis, slowerprogression
  78. 78. 78ARMD: Two Types –Dry & Wet Wet (Neovascular exudates) Blood or serum leak from newlyformed blood vessels beneathretina scar formation + visualproblems 10% this type More sudden onset More severe vision lossLearn about Wet AMD
  79. 79. 79Normal Macula vs Dry & WetARMD
  80. 80. 80Risk Factors for ARMD Age (above 50) Female gender Caucasian race and light (blue) colored eyes Family history of ARMD Cigarette smoking Ultraviolet light (sunlight) HTN, high cholesterol, cardiovascular disease Lack of dietary intake of lutein; antioxidants and zincHow to Prevent Macular DegenerationThe Risks of Smoking and Macular Degeneration
  81. 81. 81ARMD: TxNo cure at presentNew research:Photodynamic therapy uses a special laser to sealleaking blood vessels in the eyeAntioxidant vitamins (C, D, E, and Beta-carotene),lutein, & zinc may slow progress of diseaseRetinal cell transplantation or regenerationNew Macular Degeneration Treatment (just an example)
  82. 82. 82Age-Related Macular Degeneration(ARMD) Preventive MeasuresNurses should encourageRoutine ophthalmic examinationsWearing UV protective lenses in sunSmoking cessationExercising routinelyEating a healthy diet consisting of fruitsand vegetables
  83. 83. 83ARMD: Nursing Strategies(p.365, Box 26-2) Magnifying glasses Reading lamps Low-vision assistive devices Modify environment Avoid glare Use contrasting colors More auditory input (books on tape, etc.) Decrease controllable risk factors(smoking, UV exposure)How to Deal with Losing Sight
  84. 84. 84QuestionWhich type of visual problem isassociated with macular degeneration?A. Loss of peripheral visionB. Loss of central visionC. Perception of spots moving across the eyeD. Pain with movement of the eye
  85. 85. 85Detached Retina
  86. 86. 86Detached Retina Forward displacement of retina Gradual or sudden Risk factors: nearsightedness (myopia), cataract surgery,glaucoma, trauma, previous retinal detachment, family hx Symptoms: spots, blurred vision, flashes of light, curtainover visual field Blank areas of vision PainlessCauses of Retinal Detachment
  87. 87. 87Posterior Vitreous Detachment
  88. 88. 88Retinal Detachment
  89. 89. 89Detached Retina: Tx & NursingStrategiesPrompt treatmentBed rest, bilateral eye patchesReason: Reduce rapid eye movementsSafety concernsSurgery: electrodiathermy & cryosurgeryScleral buckling & photocoagulationDetached Retina (or Retinal Detachment)
  90. 90. 90Promoting Visual Safety
  91. 91. 91Promoting Visual Safety in Home Provide adequate lighting in high-traffic areas Stair rails, non skid surfaces Use contrast when painting Avoid reflective floors Signs – bright colors such as red, orange, yellow Use red-colored tape or paint on edges of stairs andentryways Avoid complicated rug patterns
  92. 92. 92Nursing Diagnoses
  93. 93. 93Nursing Diagnoses Associated withVisual Impairment (Table 26-1)Sensory/Perceptual Alterations: Visual with avariety of nursing goals and interventionsCommunicationSafetyMobilitySelf-care activitiesMood

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