Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Timby/Smith: Introductory

Medical-Surgical Nursing, 10/e

Timby/Smith: Introductory

Medical-Surgical Nursing, 10/e

Chapter 42: Caring for Clients with Eye Disorders


Approximately 18 million people in the United States have some degree of visual impairment – which include approx 1 million who are legally


Refractive ErrorsRefractive Errors• Emmetropia: Normal vision

• Myopia

• Hyperopia

• Presbyopia

• Astigmatism

• Box 42-1 pg 607

Figure 42-1 pg 607 Eyeball shape affects visual acuity in

some refractive errors.


Refractive Errors Refractive Errors

• Pathophysiology, Etiology

– Etiology - Inherited; Surgical error

– 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


Blindness, Visual ImpairmentBlindness, 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


– REVIEW: Client & Family teaching: 42-1 & 42-2, pg 608

– REVIEW: Gerontologic Considerations, pg 609

– REVIEW: Nursing Process for Blind Client, pg 609 - 610


Eye Trauma 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


Eye Trauma Eye Trauma • Medical, Surgical Management

– Emergency first aid; Antibiotic ointment or drops; Eye patch placement

– Hospitalization

– Surgical repair

• Nursing Process for Eye Trauma, pg 611 - 612

• Client & Family Teaching 42-3, Instilling eye meds

• REVIEW: Stop, Think and Respond 42-1 pg 612

Figure 42-2 pg 611 Everting the eyelid


Conjunctivitis 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: Read bullet points pg 612-613


Uveitis 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



Keratitis, Corneal UlcerKeratitis, Corneal Ulcer

• Pathophysiology, Etiology: Corneal trauma; Infectious agents

• Assessment Findings: Pain; Photophobia; Blurred vision; Tearing; Purulent discharge; Redness

• Diagnostic Findings: Flashlight illumination; Slit-lamp exam; Fluorescein drops, strips

• Medical, Surgical Management: Topical anesthetics; Mydriatics; Antibiotics; Keratoplasty

• Nursing Management: no contact lens, keep eye clear of exudate


Blepharitis 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



Hordeolum (Sty)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: separate towels, cleanliness


Chalazion (cyst)Chalazion (cyst)

• Pathophysiology, Etiology: meibomian gland becomes obstructed and the release of sebaceous secretions is blocked; cyst

• Assessment Findings: swollen, hard, can block vision if too large

• Medical, Surgical Management: Warm soaks; massage

– Severe cases: excision

• Nursing Management: review bullet points on pg 614


Macular DegenerationMacular Degeneration• Pathophysiology, Etiology: breakdown of or damage to

the macula

– Dry: Gradual onset; Wet: Abrupt onset

– Leading cause of vision loss in clients >60 yrs

• Assessment Findings

– Dry: Blurred vision; Central vision affected

– Wet: Vision distortion; Central vision affected

• Medical Management: Laser photocoagulation; Photodynamic therapy; Intravitreal injection; Macular translocation (new); Diet, vitamins



Glaucoma Glaucoma • Pathophysiology, Etiology: Aqueous fluid

imbalance; Elevated IOP


– Open-angle: May be asymptomatic, 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


Glaucoma Glaucoma

• Medical, Surgical Management: Medications; Miotics; Analgesics; Complete rest; Laser, surgical iridectomy; Laser trabeculoplasty; Corneal trephine

• REVIEW: Drug Therapy Table 42-1, pg 618

• Nursing Management: meds are lifelong - if doctors orders followed, glaucoma can be controlled

• REVIEW: Stop, Think, Respond, 42-2, pg 619


CataractsCataracts

• 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


CataractsCataracts• Surgical Management: Intracapsular or

extracapsular extraction; Phacoemulsification

– Post-op vision restoration: Corrective glasses; Contact lens; IOL implant

• Nursing Management: Review bullet points, pg 620; Review Nutritional Notes 42-2 pg 620

• REVIEW: Nursing Care Plan 42-1 pg 621 & 622

X


Retinal Detachment Retinal Detachment

• Pathophysiology, Etiology: Retinal stretching; Degenerative changes; Injury; Eye surgery; Figure 42-8, pg 622


– Blind spots; Flashes of light; Floaters; Complete vision loss

• Diagnostic Findings: Ophthalmoscope

• Surgical Management: Laser surgery; Cryopexy; Diathermy; Retinopexy; Scleral buckling; Pneumatic retinopexy



Enucleation 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: Watch for hemorrhage, infection


End of Chapter

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Documents

Transcript of Timby/Smith: Introductory Medical-Surgical Nursing, 10/e