Welcome to Main Theatres – Ophthalmology · Added to NU Placements Website May 2011 Welcome to...

Added to NU Placements Website May 2011

Welcome

to

Main Theatres

Ophthalmology


Welcome to Main Theatres – Ophthalmology

We hope you enjoy your placement in the department

and benefit from your experience. We aim to provide a

learning environment that is challenging and enables

students to fulfil outcomes set by the university. A

mentor is allocated to each student to guide you

through your learning outcomes and will regularly

review your progress. Please don’t hesitate to provide

any feedback or concerns you may have regarding your

placement.

Department Profile

Our department consists of two operating theatres

which cater for both in-patient and day case surgery.

Both theatres operate Monday to Friday from around

8:30 am to 5:30 pm. All types of ophthalmic surgery

are performed within the department including :-

- vitreo-retinal surgery

- paediatric ophthalmic surgery

- strabismus (squint) surgery

- lid surgery

- corneal surgery

- cataract surgery

- oncology surgery

- emergency surgery e.g. penetrating injury , lid

laceration


PHILOSOPHY OF CARE

We believe each individual should receive a holistic

approach to care which accounts for physical,

psychological and cultural needs.

Care should be offered in a clean, safe environment

and delivered in a courteous, professional manner.

Confidentiality, privacy and dignity should be respected

at all times through practice within the professional

code of conduct.

We aim to improve patient care through life-long

learning, audit and evidence based practice and so

offer patients informed choices in their care.

Each patient will have his or her own Named Nurse

responsible for assessing, implementing and co-

ordinating care within the multi-disciplinary team.

By use of a problem solving, patient focused approach

to care, we hope to build a partnership of care that

aims to help patients attain, maintain and restore

health.

We aim to develop our role as educators and provide a

supportive environment where learning is encouraged

for all staff, patients and carers.


There are 11 different consultant ophthalmologists who

operate regularly in our department and their

specialities include :

- Vitreo-retinal surgery

- Corneal surgery

- Eyelid and plastic surgery

- Paediatric ophthalmic surgery

- Strabismus (squint) surgery

- Glaucoma surgery

- Ophthalmic oncology surgery

There are other surgeons who specialise in fast track

cataract surgery.

These surgeons are based in Cataract Treatment

Centre and only operate in our theatres on emergency

cases.


Most patients operated on within the department are

in-patients from Haygarth Ward and usually require a

general anaesthetic. We also perform day case surgery

under local anaesthetic, usually for patients requiring

lid surgery e.g. for an in-turning eyelid (entropian).

Some of our staff have an ophthalmic nursing

qualification and training for those who don’t is

encouraged when opportunities arise.

Research is also encouraged from both nursing and

medical staff to improve and update current practice.

Primary Nursing

Patients visiting theatre from Haygarth ward are

allocated their own primary nurse on arrival. This nurse

will then be responsible for the patients care during

their entire stay in the department. The same method

is adopted for patients attending the department as

day case patients.

Each consultant is also allocated their own primary

nurse who is responsible for co-ordinating the care and

nursing team when they operate in the department.

The consultant also liases directly with their primary

nurse to ensure all requests , equipment etc are

satisfied.


MAIN THEATRE : Nursing Staff

There is one department manager (band 7) and one

junior sister (band 6)

The are also 12 band 5 staff nurses mainly full time

with various levels of experience and qualifications.

There are currently 2 theatre support workers (health

care assistants.

The department also employs one full time Operating

Department Practitioner (ODP) who mainly works with

the anaesthetic staff.

Theatre Sterile Supplies Unit

Attached to the Theatre Department is a sterile

supplies department.

All equipment requiring sterilisation is pre-washed on

site then sent to TSSU at Sunderland Royal Hospital

for Autoclaving. All equipment on return is checked and

either stored in the department or distributed to the

departments throughput the hospital

- Theatres

- Cataract Treatment Centre

- Casualty and Outpatient Departments

- Haygarth Ward

- Excimer Unit

- Diagnostic Unit


Theatre Timetable 2010

Monday Am Th. 1 Mr Tiffin Paediatrics

Th. 2 Mr Morgan Corneal/Mix

Monday Pm Th. 1 Mr Fraser Cataract/Glaucoma

Th. 2 Vitreo-retinal Emergency List

Tuesday Am Th. 1 Mr Steel Vitreo-retinal

Th. 2 Miss Chapman Lids/Plastics

Tuesday Pm Th. 1 Mr Wride Cataract/Glaucoma

Th. 2 Mr Boyce Lids/Plastics

Wednesday Am Th. 1 Mr Inglesby Vitreo-retinal

Th. 2 Mr Allchin Strabismus

Wednesday Pm Th. 1 Mr Steel Vitreo-retinal

Th. 2 Mr Allchin Strabismus

Thursday Am Th. 1 Mr Steel Macular

Th. 2 Mr Gnanaraj Paediatric/Mix

Thursday Pm Th. 1 Mr Boyce Lids/Plastics

Th. 2 Mr Morgan Corneal/mix

Friday Am Th. 1 Mr Inglesby Vitreo-retinal

Th. 2 Mr Osborne Lids/Plastics

Friday Pm Th. 1 Miss Chapman Lids/Plastics

Th. 2 Mr Osborne Lids/Plastics


Hours of Duty

Full time staff are required to work Monday to Friday

and do three 8 – 5:30 shifts and two half days. Start

and finish times are flexible when necessary either

staff or the department. Normal shift times are as

follows :

- full day, 08:00 til 17:30

- half day, 0800 til 13:00 or 13:30

- reverse half day, 12:30 til 17:30

As we are a Monday to Friday area only, there are

usually no difficulties in working your minimum of 50%

of shifts with your mentor.

If you are off sick at any time, remember to inform

both us and your university.

There are also always two members of staff on-call for

out of hours emergency cases.

Useful Telephone numbers

Office Extension 49156

Direct Line 0191 569 9156

Line Extension 46280

Coffee Room 46283

Sister’s Office 46295


Emergency Alarm Calls And Numbers

Fire Alarm

Every Thursday morning the fire alarm sounds an

intermittent tone at around 11:45 am. This is the test

procedure. If this sounds at any other time it indicates

a real fire alarm and action must be taken. All doors

and windows are to be closed and remain so until the all

clear is given. A continuous tone indicates a fire alarm

in your area and immediate investigation is required

and possible evacuation of all patients, relatives and

staff.

Crash Call

In the event of a cardiac arrest in the department the

first action is to put out a crash call and shout for

assistance. The crash trolley is located in the recovery

area of theatres.

Cardiac Arrest : 2222

Fire : 333

Security : 777


Ophthalmology

Definition

The study of the eye and its associated parts.

Ophthalmology deals with diseases of the eye and their

treatment. The word ophthalmology has greek roots

derived from the greek words ophthalmos meaning eye

and logos meaning science. So its literal meaning is ‘the

science of eyes’.

Anatomy of the Eye

Ophalmology is constantly changing and updating as

research and technology offer continually improving

treatments and equipment.

During your placement you will have the opportunity to

observe a wide variety of ophthalmic surgery in our

department. The following is a brief introduction to

the types of surgery performed in this department.


Cataract

A cataract is a misting or opacity of the lens. It

prevents light entering the eye properly and causes

dimness of vision and eventually blindness if left

untreated. Most cataracts are caused by the body’s

normal ageing process but occasionally are caused by

trauma, diabetes or drugs.The cataract can be removed

by an operation called phacoemulsification (see below).

The lens is broken down using ultrasonic vibrations

then aspirated. A plastic lens implanted inside the eye

(IOL - intra ocular lens) then replaces the cataract

(see below).


Sutures are not usually needed and the patient can

return to a normal lifestyle immediately afterwards.

Trabeculectomy

Indicated for patients with glaucoma. The operation is

performed where prophylactic treatment fails to

control the intra ocular pressure (IOP). The aqueous

fluid of the anterior chamber, in the front part of the

eye, is unable to drain sufficiently away due to a

blockage in the drainage channel, the trabecular

meshwork, located at the junction between the sclera

and the cornea.

Trabeculectomy involves creating a thin scleral flap and

internally cutting two small holes, one in the iris (an

iridectomy) and the other in the drainage channel,

usually at 12 o’clock to be less noticeable under the eye

lid. This allows the aqueous fluid to flow freely and

gradually be absorbed by the bloodstream and so

lowering the intra ocular pressure.


Lid Surgery

Ptosis

A ptosis is a drooping of the upper lid. It can be caused

by: -

- Abnormal weight on the lid due to oedema, tumour

or scarring

- trauma or disease to the muscle

- paralysis of nerves supplying the upper lid

- congenital causes

A ptosis can be corrected by lid surgery during which

the levator muscle in the lid is resected.

Entropian

Is a turning in over of the eyelid due to weakness of

the lid retractors (the muscles which open and close

the eyelids). Usually occurs in the lower eye id causing

eye to water and eyelashes to rub against the cornea

causing pain and discomfort. There are many different

operations to correct entropian but all usually involve

removing part of the eyelid therefore tightening the

retractor muscle and shortening the lid.

Ectropian

Is a turning out over of the eyelid due to a weakness of

the orbicularis muscle. Usually occurs in the lower eye

lid and causes the eye to water constantly because the

drainage hole (punctum) is not in the correct position.


The most common operation is to shorten the eyelid

and to enlarge the punctum to reduce watering.

Lid Lesions - Removal

Usually performed to remove a lesion for diagnostic

purposes. If results indicate a carcinoma further

surgery will be required to remove it and re-construct

the eyelid. Some lid lesions may also be removed for

cosmetic reasons.

Chalazion

The Meibomian glands are found in the eyelids and

produce a sebaceous substance, which creates the oily

layer of the tear film. A chalazion occurs when one of

the Meibomian glands swell due to a blockage of its

duct.

If the swelling does not subside the chalazion can be

removed by incision and curettage. A clamp is placed on

around the chalazion and the eyelid everted. A small

incision is made and the contents scooped out using a

curette. The clamp is then removed and some anti-

biotic ointment and a firm pad are applied.

Evisceration

Removal of the contents of the eye, usually after an

infection has left the eye blind. A small amount of eye


movement is retained after this surgery giving a more

cosmetically pleasing result.

Enucleation

Removal of the whole eyeball leaving the extra ocular

muscles. The socket is fitted with a conformer to

enable a good cosmetic result with a prosthesis (fitted

at a later date). It is often performed as a last stage

of treatment for a painful, blind eye following

malignant melanoma.

Dacryocystorhinostomy (DCR)

Epiphora, or watery eyes, occurs because of a blockage

in the normal lacrimal drainage system, which impairs

normal tear channelling into the nasal cavity.

Recurrent infection or dacryocystitis may occur as a

result of stagnation. DCR may alleviate symptoms and


involves surgical creation of a new passage of drainage

for tears into the nasal cavity.


Vitrectomy and Detachment Surgery

These operations are performed for patients who have

problems with their retina often associated with

diabetes, short-sightedness (myopia) or trauma. The

operations are often intricate and lengthy procedures.

Vitrectomy (internal approach) involves removing the

jelly part of the eye (vitreous) and replacing it with a

fluid containing minerals and salts and is about the

same consistency as the aqueous fluid of the anterior

chamber. Microsurgery is then performed to attempt

to rectify the specific problem such as retinal holes,

tears or membranes.


Detachment (external approach) is performed on the

outside of the eye (sclera) and involves suturing a

silicone explant onto the sclera to create an

indentation of the detached area of retina. A freezing

process (cryotherapy) is then applied over the sclera

to induce an inflammation over the retinal problem. The

inflammation will gradually subside taking the retina

back to its normal position and up against the

indentation of the explant.


Occasionally a gas bubble is (SF6 or C3F8) mixed with

filtered air is injected into the eye to tamponade

problem retinal areas. The gas bubble will expand a

little inside the eye and push up against the retina and

help keep it in place. The gas bubble is gradually

absorbed. Patients may need to posture post-

operatively to help with the success of the operation

i.e. lie in a certain position so gas bubble tamponades

the right area of retina. The posturing can be said to

be as important as the surgery itself.

Corneal Graft

A corneal graft is a transplant operation involving

removal of the central part of the cornea and its

replacement with a cornea from a donor. The donor

cornea comes from someone has expressed a wish that

their corneas be used to help someone else see after

their death. The donor cornea is sutured to the host

using either a series of interrupted sutures or one

continuous suture. The sutures may be left in place for

up to two years. Although rare, corneal rejection is a

post op complication and can occur even years after

surgery. Rejection occurs most commonly in the first

year after surgery.


LEARNING ZONES

Pre-admission Assessment Clinic

Almost all elected patients are assessed prior to

admission within one month of their surgery date,

investigations are undertaken, eg tonometry,

venepuncture, electrocardiograph, focimetry. Physical

and social needs are taken into consideration and social

services, occupational therapists or district nurses may

be required for input on discharge from hospital.

These services can be organised before admission,.

The patient can receive information about their

forthcoming surgery here.

Haygarth Clinic

Specialised nurse-led clinics are undertaken here, eg

blood monitoring, oculoplastics.

Patients attend as outpatients. Consultant

Ophthalmologists also hold regular clinics here.

Cataract Treatment Centre

Patients are assessed prior to day case surgery, nurses

prepare the patient for surgery and surgery such as

cataracts under local anaesthetic and other eye

operations are carried out and the patient is usually

discharged the same day.


Nurses carry out a post-operative telephone

assessment on the first post-operative day.

Patients are also seen as outpatients by Consultants

and listed for surgery as well as reviewed one-two

weeks post-operatively.

Main Theatre / Day Case Unit

Again, patients are assessed prior to day case surgery.

Patients undergo surgery for all manner of eye

problems under general and local anaesthetic, eg

vitrectomy, squints, cataracts, trabeculectomies.

Nurses carry out a post-operative telephone

assessment on the first post-operative day.

Accident and Emergency

Patients attending the department are triaged into one

of three categories.

1 = ocular emergency

2 = urgent

3 = non-urgent

The patient will be seen by the nurse practitioner, the

nurse consultant, or the doctor, who can carry out the

ocular examination and treatment. Conditions can

include chemical injury, embedded corneal foreign

body, arc eyes, eyelid lacerations, penetrating injuries,

conjunctivitis etc. A minor operating theatre exists


for small repairs/excision of chalazions and injection

of botulinum toxin injections.

Diagnostic Unit

Ocular ultrasound is undertaken, as well as laser

treatment and fluorescein angiograms on in-patients

and out-patients as needed.

Medical physics investigations can be done also.

The glaucoma unit also carries out tests here

Excimer Laser Unit

Patients undergo refractive surgery here carried out

by the Corneal Consultants.

Out-patients

Visual acuity is checked at each visit and doctor in the

clinic sees the patient. Adult and paediatric clinics are

held here.

Orthoptic Department - Orthoptists measure for

straight eyes.

Pharmacy

Dispensing of in and out patient prescriptions.

Opportunity to observe the working of the pharmacy

department and the various types of medications

available.


Profile of Learning Opportunities

Learning Opportunity

Resource / Relevant

Personel / Department

Use Of Telephone

- making calls

- answering calls

- ring back facility

- awareness who to

report to

- bleep system

Using HISS / Computers

- patient admission

profiles / information

- order entry

- retrieve results

- internet

- email access

Participation

- patient care

- MDT

Patient Care

- prioritising patient

needs

- different methods of

care delivery e.g.

Theatre Nursing Staff


Library Staff

Nursing and medical staff

MDT members


primary nursing,

named nursing,

nursing caseload

- observation skills e.g.

BP, temeperature,

pulse, ECG, blood

glucose, INR,

urinalysis

- accurate

documentation e.g.

early warning scores,

theatre register

- instillation eyedrops

- A-scanning

- IOP measurement

- Scrubbing for

ophthalmic surgery

- Circulating (floor)

nurse

- Recovery of patients

including airway

management,

monitoring oxygen

saturation,

administration of

oxygen, IV therapy

- Pain relief

Infection Control

- policies

- source and spread of


Anaesthetist

Medical Staff

ODP’s


Infection Control


infection

- aseptic technique

- appropriate

equipment,clothing

Oncology

- epidemiology /

aetiology

- treatment

- surgery – radioactive

plaque

- isolation nursing

Ophthalmology

- anatomy of eye

- diseases e.g.cataract

- treatment

- surgery

- ophthalmic pharmacy

- pre-assessment

- oculoplastics

- nurse led post op

clinics

- nurse led glaucoma

clinics

- outreach clinics

Health Promotion

- patient education

- health promotion

literature

Department

Infection control link

nurse


Ward Nursing Staff

Ophthalmic Oncology

Specialist – Mr Wood

Eye Infirmary Nursing

Staff

Learning Zones e.g. CTC,

Haygarth, OPD, A+E

Medical Staff

Pharmacist

Outpatient B : pre-

assessment

All Nursing and Medical

Staff

Smoking Cessation Advisor


- smoking cessation

- low visual aids

Communication Skills

- assessment /

discussion / education

patients and relatives

- interviewing /

questioning skills

during assessment

Managing care

- nursing process

- philosophy of care

- admission day case

patients

- assessment e.g. who

assesses, how, what

and where

- planning of care

- computerised care

plans

- implementation of

care

- evaluation of care

- discharge patients

- referrals to members

MDT

- risk assessment tools

e.g. EWS

LVA unit


Pre-assessment Nursing

Staff in CTC and Haygarth

Ward

Nursing Staff


GLOSSARY OF OPHTHALMIC TERMS

Abduction Turning the eye outwards.

Acanthamoeba A genus of free-living

amoeba.

Accommodation The ability of the lens to

change shape to allow near

objects to be focused on

the retina.

Adduction Turning the eye inwards.

Amblyopia Reduced vision usually due

to interference with the

eye’s development.

Alpha, Gamma and Kappa Different angles in the

eye measured between

the optic axis and the

visual axis.

Aniridia Absence of the iris.

Aphakia Absence of the lens.

Applanation tonometry Measurement of the

intra-ocular pressure by

flattening the cornea.

Arcus senilis Degenerative change in

the cornea resulting in a

white ring around the

corneal circumference.

Argon laser Laser that uses

photocoagulation.


Astigmatism Uneven curvature of the

cornea.

Binocular vision Co-ordinated use of both

eyes resulting in a single

vision.

Biometry Measurement of the axial

length of the eye.

Blepharitis Inflammation of the lid

margin.

Blepharospasm Painful involuntary spasm

of the eyelids.

Blind spot Optic disc where there

are no nerve endings, only

nerve fibres.

Bullous keratopathy Oedema of the cornea

causing ‘blister’ formation

in the epithelium.

Canthus Outer and inner areas

where the upper and lower

lids meet.

Capsulotomy Opening of the capsule of

the lens.

Cartella shield Plastic shield to protect

the eye.

Caruncle Small fleshy area in inner

corner of the eye.

Cataract Opacity of the lens.

Central field/vision Area of vision when

looking straight ahead.


Chalazion Meibomian gland cyst.

Internal hordeolum.

Chemosis Oedema of the

conjunctiva.

Chlamydia Chronic conjunctivitis

caused by serotypes D-K

of Chlamydia trachomatis.

Commotio retinae Oedema of the retina

following trauma.

Concave lens A lens which diverges

light rays, used to correct

myopia: a ‘minus’ lens.

Concretion Lipid deposit in the

conjunctiva.

Convex lens A lens which converges

light rays, used to correct

hypermetropia: a ‘plus’

lens.

Cycloplegia Paralysis of the ciliary

muscles.

Cylindrical lens A lens of cylindrical

shape, which refracts

light rays in various

directions in different

meridians, used to correct

astigmatism.

Dacryoadenitis Inflammation of the

lacrimal gland.

Dacryocystitis Inflammation of the

lacrimal sac.


Dacryocystorhinostomy An operation to make a

passage from the lacrimal

sac into the nose to

overcome obstruction.

Dendritic ulcer A branching ulcer of the

cornea caused by the

herpes simplex virus.

Descemetocele Protrusion of Descemet’s

membrane through the

stroma and epithelium of

the cornea.

Dioptre Unit of measurement of

strength of the refractive

power of the eye, or

lenses, expressed as a

fraction of a metre.

Diplopia Double vision.

Disciform keratitis Inflammation of the

cornea as a complication

of herpes simplex virus.

Distichiases Double row of eyelashes.

Drusen Small yellow nodule in

Bruch’s membrane or optic

nerve.

Ectropion Turning out of the eyelid.

Electroretinogram A recording of electrical

activity of the retina.

Emmetropia Absence of refractive

error.


Endophthalmitis Inflammation/infection of

inner structures of the

eye.

Endophthalmos Displacement of the

eyeball downwards.

Entropion Turning inwards of the lid

margin.

Enucleation Removal of eyeball and

length of optic nerve.

Epicanthus Broad fold of skin in inner

canthus.

Epilation Removal of an eyelash.

Epiphora Watering eye.

Episcleritis Inflammation of the

episcleral vessels.

Evisceration Removal of the contents

of the eyeball, leaving the

sclera intact.

Excimer laser Laser used for corneal

surgery, eg for correcting

refractive errors or

removing corneal scars.

Exenteration Removal of the contents

of the orbit, including the

eyeball and lids.

Exophthalmometer Instrument for measuring

the degree of protrusion

of an eye.

Exophthalmos Protrusion of one or both

eyes - usually refers to


that caused by thyroid

eye disease.

Field of vision The entire area that can

be seen without moving

the eye.

Fields of gaze The different areas that

can be seen when moving

the eye in all directions.

Fixation The eyes are fixed on an

object centrally at a

chosen distance.

Floaters Small, dark particles in

the vitreous.

Fundus Posterior aspect of the

retina including the optic

disc and the macula.

Fusion Co-ordinating the images

seen by both eyes into a

single image.

Glaucoma Increased intra-ocular

pressure sufficient to

damage vision.

Gonioscope A contact lens mirror used

to view the anterior

chamber angle.

Guttae (G.) Eyedrops.

Hemianopia Half-vision - unilateral or

bilateral.

Heterochromia Difference coloured irises

in one person.


Hordeolum - internal See

Chalzion

- external See Stye

Hypermetropia Long sight.

Hyphaema Blood in the anterior

chamber.

Hypopyon Pus in the anterior

chamber.

Injection Degree of redness of the

conjunctiva.

Interpupillary distance(IPD) The distance between the

two pupils.

Interstitial keratitis Inflammation of the

cornea due to syphilis.

Iridectomy Removal of a piece of the

iris.

Iridodyalysis Severance of the iris

from the ciliary body.

Iridodonesis Quivering of iris following

intra-capsular cataract

extraction.

Iridotomy A hole in the iris, usually

performed by the laser

beam.

Iris bombe Bulging forward of the

iris.

Iris prolapse A section of the iris

prolapsing through a

wound, either surgical or

traumatic.

Iritis Inflammation of the iris.


Ishihara colour plates Multi-coloured charts for

testing colour vision.

Keratitic precipitates Plaques of protein

adhered to the corneal

endothelium in uveitis.

Keratitis Inflammation of the

cornea.

Keratoconus Conical-shaped deformity

of the cornea.

Keratometer Instrument for measuring

the curvature of the

cornea.

Lacrimation Production of tears.

Lagophthalmos Incomplete closure of the

eyelids.

Lamellar graft Partial thickness corneal

graft.

Laser Light Amplification by

Stimulated Emission of

Radiation. Energy

transmitted as heat.

Microphthalmos Small eyeball.

Miotic Drug that constricts the

pupil.

Mydriatic Drug that dilates the

pupil.

Myopia Short sight.

Oculentum (Oc.) Eye ointment.

Operculum A semi-circular tear in the

retina, covered with a flap

of retina.


Ophthalmia neonatorum Severe conjunctivitis of

the newborn.

Ophthalmoplegia Paralysis of the extra-

ocular muscles.

Ophthalmoscope Instrument for examining

the retina.

Optic axis The line through the

centre of the optical

structures of the eye.

Palpebral Pertaining to the eyelids.

Pannus Neovascularisation of the

cornea.

Panophthalmitis Inflammation of the whole

eyeball.

Penetrating graft Full-thickness corneal

graft.

Perimeter Instrument for measuring

the field of vision.

Peripheral vision/field Area of vision outside

central field of vision.

Phacoemulsification Removal of a cataract by

ultrasound, breaking down

lens matter prior to it

being aspirated.

Phasing Regular frequent

measurements of intra-

ocular pressure over a few

days.

Phlyctenule Small vesicle of allergic

origin on limbal area of

conjunctiva and/or cornea.


Photophobia Sensitivity to light.

Photopsia Sensation of flashing

lights.

Phthsis bulbi Shrunken eyeball.

Pinguecula A yellowish overgrowth of

conjunctiva.

Placido’s disc A disc with alternating

black and white rings for

reflecting onto the cornea

to detect any irregularity

in its curvature.

Presbyopia Inability to focus for near

sight due to hardening of

the lens nucleus after the

age of 40 years.

Preseptal callulitis Inflammation of preseptal

portion of the eyelids.

Prism A triangular-shaped lens

used to correct diplopia.

Proptosis Protrusion of the eyeball.

Pterygium A triangular proliferation

of conjunctival tissue that

can invade the cornea.

Ptosis Drooping eyelid.

Refraction (1) Bending of light rays.

(2) Measurement of and

correction of refractive

errors of the eye.

Refractive surgery Corneal surgery to correct

refractive errors.


Retinal detachment Separation of the

epithelial layer of the

retina from its neural

layers.

Retinitis pigmentosa An hereditary

degeneration of the

retina.

Retinoblastoma Highly malignant tumour

of the retina in infancy.

Retinopathy Non-inflammatory disease

of the retina.

Retinopathy of prematurity A vasoproliferative

retinopathy occurring in

premature infants.

Retinoscope Instrument for objective

assessment of refractive

errors.

Retrobulbar Behind the eyeball.

Retropunctal cautery Cautery applied behind

the punctum to cause

fibrosis and inturning of

the lower lid.

Rhodopsin Light-sensitive pigment of

the rods in the retina -

‘visual purple’.

Rodding of fornices Passing a glass rod in

either fornix.

Rubeosis irides Neovascularisation of the

iris.

Scleritis Inflammation of the

sclera.


Scleromalacia Degeneration of the

sclera.

Scotoma An area of visual loss in

the visual field.

Seidel test A test to ascertain

leakage of aqueous

through a section or

perforative wound using

fluorescein drops.

Sjorgen’s syndrome Syndrome comprising

arthritis, dry eyes,

dysphagia and

achlorhydria.

Snellen chart A chart consisting of

graded letters, symbols or

numbers for testing

central vision.

Squint Strabismus - deviation of

one eye.

Staphyloma A protrusion of the

cornea or sclera.

Stereopsis Perception of depth with

binocular vision.

Stevens-Johnson syndrome Acute mucocutaneous

vesiculobullous disease.

Strabismus See Squint.

Stye Inflammation of one lash

follicle. External

hordeolum

Superficial punctuate keratitis Superficial spots of

inflammation of the


cornea which stain with

G.fluorescein.

Symblephron Adhesion of the bulbar

and palpebral conjunctiva.

Sympathetic ophthalmitis Severe uveitis in one eye

following trauma involved

the uvea of the other eye.

Synaechiae Adhesion of the iris (a) to

the lens - posterior

synaechiae; (b) to the

cornea - anterior

synaechiae.

Tarsorrhaphy Suturing together of the

eyelids.

Tear film The film of liquid covering

the eyeball.

Tenon’s capsule Membrane encircling globe

from limbus to optic nerve

overlying the sclera.

Tomography Computerised scan of the

optic disc.

Tonometer Instrument for measuring

intra-ocular pressure.

Topography A contour map of the

curvature of the cornea.

Toric contact lens Contact lens to correct

astigmatism.

Trachoma Potentially blinding

infection of the

conjunctiva and cornea

caused by the TRIC virus.


Trichiasis Ingrowing or inturning of

eyelashes.

Uveitis Inflammation of the uveal

tract.

Visual acuity Detailed central vision.

Visual axis The line between a point

viewed and the macula.

Visual field Area of vision.

Vitrectomy Removal of vitreous.

Xanthelasma Fatty deposits on the

eyelids.

Xerophthalmia Lack of vitamin A

resulting in corneal and

conjunctival disease.

Yag laser Laser that cuts holes in

structures.


Main Theatre / Day Case Unit

Ophthalmology

Placement Evaluation Form

Date of placement :_____________________

Mentor Name :_______________________

1. Were you allocated a mentor on arrival to the

department ?

2. Were you orientated to the area ?

3. Did you work at least 50% of your shifts with your

mentor ?

4. Did you feel adequately supported during your

placement ?


5. Did you achieve the competencies required by the

university ?

6. Did you access any of the learning zones during your

placement ?

7. If not , can you explain why not ?

8. Was the portfolio of learning opportunities helpful ?

9. Do you feel the placement has taught you any new

skills ?

10. How could we have improved your placement ?


Student Induction Checklist (Ward and Department Areas)

Student Name……………………………………………………………………………………………………. Mentor Name........................................................................................................................................... Ward/Department.................................................................................................................................... This document is to ensure that the students accessing your ward/department are inducted and orientated appropriately- within the first week of placement. This is an NMC requirement for student support and learning in practice (NMC, 2008). Students must be allocated a trained and updated mentor and must work a minimum of 50% of the time in placement with their mentor. This is necessary in order to meet the NMC requirements and to achieve a continuous and comprehensive assessment of the student. The student’s off duty should be recorded alongside their mentor’s shifts. Please take the level/year/experience of your student into consideration when discussing some of the topics listed (eg. first yr, first placement student will only require a very basic awareness about some of the identified topics) Please complete this form and retain a copy within the Evidence File (the student should also retain a copy as evidence of achievement.

Initial Interview

Mentor signature & date

Student signature & date

Issue POLO document or advised to access via NU website Discuss student responsibilities while on placement Discuss strategy to achieve learning outcomes & schedule

to review progress

Ward Orientation

Introduction to ward/department staff (including MDT)

Hierarchy of trust staff explained

Tour around ward/department environment

Nurse Call system explained

Bleep system explained

Location of ward/department useful contact numbers identified

Off duty requests explained

Shift patterns explained

Security door code given (if applicable)

POD system explained

Explain the roles of the lead/link nurses

Familiarise yourself with lead/link nurses within the ward/department

Fire Procedure

Identify ward/departments fire alarm points

Location of fire fighting equipment and fire exits on ward/department

Explain the fire procedure and contact number (333) to alert switchboard of fire.

Identify ward/departments assembly point in the event of a fire

Location of Fire Safety Policy identified

Cardiac Arrest Procedure

Location of resuscitation equipment: Resuscitation Trolley

Suction Equipment (wall mounted/portable)

Defibrillation Machine/cardiac monitor

Oxygen points and cylinders


Mentor signature & date

Student signature & date

Explain the contents of the resuscitation trolley

Demonstrate how to check and record the resuscitation trolley & Defibrillator check and frequency of checks according to policy

Explain procedure for Cardiac arrest and contact number (2222) to alert switchboard to send cardiac arrest team

Location of Resuscitation Policy identified

Manual Handling

Location of ward/departments Moving and Handling equipment

Health and Safety

Emergency Security bleep number (777) explained

Location of Health and Safety Policies (COSHH, Risk Management, Medical Devices & Decontamination policies) identified

Explain the difference between Oxygen and Air cylinders

Demonstrate how to set up oxygen (tubing/masks/valves) &suctioning equipment as appropriate to the level of the student

Medical equipment library explained

Infection Prevention and Control

Location of Infection Prevention and Control Policies identified (Disinfectant, hand washing, sharps and commode cleaning)

MRSA Screening explained

Explain the importance of the three times a day cannulae/line checks

Explain the importance of the daily catheter checks

Policies

Location and awareness of Uniform, Mobile Phone, Sickness reporting, Complaints, Data Protection & Equality and Diversity Policies

Communication/Record Keeping

The importance of consent explained

Telephone etiquette / communication skills explained

Demonstrate and explain the use of relevant patient assessments:

Observation charts and EWS Fluid Balance charts/Fluid Balance Summary Charts Diabetic Charts Nutrition/Food Charts Discharge Checklists Property lists MUST Tool Pressure Sore Assessment Accident/Incident Reporting Procedural Checklists

Audits

Additional information discussed/explained:-

Welcome to Main Theatres – Ophthalmology · Added to NU Placements Website May 2011 Welcome to...

Documents

Transcript of Welcome to Main Theatres – Ophthalmology · Added to NU Placements Website May 2011 Welcome to...