Vision Disorder
#1
1. Identify Disorder: Glaucoma
2. Name the 2 types of this disorder & which is most common:
1. Primary Open Angle Glaucoma or wide angle glaucoma
2. Primary Angle Closure Glaucoma or narrow angle
3. Name 3 Symptoms for:
POAG
- Usually affects both eyes
- No manifestations in the early stages
o Late stage manifestations included usual field defects
o Ocular pain
o Headaches
- Develops slowly
- “Halo” vision
- Loss of peripheral vision
PACG
- Can be acute angle, subacute angle, or chronic angle closure
- Sudden onset
- An emergency
- Rapidly progressive visual impairment
- Periocular pain
- Congestion
- Transient blurring of vision
- Reduced central vision
4. Name 3 Diagnostics performed to diagnosis this disorder:
1. Tonometry to measure the intraocular pressure (IOP)
2. Ophthalmoscope to inspect the optic nerve
3. Central Visual Field Testing
5. Medications Treatment
a. Name a medication under each category of medications (listed
below) used to treat this disorder
b. how it works
c. an important nursing intervention
d. one side effect
Beta-Adrenergic Blocker “ol”
a. Timolol
b. Decrease aqueous humor production
c. Contraindicated in pts with asthma, COPD, 2nd or 3rd degree heart block,
bradycardia, or HF
d. Bradycardia, hypotension
Hyperosmolar Agent/Osmotic Diuretic
a. Acetazolamide
b. Diuretic (pulls fluid off the eye)
c. Contraindicated in hypertensive patients
d. Hypertension
Prostaglandin Agonist
a. Latanoprost
b. Increase uveoscleral outflow
c. Instruct parties to report any side effects
d. Darkening of the iris, conjunctival redness, possible rash
Carbonic Anhydrase Inhibitor
a. Acetazolamide
b. Decrease aqueous humor production
c. Do not administer to pats with sulfa allergies/monitor electrolytes
d. Anaphylactic reactions
Cholinergic Agonist
a. Pilocarpine
b. Increase aqueous fluid outflow by contracting the ciliary muscle and
causing mitosis and opening of trabecular mesh work
c. Caution patients about diminished vision in dimly lit areas/pilocarpine can
be stored at room temp for up to 8 weeks and then should be discarded
d. Periorbital pain
Adrenergic Agonists
a. Apraclonidine
b. Decrease aqueous humor production
c. Educate patient about punctal occlusion to limit systemic effects
d. Eye redness, dry mouth/nasal passages
6. Which disorder form (POAG or PACG) requires emergency treatment?
a. PACG (acute angle-closure glaucoma)
Which medication would you anticipate given in this emergency?
Hyperosmostics, acetazolamide, and topical ocular hypotension agents
How do you give it (route) if IOP is 70 mm Hg?
PO or IV
What would you monitor? Fluid and Electrolytes, I/Os, ABGs, EKG
Lab values? HCO3-, pH, K, NA+, Mg, BUN, Creatinine
Vision Disorder
#2
1. Identify Disorder: Cataracts
2. On assessment how does the lens appear?
a. Brown in color
3. Identify at least 4 manifestations?
1. painless, blurry vision
2. dimmer surroundings
3. light scattering
4. reduced visual acuity and light sensitivity
4. What symptom does NOT occur with this disorder?
a. pain
5. List patient-centered care the nurse may perform.
a. teach patients to avoid smoking, about weight reductions tragedies,
controlling blood sugar (for diabetic patients), and to wear sunglasses outdoors
6. Medication used to prevent pupil constriction?
a. dilating drops
7. Identify and describe type of surgery if needed to correct disorder.
b. cataract surgery.
a. Outpatient
b. Takes <1 hr
c. Topical and intraocular anesthesia (1% lidocaine gel) applied to the
surface of the eye
d. Patients can communicate and cooperate during surgery
e. IV sedation may be used to minimize anxieties
f. One eye treated at a time
8. What 2 medications are given immediately after surgery and why?
a. post antibiotics – to prevent infection
b. steroids
9. Identify 2 post-op complications.
1. meiosis and iris prolapse
2. floppy iris syndrome (can have permanent pupil deformity, photophobia,
retinal detachment, lost lens fragements)
10. List 10 things the nurse would teach the patient post-op.
1. Elevate HOB 30-45 degrees
2. eye drops for 2-4 weeks
3. no Coumadin or ASA
4. wear dark glasses or an eye shield
5. blood shot and itchy eyes are normal
6. turn the patient on their back or non operative side (avoid laying on
the operative side
7. maintain an eye patch as prescribed
8. orient the patient to the environment
9. avoid lifting, pushing, or pulling objects >15lbs
10. use side rails for safety and assist with ambulation
11. Will have best vision in 4-6 weeks post-op
Vision Disorder
#3
1. Identify Disorder: Retinal Detachment
2. What does the patient describe that they see?
1. Sensation of a shade or curtain coming into the visual field, seeing
cobwebs, fright flashing lights, or “floaters”
3. Is there pain? Why or why not?
1. Patients do not complain of pain but tribal detachment is an ocular
emergency, requiring immediate surgical intervention for optimal
outcomes
4. When does treatment begin?
1. After visual acuity is determined, the patient must have a dilated
fungus examination using an indirect ophthalmoscope as well as
slit-lamp biomicroscopy.
5. Identify treatment that cause inflammation that binds the retina and
choroid together around the break?
1. Scleral buckle surgery (using a silicone band)
6. Identify surgical procedure that treats this disorder? Describe how it
works.
1. Vitrectomy surgery – two incisions. First allows the introduction of
a light source. Second incision passes the vitrectomy instrument
with a gas bubble, silicone oil, or perflurocarbon liquids to be
injected into the vitreous cavity.
7. List 5 postoperative things to teach your patient.
1. Patient should stay in a prone position so the injected gas bubble
can stay over the area of the detachment
2. Next day follow-up appointment emphasized
3. Post-op complication include increased intraocular pressure,
endophthalimitis, retinal detachment and the development of
cataracts.
4. Provide patient with ophthalmic team contact information
5. Call immediately if complications arise
Vision Disorder
#4
1. Identify Disorder:
a. Age related Macular Degeneration
2. Name the 2 age related types and define the difference. Which is most
common?
a. Dry age-related macular degeneration
i. Non neovasucalr and nonexudative
ii. Outer layers of the retina slowly break down
iii. Drusen start to form
b. Wet age-related macular degeneration
i. Neovasular and exudative
ii. Abrupt onset
iii. More damaging to the vision
iv. Patients see lines that are crooked or distorted
v. Distorted letters or words
vi. Blood vessels leak fluid and blood under the retina, which
causes the retina to elevate and affect the vision
3. List at least 3 manifestations.
a. Wide range of central visual loss (few patients experience total
blindness)
b. Drusen (clusters of debris or waste material that causes blurry spots
in vision)
c. Most people retain peripheral vision
4. Identify 6 risk factors.
- Over 60 years
- Those who play sports (injury to the eye)
- Fireworks exposure
- Debris from lawnmower use
- Debris from working with metals or welding
- Toys or games that can be dangerous (projectile toys: darts/pellet
guns)
5. What’s the cure for Dry AMD?
a. There is no known effective treatment or cure for dry advanced
macular degeneration
6. What is the treatment for Wet/Exudative?
a. The use of amsler grids. Patients are encouraged to look at these
grids, one eye at a time, several times each week with glasses on if
needed for corrected near vision. IF theirs is change in the way the
grid appears the patient should notify the ophthalmologist
immediately to get better glasses.
7. Patient education includes:
a. Educate children about the correct way to handle potentially
dangerous items such as scissors and pencils
b. How to use an amsler grid
c. Be careful with household spray nozzles and cleaning fluids
d. Use grease shields on frying pans
e. Wear goggles to shield eyes from fumes and splashes
f. Just wear goggles when small things can get into your eyes to
prevent eye injury