1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Timby/Smith: Introductory Medical- Surgical Nursing, 10/e 01/20 Pg 606 Chapter 42: Caring for Clients with Eye Disorders By: P.K. Williams, RN

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 23 Words to Know 02/20 Pg 606 AstigmatismCataractDiplopia Corneal Transplantation Corneal trephineEmmetropia EdophtalmitisEnucleationGlaucoma HordeolumHyperopiaIridectomy KeratitisKeratoplastyMyopia Intraocular lens implantPhotophobia Macular degenerationRetinal detachment Uvetitis TrabeculoplastyVisually impaired

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 15 Learning Objectives 03/20 Pg 606 On completion of this chapter, you will be able to: 01 Explain the different types of refractive errors. 02 Differentiate the terms blindness and visually impaired. 03 Identify appropriate nursing interventions for a blind client. 04 Discuss the nursing management of clients with eye trauma. 05 Describe the technique for instilling ophthalmic medications. 06 Explain how different infectious and inflammatory eye disorders are acquired. 07 Specify the visual changes that result from delayed or unsuccessful treatment of macular degeneration.

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 15 Learning Objectives 04/20 Pg 606 08 Differentiate between open-angle and angle-closure glaucoma. 09 Distinguish categories and mechanisms of actions of medications used to control intraocular pressure. 10 Identify a category of drugs contraindicated in clients with glaucoma. 11 Name activities clients with glaucoma should avoid because they elevate intraocular pressure. 12 Describe methods for improving vision after a cataract is removed. 13 Discuss postoperative measures that help prevent complications after a cataract extraction. 14 Give classic symptoms associated with a retinal detachment. 15 Discuss the care and cleaning of an eye prosthesis.

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Refractive Errors 05/20 Pg 606 Emmetropia: *** Normal vision Myopia;*** Hyperopia;*** Presbyopia;*** Astigmatism;*** Figure 42-1 Eyeball shape affects visual acuity in some refractive errors.

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Refractive Errors 06/20 Pg 606 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

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Blindness, Visual Impairment 07/20 Pg 608 BCVA ≤20/200, even with corrective lenses [Best Corrected Visual Acuity] 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

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Eye Trauma*** 08/20 Pg 607 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

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Eye Trauma 09/20 Pg 610 Medical, Surgical Management –Emergency first aid; Antibiotic ointment or drops; Eye patch –Hospitalization –Surgical repair Nursing Management Figure 42-2 Everting the eyelid

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Conjunctivitis 10/20 Pg 612 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

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Uveitis 11/20 Pg 613 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

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Keratitis, Corneal Ulcer 12/20 Pg 613 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

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Blepharitis 13/20 Pg 613 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

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Hordeolum (Sty)*** 14/20 Pg 614 Pathophysiology, Etiology: Staphylococcus aureus [infected make up] 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

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Macular Degeneration*** 15/20 Pg 614 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

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Glaucoma*** 16/20 Pg 616 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

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cataracts*** 17/20 Pg 619 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

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Retinal Detachment*** 18/20 Pg 620 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

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Enucleation*** 19/20 Pg 623 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 –A shell-shaped prosthesis [painted to match the remaining eye Nursing Management

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation Now NCLEX By: P.K. Williams, RN 20/20 Pg 606 pkwilliams@DNI.edu pkwilliams@DNI.edu