Visual Disorders- sensory nursing

8/8/2019 Visual Disorders- sensory nursing

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Cataract

Glaucoma

Retinal detachment

Diabetic retinopathy

Age related macular degeneration

Graves disease


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- an opacity of the lens that distorts the imageprojected onto the

retina & that can progress to blindness

CAUSESCAUSES Aging process (Senile cataracts)

Inherited (Congenital cataracts)

Injury (Traumatic cataracts)

Can occur as a result of another eye disease(Secondary cataracts)


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MEDICAL

MANAGE

MENT

MEDICAL

MANAGE

MENT-- surgical removal of the lens, one eye at a timesurgical removal of the lens, one eye at a time

-- a lens implantation may be performed at the timea lens implantation may be performed at the timeofof

surgical proceduresurgical procedure

EXTRACAPSULAR EXTRACTIONEXTRACAPSULAR EXTRACTION

- the lens is lifted out without removing the lenscapsule

- may be performed with PhacoemulsificationPhacoemulsification

PHACOEMULSIficationPHACOEMULSIfication- the lens is broken up by ultrasonic vibrations &

extracted


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- increased IOP as a result of inadequate drainage ofaqueous

humor from the canal of Schlemm or overproduction of aqueous

humor

- the condition damages the optic nerve & can resultin blindness

TYPESTYPES

1.1. primary/secondaryprimary/secondary2.2. Acute/chronicAcute/chronic3.3. Open/closedOpen/closed


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ASSESSMENTASSESSMENT Elevated IOP (Normal pressure is 10-21 mm Hg)

Blurred vision

Halos around white lights

Frontal headaches/pain

Photophobia

Increased lacrimation


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NURSING CARE FOR CHRONIC GLAUCOMANURSING CARE FOR CHRONIC GLAUCOMA

Instruct the client the importance ofmedications

a. MIOTICS:MIOTICS: to constrict the pupils

b. CARBONIC ANHYDRASE INHIBITORS:CARBONIC ANHYDRASE INHIBITORS: todecrease theproduction of aqueous humor

c. BETABETA--BLOCKERS:BLOCKERS: to decrease theproduction of aqueous

humor & IOP Instruct the client the need for life-longmedication use


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NURSING CARE FORNURSING CARE FOR

CHRONIC GLAUCOMACHRONIC GLAUCOMA Prepare the client for TRABECULOPLASTYTRABECULOPLASTY as prescribed

- to facilitate aqueous humor drainage

Prepare client for TRABECULECTOMYTRABECULECTOMY as prescribed- allows drainage of aqueous humor into the

conjunctival spaces bythe creation of an opening

Iridectomy

cyclocryotheraphy


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- occurs when the layers of the retina separate becauseof

accumulation of fluid between them

- also occurs when both retinal layers elevate away

from thechoroid as a result of a tumor

TYPESTYPES

PARTIAL RETINAL DETACHMENTPARTIAL RETINAL DETACHMENT-- becomes complete if left untreated

COMPLETE RETINAL DETACHMENTCOMPLETE RETINAL DETACHMENT

- when detachment is complete, blindness may occur


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ASSESSMENTASSESSMENT

Flashes of light Floaters

Increase in blurred vision

Sense of curtain being drawn

Loss of a portion of the visual field


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MEDICAL MANAGEMENTMEDICAL MANAGEMENT

SEALING RETINAL BREAKS BY CRYOSURGERYSEALING RETINAL BREAKS BY CRYOSURGERY

- a cold probe applied to the sclera to stimulate an inflammatoryresponse

leading to adhesions

DIATHERMYDIATHERMY

- the use of electrode needle & heat through the sclera to stimulate aninflammatory response leading to adhesions

LASER THERAPYLASER THERAPY- to stimulate an inflammatory response to seal small retinal tears

beforethe detachment occurs

SCLERAL BUCKLINGSCLERAL BUCKLING

- to hold the choroid & retina together with a splint until scar tissueforms

closing the tear

INSERTION OF A GAS OR SILICONE OILINSERTION OF A GAS OR SILICONE OIL

- to encourage attachment because these agents have a specificgravity less

than vitreous or air & can float against the retina


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Progressive damage to retina and the retinal

vessels when it is occluded

Inadequate blood supply, sections of the

retina deteriorate causing permanent visionloss

All diabetic are at risk

Hypertensive people are also a candidate


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y Types

1. Nonproliferative retinal vessels are hyper

permeable and weak

2. Proliferative capillaries are leaking


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Spiders or cobwebs floating in vision

Dark or red streaks blocks the vision

Vision loss

Fluctuating vision loss

Dark spot in the center of the vision

Poor night vision difficulty adjusting from

bright light to dim


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Photocoagulation to stop the leakage of

blood and fluid in the retina using high

energy laser beam under local anesthesia

Vitrectomy removal of blood filled vitreoususing a cutter piece by piece replaced by NSS

to maintain normal shape of eye


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Age-related macular degeneration (AMD)

The most common cause of vision loss in persons older

than age 60

Affects the macula leading to central visual deficits

Cause is unknown or hereditary

Blue rays accelerate the disease


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Types

Dry or nonexudative type is most common, 85%-90%

Slow breakdown of the layers of the retina with theappearance of drusen

Wet type

May have abrupt onset

Proliferation of abnormal blood vessels growing


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High dose anti oxidant Vit. C and E beta

carotene zinc

Injecting verteporfin (Visudyne)

Special sunglass blocks blue rays

Argon photocoagulation

Retinal transplantation


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is a malignant tumor on the retina, the light-

sensing part of the eye, and is highly curable if

treated early.

This type of cancer can be present in one or both

eyes.


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A pupil that appears white - called

leucocoria,

The eyes may not move or focus in the same

direction. Eye pain.

The pupil is constantly dilated.

Red eye(s).


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An eye exam and imaging test given

These tests include ultrasound, MRI scans, CT

scans, bone scans, spinal tap and bone

marrow tests.


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Photocoagulation. A laser is used to kill blood

vessels that feed the tumor.

Cryotherapy. Extremely low temperatures areused to kill cancer cells.

Chemotherapy-

with bilateral type- treated with a preservation

attempt. Tumor chemoreduction withcarboplatinnand other drugs may reduce the tumor

volume making them amenable to local therapies[5]


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Laser therapy (Uses infrared laser light to

precisely destroy the blood vessels surrounding

a tumor.)Radiationtherapy. as a last resort Radiation

may be given externally or internally.


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Enucleation. Treatment of choice.

Thermotherapy

Brachytherapy with beta-emitting eyeapplicators have also been a successful major

treatment.


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- a person is legally blind if the best visual acuity with correctivelenses in the better eye is 20/200 or less or a visual field of 20degrees or less in the better eye

NURSING CARENURSING CARE

When speaking to a client who has limited sight or blind, the nurseuses a normal tone of voice

Orient the client to the environment Use a focal point & provide further orientation to the environmentfrom the focal point

Allow the client to touch objects in the room Use the clock placement of foods on the meal tray to orient theclient

Promote independence as much as possible


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An endocrine disorders

Exist with or without thyroid dysfunction

Retracted both upper and lower lids

Staring or frightened expression (stellwags

sign)

Lid lag (graefes sign)- lowering of lid when

looking down

Infrequent blinking


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Fine tremor with lid closure

Jerky movements on lid opening

Globes enlarge increase size of ocular

muscles

Edema of eye tissues

Excess orbital fat

Proptosis

Double vision


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Control of thyroid abnormalities

Diuretics

Steroids

Radiotherapy

Lid surgery

Tarsorrhapy

Decompression of the orbitOcular muscle surgery


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- bleeding into the soft tissue as a result of aninjury

- causes a black eye & the discolorationdisappears in

approximately 10 days

- pain, photophobia, edema & diplopia mayoccur

NURSING CARENURSING CARE Place ice on the eye immediately

Instruct the client to receive an eye examination


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- an object such as dust that enters the eye

NURSING CARENURSING CARE Have the client look upward, expose the lower lid, wet a cotton-tipped applicator with sterile NSS & gently twist the swab overthe particle & remove it

If the particle cannot be seen, have the client look downward,place a cotton applicator horizontally on the outer surface of

the upper eye lid, grasp the lashes, & pull the upper lid outward& over the cotton applicator, if the particle is seen, gently twistover it to remove


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-- an injury that occurs to the eye in which an objectan injury that occurs to the eye in which an objectpenetrates the eyepenetrates the eye

NURSING CARENURSING CARE Never remove the object because it may be holding ocularNever remove the object because it may be holding ocular

structures in place, the object must be removed by MDstructures in place, the object must be removed by MD

Cover the object with a cupCover the object with a cup

Dont allow the client to bendDont allow the client to bend Dont place pressure on the eyeDont place pressure on the eye

Client is to be seen by MD statClient is to be seen by MD stat


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- an eye injury in which a caustic substance enters the eye

NURSING CARENURSING CARE

Treatment should begin stat

Flush the eyes at the site of injury with water for at least 15-20 mins At the site of injury, obtain a small sample of the chemical involved

At the ER, the eyes is irrigated with NSS or an opthalmic irrigationsolution

The solution is directed across the cornea & toward the lateralcanthus

Prepare for visual acuity assessment

Apply an antibiotic ointment as prescribed

Cover the eye with a patch as prescribed


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ENUCLEATIONENUCLEATION-- removaloftheentireeyeballremovaloftheentireeyeball

EXENTERATIONEXENTERATION-- removaloftheeyeball& surroundingtissuesremovaloftheeyeball& surroundingtissues

Performed for the removal of ocular tumors

After the eye is removed, a ball implant is inserted toprovide a firmbase for socket prosthesis & to facilitate the best cosmetic

result

A prosthesis is fitted approximately 1 month after surgery

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Visual Disorders- sensory nursing