NSG 223 EXAM FOUR BLUEPRINT
Glaucoma nursing assessment - CORRECT ANSWER--establish the diagnostic
category
-assess the optic nerve damage
-formulate a treatment plan.
-The patient's ocular and medical history must be detailed to investigate the
history of predisposing factors.
Exams: tonometry to measure the IOP, ophthalmoscopy to inspect the optic
nerve, and central visual field testing
Changes in optic nerve are pallor (lack of blood supply) and cupping
(exaggerated bending of the blood vessel as they cross the optic disk)
progression caused by the gradual loss of retinal nerve fibers and loss of blood
supply
As optic nerve damage increases, visual perception decreases
Glaucoma medical treatment - CORRECT ANSWER-Treatment is prevention of
optic nerve damage
Lifelong treatment-no cure
Treatment aimed at pharmacology (systemic and topical ocular medications),
laser, surgery, and a combination to control further damage
Initial target is 30% lower than current pressure
Glaucoma pharm treatment - CORRECT ANSWER-Started on low doses and then
advanced to increased concentrations until the desired IOP level is reached
Beta blockers are the preferred innitial topical medication
One eye treated first, with the other eye used as a control to determine the
efficiency of the medication, once established then the other eye treated
When results are not satisfactory, a new medication is substituted. The main
markers of the efficacy of the medication in glaucoma control are lowering of the
IOP to the target pressure, stable appearance of the optic nerve head, and the
visual field.
,Cholinergics (miotics) (pilocarpine, carbachol) {Increased aqueous fluid outflow
by contracting the ciliary muscles and causing meiosis (constriction of the pupil)
and opening the trabecular meshwork}
Beta-blockers (FIRST LINE)
(timolol) {Decrease aqueous humor production}
Alpha-adrenergic agonists (apraclonidine, bromonidine) {Decrease aqueous
humor production}
Carbonia anhydrase inhibitors (acetazolamide, dorzolamide) {Decrease aqueous
humor production}
Prostaglandin analogs (latanoprost, bimatoprost) {Increase uveoscleral outflow}
Glaucoma nursing management - CORRECT ANSWER-NO CURE-slows
progression of the disease but does not cure it
Assess for knowledge level and adherence to their prescribed medication.
The lifelong therapeutic regimen mandates patient education. The nature of the
disease and the importance of strict adherence to the medication regimen must
be included in an individualized education plan
REASSURANCE AND EMOTIONAL SUPPORT, IN HOME CARE IF BLINDNESS
OCCURS, has a familial tendency, educate family on getting tested
Medication administration - CORRECT ANSWER-When multiple eyedrops are
required, there should be an interval of 5 to 10 minutes between drops
Apply pressure to the tear duct to discourage systemic absorption for 3-5
minutes after instillation to decrease systemic absorption
Eye drops and ointments: Ointments are administered less frequently and higher
concentration but cause blurred vision
Do not use after expiration date, cloudy, discolored solution should be discarded
Some eyedrops contain benzalkonium hydrochloride, a preservative, which is
absorbed by soft contact lenses. The medications should not be applied while
wearing soft contacts and should be instilled 15 minutes or longer before
inserting soft contacts.
Cataracts nursing assessment - CORRECT ANSWER-Leading cause of blindness
in the world
, One or both eyes
Painless blurry vision- percieves surroundings as dimmer, reduced contrast
sensitivity, sensitivity to glare, reduced visual acuity, myopic shift, astigmatism,
monocular diplopia, color changes
Decreased visual acuity is directly proportionate to cataract density. The Snellen
visual acuity test, ophthalmoscopy, and slit-lamp biomicroscopic examination are
used to establish the degree of cataract formation. The degree of lens opacity
does not always correlate with the patient's functional status. Some patients can
perform normal activities despite clinically significant cataracts. Others with less
lens opacification have a disproportionate decrease in visual acuity; hence,
visual acuity is an imperfect measure of visual impairment
Surgical nursing management- Cataracts - CORRECT ANSWER-No non-surgical
treatment cures cataracts or prevents age related cataracts-optical management
is prevention (Smoking cessation, weight reduction, optimal blood glucose
control, sunglasses outdoors.)
Only does if cataract interferes with normal activities
Cataract removal
Outpatient bases, usually takes less than one hour and is discharged in 30
minutes or less afterward
One eye treated at a time with several weeks (preferably months) between
surgeries to evaluate if treatment was effective
Phacoemulsification-Portion of the anterior capsule is removed, allowing
extraction of the lens nucleus and cortex while the posterior capsule and zonular
support are left intact, ultrasonic device is used to liquefy the nucleus and cortex
which are then suctioned out through a tube: pupil is dilated to 7 mm or
greater.The surgeon makes a small incision on the upper edge of the cornea and
a viscoelastic substance (clear gel) is injected into the space between the cornea
and the lens. This prevents the space from collapsing and facilitates insertion of
the IOL
LENS REPLACEMENT: three lens replacement options: aphakic eyeglasses,
contact lenses, and IOL implants (most common) CONTRAINDICATED IN
PATIENTS WITH RECURRENT UVEITIS, PROLIFERATING DIABETIC
RETINOPATHY, NEOVASCULAR GLAUCOMA, OR RUBEOSIS IRIDIS
Discharge teaching - CORRECT ANSWER-Before discharge, the patient receives
verbal and written education regarding eye protection, administration of
Glaucoma nursing assessment - CORRECT ANSWER--establish the diagnostic
category
-assess the optic nerve damage
-formulate a treatment plan.
-The patient's ocular and medical history must be detailed to investigate the
history of predisposing factors.
Exams: tonometry to measure the IOP, ophthalmoscopy to inspect the optic
nerve, and central visual field testing
Changes in optic nerve are pallor (lack of blood supply) and cupping
(exaggerated bending of the blood vessel as they cross the optic disk)
progression caused by the gradual loss of retinal nerve fibers and loss of blood
supply
As optic nerve damage increases, visual perception decreases
Glaucoma medical treatment - CORRECT ANSWER-Treatment is prevention of
optic nerve damage
Lifelong treatment-no cure
Treatment aimed at pharmacology (systemic and topical ocular medications),
laser, surgery, and a combination to control further damage
Initial target is 30% lower than current pressure
Glaucoma pharm treatment - CORRECT ANSWER-Started on low doses and then
advanced to increased concentrations until the desired IOP level is reached
Beta blockers are the preferred innitial topical medication
One eye treated first, with the other eye used as a control to determine the
efficiency of the medication, once established then the other eye treated
When results are not satisfactory, a new medication is substituted. The main
markers of the efficacy of the medication in glaucoma control are lowering of the
IOP to the target pressure, stable appearance of the optic nerve head, and the
visual field.
,Cholinergics (miotics) (pilocarpine, carbachol) {Increased aqueous fluid outflow
by contracting the ciliary muscles and causing meiosis (constriction of the pupil)
and opening the trabecular meshwork}
Beta-blockers (FIRST LINE)
(timolol) {Decrease aqueous humor production}
Alpha-adrenergic agonists (apraclonidine, bromonidine) {Decrease aqueous
humor production}
Carbonia anhydrase inhibitors (acetazolamide, dorzolamide) {Decrease aqueous
humor production}
Prostaglandin analogs (latanoprost, bimatoprost) {Increase uveoscleral outflow}
Glaucoma nursing management - CORRECT ANSWER-NO CURE-slows
progression of the disease but does not cure it
Assess for knowledge level and adherence to their prescribed medication.
The lifelong therapeutic regimen mandates patient education. The nature of the
disease and the importance of strict adherence to the medication regimen must
be included in an individualized education plan
REASSURANCE AND EMOTIONAL SUPPORT, IN HOME CARE IF BLINDNESS
OCCURS, has a familial tendency, educate family on getting tested
Medication administration - CORRECT ANSWER-When multiple eyedrops are
required, there should be an interval of 5 to 10 minutes between drops
Apply pressure to the tear duct to discourage systemic absorption for 3-5
minutes after instillation to decrease systemic absorption
Eye drops and ointments: Ointments are administered less frequently and higher
concentration but cause blurred vision
Do not use after expiration date, cloudy, discolored solution should be discarded
Some eyedrops contain benzalkonium hydrochloride, a preservative, which is
absorbed by soft contact lenses. The medications should not be applied while
wearing soft contacts and should be instilled 15 minutes or longer before
inserting soft contacts.
Cataracts nursing assessment - CORRECT ANSWER-Leading cause of blindness
in the world
, One or both eyes
Painless blurry vision- percieves surroundings as dimmer, reduced contrast
sensitivity, sensitivity to glare, reduced visual acuity, myopic shift, astigmatism,
monocular diplopia, color changes
Decreased visual acuity is directly proportionate to cataract density. The Snellen
visual acuity test, ophthalmoscopy, and slit-lamp biomicroscopic examination are
used to establish the degree of cataract formation. The degree of lens opacity
does not always correlate with the patient's functional status. Some patients can
perform normal activities despite clinically significant cataracts. Others with less
lens opacification have a disproportionate decrease in visual acuity; hence,
visual acuity is an imperfect measure of visual impairment
Surgical nursing management- Cataracts - CORRECT ANSWER-No non-surgical
treatment cures cataracts or prevents age related cataracts-optical management
is prevention (Smoking cessation, weight reduction, optimal blood glucose
control, sunglasses outdoors.)
Only does if cataract interferes with normal activities
Cataract removal
Outpatient bases, usually takes less than one hour and is discharged in 30
minutes or less afterward
One eye treated at a time with several weeks (preferably months) between
surgeries to evaluate if treatment was effective
Phacoemulsification-Portion of the anterior capsule is removed, allowing
extraction of the lens nucleus and cortex while the posterior capsule and zonular
support are left intact, ultrasonic device is used to liquefy the nucleus and cortex
which are then suctioned out through a tube: pupil is dilated to 7 mm or
greater.The surgeon makes a small incision on the upper edge of the cornea and
a viscoelastic substance (clear gel) is injected into the space between the cornea
and the lens. This prevents the space from collapsing and facilitates insertion of
the IOL
LENS REPLACEMENT: three lens replacement options: aphakic eyeglasses,
contact lenses, and IOL implants (most common) CONTRAINDICATED IN
PATIENTS WITH RECURRENT UVEITIS, PROLIFERATING DIABETIC
RETINOPATHY, NEOVASCULAR GLAUCOMA, OR RUBEOSIS IRIDIS
Discharge teaching - CORRECT ANSWER-Before discharge, the patient receives
verbal and written education regarding eye protection, administration of
