NSG 331 - Exam 2 Study Guide.

NSG 331 Exam 2 Study Guide

Visual and Auditory Problems module (1 part) not as heavily covered as other 2 mods

WebEx Notes

o Eyes and ears not part of Final exam
o Glaucoma, MD, Cataracts - know treatment, clinical manifestations
o Hearing- know nursing care of the hearing impaired

 Glaucoma *pressure & peripheral vision*
 [Lewis Table 20.12, 20.13]
o Normal intraocular pressure: 10 to 21 mm Hg
o Can lead to structural damage.
 Optic nerve damage
 Loss of peripheral vision
o Inflow > outflow  IOP increases  vision loss
o Risk Factors
 Black people over 40
 All persons over 60
 Family history!!
 Strong genetic link
 Open angle
 Blockage is NOT at the entrance, but inside
 Primary Open-Angle Glaucoma (POAG)
o Most common: 60% of all glaucoma
o Slow onset- S/S are often unnoticed because no pain or pressure.
o Usually bilateral, leads to tunnel vision
o Common in diabetics
o Cause
o Blockage of aqueous fluid drainage  increasing IOP  cupping of the optic disc 
destroys retinal nerve fibers  painless vision loss.
o IOP: 22 – 32 mm Hg
 Symptoms
o Asymptomatic early
o Change in peripheral vision
o Bumping into objects
o Many assume normal aging changes
o Dx: elevated IOP (22-32mm/Hg), visual field loss, cupping of optic nerve
 Treatment
o Medications
 Miotic Drops
 pupil constriction and reduce formation of aqueous humor
 Sx: burning, blurred vision
 Beta Blockers
 Decreases production of aqueous humor
 Sx: burning, tearing, slowed HR, fatigue
 Topical Steroids
1

,  Used for a few days, no further meds
 Visional loss cannot be restored
o Surgical
 Laser
 Used after meds unsuccessful
 Creation of a drainage bleb for fluid to drain under subconjunctival tissue
 Argon Laser trabeculoplasty (ALT)
 Making 50 spaces increasing the outflow
 Causes scarring & contraction to improve outflow channels
 Cyclocryotherapy
 freezes ciliary tissue, decreasing aqueous humor production
o * Remember the aqueous production and outflow must be BALANCED
 Closed angle
 Block is at the entrance
 Iris bulges against the cornea causing blockage of aqueous outflow
o Happens with aging
 Not common
 Increased incidence: Asian women, over 60
 Causes
o Working in dark environment
o Use of pupil dilators too long from mydriatic drugs
o Strong emotions (more tears)
 IOP as high as 50-70mm/Hg
 Symptoms
o Blurred vision, halos, HA, eye pain, whites are red, pupil fixed
 Treatment
o Miotic eyedrops
 Work by contraction of the ciliary muscle, tightening the trabecular meshwork 
allowing increased outflow of aqueous through traditional pathways
o Hyperosmotic agents
 DECREASE VITREOUS VOLUME
 Glycerin liquid, Isosorbide solution, mannitol solution
 Immediately lower IOP  necessary in acute angle-closure glaucoma
o A medical ocular emergency that requires IMMEDIATE intervention
 If IOP way too high/low = emergency  can cause blindness
o If meds not successful
 Laser iridotomy (makes a new drainage pathway)
 Surgical iridectomy
o Patient Education: Glaucoma
 Use of eye drops
 Prevent increase of IOP
 Avoid bending
 Raise foot to tie shoe
 Push heavy objects (don’t pick up/lift)
 Avoid steroids
 Steroids increase IOP
 ID band
 Avoid sneezing, coughing

2

,  Contact MD if sudden painless loss of vision
 Take drops
 Burning & blurring vision are short lived
 Macular degeneration *central vision loss*
o Most common cause of central vision loss in people over 60 in the US
o Types Dry vs. Wet
 Dry (nonexudative)
 More common: 90% of cases
 Slowly progressive macular atrophy
 Causes painless vision loss and accumulation of yellowish (drusen) deposits
 Wet (exudative)
 More severe that leads to blindness with a rapid onset
 From abnormal blood vessels near macula
o Leak and cause scar tissue
 Had dry first
o Causes
 Aging, genetics, UV exposure, smoking
 Hyperopia
 Light colored eyes
 Lack of nutrient intake
 Eating dark leafy green vegetables (kale and spinach) may reduce risk
o Need more Vit. C, E, lutein, zeaxanthin and zinc
o Increased incidence: White people
o S/S
 Blurred vision, dark (blind) spots, and visual distortions
o Care
 No smoking
 Vitamin/mineral supplements
 Intraocular injections of endothelial growth factor inhibitors
 For Wet MD
 Photodynamic therapy: uses an IV med and a cold laser.
 It takes days for the dye to pass which is activated by light.
 The patient MUST be covered and stay out of light for at least 5 days or they could suffer
burns!

 Cataracts *opacity within the lens*
 [Lewis Table 20.8, 20.9]
o Loss of transparency of the lens
o #1 cause of blindness
o Caused by chemical changes (normal aging) within the protein material of the lens  clouding, yellow or
brown discoloration
o Contributing factors
 Sunlight
 poor nutrition
 Smoking
 Aging
 Trauma to eye
 Corticosteroid use

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