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
3
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
3
