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
1
, ▪ Topical Steroids
2
, • 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
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
1
, ▪ Topical Steroids
2
, • 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
3
