Nsg 331 Module 4 Notes

Med Surg I – NSG 331
Care of the Adult with Visual and Auditory Problems

 Care of the Adult with Visual Problems
 The Eyes
o Two components: Eyes and Neuro – how the brain interprets what the brain sees.
 The eyes that see and the brain that processes that information.
 Eyes: image receptors
o Brain: processes and interprets information from receptors into images
o Composition: orbit, ocular adnexa, eye, visual pathway
o The eyes are made up of the eye sockets.
 The lacrimal that produces tears and drainage.
 The external structures of the eye: conjunctive, cornea, sclera.
 The middle structures of the eye: iris, pupil
 The inside of the eye: aqueous humor (liquid), lens (reflects the light)

 Nursing Assessment:
o Subjective data
 Important health information
 Past health history
 Non-ocular/systemic diseases: diabetes, cancer, rheumatoid arthritis, STIs,
AIDS, macular dystrophy, myasthenia gravis, multiple sclerosis, IBD,
hypo/hyperthyroidism, stroke neurologic problems
 Do you take any vitamins? Omega-3 has many benefits.
 What is your exercise pattern like?
 Any restrictions or risk for injury?
 Any eye pain or issues with eyes?
 Ocular history
 Date of last exam; glasses/contacts
 History of: strabismus (crossed eyes), amblyopia (lazy eye), cataracts, retinal
detachment, refractive surgery, glaucoma, eye trauma; pink eye
 Allergy information

 Objective Focused Assessment:
o Inspect: Eye discoloration or drainage; color and vascularity of conjunctiva and sclera;
lens for clarity; ptosis of eyelid
o Assess: Vision (Snellen chart or look at nurse), EOM, peripheral vision, PERRLA

o Assessing functional status:
 Visual acuity: R then L
 Snellen chart: Normal is 20/20
 Legal blindness: 20/200
 Near vision or over age of 40, use Jaeger chart, newspaper, or label; hand
motion and light perception
o Extraocular muscle function
 Corneal light reflex
 Eye movement: 6 cardinal gazes, CN III, CN IV, CN VI

, o Pupil function and intraocular pressure
 PERRLA; Anisocoria (unequal pupils)
 Intraocular pressure (tonometry). Normal is 10-21 mm Hg
o Physical exam
 Assess structures
 Special assessment techniques
 Color vision – Ishihara color test
 Stereopsis – 3D, judging distance

 More Vision Assessment
o Medications: Include OTC, eye drops, herbal therapies, or dietary supplements
 Prescription drugs
 Ocular and non-ocular surgeries, laser surgery, retinal injections
o Health perception – Health management pattern
 Patient characteristics: gender, ethnicity, age
 Patient’s perception of problem
 Ability to perform self-care; eye care
 Eye-safety practices: protective eyewear
 Hereditary systemic disease/ocular problems
o Ask about changes in vision; eye redness, itching, or discomfort; drainage from eyes

 Refractive Errors
o Myopia – nearsighted (can see near)
o Hyperopia – farsighted (can see far)
o Presbyopia – loss of accommodation/inability to focus on close objects
o Astigmatism – abnormal curvature of corneal/visual distorted
o Aphakia – absence of lens
 Nonsurgical corrections
o Corrective lens or contact lenses
 Surgical therapy
o Laser, LASIK, PRK, LASEK
o Implant refractive IOL, phakic IOL

 Definition of Blindness
o Legal Blindness:
 20/200 or worse in the better eye (with correction)
 Visual field no greater than 20 degrees in the better eye
o Partial Sightedness:
 >20/50 but < 20/200 in the better eye (with correction)
 With greater than 20 degrees of visual field

o Most blindness in the US results from cataracts, glaucoma, age-related macular
degeneration, and diabetic retinopathy.
o Important because as we ask a patient to look at something, or look at a clock, time
certain things, sign paperwork – we want to make sure they can see what we’re asking
them to do.