Nursing Management Visual Problems

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Nursing ManagementVisual Problems

• George Ann Daniels, MS, RN
• Rogers State University

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Eye Dysfunction

• Sudden or slowly
• Threat to the patient
• Self-concept
• Independence

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Refractory Problems

• Prevents light rays from converging into a single
  focus on the retina
• Myopia
• Nearsightedness
• Hyperopia
• Farsightedness
• Cornea or lens lack focusing ability
• Presbyopia
• Lens less elastic
• Age related
• Cannot focus on near objects
• Astigmatism
• Unequal corneal curvature
• Aphakia
• Absence of crystalline lens
• Congenital
• Cataract surgery

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• Generally corrected with lenses
• Glasses/Contacts
• Surgical Therapy
• Radial Keratotomy (RA)
• Reshaping of the eyeball
• One eye at a time
• Complication
• Operative infection
• Corneal scarring
• Visual improvement may take up to 6 months for
  maximum results
• Intraocular Lens Implantation
• Aphakia/ Cataracts
• Most common
• Intraocular Lens (LOL

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Infection/Inflammation

• Conjunctivitis
• Infection/Inflammation of the conjunctiva
• Bacterial, Viral, or Chlamydia
• Allergic conjunctivitis
• Most common
• Bacteria Conjunctivitis
• Pink Eye
• Irritation, tearing, redness, mucopurulent
  drainage, itchy
• Contagious
• Good handwashing
• Treatment depends on etiology
• Corticosteroids, Vasoconstrictors, antiallergy,
  Antibiotics

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• NDX
• Pain R/T inflammatory process
• Cool compresses, refrigerated eye drops, avoid
  sunlight, dont rub eyes, avoid perfumed soaps,
  change make-up
• Risk for altered health maintenance
• Highly contagious (bacterial, use disposable
  tissues, dont touch eye, dont share washcloths

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• Keratitis
• Corneal Ulcers
• Assessment
• Dry, scratchy, foreign-body sensations, redness,
  swelling, pain, reduced vision
• Bacterial, viral, chlamydia
• Management depends on etiology
• Ocular lubricants, anti-infectives, analgesics
• Patching, warm/cool compress, dark room, safety
  issues (reduced vision)

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• NDX
• Pain R/T irritation
• Anxiety R/T knowledge deficit of disease
• Sensory/perceptual alternations R/T diminished or
  absent vision
• Risk for injury R/T visual disturbance
• Sleep pattern disturbance R/T complicated eye
  drop regimen

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Intraocular Disorders

• Cataracts
• Opacity of the crystalline lens
• One eye or bilateral involvement
• Etiology
• Age, trauma, congenital factors, environmental
  factors, medication injury, nutritional defects
• Progresses faster in diabetics
• Assessment
• Gradual/Sudden
• Painless blurring of central distance vision,
  double vision, glare spots
• Advance stage
• White discoloration in pupils
• Management
• Surgery only cure
• Outpatient surgery
• One eye at a time
• Removes opaque lens, replaces lens with implant

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• Pre op nursing care
• Antibiotic eye drops
• Dilating eye drops
• Mydriatic
• Nonsteriodal anti-inflmmatory eye drop
• Post op nursing care
• Ready for discharge in a few hours
• No depth perception until patch is removed
• 24 hours
• Medications antibiotic eye drops/steroid eye
  drops
• Home instructions
• Dont bend from waist, dont lift more than 20-25
  lbs, dont drive, avoid coughing, avoid sleeping
  on operated eye
• Remove patch in 24 hours
• S S of infection
• Pain management
• Tylenol
• Report
• Spots/bright flashes of light in visual field
• Curtain that obscures par of vision

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• NDX
• Risk for injury
• Pain
• Anxiety
• Risk for self care deficit
• Risk for infection

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Macular Degeneration

• Age related
• Higher in smokers
• Assessment
• Drusen in fundus
• Yellow exudate beneath retina
• Near vision lost, objects look bent or crooked,
  fixed gray spot in center of vision, peripheral
  vision only
• Management
• Laser may or may not help
• Zinc and Selenium
• Permanent loss of central vision

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• Nursing care
• Support current vision
• Large type
• yellow contrast
• Yellow transparent cover over print
• Lighting
• Magnifiers
• Optic scanners

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Glaucoma

• Increased intraocular pressure
• Normal is 10-21 mm hg
• Increased in diabetes, severe mypoia,
  hypertension, retinal detachment, and family
  history
• Types
• Primary open-angle
• Asymptomatic, slowly
• Foggy vision, headache, nausea, reduced
  near-vision, tunnel vision
• Angle-closure
• Excruciating pain around eyes
• Very sick
• Sudden onset of HA, nausea, vomiting, halos
  around lights, blurred vision, ocular redness

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• Management
• REDUCE PRESSURE
• Prevention of optic nerve damage
• Medications
• Open-angle
• Timoptic, Pilocarpine
• Closed-angle
• Oral or IV hyperosmotics
• Surgery
• NDX
• Noncompliance R/T inconvenience
• Risk for Injury R/T visual disturbances
• Self-Care Deficit R/T vision loss
• Pain

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Retinal Detachment

• Separation of retina from underlying structures
• Assessment
• Sudden painless change in vision, flashes of
  light (floaters), shower of spots (cobweb),
  curtain sensation
• Management
• Laser Photocoagulation
• Reseal tears and holes

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• Post op Care
• Positioning
• Head parallel to floor
• Turn side to side only
• 4-8 days
• Pain control
• Avoidance of nausea
• Antiemetics
• Avoid straining or coughing

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Trauma

• Contusion, abrasions, lacerations, penetrating
  injury
• Protect eye without pressure
• Leave penetrating object in place
• Chemical burns
• irrigation