INTERFERENCES TO SAFETY NEEDS
DUE TO SENSORY DEPRIVATION AND
HOW TO DETECT VISUAL
IMPAIRMENT IN INFANT
Response to objects
REHAB OF VISUALLY IMPAIRED CHILD
Sensorimotor stimulation Safety
Speed of Development
BLIND HOSPITALIZED PATIENT
CATEGORY WHAT TO DO
What to say to pt as enter room
Words like “see”
Object in room
DIAGNOSTIC EVALUATION PURPOSE
A scan ultrasound (echography)
• What is the major characteristic of this
• How does this impair vision?
• What situations increase intraocular pressure
• Why don’t we all get increased intraocular
• PRIMARY OPEN ANGLE GLAUCOMA
• ANGLE CLOSURE GLAUCOMA
Primary open angle glaucoma
• What happens to the outlflow of
• How does this effect intraocular
Angle closure glaucoma
• What changes occur to the iris?
• With these changes what happens to the
outflow of aqueous humor?
COMPARISON OF EARLY AND LATE SYMPTOMS
EARLY SIGNS LATE SIGNS AND
AND SYMPTOMS SYMPTOMS
TWO TYPES COMPARED
PRIMARY OPEN ANGLE ANGLE CLOSURE
• With progressive • OTHER NAMES:
changes what happens
to aqueus humor? • EMERGENCY
• When must the pt be
• Tonometry reading: • What happens if they
• Tonometry reading:
• Miotics: do what?
PUPIL SIZE IOP
OUTFLOW AQUEOUS HUMOR RELIEF OF GLAUCOMA
• pilocarpine hydrochloride (Isopto Carpine, Pilocar, Spersacarpine, Akarpine, Pilopine):
enhances aqueous outflow
• carbachol (Carboptic, Carbastat)
Isopto Carbachol, Miostat): may be used with or in place of pilocarpine
DRUGS: CARBONIC ANHYDRASE
How do the Carbonic anhydrase inhibitors treat glaucoma?
• acetazolamide (Acetazolam, Diamox)
• brinzolamide (Azopt),
• dorzolamide (Trusopt)
• Methazolamide (Neptazane)
ALERT ALERT ALERT ALERT ALERT!
• Digitalis, Steroids, Diuretics, Lithium
How do SYMPATHOMIMETICS treat glaucoma?
• brimonidine (AlphaganP)
• apraclonidine (Iopidine)
• epinephryl ( Epifrin, Glaucon),
• dipivefrin HCl (Propine)
PRECAUTIONS with soft contact lenses?
DRUG COMBINATION CONCERNS?
How does this treat glaucoma?
What situations is this used?
oral glycerin (Osmoglyn)
IV mannitol (Osmitrol
Or topically: glycerin (Ophthalgan)
DRUGS: BETA ADRENERGIC BLOCKERS
How do they treat glaucoma?
How do they effect the pupil?
ALERT ALERT:WHAT MAJOR PRECAUTION MUST BE USED
WITH ORAL BETA BLOCKERS AND CALCIUM CHANNEL
EXAMPLES: (what letters do all these drugs have in common?
levobunolol HCl (Betagen Liquifilm)
betaxolol HCl (Betoptic)
metipranolol HCl (Metipranolol, OptiPranolol)
carteolol HCl (Ocupress)
timolol (Betimol, Timoptic)
DRUGS: Alpha 2 Adrenergic Agonist
• HOW DO THESE DRUGS MANAGE GLAUCOMA?
Dilate pupil, decrease aqueous production at the ciliary body,
inhibit production of aqueous, but they can also facilitate
the outflow of aqueous from the eye
• brimonidine tartrate ( Alphagan):
• cannot combine with MAOI (monoamine oxidase inhibitor)
• Can precipitate hypertensive crisis
• Cannot be used with contact lens; wait 15 minutes before
inserting after administration
DRUGS: PROSTAGLANDIN AGONIST
HOW DO THESE TREAT GLAUCOMA?
• What does it do to the outflow of aqueous fluid?
• How does it effect aqueous fluid production?
EXAMPLES OF DRUGS:
• ****latanoprost (Xalatan)
• travoprost (Travatan): not to be used with pregnancy
• bimatoprost (Lumigan)
• unoprostone isopropyl (Rescula)
WHAT DO ALL THESE DRUGS HAVE IN COMMON IN
TERMS OF EFFECTING THE IRIS?
SURGERY FOR BOTH TYPES OF
• PURPOSE: to create a permanent way to drain
POSTOP NURSING CARE
• Where is the procedure done?
• How long do patients stay?
• What precautions should be taught to the
• How is the eye protected?
• What should be reported to the doctor?
• What complications occur?
• What assessments indicate complications?
POSTOP NURSING CARE CONTINUED
• AVOID ASA : why?
• What is effective for pain control?
• What is used prophylactically for 5 days?
• What is used for several weeks to reduce
inflammation and prevent scarring?
• Why avoid reading ?
• What should they wear forever? wear medic
• What medical care do they need routinely?
Described as what?
• How is vision changed?
• How do objects appear?
• What happens when pt is faced with bright
• Is there pain?
• How does the lens appear?
• When does the pt need surgery? Pt chooses
to have surgery when the loss of vision
interferes with life and safety
• Where is the surgery done? Done with local,
short stay hospital
• What is done surgically? lens is extracted
• What is given on surgical day?
• Why does the client receive oral
acetazolamide (Acetazolam )?
TYPES OF CATARACT SURGERY
• Extracapsular - incision through schlera, lens
capsule excised, lens is expressed by pressure;
• Intracapsular extraction - remove lens and
capsule that encases it; rare today
• Phacoemulsification - extracapsular; small
incision, uses high frequency ultrasound
device, breaks up lens, aspirate it, irrigation
TYPES OF SURGERY FOR CATARACTS
• Intraocular lens implant: prosthetic lens
implant inserted after any type of extraction;
good for pt over 65 who has arthritis who
cannot manage contact lens insertion
POSTOP NRSG CARE/ TEACHING
• What medications are given subconjunctivally?
• How is the eye protected?
• When is the client discharged?
• When does the client return to see the doctor who
instills what drugs?
• When assessing the eye what would you see?
• What pain level is felt by the client?
• What drugs should be avoided?
• What should be taught to client to report?
• When will sight changes be noted by pt?
• NORMALLY WHAT DOES RETINA DO?
• WHAT HAPPENS WHEN THERE IS A
• Who is more at risk for this?
• What do pts see suddenly?
• How is sight effected?
• How quickly does this occur
Same day surgery with general anesthesia
• laser photocoagulation: scar tissue formed to
closed the leakage
• schleral buckling: silicone buckle sutured into
schlera supports the breaks in retina
POSTOP NURSING CARE
• How is the eye protected?
• What activity is allowed?
• Why is the client positioned on his or her
abdomen if gas or oil has been used during
• How will the client feel postop?
• What should be avoided?
• Damage to or occlusion of the blood vessels
that nourish the retina as a result of
inadequate blood glucose control
• Weakened vesels become hyperpermeable
and leak causing microhemorrhages
• Observe for cloudy or hazy vision of sudden
• TREATMENT: laser surgery to close leak
• DEFINED: deterioration of the macula
• TWO TYPES: wet and dry
• DRY TYPE CAUSED BY: degeneration from age,
retinal cells become ischemic, leads to
blurring and distortion, with central vision
declining seen with smokers
PREVENTION: use of antioxidants, carotenoids
lutein and zeaxanthin
• Sudden decrease in vision
• Seen after serous detachment of pigment
peithelium in the macula
• Newly formed blood vessels invade the area,
fluid and blood collect under the macula like a
• Surgical removal of the entire eyeball
• A ball implant is inserted as a base for the
• This is covered with tissue, muscles
• See p 1107 for insertion and removal of ocular
KEY CONCEPTS FOR CLIENTS WITH
EYE AND VISION PROBLEMS
• Safe effective Care Environment
• Health Promotion and Maintenance
• Psychosocial Integrity
• Physiologic Integrity
• Incapacitating vertigo
• fluctuating hearing loss
• Tinnitus, nystagumus
• Nausea and vomiting
• not central nervous system or brain disease
• cause is unknown
DIET: low Na diet
DRUGS: ANTIHISTAMINES- helps with vertigo
• Diphenhydramine hydrochloride (Benadryl)
• Dimenhydrinate (Dramamine)
What class of drugs to decrease the fluid?
Why use nicotinic acid?
What SEDATIVE is used and why?
What class of drugs are these and what are they
chlorpromazine hydrochloride (Thorazine),
trimethobenzamide hydrochloride (Tigan)
• Endolymphatic sac decompression - shunt
used to drain the extra fluid
• Middle and inner ear perfusion of antibiotics -
done during overnight stay in hospital; use
• Vestibular Nerve resection - pt has already lost
hearing, nerve is cut, stops vertigo, brief