Docstoc

INTERFERENCES TO SAFETY NEEDS

Document Sample
INTERFERENCES TO SAFETY NEEDS Powered By Docstoc
					INTERFERENCES TO SAFETY NEEDS


  DUE TO SENSORY DEPRIVATION AND
              AGING
               2009
    HOW TO DETECT VISUAL
    IMPAIRMENT IN INFANT
                      SIGHTED   VISUALLY
                      CHILD     IMPAIRED
                                CHILD
Response to objects
Eye contact

Body image
development

Motor function
Crawling


How learns
  REHAB OF VISUALLY IMPAIRED CHILD

GRIEVING                   Play
Overprotection             Feeding
Sensorimotor stimulation   Safety
Bonding
Speed of Development
Touch
Mobility
                  COURTESIES TO
            BLIND HOSPITALIZED PATIENT
CATEGORY                          WHAT TO DO
Environment
walking
What to say to pt as enter room
Words like “see”
Touching pt
Object in room
Food tray
             DIAGNOSTIC EVALUATION
DIAGNOSTIC EVALUATION            PURPOSE
Tonometry

Tonography

Gonioscopy

slit lamp

opthalmoscopic exam

A scan ultrasound (echography)
                GLAUCOMA
• What is the major characteristic of this
  disorder?
• How does this impair vision?

• What situations increase intraocular pressure
  normally?
• Why don’t we all get increased intraocular
  pressure?
            GLAUCOMA
• PRIMARY OPEN ANGLE GLAUCOMA
• ANGLE CLOSURE GLAUCOMA
   Primary open angle glaucoma
• What happens to the outlflow of
  aqueous humor?

• How does this effect intraocular
  pressure?
       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
            OF GLAUCOMA

EARLY SIGNS  LATE SIGNS AND
AND SYMPTOMS SYMPTOMS
                  visual fields
                  visual acuity
                  Around lights
                  pain
TWO TYPES COMPARED
  PRIMARY OPEN ANGLE         ANGLE CLOSURE
• With progressive       • OTHER NAMES:
  changes what happens
  to aqueus humor?       • EMERGENCY
                         • When must the pt be
                           treated?
• Tonometry reading:     • What happens if they
                           aren’t treated?
                         • Tonometry reading:
                         DRUGS: MIOTICS
• Miotics: do what?



                  PUPIL SIZE                                   IOP
                   (MIOSIS)



                 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
             INHIBITORS:
How do the Carbonic anhydrase inhibitors treat glaucoma?

EXAMPLES:
• acetazolamide (Acetazolam, Diamox)
• brinzolamide (Azopt),
• dorzolamide (Trusopt)
• Methazolamide (Neptazane)

ALERT ALERT ALERT ALERT ALERT!
Drug interactions:
• Digitalis, Steroids, Diuretics, Lithium
   DRUGS: SYMPATHOMIMETICS
How do SYMPATHOMIMETICS treat glaucoma?
EXAMPLE:
• brimonidine (AlphaganP)
• apraclonidine (Iopidine)
• epinephryl ( Epifrin, Glaucon),
• dipivefrin HCl (Propine)
PRECAUTIONS with soft contact lenses?
DRUG COMBINATION CONCERNS?
               DRUGS:
           OSMOTIC DIURETICS
OSMOTIC DIURETICS:
How does this treat glaucoma?
What situations is this used?

  EXAMPLE:
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
   BLOCKERS?
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)
levobetaxolol (Betaxon)
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
EXAMPLES:
• brimonidine tartrate ( Alphagan):

•   ALERT:
•   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
            GLAUCOMA
• PURPOSE: to create a permanent way to drain
   fluid
• TYPES
1.
2.
       POSTOP NURSING CARE
• Where is the procedure done?
• How long do patients stay?
• What precautions should be taught to the
  client?
• 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
  alert
• What medical care do they need routinely?
 CATARACTS


Described as what?
             ASSESSMENTS
• How is vision changed?
• How do objects appear?
• What happens when pt is faced with bright
  light?
• Is there pain?
• How does the lens appear?
               TREATMENT
• 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;
  most popular
• 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?
        RETINAL DETACHMENT
• NORMALLY WHAT DOES RETINA DO?



• WHAT HAPPENS WHEN THERE IS A
  DETACHMENT?

• Who is more at risk for this?
      ASSESSMENT INDICATING
       RETINAL DETACHMENT
• What do pts see suddenly?
• How is sight effected?
• How quickly does this occur
         SURGICAL TREATMENT
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
       DISCHARGE TEACHING
• 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
  surgery?
• How will the client feel postop?
• What should be avoided?
DIABETIC RETINOPATHY
                CAUSED BY
• 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
  onset
• TREATMENT: laser surgery to close leak
     MACULAR DEGENERATION
• DEFINED: deterioration of the macula
• TWO TYPES: wet and dry
                 DRY TYPE
• 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
                 WET TYPE
• 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
  blister
              ENUCLEATION
• Surgical removal of the entire eyeball
• A ball implant is inserted as a base for the
  socket prosthesis
• This is covered with tissue, muscles
• See p 1107 for insertion and removal of ocular
  prosthesis
KEY CONCEPTS FOR CLIENTS WITH
   EYE AND VISION PROBLEMS
•   Safe effective Care Environment
•   Health Promotion and Maintenance
•   Psychosocial Integrity
•   Physiologic Integrity
MENIERE’S DISEASE
            ASSESSMENTS SEEN
•   Incapacitating vertigo
•   fluctuating hearing loss
•   Tinnitus, nystagumus
•   Nausea and vomiting
•   not central nervous system or brain disease
•   cause is unknown
•   episodic
     NONSURGICAL TREATMENT
DIET: low Na diet
DRUGS: ANTIHISTAMINES- helps with vertigo
• Diphenhydramine hydrochloride (Benadryl)
• Dimenhydrinate (Dramamine)
          Medication support
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
 used for?
 chlorpromazine hydrochloride (Thorazine),
 trimethobenzamide hydrochloride (Tigan)
        SURGICAL TREATMENT
• Endolymphatic sac decompression - shunt
  used to drain the extra fluid
• Middle and inner ear perfusion of antibiotics -
  done during overnight stay in hospital; use
  gentamycin, streptomycin
• Vestibular Nerve resection - pt has already lost
  hearing, nerve is cut, stops vertigo, brief
  hospital stay

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:7
posted:7/30/2012
language:Latin
pages:43