Retinal Surgery Care Quiz

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Questions and Answers

What should patients be cautious about after retinal surgery when descending stairs?

Overextending the neck

Performing vigorous exercise

Wearing protective eyewear

Maintaining balance and stability (correct)

Which manifestation is NOT commonly associated with retinal detachment?

Bright flashing lights

Brightness in peripheral vision (correct)

Sensation of a curtain across vision

Sudden onset of floaters

Which type of macular degeneration accounts for the majority of cases?

Congenital type

Wet type

Exudative type

Nonexudative type (correct)

Which postoperative care instruction is crucial for a patient after retinal surgery?

Monitor signs of increased intraocular pressure Signup and view all the answers

Which of the following is a common treatment for retinal detachment?

Scleral buckle Signup and view all the answers

Which statement accurately describes postoperative care for a patient who has undergone cataract surgery?

Patients must avoid any activities that increase eye pressure. Signup and view all the answers

What is an important aspect of managing a patient with retinal detachment?

Immediate referral to an ophthalmologist for potential surgical intervention. Signup and view all the answers

Which type of macular degeneration is characterized by abnormal blood vessel growth?

Wet macular degeneration Signup and view all the answers

In the case of an emergency eye treatment for a chemical burn, what is the first step?

Irrigate the eye with running water. Signup and view all the answers

Which of the following is a potential side effect from long-term use of topical corticosteroids in eye treatment?

Glaucoma Signup and view all the answers

What is a commonly used treatment modality for managing glaucoma?

Decreasing aqueous production Signup and view all the answers

Which sign is typically assessed to evaluate extraocular movement during an eye examination?

Gaze and position of eyes Signup and view all the answers

When examining eye structures, which condition may be indicated by the presence of discharge?

External irritation or inflammation Signup and view all the answers

What should a patient do if they experience continuous flashing lights after cataract surgery?

Call their physician immediately Signup and view all the answers

During postoperative care for cataract surgery, what is advised regarding physical activity?

Engage in light activity such as walking Signup and view all the answers

What is a significant risk factor for developing cataracts?

Advanced age Signup and view all the answers

Which symptom indicates a potential emergency following cataract surgery?

Redness and increased drainage Signup and view all the answers

What type of cataracts increases in occurrence due to trauma?

Traumatic cataracts Signup and view all the answers

What ocular condition can arise as a complication related to cataract surgery?

Ocular hypertension Signup and view all the answers

In cataract surgery, when is it unnecessary to perform surgical intervention?

If the patient is comfortable with their vision Signup and view all the answers

What eye examination technique is used to inspect the optic nerve disc in glaucoma diagnosis?

Ophthalmoscopy Signup and view all the answers

What is the primary goal of glaucoma treatment?

To prevent further optic nerve damage Signup and view all the answers

In glaucoma management, which medication is classified as a beta blocker?

Timoptic Signup and view all the answers

Study Notes

Care of Patients with Eye and Ear Disorders

Objectives include reviewing eye and ear anatomy and physiology, assessing eye and ear function, discussing treatment modalities for eye and ear disorders, and describing management of patients with specific disorders
Eye disorders include low vision/blindness, glaucoma, cataracts, retinal detachment, macular degeneration, and trauma
Ear disorders include hearing impairment and Ménière's disease
Visual and auditory cortex function and associated substructures are relevant
Eye anatomy and physiology are reviewed

Eye Anatomy and Physiology

External structures include the brow, upper lid, caruncle, inner canthus, lacrimal sac, naso-lacrimal duct, lower lacrimal canal, near lower lacrimal punctum, pupil, lacrimal gland, sclera, outer canthus, and limbus with conjunctiva and iris

Cross Section of the Eye and Extraocular Eye Muscles

Structures include retinal artery, retinal vein, optic nerve, central retinal artery and vein, macular area, sclera, retina, choroid, conjunctiva, zonules, canal of Schlemm, posterior chamber, anterior chamber, cornea, pupil, lens, iris muscle, ciliary body, vitreous body, and extraocular muscles: superior oblique, superior rectus, lateral rectus, inferior rectus, and inferior oblique muscles

Normal Retina

Important structures include the fovea, macula, optic disc, Central retinal vein, Central retinal artery, retinal venules, and retinal arterioles

Assessment and Evaluation of Vision

Assessment includes ocular history, visual acuity using Snellen chart for distance, Rosenbaum pocket screener for near vision, finger count or hand motion tests, and examination of eye structures

Examination of the Eye Structures

External examination includes checking for irritation, inflammatory processes, discharge, eyelids, sclera, pupils and pupillary response, gaze and position of eyes and eyelids, and assessing extraocular movements
Internal examination includes checking the fundus and tonometry for glaucoma risk

Impaired Vision-Refractive Errors

Different types of vision impairment are illustrated, including myopic eye, hypermetropic eye, and astigmatism

Snellen Chart

A chart with letters of decreasing size to assess visual acuity

Ohtalmic Medications

The ability of the eye to absorb medications is limited due to factors like the size of the conjunctival sac, corneal membrane barriers, blood-ocular barriers, tearing, blinking, and drainage.
Topical medications (drops and ointments) are preferred
Topical anesthetics, mydriatics (dilate) and cycloplegics (paralyze) are used, but contraindicated with narrow angles or shallow anterior chambers and in patients on MAO inhibitors or tricyclic antidepressants.
Anti-infective medications, such as antibiotics, antifungals, or antivirals are also used
Medications used for glaucoma include increasing aqueous outflow or decreasing aqueous production; these may affect the ability to focus on the lens
Possible side effects are glaucoma, cataracts, and increased risk of infection if prolonged, potentially using NSAIDs as an alternate.

Low Vision and Blindness

Low vision is visual impairment that requires devices and strategies to correct vision.
Best corrected visual acuity (BCVA) is 20/70 to 20/200
Blindness is BCVA 20/200 or less
Nursing assessment should include functional ability, coping mechanisms, and adaptations in emotional, physical, and social areas

Management of Low Vision and Blindness

Support coping strategies, grief processes, and acceptance of visual loss
Strategies for adaptation to the environment include placement of items in the room, use of 'clock method', and communication strategies; collaboration with specialists in low vision, occupational therapists, or other resources are helpful
Braille or other reading methods and service animals are also viable options

Glaucoma

A condition in which damage to the optic nerve is related to increased intraocular pressure (IOP) caused by congestion of the aqueous humor.
Normal IOP ranges from 10-21 mmHg
Increased IOP leads to irreversible mechanical or ischemic damage to the optic nerve
Types include wide angle and narrow angle glaucoma
Risk factors include: cardiovascular disease, diabetes, older age, prior eye trauma, etc

Diagnostic Studies-Glaucoma

Tonometry assesses IOP
Ophthalmoscopy inspects the optic nerve disc
Pallor of optic nerve: lack of blood supply, cupping of optic disc: exaggerating bending of blood vessels across the optic disc
Normal cup appears as a basin
Central visual field testing is also used

Treatment-Glaucoma

Goal is to prevent further optic nerve damage and maintain IOP within a range unlikely to cause additional damage
Pharmacologic therapy includes miotics (pilocarpine), beta-blockers (timolol), alpha2-agonists, carbonic anhydrase inhibitors, prostaglandins
Education about the use and effects of medications is provided
Laser procedures and surgery may also be used

Cataracts

An opacity or cloudiness of the lens
Increased incidence with aging; more than half of all Americans have cataracts by age 80
A leading cause of disability in the United States
Risk factor is age; Types include traumatic, congenital, and senile

Cataract Manifestations

Painless, blurry vision, surrounding dimming, sensitivities to glare
Reduced visual acuity
Other effects include myopic shift, astigmatism, diplopia (double vision), and color shifts including brunescens (color value shift to yellow-brown)
Diagnostic findings include decreased visual acuity and opacity of the lens by ophthalmoscope, slit lamp, or inspection

Surgical Management-Cataracts

If reduced vision does not interfere with normal activities, surgery is not needed
Performed on an outpatient basis with local anesthesia
Surgery usually takes less than 1 hour, and patients are discharged soon afterward
Complications are rare but may be significant, such as inflammation, infection, pain, light sensitivity, macular edema (swelling of the central retina), or ocular hypertension

Nursing Management-Cataract Surgery

Usual preoperative care for ambulatory surgery, like dilating eye drops or other medications as ordered
Postoperative care, including patient education with written and verbal discharge instructions
Instruct patients to call physician immediately if vision changes or flashing lights, redness, swelling, pain increase, or significant pain that is not relieved by acetaminophen

Cataract Surgery Discharge Instructions

Avoid lying on the side of the affected eye
Keep activity light
Resume the following activities only as directed
Avoid lifting heavy objects, bending or stooping excessively
Be careful when climbing or descending stairs
Sneezing, if necessary, should not be held in

Retinal Detachment

Separation of the sensory retina and the retinal pigment epithelium
Manifestations include a shade or curtain across vision, bright flashing lights, or sudden onset of floaters
Diagnostic studies include assessing visual acuity, indirect ophthalmoscope, slit lamp, stereo fundus photography, and fluorescein angiography; tomography and ultrasonography may also be used

Surgical Treatment-Retinal Detachment

Scleral buckle to compress sclera
Intraocular Procedure
Gas bubble, silicone oil, perfluorocarbon and liquids may be injected into the vitreous cavity

Nursing Management-Retinal Surgery

Patient education is vital as eye surgery is often done as an outpatient procedure
Signs and symptoms of complications, especially increased IOP and infection should be monitored
Promote patient comfort, particularly the prone position

Macular Degeneration

Accounts for 54% of all blindness in older adults
Types include dry (nonexudative) and wet macular degeneration
Dry type: slow breakdown of retinal layers with drusen
Wet type: abrupt onset, abnormal blood vessel proliferation under the retina

Macular Degeneration vs. Glaucoma

Visual impairments are compared for different causes

Ocular Consequences of Systemic Disease

Diabetic retinopathy: Diabetes is a leading cause of blindness in people aged 20 to 74 years and eye changes associated with it could be observed
Ophthalmic complications include CMV retinitis and cotton wool spots, related to hypertension
Prevention of injuries and emergency treatment of chemical eye injuries, and foreign objects, metal shields, and paper cups

Trauma

Prevention of injury, patient and public education, emergency treatment, chemical injury flushing, don't remove foreign objects, metal or paper cups are important to protect eyes
Potential for sympathetic ophthalmia causing blindness in the uninjured eye with some injuries
Sympathetic ophthalmia is an inflammatory condition created in the uninjured eye by damaged eye: treated with corticosteroids and immunosuppressants; or enucleation in extreme cases

Safety Measures and Education

Prevention of eye injuries and education to prevent injuries
Safety strategies for patients with low vision in the hospital and home setting
Patient education after eye surgery or trauma
Potential complications like loss of binocular vision with patch use, or vision impairment; and safety use of eye patch and shield

Ear Anatomy and Physiology

Ear anatomy, including outer ear, middle ear, and inner ear with ossicles, semicircular canals, vestibular nerve, auditory nerve, cochlea, and eustachian tube; and gross features of exterior ear and ear canal

Assessment of the Ear and Hearing

Ear assessment includes inspection and palpation of the externa
Otoscopic examination
Hearing assessment, including gross auditory acuity, whisper test, Weber test, and Rinne test

Weber and Rinne Tests

Weber test: sound is heard equally in both ears (normal); best in affected ear (hearing loss); best in normal hearing ear
Rinne test: air conduction is audible longer than bone conduction (normal); longer in affected ear (hearing loss); longer in affected ear (hearing loss)

Hearing Impairment

Prevalence increases with age; 50% over 70
Risk factors include exposure to excessive noise levels
Types include conductive, sensorineural, mixed, and functional (psychogenic)

Hearing Impairment Manifestations

Early symptoms include tinnitus (ringing) in the ears
Increased inability to hear in a group and turning up the volume
As hearing loss increases, deterioration of speech, fatigue, indifference, social isolation, or withdrawal may occur

Ménière's Disease

Abnormal inner ear fluid balance caused by malabsorption of endolymph from the endolymphatic sac or blockage of the endolymphatic duct
Manifestations: episodic vertigo, tinnitus, hearing loss; feeling of fullness, or pressure, nausea, and vomiting.
Treatment includes low-sodium diet (1000-1500 mg/day); avoiding caffeine, smoking cessation; medications such as meclizine (antivert), tranquilizers (Valium), antiemetics (promethazine), and diuretics; and surgical management like eliminating vertigo attacks, endolymphatic sac decompression, middle and inner ear perfusion, and vestibular nerve sectioning

Treatment for Hearing Impairment

Hearing aids amplify sound to improve hearing
Cochlear implants are auditory prosthesis for people with profound sensorineural hearing loss
Vestibular rehabilitation (outpatient clinic): Type of therapy focused on improving balance and stability for conditions affecting the inner ear.

Guidelines for Communicating with Hearing Impaired Persons

Use low-tone, normal voice
Speak slowly and distinctly
Reduce background noise and distractions
Face the person and get attention
Speak into the less impaired ear
Use gestures and facial expressions
Write out information or obtain a sign language translator if needed

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Description

Test your knowledge on the essential postoperative care and precautions for patients who have undergone retinal surgery. This quiz covers key aspects such as common manifestations of retinal detachment, types of macular degeneration, and crucial care instructions. Expand your understanding of retinal health and safety.