Eyes Diagnostic Tests Study Guide PDF

Ch 80 Reading/Study Guide  ***[DUE DECEMBER 6]***  **EYES**  Diagnostic Tests  1. Visual acuity  a. Describe how to use the Snellen chart: **a person is placed 20 ft behind the chart and then is asked to read a line iff if the chart**  b. Describe 20/20 vision**: a person can see an...

Ch 80 Reading/Study Guide  ***[DUE DECEMBER 6]***  **EYES**  Diagnostic Tests  1. Visual acuity  a. Describe how to use the Snellen chart: **a person is placed 20 ft behind the chart and then is asked to read a line iff if the chart**  b. Describe 20/20 vision**: a person can see an object at 20ftthat most people can\'t see at 20ft with normal vision**  2. Refractive exam  a. Purpose of this test: **used to determine the degree of refractive error **  b. What is the drug class of medication drops that dilate pupils?  c. What is the purpose of dilating the pupils for this exam? **provide the examiner with a better view of the internal structures**  d. Name the instrument used to determine the need for glasses and how is the test performed?  **Phorophter, different lens is streaked across and the client says which view is most clear and that decides the strength of the lense needed**  3. Ophthalmoscopic exam  a. How and why is the ophthalmoscope used? **It is used by an examiner to look through the pupils to see the retina and other internal structures**  4. Slit lamp  a. How does it work? **special type of microscope that directs a beam of light onto or through the cornea to view the eye's anterior structures. **  b. What structures of the eye is it used to look at? **conjunctiva, cornea, anterior chamber, iris, lens, and anterior vitreous**  5. Tonometer  a. What does it measure? **Intraocular pressure**  b. How is it used? (must use another resource to answer this question)  **small cone that gently touches your cornea after it has been made numb with eye drops. This cone is used to measure the pressure needed to temporarily flatten a part of your cornea.**  6. Refractive errors (pg 1418)  a. Using table 80-1, describe the following:   i. Myopia- **Light rays focus on a point in front of the retina; blurred distant vision**  ii. Hyperopia- **Light rays focus on a point behind the retina; blurred close vision**  iii. Astigmatism- **Light rays focus on two different points on the retina; distorted vision**  iv. Presbyopia- **Light rays focus on a point behind the retina; decreased close vision**  b. How are refractive errors corrected? **Eyeglasses or contacts**  c. Describe the different types of glasses- **bifocals-two lenses in one, trifocals-three lenses in one **  d. Describe contact lenses- **designed to fit directly on the cornea, where they float on a layer of tears**    Inflammatory/infectious  e. Conjunctivitis aka "pink eye"  i. What is it? **inflammation of the conjunctiva**  ii. What causes it? **bacteria, virus, or allergy**  iii. S/S- **pain, redness, swelling, itching, and sometimes purulent discharge**  iv. Treatments- **Antibiotic eye drops or ointments are prescribed for bacterial infections, and antiviral medications for viral infections**  v. Describe the KEY CONCEPT on pg 1424- **Teach the client not to rub the eyes, which can lead to corneal scaring. If eye drops are used, teach the client not to touch the eye with the dropper**  f. Hordeolum   i. May also be called: **stye**  ii. What is it? **acute inflammation of an oil or sweat gland of the eyelid**  iii. What causes it? **Clogged oil/sweat gland**  iv. S/S **red, raised, swollen, and painful. They contain pus. After the area drains, pain is relieved and healing begins.**  v. Treatments- **warm, moist compresses, and a topical antibiotic ointment to the area to help localize the infection. In severe cases, the abscess is incised and drained.**  Structural Disorders  7. Compare and contrast ectropion and entropion- **ectropion is the turning in of the eyelids, while entropion is the turning out of the eyelids, both are most common in older adults and result with aging**   8. Define ptosis- **drooping eyelid**  9. Glaucoma  a. What is it? **condition of increased fluid (the aqueous humor) pressure within the eye**  \*\* These are backwards in the book.  The section labeled Angle- Closure Glaucoma describes Open- Angle and vice versa. For clarification, use the PPT  - Open -Angle Glaucoma: **most common type of glaucoma. In this condition, drainage of the aqueous humor through the trabecular meshwork is inadequate**  - Describe what happens in the eye- **aqueous humor is draining out and leaving the eye with inadequate levels**   - How is it diagnosed?  - S/S **The client may not be aware of any vision changes, but the IOP will fluctuate or increase and there will be visual field deficits and central field vision loss late in the disease.**  - Treatments- **hypotensive agents to decrease aqueous production, such as beta-adrenergic antagonists (timolol maleate, levobunolol hydrochloride, carteolol hydrochloride, and betaxolol hydrochloride. Miotics, such as pilocarpine hydrochloride, oral (Salagen) or topical; carbonic anhydrase inhibitors, such as oral acetazolamide (Diamox), topical brinzolamide (Azopt)--brimonidine tartrate (Alphagan P); brimonidine tartrate (Alphagan P)**    - Angle Closure Glaucoma: **aqueous humor is blocked by a bulge of the iris at the anterior chamber before it filters through the trabecular meshwork**  - Describe what happens in the eye **too much aqueous humor is built up**  - Risk factors: **diabetes, cardiovascular disease, hypertension, and prolonged use of topical, periocular, inhaled, or systemic corticosteroids**  - Treatments; **Angle-closure glaucoma may be treated with eye drops, to increase aqueous outflow, or oral medication, such as acetazolamide (Diamox)**    1. Action of the following medications:  i. Acetazolamide (Diamox)- **to decrease production of aqueous humor**  ii. Timolol maleate (Timoptic)- **Beta-adrenergic blockers**  iii. Travopost (Travatan Z)- **to increase aqueous outflow**  iv. Pilocarpine - **suppress aqueous inflow**    10. Cataracts  a. What is it? **Opacity or cloudiness of the lens**  b. This is a problem with what structure of the eye? **lens**  c. What is one of the earliest symptoms? **Seeing halos around lights**  d. What are other S/S? **Diplopia, halos**  e. What causes it? **Age-related cataracts result from chemical changes in the protein of the lens in older adult clients. Traumatic cataracts result from a foreign object that causes the aqueous or vitreous humor to enter the lens capsule.**  f. What is the treatment?**surgery**  i. Describe these treatments: **extracapsular cataract extraction involves removal of the anterior capsule of the lens followed by intact removal of the lens nucleus through a larger incision. Another alternative-ultrasonic fragmentation of the lens nucleus through a smaller incision.**  11. Macular degeneration  a. What is the macula and why is it important? **central portion of the retina that surrounds the optic disk**  b. What is age related to macular degeneration? **Older than 60 typically**  c. What causes it?  (this is also a risk factor) f**ormation of yellow cellular deposits or debris called drusen.**  d. Other risk factors- **blindness in both eyes, tobacco smoking, aging, family history, hypertension, elevated cholesterol, obesity, and female gender.**  e. S/S- **blurred vision, difficultly seeing faces or discerning colors, distorted vision, drastically decreased visual acuity, and the presence of drusen**  f. What is the common form of MD? **Age related**  g. Compare and contrast dry and wet MD: **dry-progresses slowly, and there is no cure for it. Wet- degeneration is a formation of fragile blood vessels behind the macula that can leak and cause vision problems.**  Trauma  12. Contusion/hematoma  a. Define it: **blunt injury to the eye may cause swelling and bleeding into the soft tissues surrounding the orbit**  b. What causes it? **blunt force to the eye**  c. Treatments**? Cold pack and warm packs after the first 48 hours**  13. Foreign bodies  a. What is the difference between the 2 types? **External foreign bodies are found on the corneal or conjunctival surface. Internal foreign bodies may penetrate the cornea or sclera and enter the inside of the eye**  b. What is the difference in treatment for the 2 types? **external may have a topical anestethia ordered, the internal typically requires surgery**  14. Hyphema  a. Define it: **hemorrhage into the anterior chamber of the eye**  b. What causes it? **caused by blunt trauma**   c. Why is it dangerous? **can lead to glaucoma and vision loss**  d. Medications  i. What does a mydriatic medication do? **Dilate**   ii. What does a miotic medication do? **constrict**  15. Corneal abrasions  a. What is it? **which involve the outer layer of the corner**  b. What causes it?, **are often caused by tree branches, fingernails, paper, and contact lens injuries**  c. **What is a diagnostic tool used for corneal abrasions?**  d. Treatments? **instillation of antibiotic drops or ointment and pressure patching**  16. Detached retina  a. Describe what happens: **separation of the retina from the choroid**  b. What are the causes? **blow or injury, myopia, degenerative changes, surgery, tumor, diabetic retinopathy, or extreme hypertension**  c. Because you know A&P, describe why vision is lost when retina detaches: **it cannot supply blood to the layers above**  d. Main s/s: **blurry or no vision**  e. Why is there no pain?  (may have to use another resource) **could not find**     17. Eye Surgery:  pre-op/ post op  a. Name some educational points for pre-op- **Outline the steps of the surgery: what will be done and what is expected of the client. Tell the client if they will be awake during the procedure.Review postoperative care before surgery.**  b. Name some education points for post-op- **Avoid sudden movements. Do not press on or rub the operative eye. Avoid bending over with the head below the waist for about 2 weeks.**  c. Providing care in eye surgery   i. Name some nursing interventions for preparing a client for surgery- **Client and family teaching are essential for all clients who undergo eye surgery, and especially clients who are older or confused. Make sure to cover and to document all teaching.**  ii. What is the major complication that needs to be prevented postop? - **Report any paralysis of the face or on the operative side or ptosis immediately**  ***DUE December 9***  **EARS **  1. Diagnostic Tests  a. Otoscopic examination  i. How does an otoscope work?  **uses a lens and a light to view the ear**  ii. What is used to examine? **Examines the external ear canal, tympanic membrane, and other features of the ear**  b. Audiometry  i. Definition: **testing a person\'s hearing with a machine that has headphones connected**  ii. Pure tone (need to use other resource)- **tests for conductive and Sensio neural hearing loss**   2. Ear Irrigation  a. Purpose? t**o rinse drainage or medication from the ears and to remove wax or foreign bodies**  b. Steps for irrigation: (In Practice Nursing Procedure 80-2)  **Warm the solution to body temp, sit the client up, drape something over the client, straighten ear canal, expel air from sterile syringe, insert syringe into meatus, irrigate, lie client on side, dry canal and ear**  3. Types of hearing loss  a. Describe conductive hearing loss- **conduction of sound waves to the organs of hearing is disrupted**  i. What is the most common cause? **disorder in the auditory canal, eardrum, or ossicles**  b. Describe sensorineural hearing loss- **disturbance of the organs of the inner ear or of the transmitting nerve**  i. What are the 2 types and part of the inner is affected?  **Sensory-cochlear**  **Neural- 8^th^ cranial nerve**  4. Prevention of hearing loss  a. In practice educating the client 80-3  i. Name ways to prevent hearing problems  Avoid excessive noise, keep volume down and wear protective gear if working in a noisy area.  Protect ears, Wear ear plugs for swimming if ear problems are present,Dry ears thoroughly after bathing or swimming, do not place foreign objects in your ears. Do not clean your ears excessively. Do not pick or pull ears excessively, Prevent and treat infection immediately. Have ear piercing done by a healthcare provider or trained technician    External Ear  5. Impacted earwax  a. What is usually causing the impaction? **Pushing the wax in further with a foreign object**  b. What might this cause? **Injury and/or infection**  c. How is it treated? **irrigation**  d. Education points: **do not try to remove wax yourself with q-tips or anything of that sorts**    6. Foreign bodies  a. Who is most likely to have a FB in the ear? **children**  b. What is the problem with food in the ear? **The moisture will cause swelling and extreme pain**  c. How would an insect be removed? **Sometimes a flashlight will draw out the insect or add a few drops of ETHOH**  7. External otitis (otitis externa)  a. What is it? **inflammation of the external ear,**   b. Most common cause? **most commonly caused by chronic external ear inflammation.**  c. Treatment? **Antibiotic**  d. Ways to prevent this? **Wear earplugs while swimming**  8. Punctured tympanic membrane  a. How might this happen? (may need other resources)- **gunshot sound, extreme changes in pressure**   b. What is it concern? **The middle ear (eardrum).**   9. Middle Ear  a. Otitis media  i. What is it? **Inflammation in the middle ear**   ii. What causes it? **Fluid that collects in the middle ear causing an obstruction.**   iii. Who is most susceptible and why? **Children, because their auditory tubes are shorter and smaller.**  iv. There are many types but what are the most common s/s?**4 types, crackling sensation and fullness in the ear and some hearing loss**  v. What tool would be used to see the middle ear? **otoscope**  vi. Treatments? **antibiotic use or myringotomy**  vii. What is the treatment for recurring OM? **Tympanoplasty**  viii. What medications could be used for the pain and fever? **antipyretics**  ix. What medications could be used for the infection? **antibacterials**  10. Inner Ear  a. What is ototoxicity? **when a person develops hearing or balance problems due to a medicine**  i. What are some medications that cause it? **aminoglycoside antibiotics, macrolide antibiotics, loop diuretics, antimalarials**  b. Meniere Disease  i. What is it? **disturbance of the inner ear's semicircular canals**  ii. What is the function of the semicircular canals? **Maintaining balance**  iii. Potential causes? (also risk factors) **One theory suggests that the herpes simplex virus is a causative agent, but no specific cause is universally identified**  iv. What re the main s/s? **Vertigo, N/V, tinnitus**  v. What are some common treatments? **Antivirals, anti-vertigo medications**  vi. Name the classes of medications that can be used to treat the s/s and name one medication that falls under each class **antiviral-acyclovir anti-vertigo-meniett**  vii. What are some education points for the client with Meniere's?   **When caring for a client with Ménière disease, avoid jarring the bed, making sudden movements, turning on bright lights, or making loud noises**