neuro

• Cataracts


  Eye disease that causes cloudy lens and obscures light passage
• Causes of Cataracts


  • Aging
  • Other ocular conditions (infection)
  • Toxic factors (cigarettes, calcium, iron, gold, silver)
  • Down's syndrome
  • Intrauterine rubella
  • Diabetes
  • Hypoparathyroidism
  • UV light
  • Medications (steroids)
  • Nutrition (obesity, malnutrition)
  • Trauma
• Clinical Manifestations of Cataracts


  • What are the cues your patient will give you???
• Diagnosis of Cataracts


  1. Visual acuity assessment (Snellen chart)

  2. Ophthalmoscope examination

  3. Slit-lamp examination
• Treatment of Cataracts


  1. Attempt to reduce risk factors but there are no non-surgical treatments

  2. Surgical removal of lens

  3. Lens replacement
• Preoperative and Postoperative Interventions for Cataracts

  1. Preoperative: NPO, medication history, will wear eye patch for 24 hrs to rest eye

  2. Postoperative: No increase of intraocular pressure, Don't bend over, Avoid sneezing or coughing hard, Use stool softener to avoid straining
• Glaucoma


  • Increased intraocular PRESSURE!!!!
  • Second leading cause irreversible blindness

  
• Types of Glaucoma


  • Open angle (primary)
  • Angle closure (formerly narrow angle)
• Glaucoma Pathophysiology


  1. Blocked duct= increased IOP

  2. Need to slow down progression

  3. Less invasive drops
• Clinical Manifestations of Glaucoma

  • Early vs Late Cues?
• Diagnostic Testing for Glaucoma


  1. Measurement of IOP

  2. Ophthalmoscopic exam of optic disc

  3. Central visual fluid testing

  
• Treatment of Glaucoma


  1. Decrease Intraocular Pressure

  2. Pharmacologic: Increase drainage, Decrease production of aqueous humor, Topical medications

  3. Surgical Intervention: Laser trabeculosplasty, Trabeculectomy
• Marijuana can be used to treat Glaucoma
• Nursing Care of Glaucoma


  • This is a lifelong disease
  • Flow to administer medication
• Retinal Detachment


  • Involves the separation of the retina from the epithelium
  • Blindness will occur if complete detachment occurs
• Clinical Manifestations and Interventions for Retinal Detachment

  • What cues will your patient have?
  • How do you intervene?
• Surgical Treatment for Retinal Detachment

  Scleral Buckling procedure
• Nursing Care after Scleral Buckling Procedure What MUST your patient avoid?

  increasing intraoccqular pressure:
• Meniere's Disease


  • Inner ear problem caused by too much production or not enough reabsorption of endolymphatic fluid
  • Also known as endolymphatic hydrops
  • Classified as sensorineural hearing at times
  • Cause is generally not known
  • Onset occurs between 20-60
• Clinical Manifestations of Meniere's Disease


  • What are the patient cues???
• Diagnostic Testing for Meniere's Disease

  1. Audiometry testing

  2. Otoscopic examination

  3. Weber & Rinne testing

  4. Balance testing
• Interventions for Meniere's Disease

  1. No cure

  2. Monitor patient safety

  3. Diet adjustments

  4. Promote lifestyle changes

  5. Medication

  6. Safety
• Ophthalmic Medication Administration


  • Wash hands and don gloves
  • Administer drops first if both eye drops and ointment are scheduled
  • Wait 3-5 minutes if two medications are scheduled
  • Place medication in lower conjunctival sac
  • Apply gentle pressure to nasolacrimal duct 30 seconds-1 minute following administration
• Mydriatics, Cycloplegic and Anticholinergic Medications

  • Dilate pupils, relax muscles, contraindicated in glaucoma
  • Side effects: tachycardia, photophobia, hypertension, atropine toxicity (dry mouth, urinary retention, conjunctivitis)
  • Interventions: monitor side effects and toxic effects, educate that burning sensation may occur during installation
• Medications to Treat Glaucoma

  • Reduce IOP
  • Open anterior chamber angle and increases outflow of aqueous humor
  • Side effects: myopia, headache, eye pain, decreased vision in poor light
  • Interventions: assess vital signs, risk for injury, degree of diminished vision, monitor for side effect and toxic effects, monitor for postural hypotension

  
• Beta Blockers Eye Medications


  • Decrease IOP and decreases aqueous humor production, contraindicated in asthmatic and COPD patients
  • Side effects: ocular irritation, bradycardia, hypotension, bronchospasm
  • Interventions: monitor apical pulse, blood pressure, monitor for shortness of breath and notify PCP if occurs, educate patient to change positions slowly to reduce risk of orthostatic hypotension
• Carbonic Anhydrase Inhibitors


  • Decrease aqueous humor formation and IOP, contraindicated in patients allergic to sulfonamides and used with caution in those with severe renal or liver disease
  • Side effect: paresthesias, polyuria, hypokalemia, photosensitivity, drowsiness
  • Interventions: assess risk for injury, monitor intake and output, assess visual acuity, monitor for paresthesias and hypokalemia signs
• Osmotic Medications


  • Mannitol (Osmitrol) lowers IOP and are used in emergent treatment of acute closed angle glaucoma
  • Side effects: headache, GI disturbances, disorientation
  • Interventions: monitor side effects, assess risk for injury, assist with monitoring effectiveness of medication
• Medications to Treat Macular Degeneration

  • Pegaptanib (Macugen), Ranizumab (Lucentis), Bevacizumab (Avastin), Aflibercept (Eylea)
  • Side effects: blurred vision, cataracts, endophthalmitis
  • Interventions: teach patient about administration, side effects and when to notify PCP