Chapter 63 Assessment and Management of Patients with Eye and Vision Disorders by Robin Knox https://padlet.com/knoxr92106/udtuj06dsw9e Robin Knox, Madhavi Timsina, Morgan Murphy, Je'Vonna McField en-us 2019-03-22 14:39:07 UTC 2025-07-24 00:51:15 UTC hello@padlet.com Ocular Disorders mmurphy4329 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/344645496 Glaucoma
Cataracts
Retinal detachment
Age-related Macular Degeneration

]]> 2019-03-25 01:17:25 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/344645496 Eye Assessments knoxr92106 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/344812877 Not going into great depth on eye assessment because we covered this in Fundamentals.

Key things to remember on an eye assessment is to:
  • Inspect external eye for any abnormalities
    •  Is there any swelling or redness? Is the sclera white or yellow? 
  • Test the cranial nerves r/t eye function with the 6 cardinal fields of gaze
    • Assess for nystagmus and strabismus
  • PERRLA

 If you would like to brush up on your eye assessment skills, feel free to watch the video below!

]]> 2019-03-25 13:37:28 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/344812877 Major Outer Structures of the Eye knoxr92106 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/344815004 2019-03-25 13:41:13 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/344815004 Extraocular Muscles knoxr92106 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/344816183 Movement of the eye:
  • Lateral rectus -> CN VI (abducens)
  • Medial rectus -> CN III (oculomotor)
  • Superior rectus -> CN III (oculomotor)
  • Inferior rectus -> CN III (oculomotor)
  • Inferior oblique -> CN III (oculomotor)
  • Superior oblique -> CN IV (trochlear)
]]> 2019-03-25 13:43:12 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/344816183 Major Functions of the Eye knoxr92106 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/344820604
  • Sensory organ of vision
  • Absorbs light rays from our environment and transforms them into information for the brain to process
  • This form of communication between the eye and brain is known as a visual system
  • Consists of Inner and Outer structures
    • ]]>     2019-03-25 13:50:59 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/344820604     References knoxr92106 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/344824777 Cheever, K. H., & Hinkle, J. L. (2018). Brunner & Suddarths Textbook of Medical-
    Surgical Nursing     (14th ed.). Philadelphia, PA: Wolters Kluwer.
     
    RegisteredNurseRN. (2017, November 16). Eye Assessment Nursing | How to Assess Eyes for Head-to-Toe Assessment. Retrieved March 25, 2019, from https://www.youtube.com/watch?v=pgSj3l9iV6k
     
    The structure of the eye. (n.d.). Retrieved March 26, 2019, from https://www.khanacademy.org/science/health-and-medicine/nervous-system-and-sensory-infor/sight-vision/v/vision-structure-of-the-eye
     
    ]]>     2019-03-25 13:57:57 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/344824777     mtimsina https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345360746 General Patient Assessment with Low vision/Blindness: 
    •Assess age
    •Review medical history/examination
    •Asses family history of systemic/CNS disease
    •Ask the patient about specific ability to read, see television and history of falls.
    •Asses eye and lid for inflammation, edema, positional defects and deviation
    •Determine the nature of visual symptoms/onset/degree of visual loss.
    ]]>     2019-03-26 16:52:17 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345360746     Patient Assessment Specific to Vision: mtimsina https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345361826 •Assess for other systemic and/or clinical features such as cutaneous or skeletal conditions or hearing loss.
    •Look for color and clarity of iris.
    •Assess for presence of strabismus (cross-eyes), amblyopia (lazy eye), nystagmus, astigmatism, and near- or far-sightedness.
    •Assess for changes in visual acuity.
    •Assess field of vision.
    •Inquire about photophobia, night blindness, or double vision
    •Assess Aids that improve vison e.g. glasses, contact lenses, bright/natural light
    ]]>     2019-03-26 16:54:28 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345361826     Defining characteristics/Clinical manifestations: mtimsina https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345362425 •Lack of eye-to-eye contact
    •Abnormal eye movement
    •Squinting , frequent blinking
    •Bumping 
    •Diabetes: Glaucoma, cataracts
    ]]>     2019-03-26 16:55:28 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345362425     Medical Management: mtimsina https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345362719 •Magnification and image enhancement through the use of low vision aids and strategies 
    •Medications for glaucoma
    •Referrals to community agencies may be necessary for patients with low vision who live alone and cannot self-administer their medications. 
    ]]>     2019-03-26 16:56:04 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345362719     Assessment Strategies/Nursing care mtimsina https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345363846 •Introduce self to the patient, and acknowledge visual impairments
    •Orient patient to the environment
    •Speak before you touch
    •Do not make unnecessary changes in room environment
    •Provide adequate lighting 
    •Place meal try, tissues, water and call light within patient’s range of vision/reach. 
    •Recommend the use of visual aids when appropriate
    •Remove environmental barriers
    •Maintain bed in low position to prevent falls
    •Encourage the patient to use the sense of touch
    ]]>     2019-03-26 16:58:07 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345363846     Vernon Watkins (book case study) and Teaching mtimsina https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345365244 To maintain safe environment for patient with low vision like Vernon Watkins, nurses should : 
    Provide Adequate lighting.
    Make sure all objects he will need are close at hand such as incentive spirometry. 
    Remove obstacles that may be in his pathway and could cause a fall.
    Place all assistive devices that the person uses close at hand; let the person feel the devices so that he or she knows their location.
    Identify the location of objects that the person may need (e.g., “The call light is near your right hand”; “The telephone is on the table on the left side of your bed.”) ]]>     2019-03-26 17:00:50 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345365244     Common Ocular Medication Actions and Management Chart mmurphy4329 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345463106 2019-03-26 20:53:41 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345463106 Teaching Patients how to Instill Eye Medications mmurphy4329 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345503322 The nurse instructs the patient to:
    • Never use eye solutions that have changed colors.
    • Perform hand hygiene before and after the procedure.
    • Ensure adequate lighting.
    • Read the label of the eye medication to verify that it is the correct medication.
    • Remove contact lens as needed.
    • Assume a comfortable position.
    • Avoid touching the tip of the medication container to any part of the eye or face.
    • Hold the lower lid down; do not press on the eyeball. Apply gentle pressure to the cheekbone to anchor the finger holding the lid.


    ]]>     2019-03-27 00:23:59 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345503322     mmurphy4329 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345505147
  • Instill eye drops before applying ointments.
  • Apply a 0.25–0.5-inch ribbon of ointment to the lower conjunctival sac.

    • ]]>     2019-03-27 00:33:17 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345505147     mmurphy4329 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345505362
  • Keep the eyelids closed, and apply gentle pressure on the inner canthus (punctal occlusion) near the bridge of the nose for 1 or 2 minutes immediately after instilling eye drops.
  • Use a clean tissue to gently pat skin to absorb excess eye drops that run onto the cheeks.
  • Wait 5 minutes before instilling another eye drop and 10 minutes before instilling another ointment.
  • Reinsert contact lens if applicable.

    • ]]>     2019-03-27 00:34:10 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/345505362     Nursing Management jmcfield13 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/346656308 Glaucoma
    • Educate patients about self care, continuing and transitional care
    • Educate on ways to prevent further compromised vision
    • Educate patient about appropriate eye drop administration
    • Educate patient on the importance of follow up care 
    • Manage pain and anxiety (emotional support and possibly administer medication)

    Cataracts
    • Educate patients about patient receives verbal and written education regarding eye protection, administration of medications, recognition of complications, activities to avoid, what to expect and obtaining emergency care
    • Promote home, community-based, and transitional care
    • Educate patients on ways to prevent accidental rubbing or poking of the eye 
      • If recommended patient wears a protective eye patch for about the first 24 hours after surgery, followed by eyeglasses worn during the day and an eye shield at night (educate on application and care). 
    • Educate patients on the importance of follow up appointments in order to monitor visual status and implement prompt intervention if necessary.

    Ocular trauma 
    • Immediate treatment is directed at preventing further injury or vision loss. 
    • When assessing the eyes, especially in trauma, always make sure to assess and compare both eyes.
    • X-ray, CT scan, and MRI scan are all test that can be performed in order to assess  ocular function and diagnostic testing
    • Educate that there are two types of ocular trauma in which the first response is critical: Chemical burn and foreign object in the eye
      • With a chemical burn, the eye should be immediately irrigated with tap water or normal saline. 
      • With a foreign body, no attempt should be made to remove the foreign object. The object should be protected from jarring or movement to prevent further ocular damage.
    • All other traumatic eye injuries should be protected using a patch or shield if available or a stiff paper cup until medical treatment can be obtained  
    ]]>     2019-03-29 17:53:00 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/346656308     Discharge education for patients after ocular surgery jmcfield13 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/346657175
    • Informing patient what to expect:
      • Bruised or bloodshot eye for 7 days
      • Itching and mild discomfort for several days
      • Some fluid discharge
      • Sensitivity to light
      • Scratchy, sand-like feeling in the eye for about 2 weeks
    • Activity Level 
      • Do not drive for 2 days or as instructed by your eye care provider.
      • Do not drink alcohol for at least 24 hours.
      • Avoid bending at the waist to pick up objects or lifting anything heavy for 2 days
      • For the first 24 hours after surgery be sure to take it easy and relax.
    • Eye protection 
      • Do not rub or press on your eye.
      • Sleep on your back or on your unoperated side for 2 nights.
      • If instructed, wear a bandage over your eye for 2 days and 2 nights.
      • If instructed, wear a shield to protect your eye for 2 days and 2 nights.
    • Eye Drops
      • Educate on the effective and proper use of eye drops as prescribed
    • When to call the doctor
      • Bleeding or discharge from the eye
      • Sudden worsening of your vision
      • Pain that does not improve with the medication
      • Nausea or vomiting
      • Chills or fever over 100.4°F (39.1°C)

    ]]>     2019-03-29 17:55:23 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/346657175     Major Inner Structures of the Eye knoxr92106 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/346662350 Eyeball
    Composed of 3 layers:
    • The outer dense fibrous layer (Sclera), including the sclera and transparent cornea
    • The middle vascular layer (Choroid), containing the iris, ciliary body, and choroid
    • The inner neural layer (Retina), including the retina, optic nerve, and visual pathway
    ]]>     2019-03-29 18:07:52 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/346662350     Inner Structures and Functions knoxr92106 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/346674093 Outer Dense Fibrous Layer (Sclera):
    • Sclera
      • Outer covering structure that supports and protects the eye
      • "White of the eye"
      • Composed of tough fibrous tissue
    • Transparent Cornea
      • Bulge in front of the eye where light bends enters
      • Contains high concentrations of nerve fibers and is extremely sensitive to touch and pain (corneal reflex)

    Middle Vascular Layer (Choroid):
    • Choroid
      • Middle vascular layer with many blood vessels to supply nutrients to the retina
      • Dark brown membrane located between the sclera and the retina
      • Lines most of the sclera and attached to the retina but can be detached
        • Reports of a shade or curtain coming across the vision of one eye when detached and no pain
      • Has dark pigmentation to prevent light from reflecting internally
    • Ciliary Body
      • Connects the choroid with the iris and secretes aqueous humor that helps give the eye its shape
        • Aqueous humor is a clear, watery fluid that fills the anterior and posterior chamber of the eye
        • Produced by the ciliary processes and drains into the canal of Schlemm
        • If does not drain properly increases IOP can occur
      • Muscles of ciliary body control the thickness of the lens
        • The lens is a transparent structure suspended behind the iris that helps to focus light on the retina by bending light so it falls on the retina
        • Provides fine-tuning adjustment to cornea
    • Iris
      • Colored portion of the eye located in front of the lens.
      • Has central circular opening known as the pupil
        • Pupil controls the amount of light (darkness = dilation, light = constriction) admitted to the retina
        • Controlled automatically by the CNS

    Inner Neural Layer (Retina):
    Retina
    • Visual receptor layer of the eye where light waves are changed into nerve impulses
    • Thin, delicate structure in which fibers of the optic nerve are distributed
      • Point of entrance between the retina and optic nerve is the optic disc
        • Optic disc AKA blind spot because it only contains nerve fibers, lacks photoreceptor cells, and is insensitive to light
    • Bordered externally by the choroid and sclera and internally by the vitreous  
      • The vitreous is a clear jelly-like substance that fills the eye from the lens to the back of the eye
    • Contains photoreceptors known as rods and cones
      • Rods are responsible for peripheral vision and night or low light vision by reducing levels of illumination
      • Cones are responsible for color, central vision, and function at bright levels of illumination
    Optic Nerve
    • The bundle of nerve fibers at the back of the eye that carry visual messages from the retina to the brain
    Visual Pathway
    • The process of which light is converted into nerve impulses and transmitted to the brain through all of the structures listed above


    ]]>     2019-03-29 18:41:26 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/346674093     Outer Structures and Functions knoxr92106 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/346695028 Conjunctivae
    • Thin, transparent mucous membranes of the eye that line the posterior surface of each eyelid and covers the sclera
    • Helps lubricate the eye and protect it from microbes
    Lacrimal Gland
    • Produces tears that are drained through the punctum into the lacrimal duct and sac
    • Tears protect the eye from damage, dehydration and microbes
    Eyebrows + Eyelashes
    • Thick and delicate hair above the eye and hair that extends from the eyelid
    • Prevents sweat, water and other debris from falling down into the eye
    Eyelids
    • Thin fold of skin that protects and covers the eye; blinking
    ]]>     2019-03-29 20:04:01 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/346695028     NCLEX Q's mmurphy4329 https://padlet.com/knoxr92106/udtuj06dsw9e/wish/346707707 Take the quiz @
                  https://PollEv.com/surveys/MLGAInA5empKvtT6kCrnX/web
    Review your answers @
                https://docs.google.com/document/d/1ACtTOR-GmH-PJJrfVEA8Pkng7rDtgN45vVKmxB453yc/edit?usp=sharing]]>     2019-03-29 21:16:37 UTC https://padlet.com/knoxr92106/udtuj06dsw9e/wish/346707707