INTERFERENCES TO SAFETY NEEDS

DUE TO SENSORY DEPRIVATION AND AGING2009

SIGHTEDCHILD

VISUALLYIMPAIREDCHILD

Response to objects

Eye contact

Body imagedevelopment

Motor function

Crawling

How learns

HOW TO DETECT VISUAL IMPAIRMENT IN INFANT

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 EVALUATIONDIAGNOSTIC EVALUATION PURPOSETonometry

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 AND SYMPTOMS

LATE SIGNS AND SYMPTOMSvisual fieldsvisual acuityAround lightspain

TWO TYPES COMPARED

PRIMARY OPEN ANGLE• With progressive

changes what happens to aqueus humor?

• Tonometry reading:

ANGLE CLOSURE• OTHER NAMES:

• EMERGENCY • When must the pt be

treated? • What happens if they

aren’t treated? • Tonometry reading:

DRUGS: MIOTICS• Miotics: do what?

• 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

PUPIL SIZE(MIOSIS)

IOP

OUTFLOW AQUEOUS HUMOR RELIEF OF GLAUCOMA

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 (OsmitrolOr 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

• TYPES1.2.

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 dietDRUGS: 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