Introduction to Medical-Surgical Nursing, 6th ed.
53
Lesson Plans for
Eye and Vision Disorders
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 53.1:
2. Identify the nursing responsibilities for patients having diagnostic tests or procedures to diagnose eye
disorders.
4. List measures to reduce the risk of eye injuries.
Lesson 53.2:
6. Assist in developing a nursing care plan for the patient with an eye disorder.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be presented with information about the eye and vision.
• The chapter covers disorders of the eye, their signs and symptoms, and their medical diagnosis and
treatment.
• Students will have the opportunity to learn about the medical treatment of disorders of the eye and the
common therapeutic measures taken.
• Furthermore, students will be introduced to the formation of nursing care plans for patients with eye
and vision disorders.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Protection and Movement
• Concept: Sensory Perception
• Exemplar: Cataract, p. 1238
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Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Movement of the eye is controlled by __________.
a) three cranial nerves and six extraocular muscles
b) the optic nerve
c) the seventh cranial nerve
d) coordinated efforts of the upper and lower eyelids
2) The pupil of the eye is best described as __________.
a) the portion of the eye that constricts and dilates to control the amount of light entering the eye
b) the hole in the center of the iris
c) a tough outer layer of the eyeball
d) containing rods and cones
3) What part of the visual system is responsible for sending visual messages to the brain for
interpretation?
a) Retina
b) Lens
c) Pupil
d) Optic nerve
4) Which of the following conditions commonly occurs in adults beginning around 40 years of age and
results in the need for reading glasses?
a) Astigmatism
b) Cataracts
c) Presbyopia
d) Scotomata
5) A nursing assessment of a patient reveals unequal, dilated pupils that react sluggishly to light.
Further assessment should be focused on __________.
a) hypertensive findings
b) electrolyte imbalances
c) congestive heart failure
d) neurologic problems
6) The commonly used eye chart with progressively smaller rows of letters or figures is correctly known
as what?
a) Snellen chart
b) Nessler chart
c) Refractory chart
d) Myopic chart
7) Increased intraocular pressure __________.
a) can cause blockage of the normal flow from the lacrimal ducts
b) can damage the retina if untreated
c) can be detected by visual evoked response
d) is a normal periodic finding in healthy adults
8) The action of a drug in the mydriatic class is __________.
a) dilation of the pupils
b) anesthesia of the eye (used prior to surgery)
c) antiinflammatory properties
d) increase in the production of lacrimal fluid
9) The best definition of stye is __________.
a) blockage of the lacrimal duct that results in swelling
b) inflammation of the lining of the eye that can be caused by bacteria
c) a common infection of the eyelid margin caused by a staphylococcal infection
d) a dirty eye
Introduction to Medical-Surgical Nursing, 6th ed.
10) The leading cause of blindness in the United States is __________.
a) cataracts
b) untreated eye infection
c) glaucoma
d) injury or trauma to the eye
4 Chapter 53 Eye and Vision Disorders ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are the major anatomic structures of the eye?
Question: Define refraction. What are errors of refraction?
________________________________________________________ Chapter 53 Eye and Vision Disorders 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.1
Textbook Objectives Covered
1. Identify the data to be collected in the nursing assessment of the eye and vision.
3. Describe the nursing care of patients who require common therapeutic measures for eye
disorders: irrigation, application of ophthalmic drugs, and surgery.
4. List measures to reduce the risk of eye injuries.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying vision and eye disorders, including:
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• astigmatism (p. 1237)
• blepharitis (p. 1234)
• cataract (p. 1238)
• myopia (p. 1237)
• presbyopia (p. 1222)
• refraction (p. 1224)
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 1219-1223)
REVIEW
• Figure 53-1: Lacrimal structures (p. 1220)
• Figure 53-2: Internal structures of the eye (p. 1220)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1, 2 (p. 1248)
ANSWER – Study Guide
• Part IA: 11 (p. 363)
• Part IC: 1-15 (p. 364)
• Part IID: 1 (p. 364)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.1
2
READ – Textbook (pp. 1223-1226)
REVIEW
• Figure 53-5: The Snellen chart (p. 1223)
• Box 53-1: Signs of Eye Problems in Adults (p. 1223)
• Box 53-2: Assessment of the Patient with an Eye Disorder (p. 1224)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3, 4 (p. 1248)
ANSWER – Study Guide
3
READ – Textbook (pp. 1226-1230)
REVIEW
• Table 53-2: Drug Therapy: Disorders of the Eye (pp. 1227-1228)
• Figure 53-10: Eye shield (p. 1230)
ANSWER – Text
ANSWER – Study Guide
• Part IA: 2, 7, 10 (p. 363)
• Part IID: 9-12, 14, 19, 26 (pp. 365-366)
4
READ – Textbook (pp. 1230-1231)
ANSWER – Study Guide
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.1
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 53
Eye and Vision Disorders
1
External Structures
• Eyelids
• Eyelashes
TALKING POINTS:
• The external structures of the visual system serve to protect and move the eyeball.
• What is the function of the lacrimal glands?
Slide 3
The Eyeball
• Sclera
• Choroid
• Retina
• Optic nerve
• Lens
Slide 4
Visual Pathway
• Light enters eye, passes through transparent cornea, aqueous humor, lens, and vitreous
humor
• These structures are called refractive media
• Refract (bend) horizontal and vertical light rays so that the light rays focus on the
retina
• On retina, light rays are reversed and upside down
• Images carried as impulses through the optic nerve
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.1
Slide 5
Age-Related Changes in the Eye
• Skin around the eye becomes wrinkled and loose
• Eyelids usually have some excess tissue; not important unless it interferes with vision
• The amount of fat around the eye decreases, permitting the eyeball to sink deeper into the
orbit
• Tear secretion diminishes; cornea less sensitive
TALKING POINTS:
• Vision changes associated with age are related to changes in the lens and the ciliary
muscle.
• What is presbyopia?
Slide 6
Health History
• History of present illness
• Record changes in vision
• If pain, enquire about location and nature
• Sensitivity to light (photophobia)
• Discharge from the eyes
TALKING POINTS:
• What specific eye complaints should be assessed?
Slide 7
Health History (cont.)
• Family history
• Any eye diseases as well as a history of arteriosclerosis, diabetes, and thyroid
Slide 8
Physical Examination
• Inspect the external eye, assess response of the pupil to light, and evaluate gross visual
acuity
• If abnormalities suspected, inform provider or advise patient to seek medical evaluation
• Acuity commonly tested with Snellen chart
TALKING POINTS:
• Inspect the eyelids for redness, drainage, and position.
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.1
2
Slide 9
Diagnostic Tests and Procedures
• Ophthalmoscopic examination
• Refractometry
• Visual fields
• Tonometry
• Measure of electrical potential
• Fluorescein angiography
• Corneal staining
3
Slide 10
Therapeutic Measures
• Eye irrigation
• Topical medications
• Miotics
• Mydriatics
• Anesthetics
TALKING POINTS:
• Irrigations are done to remove irritating chemicals from the eye.
• How is irrigation performed safely?
• Mydriatics dilate the pupils; miotics constrict the pupils; and cycloplegics prevent
Slide 11
Preoperative Nursing Care
• Assessment
• Patient’s emotional state, ability to perform self-care, and knowledge of surgical
routines and outcomes
• Be sure the patient understands the preoperative routine
• Interventions
• Anxiety
• Self-care deficit
Slide 12
Postoperative Nursing Care
• Assessment
• Vital signs and level of consciousness
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.1
4
Slide 13
Postoperative Nursing Care (cont.)
• Interventions
• Risk for injury
• Disturbed sensory perception
• Acute pain
• Anxiety
• Ineffective self-health management
Protection of the Eyes and Vision
• Patient teaching
TALKING POINTS:
• What symptoms should the patient be told to report?
• What should patients be taught regarding nutrition and eye health?
Slide 15
Protection of the Eyes and Vision (cont.)
• Prevention of injuries
• Teach young children the danger of throwing or poking objects at the faces of
playmates
Protection of the Eyes and Vision (cont.)
• Basic eye care
• Gently cleanse the eyelids each time the face is washed; use a clean cloth without
TALKING POINTS:
• Routine eye rinses and drops are unnecessary for most people.
• Who may need to have routine eye rinses?
Slide 17
Question 1
• Aqueous humor is produced in the __________.
A. canal of Schlemm
B. ciliary body
C. pupil
D. trabecular meshwork
TALKING POINTS:
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.1
Slide 18
Question 2
• Which of the following is not an age-related change in the eyes?
A. The amount of fat around the eye increases.
B. Tear secretion diminishes.
C. The cornea becomes less sensitive.
D. A grayish ring may be seen around the outer margin of the iris.
TALKING POINTS:
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
DISCUSS
• Discuss the nursing assessment of the eye
for eye and vision disorders.
• Discuss age-related changes of the eye and
the ways in which they alter or compromise
the health and well-being of the patient.
PRACTICE
ASSESS BASELINE
• Post the Pretest and the Background
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss how
age-related changes in vision affect
everyday functioning. What changes would
the student find most challenging? Ask
students to provide constructive comments
on each other’s posts.
12 Chapter 53 Eye and Vision Disorders ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.1
2
DISCUSS
• Discuss the diagnostic tests used to
evaluate a patient for eye and vision
disorders.
• Discuss the assessment of visual fields, its
purpose, and the method.
PRACTICE
• Divide the class into small groups, and have
each group discuss how it would explain and
adapt the visual acuity testing with a Snellen
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss how
you would assess visual acuity on a patient
who has difficulty telling one letter from
another, or who has difficulty with speech.
Ask students to provide constructive
comments on each other’s posts.
3
DISCUSS
• Discuss Drug Therapy: Disorders of the Eye
(pp. 1227-1228). Review the medications
used for various conditions and the
PRACTICE
• Lead a class discussion about eye irrigation
and ask students to answer the following
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to prepare information suitable for online
• Post the following discussion topic online
and have students comment. Ask students
to prepare a video depicting the proper way
to instill eyedrops. Ask students to post
________________________________________________________ Chapter 53 Eye and Vision Disorders 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.1
4
DISCUSS
• Discuss the role of patient teaching in the
prevention of injuries to the eye.
• Discuss the importance of using protective
eyewear to avoid injury to the eyes.
PRACTICE
• Divide the class into three groups and
assign each group one of the following age
populations: pediatric, adult, or geriatric.
Have each group identify and list the
following for their assigned age population:
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to prepare information suitable for online
publication directed at persons at assigned
Critical Thinking Question
A man is doing a woodworking project at home and feels something fly into his eye. His
wife, a nurse, sees a small object floating in his eye. How should the nurse irrigate the eye?
Discussion Guidelines: Sterile normal saline or plain water can be used for irrigation. The nurse
should begin with clean hands and also cleanse her husband’s eyelids and eyelashes. Positioning
Instructor Notes/Student Feedback
14 Chapter 53 Eye and Vision Disorders ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.2
Instructor Preparation
Textbook Objectives Covered
6. Assist in developing a nursing care plan for the patient with an eye disorder.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying vision and eye disorders, including:
• The measures used to reduce the risk of eye injuries
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• astigmatism (p. 1237)
• blepharitis (p. 1234)
• myopia (p. 1237)
• presbyopia (p. 1222)