________________________________________________________ Chapter 53 Eye and Vision Disorders 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.2
Assignments 2 hours
5
READ – Textbook (pp. 1234-1247)
REVIEW
• Figure 53-13: Eversion of the eyelid (p. 1235)
• Figure 53-14: Keratoplasty (p. 1236)
• Figure 53-15: Keratoplasty, appearance of the eye after surgery (p. 1236)
• Figure 53-16: Refraction (p. 1237)
• Figure 53-17: Methods of cataract extraction (p. 1239)
• Table 53-3: Drug Therapy: Glaucoma (pp. 1243-1244)
ANSWER – Text
• Review Questions for the NCLEX Examination: 7, 8, 9, 10 (pp. 1248-1249)
ANSWER – Study Guide
• Part IA: 3-6, 9, 12 (p. 363)
• Part IB: 1-6 (p. 364)
• Part IID: 2, 17, 18, 20-25, 27 (pp. 364-367)
• Part IIE: 1-7 (p. 367)
6
READ – Textbook (pp. 1231-1247)
REVIEW
• Figure 53-11: Escorting a visually impaired person (p. 1232)
• Figure 53-12: Glare perceived by a person with normal vision and an older person (p. 1233)
• Nursing Care Plan 53-1: Patient Having Cataract Surgery (p. 1241)
ANSWER – Text
• Review Questions for the NCLEX Examination: 6 (p. 1248)
ANSWER – Study Guide
• Part IIIF: 1-5, 10 (pp. 367-368)
• Part IIIG: 1-4 (p. 369)
16 Chapter 53 Eye and Vision Disorders ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.2
50-Minute Lesson Plan
Lecture Outline 20 minutes
6
Slide 19
Effect of Visual Impairment
• Mild losses may require only some adaptations
• Serious losses affect independence, mobility, employment, and interpersonal
relationships
TALKING POINTS:
• What reactions are likely to follow loss of vision?
• If grief is resolved in a healthy manner, adaptation and acceptance eventually occur.
Slide 20
Care of the Visually Impaired Patient
• Be aware of visually impaired person’s thoughts and feelings about handicaps
• Assume that people with visual impairments can be independent and productive
• The person needs help with some tasks but should be treated as an adult
• The extent of vision loss determines the types of assistance needed
• Plan care considering whether the impairment is temporary, permanent, correctable,
treatable, or will progress.
TALKING POINTS:
• Trauma, disease, and some congenital defects account for visual handicaps throughout
the life span.
• Pity has no place in this situation because it encourages hopelessness and helplessness.
Slide 21
Care of the Visually Impaired Patient (cont.)
• Interventions
• Disturbed sensory perception
• Ineffective coping
• Self-care deficit
• Ineffective self-health management
TALKING POINTS:
• How can the nurse promote patient safety and dignity?
5
&
Blepharitis
• Inflammation of hair follicles along eyelid margin
________________________________________________________ Chapter 53 Eye and Vision Disorders 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.2
Slide 23
Hordeolum
• Commonly called a stye
• Common acute staphylococcal infection of the eyelid margin that originates in a lash
follicle
Slide 24
Chalazion
• Inflammation of the glands in the eyelids
• Swelling prevents fluid from leaving the glands, causing tenderness
• Warm compresses may bring some relief
• Provider may order antibiotics if infection, or may administer a corticosteroid injection into
the chalazion
Conjunctivitis
• Inflammation of the conjunctiva caused by microorganisms, allergy, or chemical irritants
• Bacterial conjunctivitis commonly called pinkeye
TALKING POINTS:
• If inflammation is caused by an infectious agent, the infection can be passed from one
Slide 26
Conjunctivitis (cont.)
• Viral conjunctivitis caused by herpes simplex virus type 1, herpes zoster virus, or
adenoviruses
• Characterized by redness and drainage
• Round, raised white or gray areas on the conjunctiva
• Infections caused by herpes simplex virus type 1 are treated with ointments or other
topical medications
TALKING POINTS:
• Viral infections tend to persist longer than bacterial infections.
• What other organisms can cause conjunctivitis?
18 Chapter 53 Eye and Vision Disorders ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.2
Slide 27
Keratitis
• Inflammation or infection, or both, of the cornea
• From bacteria, viruses, fungi; chemical or mechanical injuries cause inflammation that
may be followed by infection
• No noticeable drainage, but considerable pain
TALKING POINTS:
• Why are topical anesthetics not used?
• Eye pads are not used with keratitis because they provide a dark, damp environment for
microorganisms to grow.
Slide 28
Entropion
• The lower lid turns inward
• Eyelashes rub against the eye, causing pain and possibly scratching the cornea
• Surgical correction usually recommended
Slide 29
Ectropion
• The lower lid droops and turns outward
• The eye does not close completely, causing it to become dry and irritated
• The dry cornea is easily injured
• Requires surgical correction
• If object not embedded, it usually clings to swab and can be removed
Foreign Body
• Blinking/tearing wash small irritants from eye
• If object is embedded, it should be removed only by a provider
Slide 31
Corneal Opacity
• Inflammation and infection
• When cornea injured by infection or trauma, scar tissue may form
• If scar tissue prevents light from entering the eye, varying degrees of vision
impairment occur
• Only treatment is keratoplasty (removal of the scarred cornea and replacement with a
healthy cornea)
• During keratoplasty, damaged cornea removed first
TALKING POINTS:
• A healthy cornea is clear, allowing light to enter the pupil.
• What are the two types of grafts used in keratoplasty?
________________________________________________________ Chapter 53 Eye and Vision Disorders 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.2
Slide 32
Care of the Patient Having Keratoplasty
• After surgery, the patient who has had a keratoplasty has an eye pad and a metal shield
over the operative eye
• Corticosteroid eyedrops may be ordered to reduce inflammation
Slide 33
Care of the Patient Having Keratoplasty (cont.)
• Assessment
• Inspect dressing for drainage and ask if patient has pain or nausea
• After dressing is removed, inspect for corneal opacity
• Also evaluate the patient’s visual acuity
• Interventions
Slide 34
Myopia
• The medical term for nearsightedness
• The lens is situated too far from the retina
• Light rays come together to focus in front of the retina
• People with myopia have difficulty seeing distant images clearly
• New glasses needed approximately every 2 years
TALKING POINTS:
• When is myopia often recognized?
Slide 35
Hyperopia
• Commonly known as farsightedness
• The lens is too close to the retina
• Light rays come together behind the retina
• The hyperopic person sees clearly in the distance but has difficulty focusing on close
objects
• Convex corrective lenses needed
Slide 36
Astigmatism
• Irregularities in the cornea or lens
• If condition is mild, the natural lens can correct for the abnormality
• If severe, vision is distorted, and corrective lenses are needed
Presbyopia
• Poor accommodation due to loss of elasticity of the ciliary muscles
• Accommodation: adjustment of the lens for near and distant vision
TALKING POINTS:
• How is accommodation accomplished?
• Presbyopia is usually considered a normal age-related change.
20 Chapter 53 Eye and Vision Disorders ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.2
Slide 38
Medical Treatment
• Corrective lenses for errors of refraction
• Eyeglasses
• Contact lenses
• Surgical treatment
• Photorefractive keratectomy (PRK)
• Laser in situ keratomileusis (LASIK)
• Nursing care
• Encourage periodic examinations and know if the patient uses corrective lenses
TALKING POINTS:
laser is used to reshape the middle layer of the cornea.
Slide 39
Cataract
• Lens opaque (cloudy); no longer transparent
• Causes: congenital, traumatic, degenerative
• Pathophysiology
• Injuries cause opacity rapidly, whereas age-related opacity progresses slowly
TALKING POINTS:
• Congenital cataracts are those that are present at birth.
• Traumatic cataracts are caused by chemical, mechanical, heat, or radiation injury.
Slide 40
Cataract (cont.)
• Complications
• Leakage of vitreous humor, hemorrhage into the eye, and opening of the incision
• Lens replacement
• Cataract eyeglasses
• Contact lenses
• Intraocular lenses
TALKING POINTS:
• What does aphakic mean?
• Cataract eyeglasses magnified objects so much that the patient also had poor depth
________________________________________________________ Chapter 53 Eye and Vision Disorders 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.2
Slide 41
Care of the Patient with Cataracts
• Preoperative care
• Drops used before cataract surgery are mydriatics, cycloplegics, antibiotics, and
nonsteroidal antiinflammatory agents
Slide 42
Care of the Patient with Cataracts (cont.)
• Postoperative care
• Assessment
• Pain and nausea
• Patient is likely to wear a patch and shield over operative eye
• Note any drainage
• Also note level of consciousness and orientation
• Interventions
• Risk for injury
• Disturbed sensory perception
Slide 43
Glaucoma
• Pathophysiology
• Intraocular pressure is above normal
• Caused by interference with outflow of aqueous humor
TALKING POINTS:
• Glaucoma is one of the leading causes of blindness in the United States.
• Normally, aqueous humor enters and leaves the anterior chamber so that intraocular
pressure is maintained between 10 and 21 mm Hg.
• Why does the increased pressure cause vision impairment?
Slide 44
Types of Glaucoma
• Open-angle glaucoma
• Prevents the normal passage of aqueous humor through the trabecular meshwork
• Usually there are no signs and symptoms at first
Slide 45
Glaucoma (cont.)
• Surgical procedures
• Trabeculoplasty: tried first, local anesthesia, as outpatient surgery. Laser creates
multiple holes in trabecular meshwork to improve drainage of aqueous humor
• Trabeculectomy: creates a channel to allow aqueous humor to drain under the
conjunctiva
22 Chapter 53 Eye and Vision Disorders ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.2
Slide 46
Glaucoma (cont.)
• Angle-closure glaucoma
• Flow of aqueous humor through the pupil is blocked
• Pressure forces iris forward; blocks trabecular meshwork
• Rapid rise in intraocular pressure; if not lowered promptly, permanent blindness can
result
• Signs and symptoms: sudden, acute pain; blurred vision, halos around lights, nausea
Slide 47
Glaucoma (cont.)
• Surgical procedures
• Iridotomy or iridectomy: creates opening in the iris to permit aqueous humor to flow
Slide 48
Glaucoma (cont.)
• Assessment
• Collect data about patient knowledge of the disease and treatment and patient ability
to carry out self-care
• Interventions
• Risk for injury
• Fear
• Ineffective self-health management
• Acute pain
Slide 49
Retinal Detachment
• Pathophysiology
• Separation of sensory layer from pigmented layer
• Begins when a tear in the retina allows fluid to collect between the sensory and
the pigmented layers
• The fluid causes the two layers to separate
• Separation deprives sensory layers of nutrients and oxygen that normally are
supplied by the blood vessels in the choroid
• Leads to damage to the nerve tissue in the sensory layer and resultant partial or
complete loss of vision
• Retinal tears may occur spontaneously or as a result of trauma
• Some patients say it seems as if a curtain has come down or across the line of vision
Retinal Detachment (cont.)
• Signs and symptoms
• Depend on location and extent of detachment
________________________________________________________ Chapter 53 Eye and Vision Disorders 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.2
Slide 51
Retinal Detachment (cont.)
• Medical and surgical treatment
• Laser photocoagulation
• Cryotherapy
• Scleral buckling
TALKING POINTS:
• Most holes or tears must be sealed promptly.
• Laser photocoagulation
• The intense light burns the detached portion of the retina.
Slide 52
Retinal Detachment (cont.)
• Nursing care
• Before corrective measures, the patient usually is placed on strict bedrest with the
head elevated
• Postoperative care essentially the same as for other patients undergoing eye surgery
TALKING POINTS:
• What positions may be prescribed for the different procedures?
Slide 53
Senile Macular Degeneration
• Changes in the eye cause the macula to degenerate
• Both eyes usually affected
• Two types
• Dry (strophic)
• Abnormal blood vessels develop in or near the macula resulting in loss of vision in
a specific area
• Wet (exudative)
TALKING POINTS:
24 Chapter 53 Eye and Vision Disorders ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.2
Slide 54
Enucleation
• Removal of the eye
• From injury, infection, sympathetic ophthalmia, and some glaucomas and malignancies
• Postoperative: observe for excessive bleeding or increasing pain
TALKING POINTS:
• What steps should be followed to remove and clean a prosthesis?
Activities
Online
5
DISCUSS
• Discuss symptoms of external eye disorders
and treatments.
• Discuss symptoms of disorders of the
cornea and treatments.
• Discuss symptoms of errors of refraction and
treatments.
• Discuss symptoms and treatments of
internal eye disorders, cataracts, glaucoma.
PRACTICE
• Divide the board into five sections: Disease
or Disorder, Pathophysiology, Signs and
Symptoms, Diagnosis, Treatment. Calling on
individual students in turn, ask each student
to fill in at least one section for each of the
following conditions:
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to conduct an image search for pictures of
assigned eye disorders. The students should
discuss characteristics of the eye disorders.
• Post the following discussion topic online
and have students comment. Ask students
to prepare an online publication explaining
________________________________________________________ Chapter 53 Eye and Vision Disorders 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.2
6
DISCUSS
• Discuss the general requirements of a
nursing care plan for a patient with an eye or
PRACTICE
• In small groups, have students discuss and
identify appropriate goals and interventions
for the following nursing diagnoses for a
patient having cataract surgery:
• Risk for injury related to increased
intraocular pressure and trauma
condition, self-care, and limitations
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Ask students
may write material suitable for online
publication for patients who will be
undergoing a specific type of surgery. Ask
students to provide constructive comments
on each other’s videos or online publication.
Critical Thinking Question
A nurse is assigned to care for a 23-year-old construction worker who is scheduled to have
a repair of a retinal detachment. The patient is extremely anxious and says he has never
been so scared in his life. He tells the nurse that the surgeon explained everything, but he
wants her to again explain what a retinal detachment is, and asks her if he will be able to
return to his job. How should the nurse respond as she reinforces the surgeon’s teaching
while also trying to minimize the patient’s anxiety?
Discussion Guidelines: The nurse can begin by describing the retinal detachment as a separation
26 Chapter 53 Eye and Vision Disorders ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 53.2
Instructor Notes/Student Feedback
________________________________________________________ Chapter 53 Eye and Vision Disorders 27
Introduction to Medical-Surgical Nursing, 6th ed.
53
Assessments for
Eye and Vision Disorders
CHAPTER 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.
Assessments by Lesson & Objective
Lesson 53.1
1
Study Guide
• Part IA: 11 (p. 363)
• Part IC: 1-15 (p. 364)
• Part IID: 1 (p. 364)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 1, 2, 9
2
Study Guide
• Part IA: 1, 8 (p. 363)
• Part IID: 2-8, 15, 16 (pp. 364-365)
Evolve Instructor Resources
• Test Bank: 7, 8, 11
• Open Book Quiz: 1, 2
Evolve Student Resources
• Prioritization: 4, 5
3
Study Guide
• Part IA: 2, 7, 10 (p. 363)
Evolve Instructor Resources
• Test Bank: 9, 10, 29
• Open Book Quiz: 3, 4
Evolve Student Resources
• NCLEX Review: 5, 7
28 Chapter 53 Eye and Vision Disorders ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
4
Study Guide
• Part IID: 13 (p. 365)
Evolve Instructor Resources
• Test Bank: 12
Lesson 53.2
5
Study Guide
• Part IA: 3-6, 9, 12 (p. 363)
• Part IB: 1-6 (p. 364)
• Part IID: 2, 17, 18, 20-25, 27 (pp. 364-367)
• Part IIE: 1-7 (p. 367)
Evolve Instructor Resources
• Test Bank: 1, 18-25
• Open Book Quiz: 6-10
Evolve Student Resources
6
Study Guide
• Part IIIF: 1-5, 10 (pp. 367-368)
• Part IIIG: 1-4 (p. 369)
Evolve Instructor Resources
Instructor’s Notes/Student Feedback