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inflammation of the eye
conjunctivitis
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what can cause conjunctivitis
bacterial or viral infection
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is conjunctivitis contagious
yes.. readily contagious
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what can cause conjunctivitis but not be contagious
allergens/irritants
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what does PERRLA stand for
- P upils
- E qual
- R ound
- R eactive
- L ight
- A ccomodation
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what happens during accomodation
- 1. lens thicken
- 2. pupils constrict
- 3. eyes converge
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what thickens during pupil dilation
iris
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if the eyes fail to respond to light, what might this indicate
- 1. optic nerve problem
- 2. major neurologic prob
- 3. retinal damage
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if the eyes fail to respond to accomodation, this may indicate.....
neurological probs
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failure of the eyes to respond to both ACCOMODATION and LIGHT can be related to what condition
diabetes mellitus
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treatment for allergic conjunctivitis
instillation of vasoconstrictors and corticosteroid eye drops
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what's an important teaching for women pts with conjunctivitis
avoid using make up around the eye until all sx have subsided
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bacterial conjunctivitis aka?
pink eye
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manifestations of allergic conjunctivitis
edema, burning sensation, engorgement fo blood vessels (blood shot appearance), excess tears, itching
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manifestations of bacterial conjunctivitis
blood vessel dilation, mild conjunctival edema, tears, discharge
the discharge is watery at firstm then becomes thicker w/ shreds of mucus
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treatment for bacerial conjunctivitis
topical abx
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#1 teaching for pts with conjunctivitis?
HANDWASHING!
prevent spreading
avoid sharing wash cloths and towels
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this is a chronic bilateral scarring form of conjunctivitis
trachoma
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What causes trachoma?
Chlamydia Trachomatis
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This is the chief cause of preventable blindness in the world
trachoma
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What climate are the incidences of Trachoma highest?
tropical climates
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Trachoma is an endemic in w/c parts of the world?
middle east, parts of africa and asia
*poor sanitation
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is trachoma contagious?
yes
*proper handwashing again!
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How is Trachoma treated
Tetracycline or erythromycin will cure infection
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nursing intervention of Trachoma includes:
- 1.i nfection control
- 2. proper handwashing
- 3. no sharing washcloths, separate launder
*complete course of abx
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Incubation period of trachoma
5 - 14 days
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manifestations of trachoma
at first it resemble bacterial conjunctivitis: tears, photophobia, edema of eye lids and conjunctiva
follicles form on the upper eyelid conjunctiva
as the disease progresses, the eyelid scars and turns inward
causes the eye lashes to damage the cornea
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Common complaint of those with cataracts?
cloudy vision
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how do cataracts form?
age --> lose water in lense --> increase density (from compresed older lens fibers and new fibers) --> lens proteins dry out and form crystals
as density of lens increase --> lens becomes opaque w/ painless loss of transparency
*most age related are bilateral w/ no pain
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what vision is lost first with cataract formation
peripheral vision first
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are cataracts only age related?
no
may be present at birth, may develop anytime
may be age related (lens water loss and fiber compaction)
or caused by trauma (penetrating eye injury, intraocular forein bodies, radiation exposure) or exposure to toxic agents (corticosteroids, moitic agents, phenothiazine derivatives)
may occur with other disease or ocular disorders (dm, hypoparathyroidism, downs, chronic sunlight exposure)
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teaching for preventing cataract formation
- wear sunglasses
- limit uv lights in eyes
- wear protective gear during sports
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can cataracts cause blindness?
yes, without surgical intervention
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whats important to know about age related cataracts
no pain or eye redness
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what is the only cure for cataracts
surgery
impanted lens, glasses or contact lens
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post surgery care for cataracts?
abx stat
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after cataract surgery a pt has a blood shot appearnce and mild itching. is this an emergency?
no, it's normal
the eye lid may be slightly swollen
**it's not normal to have significant swelling and bruising
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pain early after cataract surgery may indicate what?
- complications:
- increased IOP
- hemorrhage
- w/ n/v
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important teachings post cataract surgery?
- 1. avoid increased IOP:
- bending from waist
- lifting >10lbs
- blowing nose, coughing, vomiting
- straining for bm
- tight collars
- 2. s/s of infection:
- redness in eye
- change in visual acuity
- tears
- photophobia
- creamy white dry crusty discharge
- yellow green drainage
**** vision should improve not get worst, best to call doctor if it worsens
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normal intraocular pressure?
10-21 mm/hg
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if someone has IOP of >21?
increase IOP
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what measures the pressure in the eyes
tonometry
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what are complications of increased IOP
perfusion is decreased --> ischemia
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This is a group of ocular disease resulting in increased IOP
glaucoma
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what causes the increased IOP in glaucoma
imbalnce between production and outflow of aqueous humor
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visual loss for glaucoma is irreversible. why?
due to increased IOP, pressure is put on the blood vessels in the eyes w/c prevents blood flow.
this results in poor oxygenated photoreceptors
these sensitive nerve tissues become ischemic and die
when too many have died, sight is lost and permanently blindness occurs
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what are the primary risk factors for developing glaucoma
age and race
- also: trauma, dm, htn
- (anything that can affect cappillaries and outflow)
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What eye drug do we not want to give to someone with glaucoma?
atropine (mydratics)
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Why wouldn't we want to give mydriatics (atropine) to someone with glaucoma?
this will dilate eyes and further increase IOP
*remember glaucoma pts already have an issue with increased IOP
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2 types of glaucoma?
- 1. open angle
- 2. angle closure
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of the two types of glaucomas, w/c type is an emergency
angle closure
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why would ANGLE-CLOSURE GLAUCOMA be an emergency?
it has sudden onset and can cause blindness in 1-2 days
- *the angle narrows or closes completely:
- -corneal flattening
- -lens thickening with accomodation
- -iris thickens w/ dilation
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w/c medications are used in ANGLE CLOSURE GLAUCOMA to "buy time"
- diuretics (help get fluids off)
- mannitol
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What is the treatment for ANGLE CLOSURE GLAUCOMA
ONLY SURGERY! this is an EMERGENCY!
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what med is given to decreased IOP before surgery?
diamox (carbonic inhydrase inhibitors)
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OPEN ANGLE GLAUCOMA is painful. t or f?
false
*angle closure glaucoma is painful because it has sudden onset
*open angle is slow and painless
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w/ OPEN ANGLE GLAUCOMA, what vision is slowly lost? central or peripheral?
peripheral
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with OPEN ANGLE GLAUCOMA, the angle between the cornea and iris is normal. It's the flow between the __ and the ___ that is obstructed
canal of schlemm and trabecular meshwork
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EYE MEDS
1. adrenergics do what?
- decrease aqueous humor production &
- attempt to increase out flow
ex. epinephrine
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EYE MEDS
2. carbonic anhydrase inhibitors
inhibit/decrease production of aqueous humor
ex. diamox
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EYE MEDS
3. cholinergics (miotics)
- increase drainage of aqueous humor
- (constrict pupil)
book: decrease amt of aquaous humor production
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EYE MEDS
4. beta-blockers
decrease rate at w/c fluid flows into the eye
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EYE MEDS
5. prostaglandins
increase outflow of aqueous humor
book: dilate blood vessels w/c increase absorption
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where are the photoreceptors of the eyes
in the retina
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what is the retina's job?
the retina contains photoreceptors of the eyes
they allow for perception of light, image transmission
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if the retina is detached, what does vision look like
spots, lines, flashes, floaters, blurred
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what can cause retina detachment
trauma or age
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how is the retina detachment managed?
surgery!
- cyryotherapy (freezing)
- photocoagulation (laser)
- diathermy (high freq current)
*common repair procedure is scleral buckling
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post retinal surgery teaching
avoid reading, writing, close work (sewing) in first week to avoid rapid eye movement and promote detachment
infect (loss of visual acuity, pain, pupil no response to light)
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diabetic retinopathy is related to ____ control
glycemic
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what happens to the capillaries of the retina in diabetic retinopathy
they become sclerotic and lose their ability to transport o2 and other nutrients (decreased perfusion)
can cause ischemia
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those with diabetic retinopathy have increased risk for what
retinal detachment
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what is done to treat diabetic retinopahty
laser photocogulation to treat
*this slows process, but DOES NOT CURE
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the area of central vision is the what?
macula
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there are 2 types of macular degeneration
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which of the 2 types of macular degeneration is an emergency
wet
because is consists of weak and leaky blood vessels which can cause blockage of capilaries and blood flow
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what happens with dry macular degeneration
the macula shrinks and and has deposits
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what is the treatment for dry macular degeneration? wet?
dry - antioxidants
wet - surgery
*no cure, but slows process
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which of the two macular degenerations is slower
dry
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what vision is lost with macular degeneration? central or peripheral?
central
peripheral remains
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wet macular degeneration is also known as?
exudative
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