NUR 229 Study Guide - Final Guide: Intraocular Pressure, Aqueous Humour, Eyepatch
21 May 2018
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Spring 2018: Exam 5 Study Guide
Sensory
1) Sensory Deprivation
2) Sensory Overload
3) Sensory Deficits
4) Factors Affecting Sensory
5) Safe Environments of Care (for pt. with sensory impairments)
1. Acute Care Setting:
6) Nursing Process
7) Assessment
8) Nursing Interventions/Implementation
9) Evaluation
10) Patient Teaching
11) Eye Diseases:
1. Glaucoma
▪ What is it? Group of ocular conditions that is characterized by optic nerve damage
that does not have a balance of aqueous production vs. drainage; aqueous outflow
is blocked, cause build-up of eye → increased intraocular pressure
▪ Risk Factors: Increase in age, family history, eye-trauma, Myopia
▪ Clinical Manifestations: “Silent thief” because the pt. is unaware they have
glaucoma until they have significant vision loss (peripheral vision is affected)
▪ Medical Manifestations
• Beta-Blockers → Eye drops that decrease aqueous humorous production
• Cholinergics → Eye drops that cause pupil constriction which increases the
aqueous fluid outflow
▪ Nursing Management: Make sure pt. knows about disease; no cure, life-long
treatment; know what IOP goal is (won’t be normal but should be set by
ophthalmologist)
2. Cataracts
▪ What is it? Cloudiness or opacity of the lens that is painless and forms slowly
▪ Risk Factors: Increase in age, trauma to eye, diabetic
▪ Clinical Manifestations: Painless, complain of blurry vision, may see ‘glares’,
may complain of poor night-vision, may see halos around objects
▪ Medical Management
• Surgery: Done when it starts to interfere with the patient’s ADLs; surgery is
done in outpatient clinic & lasts less than 1 hour; break up cataract, suck it
out & put a new lens in
o Pre-Op: check electrolytes, make sure H&H is up;
o Post-Op: wear eye-patch after surgery and metal shield at night
for a few weeks; can wear glasses, avoid heavy lifting/pulling
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(not more than 15 lbs.) because it causes an increase in IOP
and can cause trauma to the incision site
▪ Nursing Management: Tell pt. if they see any abnormal flashing lights,
redness/swelling, pain in eye, large amount of drainage → Call HCP because it
can indicate infection
3. Age-Related Macular Degeneration: Central Vision is most commonly affected
▪ What is it? Most common in people 60+ yrs.
• Dry/Non-Exudative → Slow breakdown in layers of retina; when the pt. tries
to read something it is blurry or can show no symptoms
• Wet Type → Abnormal blood vessels that grow under the retina; pt. will look
at straight lines that appear crooked to them, & letters/words will look broken
up to them
▪ Medical Management: Different types of surgery; eventually the pt. will become
legally blind over time
▪ Nursing Management: Amsler Grid: Look at the grid of straight lines several
times of day with and without glasses; if it appears distorted/crooked, see
opthalmologist for interventions
• Goal: Preserve as much vision as you can even though they will eventually
be declared legally blind
4. Retinal Detachment (Different Types)
▪ What is it? Separation of retinal pigment epithelial
▪ Clinical Manifestations: Pt. may report of sensation of shade/curtain coming
across the eye, ‘cob webs’ on their vision, bright flashing lights; sudden onset of
large number of ‘floaters’ or black spots in vision; pt. doesn’t complain of pain
▪ Surgical Management: Depends on type but know that the pt. will need to have a
surgical intervention eventually or they will go blind in their eye
▪ Nursing Management: Teach about post-op complications; tell HCP if there is an
increase in drainage, pain, swelling because it can be a sign of infection; pt. can
develop an increase in IOP (can result in glaucoma), retinal detachment, or
cataracts can occur
Diabetes
1) Classifications:
o Type I: Caused by the destruction of pancreatic beta cells; pt. requires insulin because
little/no insulin is being produced by the pancreas; Causes: viruses, genetics
o Type II: More common in people 30+ yrs. old but is being seen in children due to
obesity epidemic; if someone has a history of gestational diabetes they can develop
Type II later, Develop insulin resistance; impaired beta-cell function that results in a
decrease in insulin production
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o Prediabetes: Blood sugar that is higher than normal but is not high enough to be
classified as type II; pt. must engage in healthy lifestyle changes: healthy eating,
physical activity; if it doesn’t then they will develop type II diabetes within 10 years
o Gestational: Diabetes that occurs during pregnancy but once you deliver, it goes away
2) Clinical Manifestations: Polyuria, Polydipsia (constantly thirsty) & Polyphasia (constantly
hungry); pt. can complain of fatigue/weakness; vision changes; wounds are slower to heal
o Type I: Sudden weight loss due to muscle tissue/fat that is being broken down to
provide energy for the cells
3) Diagnostic Findings:
o Fasting Blood Glucose: Can’t eat/drink anything for 8 hours before the test; you have
a blood sugar greater than 126, you need to
o Random Glucose: Average is 79-160; 160-200 is pre-diabetes and > 200 is diabetes
o HgB A1C: Reflects the average blood sugar in the past 2-3 months; used to monitor
someone who is diabetic; measures what % of hemoglobin is coated with sugar
▪ Normal Range: 4-5%; Risk: 5.1-6.4%; Diabetic: 6.5%+
4) Overall goal/Education: Decrease the development for further complications/diseases
(chronic illness)
5) Dietary management goals
o Meal Planning: Take into consideration when the pt. eats, their preferences, lifestyle,
cultural considerations with the food they eat
o Exchange List: Understand the 6 main lists (they can only have so many of each per
day: bread, starch, meat, veggies, fruits, milk, fat)
o Nutrition Labels: Know how to read nutritional labels; how many grams of
carb/serving of food so they know how much insulin they get
o Alcohol: Hypoglycemia → when someone drinks heavily, they forget to eat, alcohol
can block the liver from releasing stored glucose into the blood stream; tell the pt. if
they’re going to drink, they need to eat & keep the same meal plan
o Nutritive Sweeteners: Fructose, Sorbedol, “fake sugars” have few to no calories but
people still need to read the labels because they have types of sugars in them even
though it says, “sugar free”
6) Exercise
o Lowers blood sugar, aids in weight loss, get them on exercise regimen; make sure the
get seen by HCP to see if they have risk factors (CV disease, obesity, smokers, HTN)
before exercising → if not, they might have a heart attack; tailor exercise to meet the
individual’s needs
o Precautions: Person needs to understand they may have to adjust their insulin based
on their exercise; eat carb snack; they can develop hypoglycemia before, during, or
up to 3 hours after exercising, they need to carry snack with them; check blood sugar
before/during/after exercise
o Exercise recommendations: Ideally, a person should engage in regular exercise. A
slow, gradual increase in the exercise period is encourage. For many patients, walking
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