VISUAL AND AUDITORY PROBLEMS 02 - NCLEX REVIEW

1.      Visual and Auditory Problems

The most common visual problem is ___________.	Refractive error
This visual defect prevents light rays from converging into a single focus on the retina...	Refractive errors (myopia, hyperopia, presbyopia, astigmatism, amblyopia and aphakia)
What are some causes of refractive errors? (3)	Corneal curvature, focusing power of the lens, or the length of the eye
Which type of refractive error is the most common?	Myopia (near-sightedness)
A client complains of blurred vision and a sensation of straining to see. He also states that he's been experiencing headaches lately. What is most likely going on?	He has a refractive error like myopia, presbyopia, etc. Blurred vision is the most common sign, followed by ocular discomfort, eye strain and headaches.
What is the difference between presbyopia and hyperopia?	Hyperopia is farsightedness, Presbyopia is farsightedness due to a decrease in the accommodative ability of the eye that results from aging.
________ is a condition that can develop in children with refractive errors that go uncorrected. It is characterized by reduced vision in the affected eye.	Amblyopia
Refractive errors in children don't produce further pathology (if uncorrected) after age _____.	6
_______ causes light rays to be focused in front of the retina and can be caused by excessive light refraction of the cornea or an abnormally long eye. There is an inability to accommodate for objects at a distance.	Myopia
_________ causes light rays to focus behind the retina and requires the patient to use accommodation to focus the light rays for near and far objects. This can occur when the cornea or lens doesn't have enough focusing power or when the eyeball is too short.	Hyperopia
________ occurs when the lens of the eye becomes larger, firmer and less elastic. The eye's accommodative abilities decrease and there's an inability to accommodate for near objects.	Presbyopia (starts to develop around age 45)
________ is caused by an abnormal corneal curvature and causes light rays to be bent unequally. The light rays don't come to a single point of focus on the retina. This can occur with any of the other refractive errors.	Astigmatism
The absence of the lens of the eye is called ________. It can occur congenitally or surgically (as with cataract surgery). This causes an image to be focused behind the retina.	Aphakia
What is functional aphakia?	A lens that is traumatically dislocated but still in the eye.
Between Caucasians, African Americans and Asian Americans, who has the highest incidence of hearing problems?	Caucasians
Between Caucasians and African Americans, who has the highest incidence of glaucoma?	African Americans
Which ethnicity has the highest incidence of diabetic neuropathy?	Hispanics
Between Caucasians and Native Americans, who has a higher incidence of otitis media?	Native Americans
Between Caucasians, Hispanics, African Americans and Asian Americans, who has the highest incidence of macular degeneration?	Caucasians
Which refractive error requires a corrective minus (concave) lens?	Myopia
Which refractive errors require a plus (convex) corrective lens?	All of them except for myopia
You are seeing a client who wears bifocals. You know that the portion of the lens that allows them to see close up (presbyopic correction) is the _______.	Bottom
Glasses to correct ________ errors are very thick, magnify images by 25%, and are heavy. Surgical procedures have reduced the need for these glasses to be worn.	Aphakia
You have a client that wears contact lenses and is on birth control. What should you tell them?	Use of birth control pills may decrease tear production and cause discomfort while wearing contacts.
What types of medications can cause discomfort for people wearing contacts, and why?	Antihistamines, decongestants, diuretics, and birth control pills. They decrease tear production.
A client who is in her second trimester comes in complaining that her contacts have really started to hurt her eyes and she's wondering if she needs new ones. What do you tell her?	The hormones from pregnancy can cause decreased tear production and make wearing contact lenses uncomfortable.
What does the mnemonic RSVP stand for with respect to visual health?	Redness Sensitivity Vision Problems Pain (when to see a doctor for contact lens wearers)
What information should a nurse collect from patients that wear contact lenses?	The pattern of wear (daily vs. extended) Care practices
Shining a light obliquely on the eyeball can help a nurse visualize a __________.	Contact lens (important in an emergency assessment)
A client who wears contacts comes in and visual inspection of the ocular area reveals redness. The client says their vision has been blurry and their eyes have been sensitive and really hurting. What is the first thing you should do?	Have them remove the contact lens immediately
___________ is the use of specially designed, rigid, gas permeable contact lenses to alter the shape of the cornea. It requires progressively fitting flatter rigid contact lenses and regular wearing of retainer lenses to maintain corneal shape.	Corneal molding/orthokeratology
What refractive errors does corneal molding/orthokeratology correct?	Myopia/Astigmatism
What does LASIK stand for?	Laser assisted in-situ keratomileusis
What is the major difference between LASIK and PRK surgeries?	In PRK, the epithelium of the cornea is removed. In LASIK, it is replaced after the cornea is sculpted.
This procedure involves using a laser or surgical blade to create a thin flap in the cornea and a wave front map is used to sculpt the cornea and correct a refractive error. Once the error is corrected, the flap is repositioned and adheres to the eye without sutures in a few minutes...	LASIK
This procedure involves using a laser or surgical blade to remove the epithelium over the cornea and then sculpting the cornea to correct a refractive error.	PRK
A client comes in wanting laser corrective surgery. During the assessment, it is noted the client has a thin cornea. Which type of surgery, LASIX or PRK is best suited for this client?	PRK (you need sufficient corneal thickness for LASIX)
What is ICR Irelated to the eyes) and who is a candidate for it?	ICR=Intracorneal ring, people with mild myopia benefit from this procedure
This procedure involves the implantation of two semicircular pieces of plastic between the layers of the cornea.	ICR/Intracorneal Ring Segments
This procedure involves removal of a client's natural lens and implantation of a small plastic lens.	Refractive IOL (Intraocular lens)
Refractive intraocular lenses are an option for clients with what type of refractive errors?	A high degree of myopia or hyperopia. New ones can correct both myopia and presbyopia.
Of all the surgical therapies available for correcting refractive errors, which one has the most risks, and why?	The refractive intraocular lenses because they actually enter the eye
This procedure involves implanting a lens in front of the eye's natural lens.	Phakic IOLs (intraocular lens). Also referred to as implantable contacts
Phakic intraocular lenses are a procedure for people with what type of refractive errors?	High degrees of myopia and hyperopia. It allows for the natural lens to adjust for reading vision.
These procedures involve using a laser or high radio frequency to apply heat to the peripheral area of the cornea to tighten it and make the central cornea steeper. It is performed on one eye only to achieve monovision which allows one eye to see far, and one eye to see close up.	Laser thermal keratoplasty (LTK) and Conductive keratoplasty (CK)
Which eye is Laser thermal keratoplasty (LTK) and Conductive keratoplasty (CK) typically performed on?	The less dominant eye
What is used to ensure that a client will adapt well to a Laser thermal keratoplasty (LTK) or a Conductive keratoplasty (CK) procedure?	A preoperative trial with contact lenses that simulate the changes
Laser thermal keratoplasty (LTK) and Conductive keratoplasty (CK) are procedures for people who have _______ or _________ refractive errors.	Hyperopia or Presbyopia
What is the definition of a severe visual impairment?	An inability to read the newspaper even with corrective lenses.
T/F A person classified as having a severe visual impairment (legally blind) has no useful vision.	False. 91% of them have some useful vision
_______ blindness is defined as no light perception and no usable vision.	Total
________ blindness is present when a patient has some light perception but no usable vision.	Functional
What compensations can a person with total or functional blindness use for ambulation?	Guide dogs and/or canes
What are the 5 most common causes of blindness?	Cataracts, glaucoma, age-related macular degeneration, diabetic neuropathy, and corneal disease (like a herpes infection). Note: Disease causes the majority of blindness, trauma accounts for 4%.
Who sets the criteria for the designation of legally blind? What does it mean for the individual?	The federal government. It determines the level of federal and state aid as well as income tax benefits
What is the criteria to be considered partially sighted?	Visual acuity of 20/50 or worse in the better eye
What are some nursing diagnoses that may be used for people with visual impairments?	Disturbed sensory perception r/t visual deficit Risk for injury r/t visual impairment and inability to see potential dangers Self care deficits r/t visual deficit Fear r/t inability to see potential danger or accurately interpret environment Grieving r/t loss of functional vision
What are the 4 overall goals to keep in mind when planning interventions for clients with recently impaired vision or maladjustment to a long-standing loss of vision?	1-make a successful adjustment to the impairment 2-verbalize feelings r/t the loss 3-identify personal strengths and external support systems 4-use appropriate coping strategies
What is the goal for a client that has been functioning well with a visual impairment?	To maintain current level of function
What are the benefits of standard and gas permeable rigid lenses?	They last longer, corrects all types of refractive errors,
hat are the risks associated with standard rigid contact lenses?	Sleeping in them can cause corneal edema or severe pain from lack of oxygen to the cornea
How are gas permeable and standard rigid contact lenses different?	Standard: least expensive, requires adaptation time, can be tinted for easier visibility Gas Permeable: initially more comfortable than standard lenses, allows oxygen to pass through to the cornea, more expensive, allows for flexible wearing schedule
What is the biggest disadvantage of rigid lenses?	They require separate solutions for cleaning, storing, and wetting.
Soft lenses are placed over the _________ of eye, whereas hard lenses are over the _________.	Soft lenses are placed over the cornea and part of the sclera. Hard lenses are placed over the cornea (slightly smaller than the cornea)
What are the major disadvantages of soft lenses?	They are less durable than hard lenses. They are more expensive. They are more susceptible to surface protein deposition, and require cleaning, sterilizing and enzymatic removal of proteins
What are the advantages of soft contact lenses?	They are more comfortable than hard lenses, they cover more of the eye allowing for less invasion of foreign particles, they come in more varieties allowing for more customizability
Which style of soft contact lenses can cause corneal edema or severe pain from corneal oxygen deprivation if they are slept in?	Standard
Which style of soft contact lenses allows for more oxygen to reach the eye, allowing it to be worn for a week without removal?	High water content
Which style of soft contact lenses is used to correct astigmatism?	Toric
Which style of soft contact lenses decrease the risk of complications to the wearer?	Disposable and daily disposable lenses
Which style of soft contact lenses are commonly prescribed to new users, teenagers and/or travelers? Why?	Daily disposable. They are tossed daily and therefore require no cleaning or disinfection
Which soft contact lenses are ideal for extended wear?	High water content lenses and Toric lenses, some disposable lenses are extended wear
___________ and __________ may contribute towards the prevention of cataract development and age-related macular degeneration.	Wearing sunglasses and practicing proper nutrition
What is the best way to protect eyes during potentially hazardous work or while playing sports?	Wear goggles/eye protection (that's hot!)
What are important components of nursing care for a patient with recent visual impairment?	Active listening and facilitating
T/F When communicating with someone who is blind, it is unnecessary to make eye contact, facing the client is acceptable.	False. Making eye contact ensures the client has no difficulty hearing the nurse, validates the nurse is attentive to the client and allows the nurse to observe facial expressions and reactions.
How can a nurse facilitate independence and reduce anxiety and fear for a client who has a vision impairment and has just been admitted to his/her floor?	By orienting the client to the environment by verbally identifying one object as a focal point and relating objects around it. (I.e. the bed is just ahead of you in about 5 steps, the table is to the left, near the head of the bed and the call bell is to the right on the wall). In addition, the nurse should explain any sounds the client might hear.
What is the sighted-guide technique in reference to assisting a blind patient?	The nurse stands slightly in front of and to one side of the patient and offers and elbow to hold. The nurse walks slightly ahead and should describe the environment to orient the person.
How does the nurse assist a visually impaired client to sit in a chair?	Guide the person's hand to the back of the chair to orient them.
__________ is a simple technique involving telling a client to sit closer to a TV or to bring print closer to their face in order to see it better.	Approach management
________ techniques involve watching TV in black and white, placing dark objects against light backgrounds (like a white plate on a black placemat), using opposite colors to demarcate the edges of steps or curbs.	Contrast enhancement
Which type of lighting is most effective for partially sighted individuals? Fluorescent or Halogen?	Halogen (also direct sunlight or gooseneck lamps)
What are the overall expected outcomes for a client with visual impairment?	No further progression of vision loss, be able to express adaptive coping strategies, no decrease in self-esteem or social interactions and/or able to function safely within her/his own environment
What are some factors that can further affect an elderly person who has developed vision problems?	Concurrent deficits (like cognitive impairment, limited mobility), limited financial resources, societal devaluation leading to isolation/poor self esteem, decreased ability to perform ADLs
One of your elderly clients has been prescribed eye drops to help with her glaucoma. What should you assess prior to sending her home?	Her ability (manual dexterity) to instill the drops
What condition, concurrent with vision problems, increases the risk of falls in the elderly population?	Confusion
You are taking a walk when you hear a piercing scream. You decide to investigate and come across a child with something lodged in his eye. Someone has already called 911. What should you do?	Assess visual acuity, do not put pressure on the eye, tell the child NOT to blow their nose, stabilize the foreign object, cover the eye with dry, sterile patches and a protective shield (which you get immediately from the ambulance as it arrives) and don't give any food or fluids.
You are taking a tour of a chocolate factory when someone starts screaming, You got that crap in my eye! It's burning! Help! Help! You realize the person screaming has a chemical eye injury, what do you do?	Begin ocular irrigation immediately with a sterile, pH balanced fluid like saline. If none is available, you use water. Continue until emergency personnel arrive. Assess visual acuity, don't put pressure on the eye, instruct the person not to blow their nose, no food or fluids.
You have a patient that has been brought into the ER that has a significant eye injury. What should you do?	Reassure the patient, monitor their pain level and anticipate surgical repair for penetrating injury, globe rupture or globe avulsion (tearing). Elevate the head of the bed 45 degrees. Don't put anything into the eye unless the Dr. says to.
__________ is the most preventable cause of visual impairment.	Trauma
How can a nurse reduce the instances of preventable vision loss?	By educating the community/individuals about the importance of wearing protective eyewear during potentially hazardous work, hobbies or sports activities. Trauma is the number 1 preventable cause of vision loss.
What is the most common condition encountered by an ophthalmologist?	Inflammation/infection of the external eye
You have a client that was just diagnosed with a hordeolum. What instructions do you give that person?	Apply warm, moist compresses to the area at least four times a day until it improves. This is usually the only treatment, occasionally antibiotic ointments are prescribed. Hordeolum=sty
You have a client that is suffering from recurrent episodes of hordeolum. What should you teach them to do?	Perform daily eyelid scrubs
A _________ is a chronic inflammatory granuloma of the meibomian (sebaceous) glands of the eyelid. It can evolve from a hordeolum or be caused by the contents released during rupture of a blocked gland.	Chalazion
The doctor tells you to give care instructions to a patient diagnosed with a chalazion. You know to tell the patient to...	Apply warm, moist compresses to the area at least 4 times a day. If it doesn't resolve, the patient may need the doctor to surgically remove the lesion (office procedure) or inject it with corticosteroids.
________ is a common chronic bilateral infection of the eyelid margins. The lids are red rimmed with many scales/crusts along the margins and lashes.	Blepharitis
What are the signs/symptoms of blepharitis?	Reddened lid margins, crusts along lashes and lids, itching, burning, irritation, photophobia.
What condition can occur concurrently with blepharitis?	Conjunctivitis
What are the two types of blepharitis?	Blepharitis caused by staphylococcus and seborrheic blepharitis
__________ blepharitis is treated with antibiotic ointment.	Staphylococcus
_________ blepharitis is treated by shampooing the scalp and eyebrows.	Seborrheic (the client is given antiseborrheic shampoo)
If a client has both types of blepharitis and it goes untreated, what can happen?	They can develop a hordeolum, keratitis (inflammation of the cornea), or other eye infection.
You have a client with blepharitis and they are unsure how to remove the crusting and scaling around their lids and lashes. You recommend...	Gentle cleansing of the lid margin with baby shampoo
The _______ conjunctiva can develop conjunctivitis from contact lenses, an ocular prosthesis or other chronic foreign body in the eye.	Tarsal (interior lining of the lids)
What helps prevent the spread of conjunctivitis?	Hand washing and using individual/disposable towels
____________ conjunctivitis is more commonly known as pink eye.	Bacterial
What are the most common causative agents of bacterial conjunctivitis?	Staph aureus (most often in adults). Streptococcus pneumoniae & Haemophilus influenzae are also common agents (most often in children)
How is bacterial conjunctivitis treated?	It is self-limiting, requiring no treatment, however antibiotics shorten the course
What are the major differences in symptoms of bacterial vs. viral conjunctivitis?	Both present with tearing and redness Bacterial: irritation and mucopurulent drainage Viral: foreign body sensation, mild photophobia, can have increased discomfort and subconjunctival hemorrhaging
_________ conjunctivitis is a viral form that can be contracted from swimming pools or direct contact with someone that is infected.	Adenovirus
How is viral conjunctivitis treated?	Usually with palliative care, if pain is especially severe, can be treated with corticosteroids which provides relief but doesn't shorten the course.
___________ is a form of conjunctivitis which is caused by the Chlamydia trachomatis (serotypes A-C) and is a major cause of blindness throughout the world.	Trachoma
How is trachoma transmitted?	Through the hands and by flies
What type of conjunctivitis is caused by C. trachomatis serotypes D through K?	Adult inclusion Conjunctivitis (AIC)
Which type of chlamydial conjunctivitis is more prevalent in the US?	Adult inclusion Conjunctivitis (AIC)
Which type of chlamydial conjunctivitis is most commonly seen in underdeveloped countries?	Trachoma
What are the signs and symptoms of Adult inclusion Conjunctivitis (AIC)/Trachoma?	Mucopurulent ocular discharge, irritation, and swelling of the lids
How are trachoma and Adult inclusion Conjunctivitis (AIC) treated?	With antibiotics
You have a client that has just been diagnosed with Adult inclusion Conjunctivitis (AIC). As you are discussing their antibiotic treatment, you know you must also discuss...	The sexual implications of the condition, people with AIC have a high risk of concurrent chlamydial infections as well as other STDS. You should also include education about the ocular condition.
What is the defining symptom of allergic conjunctivitis?	Itching (although they can also have burning, redness, tearing, and white or clear exudate).
How is allergic conjunctivitis treated?	Avoid the allergen, use artificial tears to flush the allergen from the eye, and antihistamines or corticosteroids if extremely bothersome.
If allergic conjunctivitis is chronic, what can happen?	The exudate (which is normally white or clear) can become mucopurulent.
How is keratitis different from keratoconjunctivitis?	Keratitis involves only the cornea, keratoconjunctivitis involves the cornea and conjunctiva
________ is an inflammation or infection of the cornea that can be caused by a microorganism or other factors.	Keratitis
What are risk factors for bacterial keratitis?	Mechanical or chemical corneal epithelial damage, wearing contact lenses, debilitation (weakness), nutritional deficiency, immunosuppression or use of a contaminated product (like saline, cosmetics, etc.)
How is bacterial keratitis treated?	Usually with topical antibiotics. Severe cases can require subconjunctival antibiotic injections or IV antibiotics
What is the most common cause of infectious corneal blindness in the Western hemisphere?	Herpes Simplex virus (HSV). It is most commonly caused by HSV-1, but can be caused by HSV-2.
You are assessing a patient and notice they have a corneal ulceration that is dendritic. When the patient is questioned, he tells you he had conjunctivitis, but now he's experiencing more pain and the light is hurting his eyes. You strongly suspect that he has...	HSV keratitis (the dendritic corneal ulcer is characteristic)
How can a patient with HSV keratitis have a better chance at spontaneous healing?	If the cornea is debrided to remove infected cells, the chance of spontaneous healing increases from 40% to 70%
What is involved in collaborative therapy to treat HSV keratitis?	Corneal debridement, topical therapy with vidarabine (Vira-A) or trifluridine (Viroptic) for 2-3 weeks. Oral Acyclovir (Zovirax) may also be administered
What organism is responsible for the eye condition HZO?	HZO stands for Herpes Zoster Ophthalmicus. It is caused by Varicella-zoster virus (chickenpox)
Topical ______ are usually contraindicated for treating HSV keratitis because it can deepen corneal ulcerations and cause the disease course to lengthen.	Corticosteroids
What is HZO?	It stands for Herpes Zoster Opthalmicus, a form of keratitis caused by an endogenous latent infection (you had chickenpox and now it's come back) or direct/indirect contact with a person infected with chickenpox or herpes zoster.
Who is most likely to suffer from Herpes Zoster Ophthalmicus?	An older adult or a client who is immunosuppressed.
How is Herpes Zoster Ophthalmicus treated?	Analgesics for pain (both opioid/non-opioid), topical corticosteroids, Acyclovir to reduce viral replication, mydriatic agents to dilate the pupil and alleviate pain, and topical antibiotics to combat secondary infection. Warm compresses and povidone-iodine gel can also be applied to affected skin (but not near the eye)
_________ keratoconjunctivitis is the most serious ocular adenoviral disease.	Epidemic keratoconjunctivitis (EKC)
What are the signs and symptoms of Epidemic keratoconjunctivitis (EKC)?	Tearing, redness, photophobia and foreign body sensation, and usually infects only one eye
How is Epidemic keratoconjunctivitis (EKC) spread?	In a medical setting it is spread through contaminated hands and medical instruments, it is also spread by direct contact including sexual activity
How is Epidemic keratoconjunctivitis (EKC) treated?	Ice packs, dark sunglasses, and in severe cases topical corticosteroids and topical antibiotic ointment
You have a client that has been diagnosed with EKC. You know that your most important role is to...	Teach the patient and family members regarding good hygiene practices to avoid spreading the disease
What organisms are the most common causes of fungal keratitis?	Aspergillus, Candida and Fusarium
Where is a client most likely to contract a fungal keratitis?	In an outdoor setting (like skiing and getting smacked in the eye by a low-lying tree branch)
__________ keratitis is caused by a parasite that is associated with contact lens wear. Most likely it comes from contaminated solution or cases or from homemade saline solutions.	Acanthamoeba
How is Acanthamoeba keratitis treated?	The only drug approved by the FDA is natamycin/Natacyn. If this is ineffective, a corneal transplant may be required.
What type of keratitis is a patient with exophthalmos more likely to get?	Exposure keratitis. It occurs when a patient is unable to fully close their eyelids.
Tissue loss caused by an infection of the cornea produces a _________.	Corneal ulcer
What are the signs and symptoms of a corneal ulcer?	It is very painful, tearing with purulent or watery discharge, foreign body sensation, redness and photophobia.
How is a corneal ulcer treated?	Antibiotics, antivirals, or antifungal eye drops may be prescribed as frequently as every hour for 24 hours. Untreated ulcers can lead to a need for a transplant.
What are the overall goals for a patient with inflammation or infection of the external eye?	Avoid spread of infection, maintain an acceptable level of comfort and functioning during the course of the problem, maintain or improve visual acuity, comply with prescribed therapy and promote health seeking behaviors.
What are some interventions a nurse can employ while treating a patient with an inflammation/infection of the external eye?	Apply warm or cool compresses as indicated by the condition, darken the room, provide analgesics or other comfort measures
If a client is prescribed two or more eye drops, how can the nurse provide for maximum absorption?	Stagger the drops. If two drops are ordered hourly, administer one drop, wait a half hour and administer the other drop.
What should a nurse instruct a patient that wears contacts and has a current eye infection to do?	Throw away all opened or used lens care products and cosmetics to decrease the risk of re-infection from contaminated products ( a common problem).
Keratoconjunctivitis sicca is a fancy name for the very common condition...	Dry eyes
What conditions predispose a client to experience keratoconjunctivitis sicca?	Being elderly, having scleroderma, lupus (SLE), or Sjögren's
How is keratoconjunctivitis sicca typically treated?	If the underlying problem is a lacrimal duct dysfunction, hot compresses and lid massage helps. If the problem is due to decreased tear production, artificial tears or ointments are prescribed. In severe cases, closure of the lacrimal puncta is indicated.
If a patient complains of a dry mouth and dry eyes, what condition would you suspect?	Sjögren's (an autoimmune condition which attacks the lacrimal and salivary glands leading to dry mouth and eyes).
_________ is a condition in which the patient cannot consistently focus two eyes simultaneously on the same object.	Strabismus
Esotropia is when one eye deviates _____.	In
Exotropia is when one eye deviates ______.	Out

Hypertropia is when one eye deviates ______.	Up
Hypotropia is when one eye deviates _______.	Down
Esotropia, Exotropia, Hypertropia and Hypotropia are all terms used to describe deviation directions of _____________.	Strabismus
What conditions can cause strabismus in an adult?	Thyroid disease, neuromuscular problems of the eye muscles, entrapment of the extraocular muscles in orbital floor fractures (one of the bones in the bottom of the eye socket is broken and trapping a muscle), retinal detachment repair or cerebral lesions.
What is the most common symptom reported by adults with strabismus?	Double vision (diplopia)
Penetrating keratoplasty is the scientific name for a ____________.	Corneal transplant
How are corneal scars treated?	A rigid contact lens can correct irregular astigmatisms from corneal scars, penetrating keratoplasty is used to treat corneal scars and opacities.
When harvesting a cornea from a donor, surgeons prefer that it be done in _______ or less.	4 hours
What conditions do eye banks test donors for?	HIV, hepatitis B and C.
How many days after harvesting can a cornea be kept in a nutritive solution prior to implantation?	5
_________ is a noninflammatory, usually bilateral disease characterized by a thinning of the anterior cornea causing it to protrude forward and take on a cone shape. It appears during adolescence and progresses slowly between the ages of 20-60. Blurred vision and astigmatism are the only symptoms.	Keratoconus
What conditions have been associated with the development of Keratoconus?	Downs Syndrome, Marfan's Syndrome, atopic dermatitis, aniridia, and retinitis pigmentosa.
________ is a hereditary disease characterized by bilateral primary degeneration of the retina beginning in childhood and progressing to blindness by middle age.	Retinitis pigmentosa
How is keratoconus treated?	INTACS; plastic lenses surgically inserted on the cornea perimeter to reduce astigmatism and myopia. As the corneal thinning progresses, penetrating keratoplasty (corneal transplant) is performed before the cornea perforates.
__________ is the most common surgical procedure for Americans older than 65.	Cataract removal
People with _________ tend to form cataracts earlier than those who don't have it.	Diabetes
What is the underlying cause of senile cataracts?	Metabolic processes are altered and cause the lens to accumulate water and alters the lens fiber structure.
An elderly patient comes into the clinic and complains of decreased vision, colors looking funny and describes a glare everywhere she looks. You suspect she may have...	A cataract (characterized by decreased vision, abnormal color perception and glare)
Secondary ________ can develop in a patient with cataracts if the enlarging lens causes increased intraocular pressure.	Glaucoma
_________ is a complementary/alternative therapy used to treat cataracts, retinopathy, PVD, varicose veins and diabetes mellitus.	Bilberry
What are the nursing implications of a client on bilberry?	It may lower blood glucose and blood pressure. It may increase the risk of bleeding when taken concurrently with other substances known to increase risks of bleeding. It has not been tested for its effects on lactation and safety during pregnancy. It should not be taken over long periods of time in large doses.
T/F A client with cataracts indicates a need for surgery.	False, palliative measures alone (like changing an eyewear prescription) can improve vision enough to function.
T/F Surgery is the only treatment to cure cataracts	True. If the cataract isn't removed, the vision will continue to deteriorate.
You have a client with cataracts that doesn't want to have surgery. What recommendations can you make to help the client function?	Suggest an eye exam to have their prescription increased, suggest strong reading glasses or magnifiers to help with close vision. Encourage them to increase the amount of light when reading or doing other near vision tasks. Suggest they drive during the day to reduce glare and have a family member drive them at night, and inform them about what to expect during the disease process.
A client is coming in for cataract surgery. You explain that you will be administering a mydriatic agent before the surgery. The client asks what it will do. You explain...	It is an alpha adrenergic agonist meaning it causes the pupil to dilate (by causing contraction of the iris dilator muscle).
A client is coming in for cataract surgery. You explain that you will be administering a cycloplegic drug prior to surgery. The client wants to know what it does. You explain...	To them you say: it dilates your pupils, which is short for... It is an anticholinergic agent that causes paralysis of accommodation by blocking the effect of acetylcholine on the ciliary body. It also causes pupils to dilate by blocking the effect of acetylcholine on the iris sphincter muscle.
Cycloplegia is another word for...	Paralysis of Accommodation (hence cycloplegic agents to prevent accommodation before cataract surgeries)
Mydriasis is another word for...	Pupillary dilation (hence mydriatic agents used to dilate pupils for cataract surgery)
What should a client be monitored for if they are on mydriatic and cycloplegic agents for a cataract surgery?	Signs of systemic toxicity like tachycardia, CNS effects
A client who is having cataract surgery should be advised to bring _________ to minimize discomfort after the surgery.	Dark sunglasses to minimize photophobia
__________ extraction is a type of cataract surgery where the entire lens is removed with the capsule intact.	Intracapsular
__________ extraction is a type of cataract surgery where the anterior capsule is opened and the lens nucleus and cortex are removed, leaving the capsular bag intact.	Extracapsular
During an extracapsular cataract extraction, the nucleus of the lens can be fragmented by ultrasonic vibration and aspirated from inside the capsular bag. This process is called...	Phacoemulsification
What two methods are commonly used to remove the lens nucleus during an extracapsular cataract removal surgery?	Scooping it out with a lens loop or by using phacoemulsification
________ incisions made during a cataract extraction surgery require sutures, whereas _________ incisions are self-closing and require no sutures. The type used is determined by the doctor.	Corneoscleral incisions require sutures Scleral tunnel incisions are self-closing
Which method of cataract extraction, intracapsular, standard extracapsular or extracapsular phacoemulsification has a considerably smaller incision required to perform it?	Phacoemulsification
Which type of cataract surgery (intracapsular or extracapsular) is performed most often?	Extracapsular
What type of patient will most likely need intracapsular cataract extraction?	Those patients who need surgery as a result of trauma
During cataract extraction surgery, where is the intraocular lens implant most commonly placed?	In the posterior chamber in the capsular bag behind the iris.
What type of medications are administered to a patient immediately following a cataract extraction/intraocular lens implantation?	Corticosteroids and Antibiotics are injected and then applied as ointments