NUR 105 Final Study Guide
Glaucoma:
Patho: Increased intraocular pressure (IOP) or Glaucoma is the result of inadequate drainage of aqueous humor from the anterior chamber of the eye. The increased pressure causes atrophy of the optic nerve and, if untreated, blindness.
There are two primary...
inadequate drainage of aqueous humor from the anterior chamber of the eye
• inflammatory intraocular uveiti
• hemorrhage intraocular
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NUR 105 Final Study Guide
Glaucoma:
Patho: Increased intraocular pressure (IOP) or Glaucoma is the result of inadequate drainage of
aqueous humor from the anterior chamber of the eye. The increased pressure causes atrophy
of the optic nerve and, if untreated, blindness.
There are two primary categories of glaucoma:
• Open-angle (90% of cases are chronic open-angle)
• Closed-angle (or narrow angle)
Assessment
• Assess pt for history or presence of risk factors
• Positive family history (believed to be associated with primary open angle glaucoma)
• Tumors of the eye
• Hemorrhage intraocular
• Inflammatory intraocular uveiti
• Eye contusion from
trauma. Upon Physical examination
For primary open angle
• Pt may report a loss of peripheral vision slow (see
tunnel) For primary angle closure :
• Incidence of sudden severe pain in the eye is often accompanied by headache, nausea
and
vomiting.
• Complaints halo light, blurred vision, and decreased light perception.
• The pupils are being fixed with redness due to inflammation of the sclera and
cornea looks
cloudy.
Diagnostic Examination
• Tonometri used to measure intra-ocular pressure. Glaucoma is suspected when
IOP greater
than 22 mmHg.
• Gonioskopi possible to see directly the anterior chamber angle glaucoma to
distinguish between closed and open-angle glaucoma.
• Optalmoskopi allow inspectors to see directly optic disc and internal eye structure.
Diagnosis
• Chronic pain- related to increased intra ocular pressure in the eye.
,• Impaired sensory reception/ visual- related to progressive vision loss resulting
in changes in perception of the environment
• Anxiety-related to change in physical status, presence of changes in lifestyle and the
unknown results
• Knowledge deficit- related to poor understanding of the source of the disease due
to lack of resources. Need to learn about prognosis and treatment
Planning
• Encourage Patient to express fears about surgery in order ensure comfortably.
• Explain procedure that is related to recovery
• Instruct patient on avoiding shutting eyelids tightly post op, as well as sneezing,
coughing, straining BM, bending over, and heavy lifting is to be kept at a
minimum.
• Explain and demonstrate the procedure for administering eye drops, encourage patient
to demonstrate using the teach back method.
• Provide verbal as well as written instructions about post-op care including
potential complications and what actions to take
• Recommend measures to assist patient to manage visual limitations, e.g., reducing
clutter, arranging furniture out of travel path; turning head to view subjects; correcting
for dim light and problems of night vision.
• Provide sedation, analgesics as necessary
Nursing interventions
• Assess the patient's understanding about the condition and emotional response to
the condition and plan of action.
• administer cycloplegic eyedrops in the affected eye only. In the affected eye, these drops
may precipitate an attack of angle-closure glaucoma and threaten the patient’s residual
vision.
• After trabeculectomy, give medications as ordered to dilate pupila.
• Apply topical corticostroids as ordered to rest the pupil.
• Post surgery, protect the affected eye by applying an eye patch and eye shield.
• Position the patient on his back or unaffected side, and following general
safety measures.
• Administer pain medications as ordered.
• Encourage ambulation immediately after surgery.
• Encourage the patient to express his concerns related to having a chronic condition.
• Monitor the patient’s ability to see clearly. Question the patient regularly about
the occurrence of visual changes.
• Monitor the patient’s intra-occular pressures.
• Stress the importance of meticulous compliance with prescribed drug therapy.
• Instruct the patient’s family how to modify the patient’s environment for safety.
, • Teach the patient the signs and symptoms that require immediate medical
attention, such as sudden vision change or eye pain.
Evaluation
• Ascertain that the patient understands prescribed medications – uses and
their effectiveness in lowering eye pressure/fluid balance.
• Patient demonstrates instillation of drops correctly.
• Patient understands Glaucoma medicines need to be taken regularly as directed
by physician/ optomologist, hence stopping progression of disease.
• Patient is aware of Potential side effects of therapy; headaches, stinging, burning, and
redness in the eyes from instillation of drops.
• Patient understands medications can be changed in the event of reaction.
• Patient receives current reading material relating to glaucoma, & links to
informative websites.
• Patient is aware of follow up appointments and the importance of regular check-ups
with this disease.
Breast
Disorders ADPIE
Assessment of Breast
• Mammograms starting at age 40 (yearly)
• CBE every 3 years for women in 20s, 30s, and every year for women over 40
• BSE is recommended on a monthly schedule. For women who are
having regular menstrual periods, this would be right after menstruation
when breasts are less lumpy and tender
• Mammography is a method used to visualize the breast’s internal
structure using x-rays
o Well-tolerated, detects lumps that cannot be felt.
o 3D mammography provides a clear view of overlapping breast tissues.
It can help diagnose/ detect breast cancer
o Calcifications (from aging, trauma, inflammation) are detected, usually
benign but may be associated with preinvasive cancer
o Allows for earlier treatment and the prevention of metastasis.
o If the clinical findings are suspicious and the mammogram is normal,
an ultrasound or MRI may be used. Based on these additional findings,
a biopsy may be done.
• Gynecomastia In Men
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