Nursing with Dr. Hobbick
In each episode, we'll dive deep into the core subjects that you encounter in your nursing classes. From fundamental concepts to advanced topics, we'll break down complex ideas into understandable and relatable discussions. As a nursing professor, my goal is to bridge the gap between classroom theory and real-world practice, ensuring you're well-prepared for the challenges and opportunities that lie ahead.
Join me as we explore essential nursing theories, patient care strategies, healthcare ethics, clinical reasoning, evidence-based practice, and much more. I'll draw upon my extensive experience in both nursing education and practical nursing to provide you with a comprehensive perspective that goes beyond the textbook.
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Nursing with Dr. Hobbick
Vision Problems : Macular Degeneration, Galucoma, and Cataracts
Are you ready to unravel the mysteries of Neurosensory conditions? It's a world where subtle signs like a halo around lights or a slight loss of peripheral vision can signify the onset of Glaucoma, a condition with potentially devastating impacts on vision. Join us as we embark on a deep exploration of Glaucoma, shedding light on everything from symptoms and diagnostic testing, to nursing considerations and treatments. We'll lend special focus to the proper administration of Pylocarpeen eye drops, a vital tool in the fight against this condition.
The journey doesn't end with Glaucoma; we also uncover the intricacies of Wet Macular Degeneration - a condition that can slowly blur your central vision. We'll walk you through the myriad of treatment options available, including laser therapy, ocular injections, and Vascular endothelial growth factor inhibitors. You'll learn how these treatments can slow down the progress of the disease and limit any potential damage. This adventure through neurosensory conditions is loaded with practical insights, whether you're preparing for your NCLEX or have a keen interest in the subject. Come along on this exciting journey of discovery and learning!
Hey and welcome to Nursing with Dr Habeck. Today I'm thinking about Neurosensory Just a quick overview of visual disturbance, hearing disturbance and neurological conditions. I'm actually going to throw some pediatric conditions in today because this podcast is going out to my seniors this semester as part of their review for their NCLEX. If you're a senior getting ready to study for your NCLEX, welcome aboard. If you're in nursing school and you're looking for something to help you understand the sensory disturbances or neurological conditions, welcome aboard Today.
Speaker 1:Let's start with glaucoma. Glaucoma is actually a condition that arises from a decrease in the emptying of the fluid inside the eye and because we continue to make more fluid, it's not emptying and so it increases the pressure inside the eye ball. Typically, this is something that is actually discovered during a regular visual exam. We don't really see a lot of symptoms of this in the early stages. The symptoms, of course, are increased intraocular pressure and increase in the pressure inside that eye. An eye doctor, an ophthalmologist or an optometrist can discover we might also see some trouble with accommodation or the ability to focus. Remember, when you're testing accommodation, you're testing if the pupil constricts or expands when looking from near to far or far to near objects. Those are the early symptoms, the late symptoms. If it hasn't been discovered early on, later we might see a loss of peripheral vision, which is one of the classic things that you should associate with glaucoma. The vision loss is in the periphery of the vision. They might see halos around the lights. Now that doesn't mean if you see halos around lights that you have glaucoma. You might have a stigmatism, like I do so, or you're wearing glasses. Halos around the lights, combined with increased intraocular pressure, are the things that we're thinking about here. So loss of peripheral vision, halos around lights, and then we might have decreased visual acuity. That is not correctable. So the patient has glasses. They're not working anymore. They get new glasses. Those aren't working anymore. They're going to have this visual disturbance that they just can't correct. And finally, of course, when we increase the pressure in there, we might start to have eye pain. We might have headaches and that can actually get so bad that they have nausea and vomiting, so have some of those secondary symptoms of pain. Now glaucoma is actually the second leading cause of blindness in people over the age of 80.
Speaker 1:So keep in mind, glaucoma is treatable. It is not curable. And also we we can treat it, but we can't reverse any damage that's already been done. So if the patient has gotten to the point where they have this visual acuity problem or their lost peripheral vision, we can't get that back. We can keep it from getting worse.
Speaker 1:How do we do that? We do that with eye drops, pylocarpeen. Pylocarpeen P, as in Paul I-L-O-C-A-R-P-I-N-E, is one of the very common eye drops that we might give to this patient, and what this does is it actually causes the pupil to constrict and in that constriction that muscle movement opens that Drain for that aqueous humor and so decreases the pressure inside the eye. And as long as we can keep that pressure down, we can minimize the damage or stop it from getting worse. So pylocarpeen is pretty common medication. Make sure that if you're giving your patient pylocarpeen one, you're using good administration for eye drops techniques, and that would be, of course clean your hands, sanitizer, handwashing, put on gloves, you're going to gently pull down the lower lid and that drop will go in that innercanthus pocket. After that have the patient press gently on the corner of their eye, near their nose, to keep the medication in the eye and from going into the Into that drain and having some systemic effects. You can then have the patient just dab their eye off whatever's outside the eye and After that make sure they know that may have some blurred vision for a couple of hours afterwards. Remember that this is constricting that pupil so it's going to interfere with their ability to accommodate and it's going to interfere with their ability to adapt to dark light. So dark light requires a wide pupil and since we've had a medication that's going to keep it constricted, they're going to have some trouble with that. So those are things you want to make sure that you educate your patient on. We also want to make sure that we are aware of Diagnostic testing. So the diagnostic testing we might see is a tonometer that's going to measure that intraocular pressure. We might see an Electric tonometer which is actually used to detect drainage of that aqueous humor and a goni on gonioscopy Hopefully I said that right that will allow direct visualization of the lens.
Speaker 1:Risk factors for this condition, of course, is a family history of glaucoma, a family history of diabetes, history of previous ocular problems, and then some medications can actually Cause glaucoma as a side effect. Those are things like antihistamines or anti-coloner gix. And then we have other medications that can interact and cause Glaucoma, other things that you can do as a nurse. You want to think about making sure, if your patient is low vision, that you always Announce yourself when you come in the room. You want to make sure that when your patient first is on your unit or you're taking care of them, if you're in a new Environment to the patient, that you orient them to the room, show them how to use the call light, walk them around if they're able and it's appropriate to show them where the chair is, where the Closet is, where the bed is, where the bathroom is, so that they know where everything is. Depending on their vision, you may want to describe their plate to them. So when you take the tray in, tell them, using a clock face, where everything is and what it is. When you're giving them medications, make sure that you tell them how many pills you're giving them so they know how that they've gotten them all. Make sure that you give them a half a glass of water to help avoid spills.
Speaker 1:And we want to make sure that we talked to our patient about avoiding anything that can increase Interocular pressure. So things that can increase interocular pressure are the same things that increase intra abdominal pressure, any kind of emotional upset Exertion. So pushing heavy lifting like shoveling those kinds of things, coughing a lot, excessive sneezing can actually increase interocular pressure so your patient gets a respiratory infection. They're going to want to see their provider Wearing any kind of constrictive clothing on the torso or the neck and then straining. So we don't want them to get constipated. We want to make sure that we're talking to them about a good amount of fiber. Make sure that we're talking to them about plenty of fluids, ambulation if possible and you know we can consult with the provider on Stool softeners docu-sate sodium is a good one, or whatever the provider feels would be appropriate for that patient.
Speaker 1:Older patients, of course, are at risk for constipation Because they're older. We've got to slow down in that GI tract peristalsis. You know that colon just absorbs water at a set rate. It doesn't have a oh, the transit has slowed down, so I need to slow down water absorption. It doesn't have that. So we need to make sure that we're aware of that. Again, fiber fluid feet on the floor, those three Fs that are going to help our patient with constipation Always identify yourself when you walk in the room.
Speaker 1:Make sure the patient knows and responds affirmatively before you touch them. Make sure that you always raise the side rails for someone who's newly sightless. If your patient maybe had surgery to help with the glaucoma, they may have eye patches on and not be able to see. Just make sure you put those two upper side rails up just to help them out. And we want to make sure that we are just being conscious of our non-verbal body language. If they're not able to see it, we need to make sure that we are expressing ourselves verbally so that the patient can be aware.
Speaker 1:Next, let's talk about cataracts. Cataracts are actually the leading cause of blindness in the world, and it's actually very easily corrected. So there are a lot of groups that travel to third world countries or other places where people may not have access to this kind of surgery. It really doesn't take very long. It's a very minimally invasive surgery. It's actually typically done on an outpatient basis under local anesthesia, and so I'm happy to know that there are doctors who are willing to go and help people with this surgery. In fact, if you Google an organization called C International, like SEE, they have a fantastic film called Second Sight about the organization. They are actually in 45 different countries helping so many people with cataracts be able to see again. It's a very touching film and I think it really helps you understand the impact that this has on people's lives and the fact that it's so easily fixed. During the film, the doctor performing the surgery, the facility, actually loses power and he continues. So he can continue even though they lose power. So I think that's really helps you to understand that this is really a very minimal surgery and it makes such a huge impact on people's lives. I really hope that you'll take time to watch the film. It's available on YouTube.
Speaker 1:Cataracts are the leading cause of blindness around the world. Aging is actually the cause for 95% of cataracts. Scenile cataracts is what they're called. There's also cataracts that can be caused by systemic conditions like diabetes. A toxic substances can cause cataracts. They may be congenital, being born with them, and they also can be caused by trauma.
Speaker 1:So what does this look like to the patient? It's often blurred vision. I know when we say cataracts, most people think about the cloudy lens. That's actually a pretty late sign. So patients usually will notice blurred vision. Versus our glaucoma, where the patient notices a decrease in peripheral vision, cataract patient may also experience a decrease in their color perception and photophobia is something else that they might see as well. Now, how do we treat this? They usually treat it surgically. They remove the lens and a lot of times they use an intraocular lens implant. In my experience they can set that lens up to help correct vision. The patient may go in with glasses, may not need glasses afterwards not always guaranteed and if you're like me and you've entered the stage of prespioopia, you may still need to use reading glasses.
Speaker 1:Okay, the last vision problem that we're going to talk about is macular degeneration. Macular degeneration is one of the leading causes of blindness in those over 65. Macular degeneration comes in two different types a wet type and a dry type. The dry type is typically slower to progress, but it is progressive. The wet is usually a much more sudden onset. This, the classic symptom for macular degeneration, is loss of central vision. So this patient will lose the ability to focus on things right in front of them A lot of the time. They'll end up using their peripheral vision while they can.
Speaker 1:Things to know about this one. Usually the doctor, the eye care provider, will conduct an ophthalmoscopy to assess those gross macular changes and the opacities. Hemorrhaging that can happen. Really, the management is just on trying to slow the progression of vision loss and, of course, helping the patient maximize whatever vision they actually have left and their quality of life. We want to make sure that dietary intake of lutein and zeaxanthin are increased and that central vision loss really affects the ability to read, write, recognize safety hazards and, of course, to drive. It's going to have a big impact on that. Our patients may want to have large print books, audio books, public transportation or rely on family for transportation around.
Speaker 1:Our management for the wet macular degeneration really is just to slow down the process and see, you know, if some of that fluid and blood that's in there affecting that macula would resorb, they might do some laser therapy to seal those leaking vessels. That will actually limit the damage. And then they also do ocular injections, so they actually do shots into the eye Vascular endothelial growth factor inhibitors. Those are a couple of medications that will slow down that development of new vessels. That can be a problem with wet type of macular degeneration. That's all I've got to say about the vision problems. I'll record another one here shortly about auditory and then we'll move on to neurological. Enjoy. I'll see you again next time on Nursing with Dr Havik.
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