Lippincott Certification Review Medical-Surgical Nursing


Chapter 18

●● Question the patient about exposures to chemicals, flying debris, noise, fumes, or infectious agents; ask about the use of protective equipment for eyes (safety goggles), respiratory system (masks), and ears (ear plugs). ●● Ask the patient with a vision condition how they manage ADLs. ●● Physical assessment ●● Nurse begins with inspection . ●● Observe the patient’s eye movements and ability to focus. ●● Note the appearance of the eyelids, eyeballs, and lacrimal apparatus. ●● Examine the conjunctiva, sclera, iris, anterior chamber, and cornea. ●● Check both pupils for equality of size and shape, pupillary reaction to light, and accommodation. ●● Test visual acuity using a Snellen chart and near-vision chart. ●● Specialized optometric and ophthalmic tests may be ordered, such as optical coherence tomography (OCT), visual field testing, fundus photography, IOP measurements, etc. ●● Test extraocular muscles by assessing the corneal light reflex and cardinal positions of gaze. ●● Examine intraocular structures using an ophthalmoscope (this may be challenging in the nondilated pupil). ●● Observe the ears for position and symmetry; inspect the auricles for lesions, nodules, or redness; check the ear canal for drainage, foreign bodies, and cerumen. ●● Examine the auditory canal, tympanic membrane, and bony landmarks with an otoscope. ●● Assess hearing using Weber and Rinne tests and pure tone audiometry. ●● Observe the nose for position, symmetry, swelling, deformity, and color; note any nasal discharge or flaring. ●● Inspect the nasal cavity for septal deviation or perforation; examine the vestibule and turbinates for redness, softness, and discharge. ●● Assess the patient’s sense of smell. ●● Examine the nostrils using a nasal speculum; note color, patency, and the presence of exudate. ●● Next, the nurse uses palpation . ●● Gently palpate the eyelids, noting any swelling or reports of tenderness; eyeballs should feel equally firm, but not hard or rigid. ●● Palpate the lacrimal sac while observing the punctum for excessive tearing or drainage. Age-Related Macular Degeneration ●● Description ●● Age-related macular degeneration (AMD) is characterized by small clusters of yellowish debris (called drusen) beneath the retina. ●● When drusen are located in the macular area, they cause visual loss. ●● Central vision is most often affected. ●● Two types of AMD exist: dry type and wet type. ●● Dry-type AMD is atrophic and nonexudative and is responsible for 85% to 90% of cases; in this type of AMD, the outer layers of the retina slowly break down. ●● Palpate the mastoid area and ear for tenderness, redness, or warmth. ●● Palpate the nose for pain, tenderness, swelling, and deformity. ●● Palpate the sinuses for tenderness.

●● Wet-type AMD is neovascular and exudative and may have an abrupt onset; symptoms result from the proliferation of abnormal vessels under the retina. Early identification of the progression to wet type is essential for prompt treatment and improved outcomes. ●● Although the cause of AMD is unknown, increasing age, European ancestry, and genetic factors are risk factors for development of the disease. Smoking is the main modifiable risk factor. ●● AREDS or AREDS 2 antioxidant vitamin and mineral supplementation should be considered for patients with intermediate to advanced AMD. ●● AMD is a leading cause of visual loss in high-income countries. ●● Signs and symptoms ●● In dry-type AMD, drusen can be seen beneath the retina; atrophy of the retinal pigment epithelium (RPE) also occurs. Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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