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Visual and Auditory ProblemsMedical-Surgical Nursing

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This type of glaucoma presents with no symptoms of pain or pressure. The client experiences gradual peripheral vision loss that results in tunnel vision if left untreated.
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Primary Open Angle Glaucoma (POAG)
This type of glaucoma presents with sudden, excruciating pain in or around the eye, often accompanied by nausea and vomiting. The patient will often report colored halos around lights, blurred vision and ocular redness. Corneal edema may also occur, causing a frosted appearance.
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Primary Angle Closure Glaucoma (PACG)
During a routine health assessment a client tells you she has a history of attacks where her vision is blurred, and her eyebrows were tender and painful. She further explains that she would see halos around lights. She reported it would improve if she slept. You suspect she may have...
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Subacute/chronic angle-closure glaucoma (characterized by history of blurred vision, seeing colored halos, ocular redness, brow or eye pain).
In open-angle glaucoma, intraocular pressure is normally between _____. In acute-closure glaucoma it may be _____.
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POAG= 22-32 mm Hg PACG= 50 mm Hg or higher
What are the differences seen between POAG and PACG when using slit lamp microscopy to view the eye?
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Open angle = normal angle Angle Closure = markedly narrow or flat anterior chamber angle, an edematous cornea, a fixed and markedly dilated pupil and ciliary injection
______ allows good visualization of the eye's anterior chamber angle and is useful when diagnosing glaucoma.
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Gonioscopy
_______ glaucoma results in peripheral vision loss, whereas ________ glaucoma results in reduced central vision acuity.
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Open angle glaucoma = loss of peripheral vision Angle closure glaucoma = loss of central vision
__________ is the term for when an optic disc becomes wider, deeper and paler (light gray or white). It may be one of the first signs of chronic open-angle glaucoma.
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Optic disc cupping
Glaucoma is initially treated with _______ which will control, but not cure the condition.
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Drugs
_______ involves lasering 50 spots around the superior or inferior 180 degrees of trabecular network, opening outflow channels to decrease intraocular pressure.
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Argon Laser trabeculoplasty (ALT)
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What is the most common complication of Argon Laser trabeculoplasty (ALT)?
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Increased intraocular pressure postoperatively. To combat this, the patient is given glaucoma medication
__________ is a filtering procedure where the surgeon makes conjunctival and scleral flaps, removes part of the iris and trabecular meshwork and closes the scleral flap loosely. The aqueous humor percolates through the area of missing iris and is trapped by the conjunctiva and absorbed into systemic circulation. It is usually done when medical management and laser therapy are unsuccessful in treating chronic open angle glaucoma.
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Trabeculectomy
How does the application of Mitomycin (Mutamycin) or 5-fluorouracil (5-FU) increase the success rate of trabeculectomies?
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It prevents scarring and subsequent closure of the flap created in the sclera during surgery
When is an implant of a small tube and reservoir to shunt aqueous humor from the anterior chamber to the implanted reservoir considered a treatment option for a patient with open angle glaucoma?
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When filtration surgery has failed
________ Glaucoma is considered an ocular emergency that requires immediate intervention.
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Acute Angle Closure Glaucoma
What medications are used to lower intraocular pressure in patients with Acute Angle Closure Glaucoma?
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Miotics (cholinergic agents) and oral or IV hyperosmotic agents
What is the long term treatment for Acute Angle Closure Glaucoma?
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A laser peripheral iridotomy or iridectomy which allows aqueous humor to flow into the newly created hole in the iris and into normal outflow channels.
What are the beta adrenergic drugs used to treat acute and chronic glaucoma?
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Betaxolol (Betoptic) Carteolol (Ocupress) Levobunolol (Betagen) Metipranolol (Optipranolol) Timolol maleate (Timoptic/Isalol)
What are the alpha adrenergic agonists used to treat acute and chronic Glaucoma?
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Dipivefrin (Propine) Epinephrine (Epifrin, Eppy, Gaucon, Epitrate, Epinal, Eppy/N) Apraclonidine (Lopidine) Brimonidine (Alphagan) Latanoprost (Xalatan)
In general, what effect do the beta adrenergic blockers have on glaucoma?
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The method of action is not for certain, but they probably decrease aqueous humor production.
Which of the beta adrenergic blockers can be used in clients that have COPD or asthma because it is cardioselective (B1 blocker)?
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Betaxolol (Betoptic)
  
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