Ophthalmic Nursing E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 486

Veröffentlichungsjahr: 2013

Beschreibung

There have been many changes in the arena of ophthalmic care since the last edition of this book was published. This fourth edition has been fully updated and revised to reflect these recent advances in care, and incorporates new information on patient care, contexts of care, and expanded roles.

It includes a greater emphasis on the primary care setting, more information on issues such as new treatments, infection control, and use of technology, greater detail on theatre, anaesthetics and recovery, and new information on the role of other healthcare professionals involved in ophthalmic care. Now with colour illustrations throughout, this accessible text also includes evidence-based procedure guidelines and reflective practice exercises that enable the reader to apply the learning in practice.

Written by highly regarded authors based at The University of Manchester and Manchester Royal Eye Hospital, Ophthalmic Nursing is a must-have for every eye department.

Leseprobe

Contents

Foreword

Preface

Acknowledgements

Chapter 1 The Ophthalmic Patient

Introduction

Registration for the sight-impaired or severely sight-impaired

Assistance and rehabilitation

Voluntary organisations

Chapter 2 The Ophthalmic Nurse

Introduction

Assessment of patients

Patient information and teaching

Professional issues

The nurse in the outpatient department

The nurse in the accident and emergency department

The day case and ward nurse

The nurse in the theatre

Chapter 3 Ophthalmic Nursing Procedures

General principles

Recording visual acuity

Ophthalmic procedures utilising ANTT principles

Principles and protocol for ophthalmic medication instillation/application

Clinical practice guidelines

Chapter 4 Emergency Ophthalmic Procedures

Slit-lamp examination

Goldmann applanation tonometry

Examining the eye

Removing a conjunctival or corneal foreign body

Applying pad and bandage

Removing a corneal rust ring

Testing for tear film break-up time: assessing the quality of tears

Irrigating the eye

Chapter 5 The Globe: A Brief Overview

Introduction

The nerve supply to the eye

The blood supply to the eye

Chapter 6 The Protective Structures, Including Removal of an Eye

The orbit

The eyelids

Conditions of the orbit

Removal of an eye

Conditions of the eyelids

Reflective activity

Chapter 7 The Lacrimal System and Tear Film

Introduction

The lacrimal gland

The lacrimal drainage system

The tear film

Conditions of the lacrimal system

Reflective activity

Chapter 8 The Conjunctiva and Sclera

The conjunctiva

Conditions of the conjunctiva

The sclera

Conditions affecting the sclera

Reflective activity

Chapter 9 The Cornea

Introduction

Physiology of corneal symptoms

Conditions of the cornea

Reflective activity

Chapter 10 The Uveal Tract

Introduction

The choroid

The ciliary body

The iris

Conditions of the uveal tract

Reflective activity

Chapter 11 Glaucoma

Introduction

Methods of measuring intra-ocular pressure

Anatomy and physiology

Related disorders – glaucoma

Reflective activity

Chapter 12 The Crystalline Lens

Introduction

Cataract

Complications of cataract extraction

Cataract operations

Aphakia

Dislocated lens

Reflective activity

Chapter 13 The Retina, Optic Nerve and Vitreous Humour

The retina

The optic nerve

The vitreous humour

Colour vision

Rhodopsin

Conditions of the retina

Toxoplasmosis

Toxocariasis

Conditions of the macula

Conditions of the optic nerve

Conditions of the vitreous humour

Reflective activity

Chapter 14 The Extra-ocular Muscles

Introduction

Eye movements

Strabismus or squint

Paralytic squint

Reflective activity

Chapter 15 Ophthalmic Trauma

Introduction

Prevention of ocular trauma and eye protection

Reflective activity

Chapter 16 Ocular Manifestations of Systemic Disease

Diabetes mellitus

Acquired immune deficiency syndrome

Thyroid disease

Hypertension

Giant cell arteritis

Herpes simplex virus

Herpes zoster virus

Tuberculosis

Sarcoid

Behçet’s disease

Syphilis

Toxoplasmosis

Toxocara

Rheumatoid arthritis

Still’s disease

Ankylosing spondylitis

Ulcerative colitis and Crohn’s disease

Neurofibromatosis

Migraine

Reflective activity

Chapter 17 Ophthalmic Drugs

Mydriatics

Miotics

Drugs of choice used in the treatment of glaucoma

Antibiotics

Antiviral agents

Corticosteroids

Local anaesthetics

Diagnostic drops

Tear replacement

Miscellaneous

General note

Appendix 1: Correction of Refractive Errors

A1.1 Long sight or hypermetropia

A1.2 Short sight or myopia

A1.3 Presbyopia

A1.4 Astigmatism

A1.5 Techniques for correcting refractive errors

A1.6 Refractive surgery

A1.7 Paralytic squint

Appendix 2: Contact Lenses

A2.1 Uses of contact lenses

A2.2 Types of lens

A2.3 Care of contact lenses

A2.4 Complications of contact lens wear

Glossary

References and Further Reading

Index

This edition first published 2010

© 1987, 1997 by Blackwell Science Ltd for first and second editions© 2005 by Blackwell Publishing Ltd for third edition © 2010 Mary E. Shaw and Agnes Lee

Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing programme has been merged with Wiley’s global Scientific, Technical, and Medical business to form Wiley-Blackwell.

First edition published 1987 by Blackwell Science LtdSecond edition published 1997 by Blackwell Science LtdThird edition published 2005 by Blackwell Publishing LtdFourth edition published 2010

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Library of Congress Cataloging-in-Publication Data

Shaw, Mary E.

Ophthalmic nursing / Mary E. Shaw, Agnes Lee ; founding editor, Rosalind Stollery. – 4th ed. p.; cm.

Rev. ed. of: Ophthalmic nursing / Rosalind Stollery, Mary E. Shaw, Agnes Lee. 3rd ed. 2005. Includes bibliographical references and index.

ISBN 978-1-4051-8429-8 (pbk.: alk. paper) 1. Ophthalmic nursing. I. Lee, Agnes (Agnes E.) II. Stollery, Rosalind. III. Stollery, Rosalind. Ophthalmic nursing. IV. Title. [DNLM: 1. Eye Diseases–nursing. WY 158 S535o 2010]

RE88.S76 2010

617.7’0231–dc22

2009040326

A catalogue record for this book is available from the British Library.

1 2010

Foreword

Ophthalmic nursing is a specialist area of nursing, about which few people outside the profession know very much. Ophthalmic nurses often feel that others from our profession think that all we do is instil eye drops! Eye nurses know much better than this, however. There are few specialties within nursing and allied health where patients are aged from a few days to the very elderly, where those needing care may be suffering from trauma, acute illness or chronic disease or may need support or rehabilitation.

The focus of our care is a patient with an eye problem, but many other body systems may be involved, and we need to be aware of neurology, diabetology, rheumatology, oncology and all the other problems that are part of eye disease.

The eye is the only organ whose interior can be examined without damaging the body in the process. Blood vessels and nerve tissue may be seen, working, inside the body. The organ of sight is incredibly complex and, because of this, it can malfunction in many different ways, and these all have consequences for the patient experiencing the problem.

Ophthalmology then is a very complex speciality, and ophthalmic nurses must have a good working knowledge about their speciality in order to provide individualised and effective care for their patients.

This book, the fourth edition of the text, provides an overview for those just setting out in a role within ophthalmic nursing. It includes basic and comprehensible anatomy and physiology (which are the foundations for understanding how the eye functions, and why and how problems occur), and relates this to the care and needs of the patient. The chapters have been updated and include new colour images and diagrams, as well as the most recent NICE guidelines for glaucoma and age-related macular degeneration.

The inclusion of reflective activities in each chapter is new and allows readers to apply their knowledge to the realities of the care settings, and to use this knowledge for their continuing professional development.

The phrase, ‘knowledge is power’ was coined by Francis Bacon, scientist and philosopher, in 1597. It has been used many times since, and it is as true now as it ever was. This book provides nurses with the ability to acquire knowledge and to use it, to enhance their power to care for patients with eye problems.

I hope it instils in ‘new’ ophthalmic nurses, the beginnings of a passion for ophthalmology and the care of patients with eye problems, which I and many of my ophthalmic nursing colleagues have developed during our careers.

Janet MarsdenProfessor of Ophthalmology and Emergency CareManchester Metropolitan University

Preface

Since the publication of the third edition of this book, patient care, the personnel looking after them and the context in which patient care happens have changed. The ophthalmic nurse has taken on many expanded roles, and other roles have developed as a result, including the Assistant Practitioner and other support worker roles. Some specialist ophthalmic nurses have completed prescribing courses as well as master’s degrees and have taken on Nurse Consultant roles. Optometrists on the high street and in hospitals are increasingly responsible for managing the ocular health of the population, including managing glaucoma patients. Orthoptists are also expanding their roles to include the management of stable glaucoma patients.

‘Stollery’ continues to help and guide the practices of those caring for the ophthalmic patient. Once again in editing this edition, we have continued to build on the framework that has stood the test of time. Newer source materials have been included and are reflected in the chapters. References, further reading and websites have been updated to reflect current trends.

For the sake of ease and clarity, the nurse/carer is referred to as ‘she’ and the patient as ‘he’ with no discrimination intended.

Mary ShawAgnes Lee

Acknowledgements

We would like to thank all of those who have been supportive to us as we undertook the re-working of this edition, especially our families and the publisher. We particularly wish to thank Debbie Morley, Corneal Sister, and Nigel Poole, Senior Fields Technician, for their contributions to chapters in this book. We would also like to thank the staff at the Manchester Royal Eye Hospital, including the Ophthalmic Imaging Department who provided images, and staff at the University of Manchester School of Nursing, Midwifery and Social Work.

Chapter 1

The Ophthalmic Patient

This chapter looks at the nature of the patients seen in ophthalmic or in primary care settings.

Introduction

The ophthalmic patient may be of any age and from any background. Ophthalmic conditions affect all age groups – ranging from a few days to more than 100 years old – although, in most ophthalmic settings, the majority of patients seen are elderly.

Infants and children will have parents or guardians who wish to be involved in their child’s care. The infant or child whose parents or guardians are either unable or unwilling to become involved will need the extra care and attention of a nurse to reassure him in unfamiliar and possibly frightening surroundings.

The ophthalmic patient may have other diseases such as diabetes mellitus (Type 1 or Type 2), ankylosing spondylitis or arthritis, as these conditions have ocular manifestations. He may also suffer from unrelated diseases. Patients with co-morbidity can be challenging for the ophthalmic nurse who will have to make decisions about care and management based on need.

Many people with learning disabilities are known to have ocular problems, including: visual impairment, refractive errors, squint, keratoconus, nystagmus, cataract and glaucoma. They face more problems than most members of society, including having difficulty accessing services when disease is detected, and few ophthalmic nurses have training specifically designed to meet the needs of these people.

The ophthalmic patient will arrive at the eye hospital or unit either as a referral to the outpatient department or as a casualty, where many are self-referred and may not be ‘emergencies’ as such. They will present with a variety of conditions, from a lump on the lid to sudden visual loss or severe ocular trauma. In addition, the ophthalmic patient may access care via walk-in centres, NHS direct, the high street optometrist or GP services, including the practice nurse. The Darzi report (Department of Health, 2008a) is driving the agenda for an increasing amount of care in the community, and the author insists that the care should be of a high quality. There is also an emphasis on patient wellbeing and preventive care.

Most people will be anxious on a first visit to a hospital or other health care setting. Even for the elderly but otherwise fit person, it might be his first experience of a hospital. Those arriving following trauma will be in varying degrees of shock depending on the nature and type of accident and they, and their relatives, may be very anxious. Something that seems fairly minor to the nurse with ophthalmic knowledge may, to the layman, appear serious and be thought to threaten sight.

Many people have a fear of their eyes being touched, making examination difficult. Some feel faint – or do faint – while certain procedures, such as removal of a foreign body, are being performed.

There are some old wives’ tales about the eye. One of the most common is that the eye can be removed from the socket for examination and treatment, and be replaced afterwards. This kind of false information does not help the patient’s frame of mind.

Each person will arrive at the hospital with his own individual personality and past experience to influence any attitude towards the eye condition. Some will be stoical, others extremely agitated. Those with chronic or recurrent eye conditions may become more accustomed to visiting the eye hospital. Most patients having ophthalmic surgery are outpatients, day cases or overnight-stay patients. This means they have a very short time to adjust to the hospital setting and have little time to ask the questions that may be initially forgotten in the midst of all the activity. They may feel reluctant to express minor concerns when there appears to be little contact time with nurses.

The actual visual impairment experienced by the patient will vary with the eye condition. With many conditions there is no, or only slight, visual impairment and this may be temporary. Other conditions cause gross visual loss that may have occurred suddenly or gradually over the years. This visual loss may be untreatable and permanent, may be progressive, or sight may be restored. Some patients will have only one eye affected and others both eyes, probably to different degrees. Some will have blurred vision; some will only be able to make out movements. Others will be able to differentiate only between light and dark, or will see nothing at all. Some will have lost their central vision, others their peripheral vision. A number of patients will see better in bright light than dim light, and vice versa. Some degree of visual loss can be very upsetting to the patient and can prove to be a severe impairment to daily living. All patients experiencing severe visual loss will require practical and emotional help in coming to terms with their loss, regardless of the cause and the course it has taken.

Registration for the sight-impaired or severely sight-impaired

Research carried out by the Royal National Institute for the Blind (RNIB) (Bruce et al., 1991) suggested that there are three times more people eligible for registration as sight-impaired or severely sight-impaired than are in fact registered. There is no reason to suppose that this situation has changed. People are reluctant to take the final step as it can appear to be the giving up of any hope that treatment will help. This need not be the case, however: sight-impaired or severely sight-impaired registration can be a much more liberating experience for many as they realise, with help and support, that they can maximise their quality of life. Being registered blind or severely sight-impaired can give access to a variety of benefits, including tax allowance; parking concession (blue badge) and a 50% reduction in TV licence fee.

Severely sight-impaired

The statutory definition for the purpose of registration as a blind person under the National Assistance Act 1948 is that the person ‘is so blind as to be unable to perform any work for which eyesight is essential’. This refers to any form of employment, not only that which the patient formerly followed. It also only takes into account visual impairment, disregarding other bodily or mental infirmities. People with a visual acuity of less than 3/60 on the Snellen (1.0 LogMAR) chart, or with a visual acuity of 6/60 (1.0 LogMAR) but with a marked peripheral field defect, will be eligible for registration.

Sight-impaired

There is no statutory definition of partial sight, although a person who does not qualify to be registered as blind but nevertheless is substantially visually impaired can be registered as partially sighted. Those people with 3/60 to 6/60 (1.0 LogMAR) vision and full peripheral field, those with vision up to 3/60 with moderate visual field contraction, opacities in the media, aphakia and those with 6/18 (10.5 [approximately] LogMAR)or better visual acuity but marked field loss can be included on this register. In England and Wales, a Letter of Vision Impairment (LVI) is obtainable from high street optometrists. In outpatient settings, staff complete the Referral of Vision Impaired Patient (RVI) and, if eligible, patients can take it to their social services department (RNIB 2003).

Assistance and rehabilitation

The National Assistance Act 1948 directed all local authorities to compile a register of blind and partially sighted people residing in their area and to provide advice, guidance and services to enable them and their families to maintain their independence and to live as full a life as possible.

Registration is voluntary. People can choose to register but, if they do so, they can have their names removed from the register at any time should they wish. The local authority has the responsibility of reviewing the register regularly and updating the circumstances of the people on it. Local authorities must offer services to all those identified as visually impaired, whether they choose to register or not. However, registration is necessary to qualify for certain financial benefits and for help from the many voluntary organisations such as the National Library for the Blind. Registration is a good guide as to whether a person is coming to terms with their sight loss.

The process of registration starts with the ophthalmologist certifying on a form. A new system for registering as blind was introduced in England and Wales in November 2003. The Certificate of Visual Impairment (CVI 2003) replaced the old BD8. It is argued that the new system is easier to use and will speed up the process. The BP1 in Scotland and the A655 in Northern Ireland, for which a person is eligible to register as either blind or partially sighted, are still in place. By signing the form, the patient is agreeing for their information to be shared with their local social services, general practitioner and the Department of Population Census, which maintains records of all those opting to share this information.

The Social Services Department has the responsibility for registering people. Some social services departments have delegated this task to their local voluntary organisation that deals with the blind and partially sighted people within their area. The role of the social worker is that of counsellor, providing support and information about the services available. Such services include entitlement to benefits and referral to other statutory bodies involved with retraining, special needs education for those of school and college age, rehabilitation, employment, social, leisure and recreational activities, and introduction to self-help groups.

Voluntary organisations

A number of voluntary organisations work with the visually impaired and most local areas or counties have their own organisations, which were established to provide aids and social contact. Many local authorities have an arrangement with voluntary organisations to provide services to facilitate independent living, ranging from talking or tactile watches and clocks to alarms that sound when rained upon so that the washing can be brought in. Technological developments have resulted, for example, in equipment being available to enlarge print onto a computer screen, to convert the written word into Braille or to use voice synthesisers.

Local voluntary organisations are often centres of social contact for the visually impaired and their carers. Some voluntary organisations maintain contact through radio stations; Glasgow, for example, has a radio station dedicated entirely to people with visual impairment. Many self-help groups are supported by the voluntary sector; for example, glaucoma or macular disease support groups exist across the UK, with some being facilitated in hospital settings while others are supported in the community.

The needs of people from minority ethnic groups are also catered for by the voluntary sector. Ethnic Enable (http://www.ethnicenable.org.uk), for example, is an organisation set up to assist people with visual impairment who are from specific ethnic groups.

Chapter 2

The Ophthalmic Nurse

This chapter explores the role of the nurse caring for the ophthalmic patient in a variety of settings.

Introduction

It is becoming increasingly common for ophthalmic patients to be cared for in environments other than specialist ophthalmic units. Primary care settings are the focus of many aspects of ophthalmic care, for example in walk-in centres where people attend with a variety of ailments for advice, treatment or referral. In addition, high street optometrists are expanding the range of conditions they diagnose and manage.

The nurse with overall responsibility for the care of the ophthalmic patient should ideally hold a first degree and a specialist ophthalmic qualification. In addition, programmes to prepare others to care for the ophthalmic patient are available at NVQ level 2 or 3. All must have gained applied knowledge and skills whilst practising clinically. Within the wider workforce planning agenda, other clinical roles are being developed such as assistant practitioners and surgical care practitioners.

Ophthalmic nurses will naturally be continuing to expand their practice to include, for example: nurse consent; pre-operative assessment; sub-tenon’s local anaesthesia; and diagnosis and management of ocular emergencies (including telephone triage). As specialist practitioners, ophthalmic nurses will also care for and manage groups of patients linked to ophthalmic sub-specialities: stable glaucoma patients, or those involving oculoplastic procedures, cataracts, corneal conditions, uveitis or emergencies. With any of these expanded roles, the ophthalmic nurse must always be mindful of her professional accountability (Nursing and Midwifery Council, 2008).

The ophthalmic nurse must naturally possess all the qualities required of a nurse working in any speciality or environment. Some characteristics, however, are more important to a nurse specialising in the diseases and conditions of the eye. The eye is very delicate and sensitive, and most of the patients the nurse will attend to will have varying degrees of anxiety about their eye and pain or discomfort in or around the eye. In order to allay any fears the patient may have about his eyes being touched, the ophthalmic nurse must be extremely gentle with her hands and in her manner. The nurse should be aware of her position and work on the patient’s right-hand side when dealing with the right eye and vice versa with the left.