After Gallbladder Surgery

INTRODUCTION

ü The eyes are the organs of vision which we connect with the visual world. They consist of highly specialized and complex structure that receives and sends visual information to the cortex. This sense allows us to identify different qualities of bodies are animate and inanimate in the environment, more or less near the body.
This is done by pro's ability to catch the eye of light rays reflected on the bodies.

Physiology of the ocular system:

ü Anatomically differs in the eyeball, optic pathway (optic nerve), central nervous structures and accessory structures eye. Ü

accessory structures of the eye: around the globe and their functions are protection, cleaning, lubrication, eye movement and encouraging proper refraction. Ü
These structures include: eyebrows, eyelids, eyelashes, lacrimal apparatus and extrinsic oculomotor muscles.

Eyeball

is reversed from 3 primary layers: sclera, uvea and retina. Ü

Sclera: outer layer at the back has an opening for passing the optic nerve and retinal blood vessels in the anterior part is continuous with cornea. Ü
Uvea: pigmented middle layer consists of choroid, iris and ciliary body. Ü
Retina: inner layer is semi-transparent thin tissue that covers eight layers inside the eye wall. It contains light-sensitive cells (rods and cones)

anterior chamber structures:

ü portion of the eye is limited in the rear by the front surface of the iris and lens, and part earlier in the cornea.
ü The anterior chamber is filled with liquid, the aqueous humor maintains intraocular pressure. Ü
Cornea: transparent convex structure that covers one sixth of the eye. Ü
Iris: raised vascular structure with variable pigment. Ü
Pupil: is the space left by the inner ring of the iris. Ü
Lens: biconvex structure not clear colorless vascular sustained lifting behind the iris by the ciliary body zonules. Ü
ciliary body: is a ring adjacent to the iris tissue following a course of 360 ° in the rear. Produces aqueous humor and adjusts the shape of the lens to accommodate, or focus. Ü
Humor aqueous: is produced in the posterior chamber by the ciliary body and circulates around the lens and iris in the anterior chamber. Provides essential nutrients to the nonvascularized tissues of the anterior chamber of the eye removed metabolites and provides a suitable chemical environment.

posterior chamber structure:

ü Limited is a small segment in the anterior and posterior vitreous humor. Ü
ciliary body was found, the ciliary zonules, the posterior aspect of the lens and aqueous humor.
ü The vitreous is the largest chamber and posterior. For the front is limited by the lens and ciliary body, on the back of the retina. It is made of transparent and liquid collagen gel, shapes the eyeball.

The outer layer or tunic (sclera, or white of the eye and cornea) is fibrous and protective. The layer of the tunica media (consisting of the choroid, ciliary body and iris) is vascular. The innermost layer is nervous or sensory retina. Eye fluids are separated by the lens into the vitreous humor behind the lens and aqueous humor in front of the lens. The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.

visual processing:

ü phototransduction of light in bioelectric potentials takes place in outer segments of photoreceptors (cone and rod). Ü
Stimulation of the photo pigments by photons of light is the first mechanism of phototransduction. Ü
chemical changes caused in the photo pigments containing rods and cones produce visual cell hyperpolarization and the generation of photoreceptor potential is transmitted to the bipolar cell, ganglion and optic nerve. Ü

The visual signals are processed in the thalamus and occipital cortex carried, in the visual cortex produces a holistic integration of all information related to your subject: color, shape, size, movement and spatial organization. Considerations

gerantológicas

ü With advancing age, the vision becomes less efficient. The pupil reacts less in accordance with the light, pupillary sphincter sclerosis, which reduces the diameter of this hole.
ü The lens becomes more opaque visual field decreases, which makes peripheral vision
ü eyes adapt to darkness more slowly, so vision at night or in poorly lit areas is less clear. Ü
slows the process of accommodation and the lens loses its elasticity and becomes a relatively solid mass ü
ciliary muscles become less flexible and functional. The vision of nearby objects require more work of the ciliary muscles.
ü The liquid portion of the vitreous is increased by 50%. The collagen material coalesce and vitreous floaters occur typically seen in the visual field. Ü
degenerating retina, especially in the macula, which cause deterioration sclerotic changes vision.


rating ophthalmology

ü ophthalmic Background: Data on changes in vision, congenital disorders, diseases such as diabetes or hypertension, use of glasses. Ü
ophthalmic symptoms such as photophobia, headache, tingling, sore eyes or eyebrows, itching, tearing, floaters, secretions. Ü Use of drugs


Medical History:

§ observable changes in the structure and visual function.
§ § Background Psychosocial Assessment
physics of vision and §
eye visual acuity assessment (Snellen chart) §
eye movement rating


visual field assessment:

- Physical examination of the eye (external and internal structures): exophthalmos, ptosis, entropy , poliosis
- Consideration of the anterior sclera and conjunctiva of the eye.
- Review of the cornea, anterior chamber, iris, pupil, lens.
- Ophthalmoscopy
- Measurement of eye pressure (tanometría)

slit lamp examination:

slit lamp, which is a microscope specialized growth, is used to examine the structures of the eye such as cornea, iris, vitreous and retina. The slit lamp is used to examine, treat with laser and shoot the eye.

EYE DISORDERS

The eye is subject to various conditions, the different structures of the eye.

disorders of the eyelids:

blepharitis: inflammation of the eyelid margins.

Horzuelo: infection of the glands of Zeis or Moll's surface eyelids.

lacrimal system disorders:

has to do with the production of tears or inflammation of the drainage system.

dacryocystitis: suppurative cellulitis of the lacrimal sac secondary to nasolacrimal duct obstruction.

disorders of the conjunctiva:

Conjunctivitis: inflammation of the conjunctiva characterized by inflammation and exudate. Can be infectious, immunologic, imitative, related to systemic disease.

pterigon: overdevelopment of fibrovascular tissue triangular intrapalpebral bulbar conjunctiva with extension into the cornea.

hemorrhage of the conjunctiva: dilated superficial blood vessels in the conjunctival background which fades into the corneal scleral limbus.


cornea disorders:

ü corneal abrasions: epithelial layer defects caused by trauma, foreign bodies, contact lenses, difficulty closing the eyelids or eyelid malposition or eyelashes. Ü

microbial keratitis: infection of the cornea, produces a marked inflammation of the eye, drainage mucupurulenta, hypopyon (pus in anterior chamber)

crystalline disorder:

ü Cataracts: Opacity Crystal

ü It is a cloudy or opaque area (an area through which a person can not see) in the lens of the eye.

Causes and risk factors

The lens of the eye is normally clear and when the lens becomes cloudy, the condition is known as cataract. Rarely, cataracts may be present at or shortly after birth, in which case they are called congenital cataracts.
The Adult cataracts usually develop with advancing age and can run in families. Cataracts develop more quickly in the presence of some environmental factors such as smoking or exposure to other toxic substances, and can occur at any time after an eye injury. Metabolic diseases such as diabetes also greatly increase the risk of developing cataracts and certain medications such as cortisone, can also accelerate their training.

Cataracts defects can also be inherited and the gene that produces it is autosomal dominant (autosomal dominant), which means that the defective gene will cause the condition even if only one parent passes it along. In families where one parent carries the gene, there is a 50% chance in each pregnancy that the child is concerned.
Congenital cataracts can also be caused by infection of the mother during pregnancy such as rubella may be associated with metabolic disorders such as galactosemia.

Risk factors are inherited metabolic diseases, family history of cataracts and infection maternal viral during pregnancy.
The Adult cataracts are generally associated with aging and they develop slowly and painlessly, with a gradual deterioration in vision.

Visual problems may include the following changes:

• Difficulty seeing at night
• Seeing halos around lights
• Being sensitive to glare
• Problems with vision associated with cataracts generally move towards decreased vision, even during the day.

cataracts in adults are classified as immature, mature and hypermature. A lens that has maintaining clear areas called an immature cataract. A mature cataract is completely opaque, while hypermature cataract has a liquefied surface that leaks through the capsule and can cause inflammation of other structures in the eye.
Most people develop some clouding of the lens after age 60. About 50% of people between 65 and 74 years old, like 70% of people 75 years or older, have cataracts that affect vision.
Most people with cataracts have similar changes in both eyes, although one eye is worse than the other. Many people with this condition have only slight visual changes and are not aware of the problem.
Other factors that may contribute to cataract development are low serum calcium levels, diabetes, prolonged use of corticosteroids, and various inflammatory and metabolic disorders. Environmental causes include trauma, radiation exposure and too much exposure to ultraviolet light (sunlight).
In many cases, the cause of cataracts is unknown.

Cataracts are a leading cause of vision loss in older individuals, but children may have congenital cataracts. With surgery, cataract removal is possible and a new lens implanted and the patient can usually return home the same day. Symptoms

- Blurred vision, blurry, fuzzy or blurred
- Loss of color intensity
- Frequent changes in prescription glasses or goggles
- The glare from bright lights causes problems vision at night, especially when driving
- sensitivity to glare from lamps or the sun
- Halos around lights
- Double vision in one eye
- Decreased contrast sensitivity (the ability to see shadows or shapes against a background)

Signs and tests

- Standard ophthalmic exam, including slit lamp examination
- Ultrasound of the eye in preparation for cataract surgery
- Other tests may be done (rarely) are
- Test
brightness - contrast sensitivity test
-
potential vision test - specular microscopy of the cornea in preparation for cataract surgery treatment

The only treatment Cataract surgery is to remove them, which takes place when a person is unable to perform normal activities, even with glasses. For some, the act of changing glasses, getting stronger bifocals, or using a magnifying lens is helpful, while others choose to undergo cataract surgery.
If cataracts do not disturb a person, surgery is usually not necessary. There are times when you may have an additional eye problem that can not be solution without first having cataract surgery.
This surgery involves removing the eye's lens and its replacement with an artificial one. The cataract surgeon will discuss the options with the patient and together will decide on the type of removal and lens replacement is best.

REMOVAL OF LENS:

There are two different types of surgery that can be made for the removal of a cataractous lens. The
extracapsular surgery is the surgical removal of the lens leaving the back half of the intact capsule (the outer covering of the lens). You can use high frequency sound waves (phacoemulsification) to soften the lens to facilitate removal through a smaller incision.
The intracapsular surgery involves the surgical removal of the entire lens, including the capsule and is a procedure that is now very rare.

REPLACEMENT LENS:

People who perform cataract surgery usually receive an artificial lens at the same time. This artificial lens is a hard synthetic (manufactured) called intraocular lens is usually placed in the lens capsule inside the eye.
There are other options such as contact lenses or cataract glasses.
The surgery can be performed in a hospital or in an outpatient setting. Most people do not need to be hospitalized overnight, but need a friend or family member to move them from their homes and care after outpatient surgery. It is important that the surgeon will follow up the patient.

- The lens of the eye is normally clear. A cataract occurs when the lens becomes cloudy as you get older.
- Surgery is recommended for people with vision problems or other major problems caused by cataracts.
- In the treatment of cataracts using two procedures. In the manual extraction procedure, a small incision is made on the edge of the outer lining of the eye (cornea). After the lens is removed and replaced with an artificial

- Another procedure is called phacoemulsification, which involves inserting a needle through a small incision in the eye. The end of the needle produces sound waves that break the lens, which is then sucked through the needle.
- This procedure requires a smaller incision than the manual extraction procedure.
- The outcome of cataract surgery is usually excellent. The operation has few risks, pain and recovery time are minimal and the improvement of vision is remarkable. 95% or more of all cataract surgeries improve vision.


system disorders uveal
uveal ü The system consists of iris, ciliary body and choroid. Ü

Uveitis inflammation of one or all three uveal system structures. Produces pain, photophobia, blurred vision, and red eye.

MOVEMENT DISORDERS OF THE AQUEOUS HUMOR

Glaucoma:

Glaucoma refers to a group of disorders that lead to damage occurs to the optic nerve, the nerve that carries visual information from the eye to the brain. The damage to the optic nerve causes vision loss, which may progress to blindness. Most people with glaucoma have increased fluid pressure in the eye, a condition known as increased intraocular pressure.

Causes and risk factors

- Glaucoma is the second most common cause of blindness in the United States and there are four main types:

- open-angle glaucoma (chronic)
- Angle-closure glaucoma (acute)
- congenital glaucoma
- Glaucoma secondary

The four types are characterized by increased pressure within the eyeball, and therefore all can cause progressive damage to the optic nerve. Open-angle glaucoma (chronic) is by far the most common type of glaucoma.
The front of the eye is filled with clear fluid called aqueous humor, which is produced constantly in the back of the eye. It leaves the eye through channels located in the anterior chamber (front) and eventually drains into the bloodstream. The channels that drain the aqueous humor are in an area called the anterior chamber angle or simply angle.
In open-angle glaucoma, the channels in the angle gradually narrow with time, preventing proper fluid drainage. The accumulation of fluid causes increased pressure in the eye, which pulls the junction of the optic nerve and retina at the back of the eye, reducing the blood supply to the optic nerve.
As the optic nerve deteriorates due to decreased blood supply, blind spots develop in the field of vision. Affected first is the peripheral vision (side vision). This is usually not noticed until you lose a little vision. If the disease is not diagnosed and it is, you can lose much of the vision before the person is aware of the problem.
open-angle glaucoma tends to run in families and the risk is greater if you have a parent or grandparent with this condition. The black people have a particularly high risk for this disease.
angle-closure glaucoma (acute) is caused by a change in the position of the iris of the eye that suddenly blocks the exit of aqueous humor. This causes a quick, severe and painful pressure within the eye (intraocular pressure). Most people with angle-closure glaucoma redness and swelling in the affected eye. You can have nausea and vomiting. Angle-closure glaucoma is an emergency situation is very different from open angle glaucoma, which damages vision painlessly and slowly.
If you have had acute glaucoma in one eye, almost certainly at risk of an attack in the second eye, and the doctor may recommend preventive treatment.
drops to dilate the eyes and certain systemic medications may trigger an acute glaucoma attack if the person is at risk.
Secondary glaucoma is caused by other diseases, including eye diseases such as uveitis, systemic diseases, as well as by the use of some medications such as corticosteroids.
congenital glaucoma, present at birth is the result of abnormal development of the liquid flow channels of the eye and requires surgical correction. Congenital glaucoma is usually inherited.

Glaucoma is a condition caused by increased fluid pressure in the eye. The increased pressure causes compression of the retina and optic nerve, which can gradually lead to nerve damage. Glaucoma can cause partial vision loss and even blindness as a possible outcome over time.

Symptoms

OPEN ANGLE:

- Most people have no symptoms
- gradual loss of vision (side)

ACUTE:

- severe eye pain, facial pain
- Blurred vision or decreased
-
Red eye - Inflammation of the eye
- pupil does not react to light
- Nausea and vomiting (may be the major symptoms in the elderly)

CONGENITAL

- Tearing
- Sensitivity
light - Red eye
- Opacity in front of the eye
- Enlargement of one or both eyes

Signs and tests

An eye exam can be used to diagnose glaucoma. However, it is not enough to check the intraocular pressure alone (tonometry), since pressure changes. It is necessary to examine inside the eye looking through the pupil, often when it is enlarged.
usually makes a complete eye examination.

Tests include:

- Review of the retina
- Measurement of intraocular pressure by
tonometry - visual field measurement
- visual acuity
- Refraction
- pupillary reflex response
- Examination with the slit lamp
- Optic nerve imaging (photographs of the interior of the eye)
- consisting Gonioscopy in the use of special glasses to observe the flow channels

angle Treatment

The goal of treatment is to reduce intraocular pressure, which is achieved by using drugs or surgery, depending on the type of glaucoma .

treatment of open angle glaucoma:

Most people with glaucoma can be successfully treated with eye drops. In the past, eye drops for glaucoma caused blurring of vision, but most of the drops used today have few side effects. Your doctor will evaluate your medical history and determine the appropriate drops for everyone. It is possible that a person needs more than one type of drop. Some patients are also treated with pills to lower pressure in the eye.
drops are being developed and new pills that directly protect the optic nerve from glaucoma damage. Some patients
require additional forms of treatment such as laser treatment to help open the fluid flow channels. This procedure is usually painless. Others may need traditional surgery to open a new outflow channel.

treatment of angle closure glaucoma:

This type of glaucoma is a medical emergency and blindness can occur within a few days if not treated. Using eye drops, pills and intravenous drugs to lower blood pressure. It is likely that the patient also needs an emergency operation, called an iridotomy, a laser procedure used to open a new channel in the iris. This new channel relieves pressure and prevents another attack.

Congenital glaucoma

ü This form of glaucoma is almost always treated with surgery to open the channels of flow angle and is performed under general anesthesia (asleep and pain free).

posterior chamber Disorders:

Retinal detachment:

ü is the separation of light-sensitive membrane located on the back of the eye (retina) from its supporting layers .

Causes and risk factors

ü The retina is a transparent tissue in the back of the eye that helps you see the images focused on it by the cornea and lens. Retinal detachments are often associated with a tear or hole in the retina through which fluid can leak from the eye. This causes separation of the retina from underlying tissues. Ü
Retinal detachment often occurs spontaneously, without an underlying cause. However, it also can be caused by trauma, diabetes, an inflammatory disorder.
ü During detachment, bleeding from small retinal blood vessels can cause opacity inside the eye, which is normally filled with vitreous humor. Central vision becomes severely affected if the macula, the part of the retina responsible for fine vision, becomes detached. Ü
risk factors are previous eye surgery, myopia, family history of retinal detachment, uncontrolled diabetes, and trauma. Approximately 10,000 people per year have a retinal detachment.


Symptoms

ü Bright flashes of light, especially in peripheral vision
ü Translucent specks of various shapes (floaters) in the eye Blurred vision

ü ü Shadow or blindness in one part of the visual field of one eye

Signs and tests

ü Tests that are performed to determine the integrity of the retina are : ü
direct and indirect ophthalmoscopy
visual acuity
ü ü ü Refraction test
disorders Determination of color vision ü
pupillary reflex response
ü slit lamp examination
ü intraocular pressure determination
ü Eye ultrasound
ü Retinal photography
Angiofluoresceinografía
ü ü Electroretinogram (a record of electrical currents in the retina produced by visual stimuli)

Treatment

Laser surgery can be used to seal the tears or holes in the retina, which generally precede detachment.
The application of intense cold, for example, with an ice probe (known as cryopexy) is another technique that leads to the formation of a scar that holds the retina to the underlying layer. This technique is used in combination with the injection of a bubble gas and maintenance of certain specific positions of the head to prevent re-accumulation of fluid behind the retina.
Surgery is required if the retina has already detached. Some detachments can be repaired by placing a gas bubble in the eye to the retina back into place (pneumatic retinopexy), followed by laser surgery to permanently fix it in place. This procedure is usually performed in the office, but more extensive detachments may require surgery in the operating room. The aim of such surgery may be to indent the eye wall (scleral buckle) or remove vitreous gel or scar tissue pulling on the retina using microsurgery (vitrectomy).


Diabetic Retinopathy

is a progressive damage of the retina of the eye caused by the prolonged presence of diabetes and can cause blindness.

Causes and risk factors

ü Diabetic retinopathy is a leading cause of blindness in Americans of working age and risk of developing both people with type I diabetes, as those with type II diabetes.
ü The likelihood and severity of retinopathy increases with duration of diabetes and can worsen if there is a good control of it. Almost all people who have had diabetes for over 30 years show signs of diabetic retinopathy.
ü The cause of this disease is damage to blood vessels of the retina. In the earliest type and less severe in this condition (diabetic retinopathy prolifetrativa), existing blood vessels become porous and keep out the fluid into the retina, causing blurred vision. In the most advanced type and more severe disease (proliferative retinopathy) presents a new vessel growth blood inside the eye, which are fragile and can bleed, causing vision loss and scarring. Symptoms

ü Decreased visual acuity
ü floaters in the eyes (floaters)
ü Many people have no early symptoms before a major hemorrhage in the eye, which is why everyone with diabetes should be reviewed regularly.

Signs and tests

ü ü
Eye Examination Retinal Photography
Treatment

The goal of treatment is to control diabetes and high blood pressure that is associated with it. Treatment usually does not reverse existing damage, but slows the progression of the disease. It may recommend laser surgery to seal leaking vessels or eliminate abnormal fragile blood vessels.
surgical treatment (vitrectomy) is used in cases of bleeding in the eye or retinal detachment repair, caused by bleeding and subsequent healing. TThe
people with diabetes should see an ophthalmologist for an exam Routine eye retina once a year to reduce the likelihood of severe vision loss.

Hypertensive retinopathy

is damage to the retina caused by high blood pressure.

Causes and risk factors

ü High blood pressure can cause damage to blood vessels of the eyes. The higher the blood pressure and the longer the time that it remains high, it is likely that the injury is more serious.
ü The doctor may see a narrowing of the vessels blood and excess fluid oozing from them with an instrument called an ophthalmoscope. The degree of retina damage (retinopathy) is graded on a scale of I to IV.
ü In Grade I, the lesion may be asymptomatic. Grade IV hypertensive retinopathy includes swelling of the optic nerve and visual center of the retina (macula), which can cause decreased vision.

The damage to the retina caused by high blood pressure is called hypertensive retinopathy occurs as the existing high blood pressure causes changes in the microvasculature of the retina. Some early findings in this disease are flame hemorrhages and cotton wool spots. As hypertensive retinopathy progresses, hard exudates can appear around the macula along with swelling of the latter and the optic nerve, causing vision impairment. In severe cases, permanent damage can occur to the optic nerve or macula. Symptoms

ü ü Headaches
visual disturbances

Signs and tests

Ophthalmoscopic examination
ü ü ü
fluorescein angiography Pressure
blood
Treatment

The only treatment for this disease is to control high blood pressure (hypertension).


NURSING CARE OF PATIENTS WITH EYE PROBLEMS

rating

-
lens wear - Background morbid (DM, hypertension)
- Visual Impairment (does not see near or far objects, decreased night-vision distinguish whether one or both eyes, evolution of deficiencies)
- Eye pain
- Appearance
secretions - Redness
- Itching
- Overview
flashes - Diplopia
- Photophobia
- tearing or dry eyes
- Grade automonia
- Posture towards reading

Under consideration as the fundus observed:
Absence of red reflex
-rings or crescents around the pupil
-bleeding, lesions or holes in the back of the retina opacities
-color anomalies.
- blind spots or areas
- Photophobia
- opacities
- pupillary reflexes
-
eyestrain - Pupil (size and reaction to light)
- Arco senile
- Purulent
- Symmetry facial and ocular (protrusion = exophthalmos, enophthalmos sunken eyes =)
- Eyebrows and eyelashes
- Eyelid: ptosis, redness, stiffness, injury, swelling and closing
- lacrimal apparatus, swelling or edema
- Cornea: cloudy or mottled
- Parallel or alignment of the eyes
- Giro
Eye - Movements conjugated or misuse of movements: nystagmus, strabismus, exodesviación (turning out), esodesviación (turning inward)
- Muscle imbalance
eye - Blinking, efficiency of eyelid closure.
- Assessment of complementary examinations (visual acuity, visual fields, fundus, intraocular pressure, etc)



Nursing diagnosis

- visual sensory impairment related to an inflammatory condition of ocular structures.
- Acute pain related to alteration of ocular structures.
- Fear related to symptoms of vision loss
- Risk of injury related to decreased vision. Objectives

- Recover in whole or in part acuity aided visual medical treatment and nursing measures.
- Reduce the pain all the time with nursing care and therapeutic measures
- Reduce the fear of verbal expression and providing education about their disease.
- Reduce the risk of injury, through the implementation of safety measures and education.


Performances and activities
WC
ü ü eye as needed

Control vital signs ü Maintain accident prevention measures. (Railings, timbre)
ü Maintain an appropriate environment, easy access to the bathroom, unfurnished or hinder the passage carpets. Ü
manager helps determine your care
ü Encourage their independence in their personal care
Administration ü as appropriate medical treatment (antibiotics, eye drops, analgesics) ü
instillation of drops properly (hand washing prior application)
ü Use of devices for ambulation
ü instruct on how to handle eye (avoid rubbing or applying ointments and nonprescription)
ü Patient education about surgical intervention when appropriate. Ü
preparation for surgery. Ü
assess pain intensity according to schedule. Ü
dressings or eye patches Keep clean and dry.
ü Place the patient eye protection when required. Ü Keep
control of chronic diseases (hypertension and DM)



Assessment - The patient shows an improvement in visual perception.
- The patient has no pain or pain EVA <>