- Email: [email protected]
Examination: Topical Anesthesia—A New Approach To Cataract Surgery
SEPTEMBER 2001, VOL 74, NO 3
Examination TOPICAL ANESTHESIA-A NEW APPROACH TO CATARACT SURGERY
1.The earliest documented cataract procedures date
nal surface of the eye. a. lens b. iris c. cornea d. zonule
from the a. fifth century BC. b. tenth century BC. c. tenth century AD. d. eighteenth century AD.
8.The function of the iris is to a. change size to accommodate for the amount of light available. b. transmit light to the retina. c. help suspend the lens. d. help regulate the amount of light entering the eye.
2.Who was the surgeon who performed a type of cataract surgery known as couching? a. Ridley b. Daviel c. Susruta d. DeForest
9. The
changes size to adjust for the amount of available light. a. pupil b. iris c. cornea d. lens
3.How was the couching procedure performed? a. The lens was displaced from the pupil into the vitreous cavity. b. The crystalline lens was removed intact. c. The lens was not removed but was broken into pieces and left in place. d. The iris was removed with the lens.
1QThe primary role of the lens is to refract light rays so that they give a clear image to the retina. a. true b. false
&To be aphakic means the person a. is color-blind. b. does not have the crystalline lens in the eye. c. has a cataract. d. cannot accommodate for light.
1l.The ligaments that help support the lens are called a. capsulorhexis. b. ciliary bodies. c. zonules. d. cortex.
5.Which physician is recognized as having implanted the first intraocular lens? a. Harvey Cushing b. William Halstead c. Lee DeForest d. Harold Ridley
12
6.A patient usually decides to have cataract surgery as soon as a. his or her vision is diagnosed at 20/200. b. the cataract interferes with activities of daily living. c. the eye becomes painful. d. the cataract is mature (ie, ripe). 7.The
is the transparent exter-
is another name for the lens cortex. a. Secondary lens fibers b. Epithelium c. Nucleus d. Ciliary body
13.A cataract is when the crystalline lens becomes cloudy, and it causes a. saccular dilatations of the retinal veins and punctate hemorrhages into the vitreous.
352 AORN JOURNAL
SEPTEMBER 200 I , VOL 74, NO 3
b. an increase in intraocular pressure and degeneration of the optic nerve. c. a decrease in visual acuity, blurred vision, glare, and a decrease in green-blue color vision. d. the neural portion of the retina to detach from its pigment layer.
cedure or is not mentally impaired. 20.Some of the disadvantages of retrobulbar anesthesia are a. peripheral nerve damage, ptosis, conjunctival or eyelid bruising, and optic nerve damage. b. prolonged anesthesia exposure, ptosis, globe penetration, and conjunctival or eyelid bruising. c. extreme hypotensive episodes, optic nerve damage, and central vein and artery occlusion. d. hemorrhage, globe penetration, optic nerve damage, brain stem anesthesia, and death.
I A T h e most common cause of cataract formation is a. prolonged sun exposure. b. age. c. trauma. d. ionizing radiation.
15.h example of ionizing radiation is prolonged
21.Topical anesthesia would not be a good choice for a patient who a. has concurrent cardiovascular disease but no communication problems. b. has diabetes, is unable to lie still, or does not have language barriers. c. has arthritis, diabetes, or concurrent cardiovascular disease. d. has severe claustrophobia, is unable to cooperate, or has an uncorrected hearing deficit.
exposure to the sun. a. true b. false 16.Diabetes can cause cataract formation because of an increase in ocular glucose content. How does the glucose enter the lens? a. mitosis b. osmosis c. miosis d. diffusion
22.What is the leading cause of death after anesthe-
17.What is the risk of congenital and infantile cataracts? a. 1 in 5,000 live births b. 1 in 2,000 live births c. 1 in 10,000 live births d. 1 in 100 live births
1&Most congenital and infantile cataracts are a. caused by premature births. b. a result of having a parent with insulin dependent diabetes. c. from undetermined causes. d. a result of the mother having had gestational diabetes. 19.General anesthesia is best for the patient who a. is young, is mentally impaired, has language barriers, or has a known sensitivity to local anesthesia. b. has concurrent cardiovascular disease or uncorrected hearing loss. c. will be undergoing an uncomplicated cataract replacement or has hypertension or language barriers. d. is able to tolerate lying very still during the pro-
sia and surgery in the older adult population? a. cardiac morbidity b. infection c. conhsion or delirium d. thrombophlebitis =.An appropriate nursing diagnosis for the older adult population undergoing cataract surgery would be a. risk for infection related to neuromuscular function. b. risk for injury related to visual impairment. c. risk for nutritional deficit related to NPO status. d. risk for ineffective breathing patterns related to positioning. =The outcome criteria for the nursing diagnosis risk for injury related to visual impairment would include that a. the patient verbalizes the ability to cope throughout the perioperative period. b. the patient returns demonstration on proper medication administration. c. the patient communicates sequence of wound healing related to the surgical procedure. d. the patient's function, sensation, and motion are maintained or improved.
354 AORN JOURNAL
SEPTEMBER 2001, VOL 74, NO 3
=.The nurse educates the patient before arrival at the hospital by instructing the patient to a. remain NPO after midnight, take insulin as normal the morning of surgery, and arrive at the hospital one hour before procedure time. b. limit fluid intake the day before surgery, remain NPO after midnight, and arrange for an adult to take him or her home after surgery. c. increase fluid intake the day before surgery, remain NPO after midnight, and not take insulin the morning of surgery. d. arrange for a responsible adult to take him or her home after surgery, remain NPO after midnight, take insulin as normal the morning of surgery. 26.The diabetic patient is instructed to a. not take his or her morning insulin dose until after serum glucose test results are drawn and reviewed at the hospital. b. eat a light breakfast of fruit, toast, and juice but hold off on his or her morning insulin dose. c. take his or her usual morning insulin dose but to bring the insulin bottle to the hospital for use later if needed. d. eat a light breakfast of fruit, toast, and juice and take his or her usual morning insulin dose.
27.To ensure that surgery is performed on the correct eye a. the preoperative nurse checks the patient’s clinic record, reviews the operative consent, and uses a marking pen to place “X” above the brow of the surgical eye. b. the preoperative nurse identifies the patient, cross checks the surgical consent, and calls the surgeon’s ofice to confirm the surgical eye. c. the surgeon checks the patient’s clinic record, places an “X” above the brow of the surgical eye, and signs the operative consent. d. the surgeon identifies the patient, asks the patient to confirm the surgical eye, and uses a marking pen to place an “X” above the brow of the surgical eye. 28. The perioperative nurse performs the preoperative assessment and provides patient instruction on a. what the patient may experience during surgery, positioning, and postoperative eye exercises. b. positioning, surgical skin prep, anesthesia risks, and postoperative recovery eye exercises.
c. how the patient must remain very still, benefits and risks of anesthesia options, and positioning. d. the OR environment, positioning, patient responsibilities, and how to ask for pain medication. 2 9 . A pillow is placed beneath the patient’s knees during the procedure to a. help relieve pressure on the lower back. b. prevent hip displacement in the older adult population. c. prevent the pillow from being discarded. d. eliminate the possibility of the patient moving during the procedure. =.The medication given to reduce the blink reflex is a. medazolam. b. tetracaine. c. cyclopentolate. d. lidocaine. 31.The patient is to have surgery on the right eye so the nurse preps a. the left eye. b. both eyes. c. the right eye. d. neither eye.
=The only prep solution that is instilled in the eye is a. green soap. b. 5% povidone-iodine solution. c. alcohol. d. 10% hibiclens soap. 33.To make it easier for the patient to breathe during the procedure, the scrub person and anesthesia care provider a. form a tent with the drapes and provide supplemental oxygen through a nasal cannula. b. provide supplemental oxygen with a face tent mask and put the patient in a semi-reclining position. c. put the patient in the lateral position with the surgical eye facing up and provide supplemental oxygen. d. provide supplemental oxygen with a nonrebreathing mask and form a tent with the drapes. =The incision sites are made at the 10 o’clock and 2 o’clock positions, which allows a. additional anesthesia to be provided during the
356 AORN JOURNAL
SEPTEMBER 2001, VOL 74, NO 3
procedure if needed. b. the intraocular lens implant to be easily maneuvered into position. c. the surgeon to instill balanced salt solution (BSS) and insert instruments. d. the surgeon to make the capsulorhexis and hydrodissect simultaneously. =.The medication given to maintain the chamber shape, ocular volume, and ocular pressure during the procedure is a. phenylephrine. b. cyclopentolate. c. sodium hyaluronate. d. carbachol. is the rupture of the lens capsule. a. Phacoemulsification b. Capsulorhexis c. Hydrodissection d. Emulsification
36.
37.The method for removing a cataract by breaking it up with ultrasonic vibrations is a. phacoemulsification. b. laser surgery. c. extracapsular extraction. d. intracapsular extraction. 38.The incision seals around the microflow tip, which a. prevents postoperative brow pain. b. allows for concurrent irrigation and aspiration. c. prevents radical pressure fluctuations. d. allows for insertion of the foldable intraocular lens. =.Balanced salt solution is injected immediately after the carbachol to a. maintain pupil dilatation. b. prevent postoperative brow pain. c. stimulate cycloplegia. d. prevent postoperative infections. #.No eye patch is needed so a. weight and drag on the skin around the surgical eye is minimized. b. air flow is encouraged, which decreases the potential for infection. c. some peripheral vision is possible. d. problems with depth perception are minimized.
41.The IV line is discontinued
a. when the patient is able to tolerate oral fluids. b. one hour after surgery. c. when the patient is able to tolerate solid food. d. 90 minutes after surgery. =Discharge criteria include a. visual acuity of 201100 in the nonsurgical eye, stable vital signs, and ability to ambulate without dizziness. b. pain manageable with oral narcotics, visual acuity of 201100 in the nonsurgical eye, and stable vital signs. c. stable vital signs, pain manageable with oral narcotics, and ability to tolerate oral fluids without vomiting. d. stable vital signs, ability to tolerate oral fluids without vomiting, ability to ambulate without dizziness, and ability to urinate. 43.The postanesthesia care unit nurse provides the patient with discharge instructions, which include directions to a. keep eye shield in place for 12 to 18 hours and use over-the-counter eye drops for lubrication as needed. b. continue presurgery diet and fluids, keep the eye shield in place for 12 to 18 hours, and use a laxative if needed. c. have a responsible adult remain with the patient for 24 to 48 hours after surgery and use overthe-counter eye drops for lubrication as needed. d. limit the number of trips up and down stairs but walk as much as possible otherwise. -The patient is instructed to call the physician if he or she experiences a. nausea or vomiting, hypotension resulting in dizziness, or constipation. b. hypotension resulting in dizziness, unrelieved pain, or nausea and vomiting. c. pain unrelieved with over-the-counter medicine, nausea or vomiting, or worsening vision. d. bleeding that saturates the eye patch, nausea and vomiting, or constipation. -.The greatest risk of topical anesthesia is a. the inability to fixate, requiring a nerve block. b. exacerbation of concurrent cardiovascular disease. c. severe conjunctival or eyelid bruising.
357 AORN JOURNAL
SEPTEMBER 2001, VOL 74, NO 3
d. destroying the eye with sudden patient movement.
b. the lidocaine to act as a preservative. c. the BSS as a vasoconstrictor to decrease bleeding. d. the BSS to help prevent postoperative infection.
46.The general risks of any cataract procedure include a. anterior capsule tears with vitreous fluid loss and decreased intraocular pressure. b. anterior capsule tears with vitreous fluid loss and intraocular hemorrhage. c. posterior capsule tears with vitreous fluid loss and decreased intraocular pressure. d. posterior capsule tears with vitreous fluid loss and intraocular hemorrhage. 47.
49.Phenylephrine is a mydriatic medication that a. constricts the pupil so the patient's eye cannot focus. b. constricts the pupil so the patient's eye can focus. c. dilates the pupil and inhibits focusing of the eye. d. dilates the pupil but permits the patient to focus.
48.Epinephrine 0.5 mL is added to a. the tetracaine as a vasoconstrictor to decrease bleeding.
!iO.Tetracaine is a topical anesthesia that has an a. onset of 5 to 20 seconds and a duration of 10 to 20 minutes. b. onset of 5 to 20 seconds and a duration of 45 to 60 minutes. c. onset of 60 seconds and a duration of 10 to 20 minutes. d. onset of 60 seconds and a duration of 45 to 60 minutes.
is an irrigation solution used to maintain pupil dilation and keep the eye tissue moist. a. Balanced salt solution b. Xylocaine c. Carbachol d. Lactated Ringer's solution
AORN Association of perioperotive Registered Nurses, is accredited as a provider of continuing education in nursing by the American Nurses Credentioling Center's (ANCC's) Commission on Accreditofion. AORN recognizes this activity 0s continuing educotian for registered nurses. This recognition does not imply hoi AORN or the ANCCs Commission on Accreditation opproves 01 endorses any product included in the activity. AORN maintains the following state board of nursing provider numbers: Alabamo ABNP0075, Califomia CEP 13019, and Florid0 FBN 2296. Check
with your state board of nursing for acceptability of education activity for relicensure. Profmionol nutses are invited to submit manuscripts far the Home Shdy Program. Monuscripts or queries should be sent to Editor, AORN Journal, 2 170 S Pofker Rd, Suite 300, Denver, CO 8023 1571 I . As with 011 manuscripts sent to the Journal, papets submitted for Home Shdy Programs should not hove been previously published or submitted simultaneously to any other publication.
AORN Research Poster Display Call for Abstracts Be a part of the AORN Research Poster display session at the 49th annual AORN Congress in Anaheim, Calif. To have a poster accepted for display, the research must be applicable to perioperative nursing. For more information and guidelines
for submitting abstracts, contact Melissa Parlapiano via telephone at (800) 755-2616 x 248, or download the PDF file located on the AORN web site at http://www.aorn.org/research/pdUpdf.htm.The deadline for accepting abstracts is Oct 1,200 1.
358 AORN JOURNAL
SEPTEMBER 2001, VOL 74, NO 3
Answer Sheet ID Number
TOPICAL ANESTHESIA-A NEW APPROACH TO CATARACT SURGERY
1
0000000000 0000000000 0000000000 0000000000 0000000000 0000000000
P
lease till out the application and answer form on this page and the evaluation form on the back of this page. Tear the page out of the Journal or make photocopies and mail to: AORN Cistomer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 8023 1-57 11 Or fax with credit card information to (303) 750-3212
A
Session Number 0000000000 0000000000 0000000000 0000000000
A score of 70% correct is required for credit.
Session # 6428 Event # 02014 Contact hours: 2.5 Fee: Members $12.50; Nonmembers $25 Program offered September 200 1. The deadline for this program is Sept 30,2004. 1. Record your identification number in the appropriate section below. 2. Completely darken the space that indicates your answer to the examination starting with question one. Use blue or black ink. 3. Record the time required to complete the program
4. Enclose fee if information is mailed. AORN (ID) # Name Address City State Zip RN license # State Phone number ( ) If nonmember, please provide Social Security number Fee enclosed or bill the credit card indicated 0 MC 0Visa 0Am Express 0 Discover Card # Expiration date Signature (for credit card authorization)
359 AORN JOURNAL
SEPTEMBER 2001, VOL 74, NO 3
Learner Evaluation TOPICAL ANESTHESIA-A
NEW APPROACH TO CATARACT SURGERY
The following evaluation is used to determine the extent to which this Home Study Program met your learning needs. Rate the following items on a scale of 1 to 5 . OBJECTIVES
Session Number 0000000000~ 0000000000 0000000000 0000000000
(High) (Low)
To what extent were the following objectives of this Home Study Program achieved? (1) Discuss the historical perspective of cataract treatment. (2) Discuss the etiology of cataract formation. (3) Describe the anesthetic options appropriate for cataract surgery. (4) Describe the patient selection process and preoperative patient preparation. (5) Discuss the steps of the surgical procedure for cataract extraction. (6) Describe perioperative nursing care of the patient undergoing cataract surgery under topical anesthesia. PURPOSLICOIL
To educate the perioperative nurse about using topical anesthesia in cataract surgery. CONTENT
(7) Did this article increase your knowledge of the subject matter? (8) Was the content clear and organized? (9) Did this article facilitate learning? (1 0) Were your individual objectives met? (1 I ) How well did the objectives relate to the overall purpose/goal? TEST QUESTlONSlANSWERS
(12) Were they reflective of the content? ( 13) Were they easy to understand? (14) Did they address important points?
What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
Author names and addresses:
360 AORN JOURNAL
Examination TOPICAL ANESTHESIA-A NEW APPROACH TO CATARACT SURGERY
1.The earliest documented cataract procedures date
nal surface of the eye. a. lens b. iris c. cornea d. zonule
from the a. fifth century BC. b. tenth century BC. c. tenth century AD. d. eighteenth century AD.
8.The function of the iris is to a. change size to accommodate for the amount of light available. b. transmit light to the retina. c. help suspend the lens. d. help regulate the amount of light entering the eye.
2.Who was the surgeon who performed a type of cataract surgery known as couching? a. Ridley b. Daviel c. Susruta d. DeForest
9. The
changes size to adjust for the amount of available light. a. pupil b. iris c. cornea d. lens
3.How was the couching procedure performed? a. The lens was displaced from the pupil into the vitreous cavity. b. The crystalline lens was removed intact. c. The lens was not removed but was broken into pieces and left in place. d. The iris was removed with the lens.
1QThe primary role of the lens is to refract light rays so that they give a clear image to the retina. a. true b. false
&To be aphakic means the person a. is color-blind. b. does not have the crystalline lens in the eye. c. has a cataract. d. cannot accommodate for light.
1l.The ligaments that help support the lens are called a. capsulorhexis. b. ciliary bodies. c. zonules. d. cortex.
5.Which physician is recognized as having implanted the first intraocular lens? a. Harvey Cushing b. William Halstead c. Lee DeForest d. Harold Ridley
12
6.A patient usually decides to have cataract surgery as soon as a. his or her vision is diagnosed at 20/200. b. the cataract interferes with activities of daily living. c. the eye becomes painful. d. the cataract is mature (ie, ripe). 7.The
is the transparent exter-
is another name for the lens cortex. a. Secondary lens fibers b. Epithelium c. Nucleus d. Ciliary body
13.A cataract is when the crystalline lens becomes cloudy, and it causes a. saccular dilatations of the retinal veins and punctate hemorrhages into the vitreous.
352 AORN JOURNAL
SEPTEMBER 200 I , VOL 74, NO 3
b. an increase in intraocular pressure and degeneration of the optic nerve. c. a decrease in visual acuity, blurred vision, glare, and a decrease in green-blue color vision. d. the neural portion of the retina to detach from its pigment layer.
cedure or is not mentally impaired. 20.Some of the disadvantages of retrobulbar anesthesia are a. peripheral nerve damage, ptosis, conjunctival or eyelid bruising, and optic nerve damage. b. prolonged anesthesia exposure, ptosis, globe penetration, and conjunctival or eyelid bruising. c. extreme hypotensive episodes, optic nerve damage, and central vein and artery occlusion. d. hemorrhage, globe penetration, optic nerve damage, brain stem anesthesia, and death.
I A T h e most common cause of cataract formation is a. prolonged sun exposure. b. age. c. trauma. d. ionizing radiation.
15.h example of ionizing radiation is prolonged
21.Topical anesthesia would not be a good choice for a patient who a. has concurrent cardiovascular disease but no communication problems. b. has diabetes, is unable to lie still, or does not have language barriers. c. has arthritis, diabetes, or concurrent cardiovascular disease. d. has severe claustrophobia, is unable to cooperate, or has an uncorrected hearing deficit.
exposure to the sun. a. true b. false 16.Diabetes can cause cataract formation because of an increase in ocular glucose content. How does the glucose enter the lens? a. mitosis b. osmosis c. miosis d. diffusion
22.What is the leading cause of death after anesthe-
17.What is the risk of congenital and infantile cataracts? a. 1 in 5,000 live births b. 1 in 2,000 live births c. 1 in 10,000 live births d. 1 in 100 live births
1&Most congenital and infantile cataracts are a. caused by premature births. b. a result of having a parent with insulin dependent diabetes. c. from undetermined causes. d. a result of the mother having had gestational diabetes. 19.General anesthesia is best for the patient who a. is young, is mentally impaired, has language barriers, or has a known sensitivity to local anesthesia. b. has concurrent cardiovascular disease or uncorrected hearing loss. c. will be undergoing an uncomplicated cataract replacement or has hypertension or language barriers. d. is able to tolerate lying very still during the pro-
sia and surgery in the older adult population? a. cardiac morbidity b. infection c. conhsion or delirium d. thrombophlebitis =.An appropriate nursing diagnosis for the older adult population undergoing cataract surgery would be a. risk for infection related to neuromuscular function. b. risk for injury related to visual impairment. c. risk for nutritional deficit related to NPO status. d. risk for ineffective breathing patterns related to positioning. =The outcome criteria for the nursing diagnosis risk for injury related to visual impairment would include that a. the patient verbalizes the ability to cope throughout the perioperative period. b. the patient returns demonstration on proper medication administration. c. the patient communicates sequence of wound healing related to the surgical procedure. d. the patient's function, sensation, and motion are maintained or improved.
354 AORN JOURNAL
SEPTEMBER 2001, VOL 74, NO 3
=.The nurse educates the patient before arrival at the hospital by instructing the patient to a. remain NPO after midnight, take insulin as normal the morning of surgery, and arrive at the hospital one hour before procedure time. b. limit fluid intake the day before surgery, remain NPO after midnight, and arrange for an adult to take him or her home after surgery. c. increase fluid intake the day before surgery, remain NPO after midnight, and not take insulin the morning of surgery. d. arrange for a responsible adult to take him or her home after surgery, remain NPO after midnight, take insulin as normal the morning of surgery. 26.The diabetic patient is instructed to a. not take his or her morning insulin dose until after serum glucose test results are drawn and reviewed at the hospital. b. eat a light breakfast of fruit, toast, and juice but hold off on his or her morning insulin dose. c. take his or her usual morning insulin dose but to bring the insulin bottle to the hospital for use later if needed. d. eat a light breakfast of fruit, toast, and juice and take his or her usual morning insulin dose.
27.To ensure that surgery is performed on the correct eye a. the preoperative nurse checks the patient’s clinic record, reviews the operative consent, and uses a marking pen to place “X” above the brow of the surgical eye. b. the preoperative nurse identifies the patient, cross checks the surgical consent, and calls the surgeon’s ofice to confirm the surgical eye. c. the surgeon checks the patient’s clinic record, places an “X” above the brow of the surgical eye, and signs the operative consent. d. the surgeon identifies the patient, asks the patient to confirm the surgical eye, and uses a marking pen to place an “X” above the brow of the surgical eye. 28. The perioperative nurse performs the preoperative assessment and provides patient instruction on a. what the patient may experience during surgery, positioning, and postoperative eye exercises. b. positioning, surgical skin prep, anesthesia risks, and postoperative recovery eye exercises.
c. how the patient must remain very still, benefits and risks of anesthesia options, and positioning. d. the OR environment, positioning, patient responsibilities, and how to ask for pain medication. 2 9 . A pillow is placed beneath the patient’s knees during the procedure to a. help relieve pressure on the lower back. b. prevent hip displacement in the older adult population. c. prevent the pillow from being discarded. d. eliminate the possibility of the patient moving during the procedure. =.The medication given to reduce the blink reflex is a. medazolam. b. tetracaine. c. cyclopentolate. d. lidocaine. 31.The patient is to have surgery on the right eye so the nurse preps a. the left eye. b. both eyes. c. the right eye. d. neither eye.
=The only prep solution that is instilled in the eye is a. green soap. b. 5% povidone-iodine solution. c. alcohol. d. 10% hibiclens soap. 33.To make it easier for the patient to breathe during the procedure, the scrub person and anesthesia care provider a. form a tent with the drapes and provide supplemental oxygen through a nasal cannula. b. provide supplemental oxygen with a face tent mask and put the patient in a semi-reclining position. c. put the patient in the lateral position with the surgical eye facing up and provide supplemental oxygen. d. provide supplemental oxygen with a nonrebreathing mask and form a tent with the drapes. =The incision sites are made at the 10 o’clock and 2 o’clock positions, which allows a. additional anesthesia to be provided during the
356 AORN JOURNAL
SEPTEMBER 2001, VOL 74, NO 3
procedure if needed. b. the intraocular lens implant to be easily maneuvered into position. c. the surgeon to instill balanced salt solution (BSS) and insert instruments. d. the surgeon to make the capsulorhexis and hydrodissect simultaneously. =.The medication given to maintain the chamber shape, ocular volume, and ocular pressure during the procedure is a. phenylephrine. b. cyclopentolate. c. sodium hyaluronate. d. carbachol. is the rupture of the lens capsule. a. Phacoemulsification b. Capsulorhexis c. Hydrodissection d. Emulsification
36.
37.The method for removing a cataract by breaking it up with ultrasonic vibrations is a. phacoemulsification. b. laser surgery. c. extracapsular extraction. d. intracapsular extraction. 38.The incision seals around the microflow tip, which a. prevents postoperative brow pain. b. allows for concurrent irrigation and aspiration. c. prevents radical pressure fluctuations. d. allows for insertion of the foldable intraocular lens. =.Balanced salt solution is injected immediately after the carbachol to a. maintain pupil dilatation. b. prevent postoperative brow pain. c. stimulate cycloplegia. d. prevent postoperative infections. #.No eye patch is needed so a. weight and drag on the skin around the surgical eye is minimized. b. air flow is encouraged, which decreases the potential for infection. c. some peripheral vision is possible. d. problems with depth perception are minimized.
41.The IV line is discontinued
a. when the patient is able to tolerate oral fluids. b. one hour after surgery. c. when the patient is able to tolerate solid food. d. 90 minutes after surgery. =Discharge criteria include a. visual acuity of 201100 in the nonsurgical eye, stable vital signs, and ability to ambulate without dizziness. b. pain manageable with oral narcotics, visual acuity of 201100 in the nonsurgical eye, and stable vital signs. c. stable vital signs, pain manageable with oral narcotics, and ability to tolerate oral fluids without vomiting. d. stable vital signs, ability to tolerate oral fluids without vomiting, ability to ambulate without dizziness, and ability to urinate. 43.The postanesthesia care unit nurse provides the patient with discharge instructions, which include directions to a. keep eye shield in place for 12 to 18 hours and use over-the-counter eye drops for lubrication as needed. b. continue presurgery diet and fluids, keep the eye shield in place for 12 to 18 hours, and use a laxative if needed. c. have a responsible adult remain with the patient for 24 to 48 hours after surgery and use overthe-counter eye drops for lubrication as needed. d. limit the number of trips up and down stairs but walk as much as possible otherwise. -The patient is instructed to call the physician if he or she experiences a. nausea or vomiting, hypotension resulting in dizziness, or constipation. b. hypotension resulting in dizziness, unrelieved pain, or nausea and vomiting. c. pain unrelieved with over-the-counter medicine, nausea or vomiting, or worsening vision. d. bleeding that saturates the eye patch, nausea and vomiting, or constipation. -.The greatest risk of topical anesthesia is a. the inability to fixate, requiring a nerve block. b. exacerbation of concurrent cardiovascular disease. c. severe conjunctival or eyelid bruising.
357 AORN JOURNAL
SEPTEMBER 2001, VOL 74, NO 3
d. destroying the eye with sudden patient movement.
b. the lidocaine to act as a preservative. c. the BSS as a vasoconstrictor to decrease bleeding. d. the BSS to help prevent postoperative infection.
46.The general risks of any cataract procedure include a. anterior capsule tears with vitreous fluid loss and decreased intraocular pressure. b. anterior capsule tears with vitreous fluid loss and intraocular hemorrhage. c. posterior capsule tears with vitreous fluid loss and decreased intraocular pressure. d. posterior capsule tears with vitreous fluid loss and intraocular hemorrhage. 47.
49.Phenylephrine is a mydriatic medication that a. constricts the pupil so the patient's eye cannot focus. b. constricts the pupil so the patient's eye can focus. c. dilates the pupil and inhibits focusing of the eye. d. dilates the pupil but permits the patient to focus.
48.Epinephrine 0.5 mL is added to a. the tetracaine as a vasoconstrictor to decrease bleeding.
!iO.Tetracaine is a topical anesthesia that has an a. onset of 5 to 20 seconds and a duration of 10 to 20 minutes. b. onset of 5 to 20 seconds and a duration of 45 to 60 minutes. c. onset of 60 seconds and a duration of 10 to 20 minutes. d. onset of 60 seconds and a duration of 45 to 60 minutes.
is an irrigation solution used to maintain pupil dilation and keep the eye tissue moist. a. Balanced salt solution b. Xylocaine c. Carbachol d. Lactated Ringer's solution
AORN Association of perioperotive Registered Nurses, is accredited as a provider of continuing education in nursing by the American Nurses Credentioling Center's (ANCC's) Commission on Accreditofion. AORN recognizes this activity 0s continuing educotian for registered nurses. This recognition does not imply hoi AORN or the ANCCs Commission on Accreditation opproves 01 endorses any product included in the activity. AORN maintains the following state board of nursing provider numbers: Alabamo ABNP0075, Califomia CEP 13019, and Florid0 FBN 2296. Check
with your state board of nursing for acceptability of education activity for relicensure. Profmionol nutses are invited to submit manuscripts far the Home Shdy Program. Monuscripts or queries should be sent to Editor, AORN Journal, 2 170 S Pofker Rd, Suite 300, Denver, CO 8023 1571 I . As with 011 manuscripts sent to the Journal, papets submitted for Home Shdy Programs should not hove been previously published or submitted simultaneously to any other publication.
AORN Research Poster Display Call for Abstracts Be a part of the AORN Research Poster display session at the 49th annual AORN Congress in Anaheim, Calif. To have a poster accepted for display, the research must be applicable to perioperative nursing. For more information and guidelines
for submitting abstracts, contact Melissa Parlapiano via telephone at (800) 755-2616 x 248, or download the PDF file located on the AORN web site at http://www.aorn.org/research/pdUpdf.htm.The deadline for accepting abstracts is Oct 1,200 1.
358 AORN JOURNAL
SEPTEMBER 2001, VOL 74, NO 3
Answer Sheet ID Number
TOPICAL ANESTHESIA-A NEW APPROACH TO CATARACT SURGERY
1
0000000000 0000000000 0000000000 0000000000 0000000000 0000000000
P
lease till out the application and answer form on this page and the evaluation form on the back of this page. Tear the page out of the Journal or make photocopies and mail to: AORN Cistomer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 8023 1-57 11 Or fax with credit card information to (303) 750-3212
A
Session Number 0000000000 0000000000 0000000000 0000000000
A score of 70% correct is required for credit.
Session # 6428 Event # 02014 Contact hours: 2.5 Fee: Members $12.50; Nonmembers $25 Program offered September 200 1. The deadline for this program is Sept 30,2004. 1. Record your identification number in the appropriate section below. 2. Completely darken the space that indicates your answer to the examination starting with question one. Use blue or black ink. 3. Record the time required to complete the program
4. Enclose fee if information is mailed. AORN (ID) # Name Address City State Zip RN license # State Phone number ( ) If nonmember, please provide Social Security number Fee enclosed or bill the credit card indicated 0 MC 0Visa 0Am Express 0 Discover Card # Expiration date Signature (for credit card authorization)
359 AORN JOURNAL
SEPTEMBER 2001, VOL 74, NO 3
Learner Evaluation TOPICAL ANESTHESIA-A
NEW APPROACH TO CATARACT SURGERY
The following evaluation is used to determine the extent to which this Home Study Program met your learning needs. Rate the following items on a scale of 1 to 5 . OBJECTIVES
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(High) (Low)
To what extent were the following objectives of this Home Study Program achieved? (1) Discuss the historical perspective of cataract treatment. (2) Discuss the etiology of cataract formation. (3) Describe the anesthetic options appropriate for cataract surgery. (4) Describe the patient selection process and preoperative patient preparation. (5) Discuss the steps of the surgical procedure for cataract extraction. (6) Describe perioperative nursing care of the patient undergoing cataract surgery under topical anesthesia. PURPOSLICOIL
To educate the perioperative nurse about using topical anesthesia in cataract surgery. CONTENT
(7) Did this article increase your knowledge of the subject matter? (8) Was the content clear and organized? (9) Did this article facilitate learning? (1 0) Were your individual objectives met? (1 I ) How well did the objectives relate to the overall purpose/goal? TEST QUESTlONSlANSWERS
(12) Were they reflective of the content? ( 13) Were they easy to understand? (14) Did they address important points?
What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
Author names and addresses:
360 AORN JOURNAL