Nursing Care Plan | NCP Hyperopia

Nursing Care Plan

Hyperopia is one of several eye conditions called refractive errors, which means that light entering the eye is not properly focused on the retina (the light-sensitive layer of tissue at the back of the eyeball). It is not a disease of the eye in the strict sense. Hyperopia, or farsightedness, is a condition that develops when a persons eyeball is abnormally short from front to back, or when the cornea (the clear front portion of the eyeball) is abnormally flat. In a normal eye, light entering the eye through the cornea is focused by the lens of the eye on the retina. In hyperopia, the abnormal shortness of the eye or the flatness of the cornea causes the lens to focus images behind the retina. This incorrect focus means that objects at a distance can be seen more clearly than those that are close to the viewer. If the hyperopia is severe, the person may be able to see clearly only objects that are quite far away. Hyperopia is a common refractive error in the general population, affecting about 25 percent of the general population. In addition, the condition tends to run in families. Hyperopia is often combined with astigmatism, another type of refractive error caused by irregularities in the curvature of the cornea or the lens of the eye. Most babies are mildly hyperopic at birth. Hyperopia in children is usually less severe than hyperopia in adults, partly because the eyeball in many children lengthens as they grow older and allows the eye to focus normally. It is thought that between 6 and 9 percent of children in the United States may have mild hyperopia. Boys and girls are equally affected. There are, however, racial and ethnic differences, with Native Americans, African Americans, and Pacific Islanders having higher than average rates of hyperopia.

There is a condition similar to hyperopia called presbyopia that appears in middle-aged adults. Presbyopia is a type of farsightedness that develops because the lens of the eye becomes less flexible with age and cannot change its shape as easily when the person is trying to focus on near objects (usually reading materials). Most people over forty will develop some degree of presbyopia. Hyperopia that went unnoticed during a persons younger years may become apparent in middle age, when the person begins to develop presbyopia as well. Nursing Care Plan Signs and Symptoms In addition to a short eyeball or flatter cornea, hyperopia can be caused in some people by abnormal development of the eye or by trauma to the eye. In a very few cases, hyperopia may be related to disorders of the nervous system or to medications that affect the eyes ability to focus. In general, genetic factors are thought to play a more important role in hyperopia than environmental factors or personal history. Hyperopiain younger children may not cause noticeable symptoms. Older children and adults, however, will often develop the following symptoms: Having to squint while reading. Frequent blinking and difficulty focusing on close objects. Red or teary eyes, or burning or aching in the eyes. Blurry vision. Headaches or general discomfort in the eye after a long period of reading, writing, or doing other close work. People who have these symptoms should make an appointment with an optometrist (an eye care professional who is trained to diagnose refractive errors) or an ophthalmologist (a doctor who specializes in diagnosing diseases of the eye) to find out whether they need corrective lenses.

Nursing Care Plan Diagnosis Hyperopia and other refractive errors are evaluated by a series of vision tests. After the examiner takes a history of the patients symptoms (including a family history of eye problems), the patient is usually asked to read the letters on an eye chart. The examiner may also shine lights into the eyes or administer eye drops that allow him or her to see all the structures inside the eye clearly. To measure the strength of the lens needed to correct the patients hyperopia, the examiner uses a device called a photopter (or refractor). The photopter is placed in front of the patients eyes, and the examiner moves various lenses in and out of the device while the patient reads letters on an eye chart located 20 feet (6 meters) away. Nursing Care Plan Treatment Screening for and treatment of hyperopia in school-age children is important because significant hyperopia can lead to strabismus (inability of the eyes to work together) or amblyopia, a condition in which there is poor vision in one eye that is not caused by disease. In addition, uncorrected hyperopia can lead to problems in school, including learning disorders and loss of interest in reading. Hyperopia can be treated nonsurgically by prescription eyeglasses or contact lenses, which are prescribed by the optometrist or ophthalmologist but made and fitted by an optician. There are also surgical options for people who dislike glasses or contact lenses. The two most common surgical procedures for hyperopia involve reshaping the cornea with a laser or implanting an artificial lens in the front of the eye. Reshaping the cornea works better if the refractive error is only low to moderate. Patients with a high degree of refractive error generally do better with lens implantation. There are drawbacks to surgical correction for refractive errors, however. These include the risks of infection, development of haze in the cornea, or dry eyes. In some cases the surgeon may need to perform a second operation if the first one either overcorrected or undercorrected the shape of the patients cornea. It is important for a patient diagnosed with hyperopia to discuss all the treatment options with the optometrist or ophthalmologist, as no two people will have exactly the same degree of farsightedness or the same lifestyle. Nursing Care Plan Prognosis Most patients with hyperopia do well after being fitted with corrective lenses or having eye surgery. Hyperopia caused by the shape of the eyeball or the cornea does not get worse with age and is unlikely to lead to vision loss. Nursing Care Plan Prevention Hyperopia is largely a matter of heredity and cannot be prevented. People can, however, prevent strabismus or other complications of hyperopia by visual screening in childhood and regular eye checkups at all ages.

The Future It is possible that laser treatment and other types of vision surgery will be further refined in the future and have fewer risks or side effects.

Hyperopia, or farsightedness, is a condition that develops when a persons eyeball is abnormally short from front to back, or when the cornea (the clear front portion of the eyeball) is abnormally flat.

Nursing Diagnosis: Disturbed Sensory Perception: Visual Vision Loss; Macular Degeneration; Blindness
NANDA Definition: Change in the amount or patterning of incoming stimuli, accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli Visual impairment and/or loss of vision affects more than 100 million Americans. Genetics, aging, and chronic diseases such as diabetes and glaucoma account for the majority of visual impairment. Trauma, usually associated with alcohol use, also accounts for visual impairment or loss to a lesser degree. Some forms of visual impairment can be corrected, either by refraction (glasses, contact lenses), medications (used mainly in the treatment of glaucoma), or surgery (lens implants, keratorefractive procedures). These include myopia (nearsightedness), hyperopia (farsightedness), astigmatism (caused by abnormal corneal curvature), and presbyopia (loss of accommodation as the result of normal, agerelated changes in the lens). Other types of visual impairment or loss

cannot be corrected. As the American population ages, visual impairment, including noncorrectable loss from progressive macular degeneration, is a growing concern. Nursing interventions in persons with visual impairment are aimed at assisting the individual to cope with the loss and remain functional and safe. Ability to be independent with self-care, especially in the management of medications, may require ongoing supervision and/or institutionalization. This care plan addresses needs of persons who are out of their usual environments (e.g., in outpatient settings, hospitals, or long-term care facilities). Defining Characteristics:
                  

Lack of eye-to-eye contact Abnormal eye movement Failure to locate distant objects Squinting, frequent blinking Bumping into things Clumsy behavior Closing of one eye to see Frequent rubbing of eye Deviation of eye Gray opacities in eyes Head tilting Disorientation Reported or measured changes in visual acuity Anxiety Change in usual response to visual stimuli Anger Visual distortions Incoordination History of falls, accidents Related Factors:

Diabetes

       

Glaucoma Cataracts Refractive disorders (myopia, hyperopia, astigmatism, presbyopia) Macular degeneration Ocular trauma Ocular infection Retinal detachment Conjunctival Kaposis sarcoma of acquired immunodeficiency syndrome (AIDS) Disease or trauma to visual pathways or cranial nerves II, III, IV, and VI, secondary to stroke, intracranial aneurysms, brain tumor, trauma, myasthenia gravis, or multiple sclerosis Advanced age Expected Outcomes

Patient achieves optimal functioning within limits of visual impairment as evidenced by ability to care for self, to navigate environment safely, and to engage in meaningful activities.