Question 1

Vitrectomy is narrowly defined as removal of all or part of the vitreous gel (body).Vitrectomy can also vacuum any pooled blood to enhance visual clarity.Select all indications and complications that apply to vitrectomy.
A)Excision of fibrotic membranes
B)Electrocoagulation of bleeding vessels
C)Extraction of floaters
D)Removal of retained foreign bodies
E)Infection
F)Retinal tears and detachment 
G)Total vision loss.
H)Cataract

Accepted Answer

In the broader clinical sense of the term,vitrectomy surgery can also include the excision and removal of fibrotic membranes;the removal of epiretinal membranes;the electrocoagulation of bleeding vessels;the treatment of long-standing vitreous opacities,advanced diabetic eye disease,or severe intraocular trauma;the removal of retained foreign bodies;and the treatment of proliferative vitreoretinopathy,retinal detachment from giant tears,endophthalmitis,and diagnostic vitreous biopsy.Complications of vitrectomy include retinal detachment,retinal tears,cataract,and infection.Alternatively,the risk of no treatment can be total loss of vision.

Question 2

The procedure for cataract extraction with implantation of an intraocular lens (IOL)exposes the patient to risks of infection of the anterior chamber and corruption of the implanted device.Appropriate measures for the circulating nurse and scrub person include managing patient safety needs.Efforts are directed at preventing foreign substances from being introduced intraocularly.Select all of the nursing actions that may ensure this outcome.
A)The sterile field should be created with lint-free drapes.
B)Powder-free gloves should be worn.
C)Instruments should be cleaned with gauze sponges.
D)Gloved hands should not touch the intraocular tip of the instrument.
E)Instruments should be soaked in sterile water when not in use.f.The procedure room should be warm,quiet,and peaceful.

Accepted Answer

Both the scrub person and the perioperative nurse must also manage additional patient safety needs.Foreign substances must not be introduced intraocularly.Lint-free drapes should be used to create the sterile field.If powder-free gloves are not used,gloved hands must be wiped with moistened gauze sponges to remove starch powder particles before the procedure begins.Gloved hands should not touch the portion of an instrument used in an intraocular wound,and debris should be cleansed from instruments with cellulose sponges.

Question 3

Toxic anterior segment syndrome (TASS),also known as sterile endophthalmitis,is a sterile noninfectious form of acute inflammation that occurs after eye surgery (typically cataract surgery).It frequently begins within 24 hours after surgery and is characterized by decreased vision,significant corneal edema,and moderate to severe inflammation in the anterior chamber of the eye.Select all of the possible causes and risk reduction strategy statements.
A)Introduction of an infectious,toxic substance into the anterior chamber during surgery
B)Introduction of a noninfectious,toxic substance into the anterior chamber during surgery
C)Introduction of sterile lint or debris into the anterior chamber during surgery
D)Introduction of sterile mineral deposits into the anterior chamber during surgery
E)Educate patient/family about signs and symptoms of TASS before discharge.
F)Practice vigilant compliance with cleaning,disinfection,and sterilization of equipment and instrumentation.

Accepted Answer

TASS can be a very serious and sight-threatening condition.TASS is thought to be a response to the introduction of a noninfectious,toxic substance into the anterior segment of the eye during surgery.Substances that have been implicated include irrigating solutions and other agents such as anesthetics and antibiotics.TASS may also be related to the improper cleaning or sterilization of instruments.The perioperative nurse plays a key role in implementing risk reduction strategies for TASS,not only in prevention through the vigilant implementation of recommended practices for the use,cleaning,disinfection,and sterilization of equipment and instrumentation,but also in the provision of effective patient education.

Question 4

Anna Lindeman,a 59-year-old woman with a significant retinal tear close to the macula,emerges from anesthesia in the PACU after a 4-hour pneumatic retinopexy with scleral buckling,posterior vitrectomy,and injection of a gas bubble to close and support the retinal tear.She will have to maintain a face-down head position for 7 to 10 days,followed by laser surgery or cryotherapy to seal the tear.As she prepares for discharge from the PACU,she informs the perioperative nurse that she has reserved a flight to Denver,Colorado in 3 weeks to visit friends and celebrate the end of her ophthalmic surgeries and survival of sustained face-down positioning during recovery.The nurse firmly informs Anna that she should cancel and delay her trip until the surgeon approves that type of travel.What statement below justifies the nurse's response to Anna's vacation plans?
A) Facial edema from sustained face-down position will not have resolved within the time frame before her vacation.
B) Airplane cabin pressure and recirculated air are significant risk factors for infection after complex vitreous surgery.
C) The dry air and high elevation of Denver will dehydrate the cornea and sclera,causing the sclera to buckle and the tear to loosen.
D) Airplane cabin pressure and high elevations will cause severe enlargement of the gas bubble and increase intraocular pressure.

Accepted Answer

In pneumatic retinopexy an intraocular injection of a bubble of air or therapeutic gases provides pressure against retinal breaks,allowing the detached retinal breaks to approximate the pigment epithelium.The intent of instilling a gas bubble is to sustain its size and hold the retina in place.Patient positioning after retinopexy is often face-down for several days to weeks but may include tilting the head to one side or the other as well.The head position is determined by the location of the retinal tear/hole.Adherence is often difficult because of physical and psychologic challenges.Patients are instructed to avoid air travel until the gas bubble is completely resolved or decreased to a level of 5% of the vitreous volume.Cabin pressurization in air travel will cause severe enlargement of the gas bubble with an increase in intraocular pressure and eye pain.Car or train travel to high elevations should also be avoided unless the change in altitude is done gradually.

Question 5

MATCHING
Match the three descriptive statements with their appropriate globe and orbital surgical procedures.
a.Removal of the eye contents with sclera and muscles left intact
b.Removal of the entire orbital contents,including the periosteum
c.Removal of the entire globe,severing muscular attachments and optic nerve
-Enucleation

Accepted Answer

The answer of MATCHING
Match the three descriptive statements with their...

Question 6

MATCHING
Match the three descriptive statements with their appropriate globe and orbital surgical procedures.
a.Removal of the eye contents with sclera and muscles left intact
b.Removal of the entire orbital contents,including the periosteum
c.Removal of the entire globe,severing muscular attachments and optic nerve
-Exenteration

Accepted Answer

The answer of MATCHING
Match the three descriptive statements with their...

Question 7

MATCHING
Match the three descriptive statements with their appropriate globe and orbital surgical procedures.
a.Removal of the eye contents with sclera and muscles left intact
b.Removal of the entire orbital contents,including the periosteum
c.Removal of the entire globe,severing muscular attachments and optic nerve
-Evisceration

Accepted Answer

The answer of MATCHING
Match the three descriptive statements with their...

Quiz 17: Ophthalmic Surgery

Vitrectomy is narrowly defined as removal of all or part of the vitreous gel (body) .Vitrectomy can also vacuum any pooled blood to enhance visual clarity.Select all indications and complications that apply to vitrectomy.