Homonymous Hemianopsia – Stroke Nursing Care in Med-Surg

by Rhonda Lawes

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    00:01 All right. I promised you it was coming. Now, you got homonymous hemianopsia.

    00:06 Also sounds like a wrestler to me if you want to do it, but here's how your vision really works. The left half of the brain processes visual information from both eyes about the right side of their visual world. Now it's the opposite on the right side.

    00:20 The right half of the brain processes the visual information from both eyes about the left side of the visual world. So, kinda looks like this.

    00:29 So, with homonymous hemianopsia, a person can only see the right or left side of their visual world.

    00:38 Okay. This is really a bizarre feeling, and we've tried to give you a taste of this, and I'm so thankful I've never experienced it personally.

    00:47 So, what are the symptoms? I mean, how would you pick this up in your patient? You may be the first one who notices this with your patient.

    00:55 Well, if they were walking, you might notice them bumping or falling into things. That's -- notice that one side, the same side, they keep running into the wall when they go through your doorway, or they keep bumping into furniture that's on a certain side of the room. So, this makes everyday tasks like crossing the street, or driving a car, for various obvious reasons, very, very unsafe.

    01:18 So, if Mr. Johnson is experiencing this, he's not going to be able to drive for a while until we can figure out if this will resolve itself.

    01:26 Now, you might show them an eye chart, they might be missing entire parts of an eye chart on a certain side of where they're affected.

    01:34 They might not notice objects on their bedside table or on the desk or even food on their plate. They may just eat right down a certain side of their plate if it's really severe.

    01:45 Now, this will be very frustrating for your patient. Remember, their brain's taken a hit, right? They've had a stroke. So it's very frustrating and they can already be kind of emotional labile, so be patient.

    01:57 If you ask them to read something, it's going to be hard for their eyes to pick up the beginning of the next line. So they're not going to understand what's happening, they might turn the head or body away from the side of where they can't see. Isn't that weird? So like, if they can't see the left, you may notice they turn their body or their head that way. So be aware and alert if you're patient seems to be doing any of these behaviors.

    02:21 They also might kind of drift in a direction away from the side when they're walking.

    02:25 So if I can't see here, I may kind of drift to the right.

    02:29 They also might see some weird lights and shapes or figures or floating things, instead of recognizable objects, so their vision is significantly impaired.

    02:40 Now, sometimes, a movement on the normal side of vision they also think is, at the same time, on the side of loss. So, you know, that's a lot of very specific examples, but just know that it is bizarre to have that type of vision, and it's going to take them a while to adjust to it.

    02:55 Would be great if it's just, you know, temporary, but this may be what the patient has to deal with for the rest of their life. So, what's my job as a nurse? First of all, I'm going to be on the alert to know that this may be happening to Mr. Johnson. And I'm going to assess him for any of those behaviors we just discussed. Now, here's what you can do if we know that he does have it. Okay. So, when we're moving through the environment, you're going to teach him to learn to direct his eyes toward the good side, right, toward the good visual field. When he's walking into a new environment, we want him to pause and move his head from side to side, right? Want him to observe where objects and people are located, so he's kind of getting a game plan before he ever walks into the room. So, he doesn't want to just -- we don't ever want him rushing into a room, right? We want him to pause, be casual, make sure he scans the room, using his good visual field. So he can almost like paint a picture of what he sees in his brain. By practicing this, particularly in the 6 months after vision loss, can help him train his brain to do it automatically.

    03:59 I mean, your brain is amazing. My eyes have gone through the change, right? So, you have where I can't see things up close as much as I used to be able to.

    04:10 Used to make fun of people. Now I realize it's not that funny when it happens to you.

    04:15 But when I was at the eye doctor, you know how it goes; this one, that one, this one, that one, this one, that one, this one that one, which just breaks me out in a sweat. But he talked to me about instead of using bifocal contacts, would I consider putting one in the eye and not wearing a contact in the other eye.

    04:31 Well, as I'm talking to him, I had the vision on. I was like, "I don't really know if I can do that," because I was very nervous. He said, "Stop.

    04:38 Rhonda, you're doing it now. I have this set.

    04:42 So it'd be if you're wearing only 1 contact in your eye," and I was like, "Oh." My brain did that naturally.

    04:51 I didn't even have to train it. So, your brain is able to do things, even brains that have taken a hit like stroke, without you being aware of it.

    04:59 But if we teach him to do it with his body first, his brain will catch on, and hopefully, will start to do that naturally. Now, if he's walking with someone, we want the partner to walk on the blind side. So, when you're walking with Mr. Johnson, or when the physical therapist is walking with Mr. Johnson or his wife or family, you want them to walk on the blind side, and make sure he has your arm just to kind of provide for guidance.

    05:25 Now, if you're in a group situation, this will be literally after discharge, we don't usually have any group parties in the hospital. But when you're in a group situation, you want people in the good field of vision as much as possible.

    05:37 So, you know, when you go out to dinner, you want to make sure that you find a seat for this patient that will allow them to see the people in their good vision. So, it's kinda like I am almost deaf in my left ear.

    05:50 So when I go to restaurants, I'm always very particular and my friends and family know, so I sit with my good ear towards the conversation. Same thing for Mr. Johnson, you'd want to sit him so his field of vision is toward the people.

    06:03 Now, how about if you go to a movie? Yeah, we go to a movie, you want to sit far over to the blind side, so that all the action takes place in the normal visual field.

    06:13 These are examples of things that we would teach Mr. Johnson and his family to let them know, "Hey, yes, this is a difficulty, but we can overcome it." Now, we wanted to play real life, not computer-based card games. We want to do crossword puzzles, and that'll help him regain coordination between his vision and his touch. So, here's a recipe for playing games.

    06:34 My favorite is spades. Love a good game of spades, but there's lots of games to choose from. So help him do word searches or picture searches. And remember, they have word searches with jumbo letters. Let's start with that instead of the little tiny letters.

    06:49 Puzzles are a great thing for dexterity, and to help him improve eyes scanning at near distances.

    06:57 Okay. That's lots of information, but these are the kind of things that nurses and therapists -- these are real life applications that we want to help our patients learn about because this is going to change the ability for them to lead a full life of quality.

    About the Lecture

    The lecture Homonymous Hemianopsia – Stroke Nursing Care in Med-Surg by Rhonda Lawes is from the course Neurology Case Study: Nursing Care of Stroke Patient.

    Included Quiz Questions

    1. Homonymous hemianopsia
    2. Achromatopsia
    3. De Morsier's syndrome
    4. Optic nerve hypoplasia
    1. Bumping or falling into things on the side of the hemianopsia
    2. Not noticing objects on a table or desk that are on the side of the hemianopsia
    3. Drifting away, or turning the head away, from the side of the hemianopsia
    4. Visual hallucinations appearing as lights, shapes, or figures
    5. An area of blindness noted in the visual field opposite to the hemianopsia
    1. This practice can help train the client's brain to do this automatically.
    2. It makes sure that the client does not fall or trip.
    3. It reminds the client that there are objects that can be found on the side of the hemianopsia.
    4. It will help the client to balance and stop drifting toward the side of the hemianopsia.
    1. If one is going to a movie theater or show, sit far over to the blind side.
    2. When sitting at a table or in group situations, situate people so that they are on the good side of the visual field.
    3. When walking with a partner, let that partner walk on the blind side.
    4. Play computer-based games such as card games and word searches.
    5. Complete all activities of daily living only when someone else is present to assist.

    Author of lecture Homonymous Hemianopsia – Stroke Nursing Care in Med-Surg

     Rhonda Lawes

    Rhonda Lawes

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