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Concept Map #1
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Medical Surgical Nursing Concept Map
Age-Related Macular Degeneration
Geraldine Bermudez
Jerald Del Pilar
Samantha Kasingsing
Matthew Lu
Introduction
Patient Profile
P.J 74 year old female
Recently discharged one ago after a 14-day stay for a gangrenous open cholecystectomy (removing the gallbladder)
The gangrene extended into the common bile duct and she suffered a bile leak postoperatively
On the visit to the emergency room, she is complaining of diminished vision in the left eye for the past 7 days
Medication
Medications she is currently taking
Valsartan - Used to treat high blood pressure and congestive heart failure
Amitriptyline - Antidepressant
Aspirin - Pain reliever
Alprazolam - Treat anxiety and panic disorders
Medication
Subjective Data
Subjective Data
- States her vision has become “fuzzy and distorted” in the left eye
- Patient stated, “I survived that horrid ordeal with my gallbladder and now I have trouble with my vision”
- Patient stated that she was never married, but has a good support system with friends and caretakers.
Objective Data
Objective Data
- BP 119/79
- Pulse- 82
- Temp- 97.7
- RR- 16 bpm
- Alert/oriented
- Diminished breath sounds bilateral lower lobes posteriorly
- O2 sat 96% on room air
Initial Exam Results
- Scar in the central area (macula), suggesting age related macular degeneration
- Ophthalmologist feels that Treatment should be aimed at preventing further vision loss and schedules P.J for photodynamic therapy.
Pathology of Macular Degeneration
There are two forms of Macular Degeneraton: Dry (nonexudative and atrophic) and Wet (exudative or neovascular).
- All forms of Age-Related Macular Degeneration starts off as dry. About 85% of people only have Dry AMD. Wet AMD occurs in about 15% of people.
Dry AMD - Changes of the retinal pigment epitheli...
Dry AMD - Changes of the retinal pigment epithelium, typically visible as dark pinpoint areas. The retinal pigment epithelium plays a critical role in keeping the cones and rods healthy and functioning well. Accumulation of waste products from the rods and cones can result in drusen, which appear as yellow spots.
Wet AMD - Occurs when new abnormal blood vessels develop under the retina in a process called choroidal neovascularization (abnormal new vessel formation). Localized macular edema or hemorrhage may elevate an area of the macula or cause a localized retinal pigment epithelial detachment.
Etiology of Age- Related Macular Degeneration
The exact cause of macular degeneration isn't known, but the condition develops as the eye ages.
Discussion Questions
Discussion Questions
#1
Name six potential causes of P.J’s blurry vision
- Valsartan, side effect causes blurred vision
- Old age
- Anesthesia used in surgery reduces tears, causing blurred vision
- Gallbladder disease can cause dry eyes, contributing to the blurred vision
- Gangrene could potentially have spread to brain, causing blurred vision
- Macular Degeneration
#2
What additional health history information would you obtain from P.J
- We should ask if she has a family history of cataracts, glaucoma, or macular degeneration
- Ocular and nonocular history
- Ask if she has any allergies that cause eye symptoms
- Ask about her sleeping patterns
Nutritional pattern
#3
What will you include in P.J’s focused assessment?
- External examination
Appearance of eyelid, eyelashes
Positioning and mobility of eyes
- Pupillary Response
Reaction to light
- Accomodation
Focusing on near objects
- Visual acuity measurements
- Ophthalmoscopy
Look for drusen (abnormal accumulation of yellowish extracellular deposits
#4
What are the early signs of age-related macular degeneration?
- Blurred and darkened vision
- Scotomas- blind spots in the visual field
- Metamorphopsia- distortion of vision
- If patients have only one eye affected, they may not notice early changes in their vision
#5
What tests can be done to determine if P.J has age-related macular degeneration?
- Amsler grid test
Help define the involved area, and it provides a baseline for future - comparison
Used to detect vision problems resulting from damage to the macula (central part of the retina) or optic nerve
- Fundus photography and IV angiography with fluorescein and or indocyanine green dyes
Helps to further determine the extent and type of AMD
-Optical coherence tomography
Analyzes retinal anatomy
#6
What risk factors are associated with macular degeneration?
- Genetic factors
- Family History
- Chronic inflammation conditions
- Smoking
- Hypertension
- White ethnicity
- Nutritional factors
#7
What diet related teaching will you provide P.J.
- We will encourage P.J to eat a lot of dark greens, leafy vegetables containing lutein (kale and spinach).
This may help reduce the risk of AMD. The antioxidant vitamins in fruits and vegetables contribute to eye health.
- Limit intake of refined carbohydrates
- Eat fish or take fish oil supplement.
- Don’t smoke.
#8
Using Roy Model, identify 2 priority nursing diagnosis. Select one. What would be your goal and nursing interventions for that diagnosis? - How would you evaluate if your interventions were successful?
Risk for injury in relation to vision loss
Teach patient about her diagnosis
Teach her about change in lifestyle
- Ineffective coping in relation to depression
Cited Source
Lewis, S.L., Bucher,L, Heitkemper,M.M., & Harding, M. (2017). Medical-surgical nursing,(10th ed.)St. Louis. MO: Mosby.