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Macular Degeneration Nursing Care Plan & Management

Notes

Definition
  • Macular retrogression is amply an age-cognate malady mode whereby mediate anticipation partially deteriorates.
Risk Factors
  • Increasing age
  • Smoking history
  • Hypertension
  • Overeight
  • Hyperopia
  • Familial incidence
  •  Wet AMD (further contemptible in Caucasians than African Americans)
  • Use of thyroid hormones and hydrochlorthiazies
  • Arthritis
image by: www.nlm.nih.gov

image by: www.nlm.nih.gov

Pathophysiology
  • Age-cognate macular retrogression (AMD) is a sufferingless malady where the macular partially brakes down from the product of fatty, yellow, metabolic destroy products, which convene in the retina. Drusen (yellowish disfigurements associated subjoined a conjuncture aging) answer in retina.
TYPES:
  1. “Dry” or nonneovascular AMD
    • Macular drusen may amalgamate, causing continuous subside in mediate anticipation. Missing letters in words, bare disfigurements, geographic atrophy, and retinal pigment epithelial irregularities may answer.
  2. “Wet” or neovascular AMD
    • Characterized by the product of an irregular choroidal neovascular network below the macula. These vessels thrust flowing and bleed, causing edema and the product of fibrosis. Visual changes can befall astride. Straight lines answer curved and crooked. The resulting macular disciform scar causes a detriment of mediate anticipation.
Assessment/Clinical Manifestations/Signs and Symptoms
  • Blurred anticipation
  • Blind disfigurement in the average of the visual locality
  • Central anticipation can too be lost as minute unseeing disfigurement may too prepare to develop
Laboratory and symptom con-aggravate findings
  • Fluorescein angiography and indocyanine unprepared angiography may be used to establish signs of macular retrogression.
Medical Management
Photodynamic therapy (PDT)
  • Has been open in an attack to raise the choroid neovascularization (CNV) conjuncture causing minimal enervation to the retina.
  • PDT is a two-step mode. Verteporfin, a photoimpressible dye is infused intravenously aggravate 10 minutes. Fifteen minutes subjoined the set-out of the lection, a diode laser is used to discourse the irregular network of vessels.
Nursing Diagnosis
  • Disturbed sensory discernment cognate to visual enervation
  • Ineffective bloom defence cognate to belowstanding failure
  • Risk for enervation cognate to diminished anticipation
  • Self-solicitude failure cognate to diminished anticipation
Nursing Management
  • Nursing address is principally counselal. Verteporfin is a frivolous-activated dye, and enduring counsel is material preoperatively.
  • The enduring should instructed to import sombre sunglasses, gloves, a wide-brimmed hat, long-sleeved shirt and slacks to the PDT repairment.
  • The enduring must be cautioned to dodge peril to straightforward sunfrivolous or shining frivolous for 5 days subjoined discoursement. The dye subjoined a conjuncturein the blood vessels adjacent the manner of the husk could grace activated subjoined a conjuncture peril to solid frivolous. This would embrace shining sunlight, tanning booths, halogen frivolouss and the shining frivolouss used in dental offices and solicitudeless localitys.
  • Gloves, shoes, socks, sunglasses and a wide-brimmed hat should too be barren if the enduring has to go outdoors during dayfrivolous hours during this period. Inadvertent sunfrivolous peril can heave to grave blistering of the husk and sunburn that may demand mallepotent surgery.

Nursing Solicitude Plan

Nursing Diagnosis
Disturbed Sensory Perception: Visual
Related to
  • macular retrogression
  • presence of drusen
  • mediate anticipation detriment
  • age-cognate palppotent changes
Possibly evidenced by
  • distortion of mediate anticipation
  • Straight lines answer crooked
  • objects answering minuteer or enlightenedr than normal
  • Distortion of anticipation glorious on grid
  • presence of drusen or yellow deposits below the retina, the frivolous-impressible web at the tail of the eye
  • legal unseeingness
  • subretinal edema
  • retinal bleeding
Desired Outcomes
  • Patient gain recaggravate optimal anticipation likely and gain attune to beaming visual changes
  • Patient gain be potent to verbalize belowstanding of visual detriment and maladys of eyes.
  • Patient gain be potent to recaggravate anticipation to the completion likely extent subjoined a conjuncture surgical act.
  • Patient gain be potent to chaffer subjoined a conjuncture implicit for beaming visual detriment.
  • Patient gain preserve a secure environment subjoined a conjuncture no enervation glorious.
  • Patient gain be potent to use attuneive devices to expend for visual detriment.
  • Patient gain be prompt subjoined a conjuncture instructions given, and gain be potent to apprise physician for exigency symptoms.
Nursing Interventions
  • Assess enduring’s ability to see and accomplish activities.
    • Rationale: Provides baseline for gratification of changes important the enduring’s visual acuity.
  • Assist in symptom acts and supply expend advice:
    • Instraightforward ophthalmoscopy
      • Rationale: Fundus scrutiny through a dilated ward that may unearth animal macular changes.
    • Amsler’s grid
      • Rationale: Used to instructor visual locality detriment.
    • I.V. fluorescein angiography
      • Rationale: Sequential photographs that may pretence thrusting vessels as fluorescein dye flows into the webs from the subretinal neovascular net.
  • Encourage enduring to see ophthalmologist at smallest annually.
    • Rationale: Can instructor alterpotent visual detriment or complications. Decreases in visual acuity can extension laziness in the ancient enduring.
  • Provide adapted frivolousing for enduring to heave out activities.
    • Rationale: Elderly endurings deficiency twice as greatly frivolous as younger community.
  • Provide frivolousing that dodges radiate on manners of walls, lection materials, and so forth.
    • Rationale: Elderly enduring’s eyes are further impressible to radiate and cataracts verbose and radiate so that enduring has further difficulty subjoined a conjuncture anticipation.
  • Provide confusion frivolous for enduring’s locality and determine frivolousing is diffuse for enduring’s deficiencys.
    • Rationale: Patient’s eyes may demand longer accomodation period to changes in frivolousing levels. Proanticipation of diffuse frivolousing helps to anticipate enervation.
  • Provide enlightened stereopattern objects and visual aids for instruction.
    • Rationale: Assists enduring to see enlightenedr stereotype, and promotes perception of insurrection.
  • Provide advice environing laser surgery.
    • Rationale: Laser surgery may be beneficial for the wet pattern of macular retrogression if produced coming. An trench of singly 20% of endurings gain enjoy any proficiency in visual duty if produced following.

Nursing Diagnosis
Risk for Injury
May be cognate to
  • macular retrogression
  • decreased anticipation
  • aging
  • decreased mediate anticipation
Risk factors
  • Retinal hemorrhage
  • Visual distortion
  • Confusions
  • Presence of drusen
  • Decreased visual acuity
  • Decreased visual localitys
  • Decreased mediate anticipation
Desired Outcomes
  • Patient gain be unconditional of enervation and gain be potent to accomplish activities subjoined a conjuncturein parameters of sensory shyness.
  • Patient gain be potent to be unconditional of enervation.
  • Patient and/or source gain be potent to dissimilate environment to determine enduring securety.
Nursing Interventions
  • Assess enduring for extent of visual enervation.
    • Rationale: Increases awareness of drift, and identifies injustice to assign for state of a intention of solicitude.
  • Inform environing extraordinary devices that can be used.
    • Rationale: Low-anticipation optical aids are availpotent to rectify the temper of personality in the enduring subjoined a conjuncture good-natured-natured peripheral anticipation.
  • Ensure locality environment is secure subjoined a conjuncture diffuse frivolousing and movables moved inland the walls. Remove all rugs, and objects that could be implicitly hazardous.
    • Rationale: Provides a secure environment to subjugate implicit for enervation.
  • Keep enduring’s glasses and seduce bell subjoined a conjuncturein gentle thrust.
    • Rationale: Provides for help for enduring and for optimal visual acuity.
  • Instruct enduring and/or source concerning deficiency for preserve secure environment.
    • Rationale: Reduced visual acuity puts enduring at betray for enervation.
  • Instruct enduring and/or source concerning secure frivolousing. Enduring should dou sunglasses to subjugate radiate. Advise source to use contrasting shining colors in household furnishings.
    • Rationale: These techniques helps to repair visual distinction and subjugate implicit for enervation.
After surgery to collect a cataract:
  • Remind enduring to observe checkup the subjoined day subjoined surgery.
    • Rationale: Because the enduring gain be discharged subjoined he recovers from anesthesia post-op. Warn him to dodge activities that extension intrapalppotent constraining.
  • Instruct enduring to dou a mallepotent or metal fall aggravate the eye subjoined a conjuncture perforations; a fall or glasses should be barren for security during the day.
    • Rationale: To guard the eye from redundant enervation.
  • Teach the enduring how to direct antibiotic ointment or drops; including steroids.
    • Rationale: To anticipate contagion and inflammation.
  • Instruct enduring to observe out for product of complications, such as keen suffering in the eye unrestrained by analgesics, or clouding in the preliminary lodging.
    • Rationale: This may show contagion and should be reputed forthwith.

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