Question

MH, a 70-year-old woman with postoperative acute glaucoma, is prescribed one drop of latanoprost 0.005% ophthalmic solution each evening and one drop of timolol 0.25% ophthalmic solution each morning and evening.

After a few months on these medications, MH notices changes in the appearance of her eyes. Describe the changes that MH is likely experiencing, and explain which drug is responsible.

1. Write a complete nursing diagnosis for case study. (Nursing Diagnosis R/T ________ secondary to __________ AEB _____________.
2. List 2 interventions with rationales for the nursing diagnoses you wrote for each case study.

Answer 1

The colour change in the eye is due to the administration of Latanoprost eye drops which gradually change eye colour by increasing the amount of brown pigment in the iris. Before treatment is instituted, patients should be informed of the possibility of a permanent change in eye colour. Unilateral treatment can result in permanent heterochromia.

This change in eye colour has predominantly been seen in patients with mixed coloured irides, i.e. blue-brown, grey-brown, yellow-brown and green-brown. In studies with latanoprost, the onset of the change is usually within the first 8 months of treatment.

The colour change is due to increased melanin content in the stromal melanocytes of the iris and not to an increase in number of melanocytes. It has not been associated with any symptom or pathological changes in clinical trials to date.
Possible nursing Diagonsis are
1.Anxiety related to physiological factors, change in health status; presence of pain; possibility/reality of loss of vision Unmet needs,Negative self-talk as evidenced by apprehension, uncertainty expressed concern regarding changes in life events.

Nursing Interventions	Rationale
Evaluate anxiety level, degree of pain experienced or suddenness of onset of symptoms, and current knowledge of the condition.	These factors affect the patient’s perception of threat to self, potentiate the cycle of anxiety, and may interfere with medical attempts to control IOP.
Give accurate, honest information. Discuss the probability that careful monitoring and treatment can prevent additional visual loss.	Lessens anxiety related to unknown or future expectations, and provides a factual basis for making informed choices about treatment.
Allow the patient to acknowledge concerns and express feelings.	Provides an opportunity for the patient to deal with the reality of the situation , clarify misconceptions , and problem-solve concerns
Identify helpful resources and people.	Provides reassurance that patient is not alone in dealing with the problem.

2. Deficient Knowledge related to lack of recall, information misinterpretation as evidenced by evidenced by Questions; statement of misconception.

Nursing Interventions	Rationale
Stress the importance of glaucoma screening.	For early detection and prevention. All people older than age 35, especially those with family histories of glaucoma, should have an annual tonometric examination.
Review pathology and prognosis of the condition and lifelong need for treatment.	Provides an opportunity to clarify and dispel misconceptions and present condition and something that is manageable.
Educate the patient about the drug Timolol	It will help to create awareness as well as help the patient to reduce his /her anxiety .
Educate the patient about the drug latanoprost(Sympathomimet)Light-colored eyes are more responsive to these drugs than dark-colored eyes,	It will help to create awareness as well as help the patient to reduce his /her anxiety .