Question

I. Read Chapters 20 and 21 from your Text Book.  

II. NCLEX Review Questions Chapters 20 and 21 from Evolve Resources

III. Case Study:  Age-Related Macular Degeneration

Patient Profile

P.J. is a 74-year-old female who has been seen multiple times in the past with a complex medical history. Most recently, she was discharged one month ago after a 14-day stay for gangrenous open cholecystectomy. The gangrene extended into the common bile duct and she suffered a bile leak postoperatively. On this visit to the emergency room, she is complaining of diminished vision in the left eye for the past seven days. She is currently taking the following medications:

valsartan 160 mg/25 mg PO daily

amitriptyline 25 mg PO daily

aspirin 81 mg PO daily

alprazolam 0.25 mg every 6 hours PRN for anxiety

Subjective Data

States her vision has become “fuzzy and distorted” in the left eye

States, “I survived that horrid ordeal with my gallbladder and now I have trouble with my vision.”

Never married; has a good support system with friends and caretakers

Objective Data

Physical Examination

Blood pressure 119/79, pulse 82, temperature 97.7° F, respirations 16

Alert and oriented to person, place, and time

Diminished breath sounds bilateral lower lobes posteriorly

Oxygen saturation 96% on room air

Discussion Questions

Name six potential causes of P.J.’s blurry vision.

Case Study Progress

A consult is sent to the on-call ophthalmologist. The initial exam results show a scar in the central area (macula), suggesting age-related macular degeneration. The ophthalmologist feels at this point that the treatment should be aimed at preventing further vision loss and schedules P.J. for photodynamic therapy.

2. What are the early signs of age-related macular degeneration (AMD)?

3. What tests can be done to determine if P.J. has age-related macular degeneration

4. What risk factors are associated with macular degeneration?

5. What diet related teaching will you provide P.J.?

Answer 1

Causes for blurred vision in P.J's patient

• Age-related changes in the eye.
• Persistent high blood pressure may cause hypertensive retinopathy.
• Alprazolam belongs to a class of drug benzodiazepine used for anxiety-related disorders that cause blurred vision.
• Amitriptyline is a tricyclic antidepressant drug that increases dryness in your eyes.
• Aspirin is a nonsteroidal anti-inflammatory drug that increases the sensitivity of light to eyes.
• Valsartan tablet is a combination of Valsartan and hydrochlorothiazide drugs and available as a brand name Diovan HCT. Valsartan is an angiotensin-receptor blocker type II and hydrochlorothiazide is a diuretic. These drugs increase dryness in your eyes.

From the above-mentioned points, we can easily conclude that age-related changes and medication-taking for treating hypertension, depression, and anxiety are responsible for the deteriorating vision of P.J's eyes.

2. What are the early signs of age-related macular degeneration (AMD)?

Answer:

Age-related macular degeneration is an eye disorder that occurs due to damage to the macula. The macula is a part of the retina. This is associated with the loss of central vision and peripheral vision being normal.

Two types of AMD

1. Dry AMD

• Most common form
• macula gets thinner with age
• tiny clumps of protein as drusen seen
• It is difficult to detect dry macular degeneration in its early stages.
• The most common symptom is blurred vision.

    2.Wet AMD

• Less common
• More serious than dry AMD
• Abnormal blood vessels grow under the retina leaking fluids and scarring of the retina.
• Vision loss faster with wet AMD than with dry AMD.
• Symptoms include blurred vision and distortion of the retina or a dark spot in central vision.

Most common symptoms found in AMD are as follows:

1. Blurred or “fuzzy” vision.
2. Sentences appear as wavy or distorted lines.
3. Blurred areas on a printed page.
4. Difficulty in reading fine letters and fine articles at low light levels.
5. Extra sensitivity to glare.

3. What tests can be done to determine if P.J. has age-related macular degeneration?

Answer:

This includes a series of tests depending on symptoms and stages of AMD and to evaluate its type.

These are as follows:

Autofluorescence-

It involves the evaluation of autofluorescence photos of the retina to check for geographic atrophy i.e death of light-sensitive cells in retinal pigment epithelium.

Dilated Eye - include Fundoscopy or Ophthalmoscopy

Evaluation of the back of the retina, any sign of its disease, and checking for the optic nerve damage.

Visual Acuity Test or Eye Chart Test

It is done to check your sight from various distances.

Fluorescein Angiography

It is done in case of wet AMD to check for the leaking of fluids from blood vessels.

Optical Coherence Tomography (OCT)

Produces cross-sectional images of the retina with different layers and their thickness. It can identify the thinning of the macula in dry AMD.

Tonometry

It measures the pressure inside the eye.

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