Question

PPT Case Study- The Nguyen's... Create a plan of care based on the information and questions in the PPT.

Ma i Nguyens,Nam Ngugens mother has been experince blurred vision .What are possible causes of blurred vision?

She reports to the primary care clinic today, accompanied by Nam. Mai tells you, “I don’t know what happened. I was pulling into a parking space at the grocery store, and the next thing you know, I hear this loud boom. I don’t know how I did it, but I hit the car next to me. I just didn’t see it.” Nam is very concerned and questions whether his mother should be allowed to drive. Mai is visibly upset. “I don’t want to hurt anyone, but I don’t want to lose all my freedom.” Nam insisted on this appointment to discuss his concerns.

At a recent ophthalmology appointment, she was told she has bilateral cataracts that will require surgical removal.

•What data will you need to gather from Mai and Nam?

What assessments will you need to perform?

How will cataract surgery most likely affect Mai? You will need to learn about the surgery and recover to answer his questions.

What information would you offer to Mai and Nam?

Create a Plan of Care for Mai?

Answer 1

#. Causes of blurred vision :-

- refractive errors, such as near-sightedness, far-sightedness, or astigmatism.

- abrasions to the cornea.

- age-related macular degeneration.

- cataracts.

- corneal opacification, or scarring.

- infectious retinitis.

- migraine.

- optic neuritis.

#. Assessment:

Age is important b/c cataracts are most prevalent in the older adult. Ask about these predisposing factors:

-Recent or past eye trauma

-Exposure to radioactive materials, x-rays, or UV light

-Systemic disease (diabetes mellitus, hypoparathyroidism, Down syndrome)

-Prolonged use of corticosteroids, chlorpromazine, beta blockers, or miotic drugs

-Intraocular disease (recurrent uveitis)

Ask patient to describe his or her vision.

#. Cataract surgery is the only cure for cataract and it will affect Mia positively .

#. Care plan :-

Preoperative care

-Ask patient if taking any drugs that affect blood clotting, like aspirin, warfarin (Coumadin), clopidogrel (Plavix), and dabigatran (Pradaxa).

-Communicate this information to the surgeon as these drugs may need to be discontinued prior to surgery.

-Give the patient accurate information so he or she can make informed decisions about treatment. Obtain informed consent. Reinforce this information and teach about the nature of cataracts, their progression, and their treatment.

-Assess how the patient's vision affects ADLs, especially dressing, eating, and ambulating.

-Stress that care post surgery requires the instillation of different types of eyedrops several times a day for 2 -4 weeks. Careful assessment of eye appearance is needed. If patient cannot perform these tasks, help him or her make arrangements for this care.

-An IV infusion may or may not started in the operating room. Sedative is given prior to surgery, and a series of ophthalmic drugs are instilled just before surgery to dilate the pupils and cause vasoconstriction.

Phacoemulsification

Extraction of the lens most commonly performed. A probe is inserted through the capsule and high-frequency sound waves break the lens into small pieces, which are then removed by suction. The capsule remains intact, and the replacement intraocular lens is placed inside it to focus light rays in the retina.

Postoperative care

-Immediately after, antibiotics are given subconjunctivally. Antibiotic and steroid ointments are also instilled.

-Eye left unpatched and the patient is discharged within an hour after surgery.

-Instruct patient to wear dark glasses outdoors or in brightly lit environments until the pupil responds to light.

-Remind patient to avoid activities that might increase IOP.

-Don't get water in eye.

-Teach patient and/or family members to instill prescribed eyedrops. Help them create a written schedule for timing and the order of eyedrops administration.

-Stress the importance of keeping all follow-up appointments.

-Remind patient that mild eye itching is normal, as is a "bloodshot appearance." Eyelid may be slightly swollen.

-Cool compresses may be beneficial.

-Discomfort at the site is controlled by a mild analgesic such as acetaminophen (Abenol, Tylenol), or acetaminophen with oxycodone (Endocet, Percocet, Tylox). Avoid aspirin because of its effects on blood clotting.

-Significant swelling or bruising is abnormal.

-If pain early after surgery, may indicate an increase in intraocular pressure or hemorrhage. Contact surgeon if pain occurs with nausea or vomiting.