Macular Degeneration Nursing Care Plan
Nursing Diagnosis
Disturbed Sensory Perception: Visual
Related to
- macular degeneration
- presence of drusen
- central vision loss
- age-related ocular changes
Possibly evidenced by
- distortion of central vision
- Straight lines appear distorted
- objects appearing smaller or larger than normal
- Distortion of vision noted on grid
- presence of drusen or yellow deposits under the retina, the light-sensitive tissue at the back of the eye
- legal blindness
- subretinal edema
- retinal bleeding
Desired Outcomes
- Patient will regain optimal vision possible and will adapt to permanent visual changes
- Patient will be able to verbalize understanding of visual loss and diseases of eyes.
- Patient will be able to regain vision to the maximum possible extent with surgical procedure.
- Patient will be able to deal with potential for permanent visual loss.
- Patient will maintain a safe environment with no injury noted.
- Patient will be able to use adaptive devices to compensate for visual loss.
- Patient will be compliant with instructions given, and will be able to notify physician for emergency symptoms.
Nursing Interventions
- Assess patient’s ability to see and perform activities.
- Rationale: Provides baseline for determination of changes affecting the patient’s visual acuity.
- Assist in diagnostic procedures and provide appropriate information:
- Indirect ophthalmoscopy
- Rationale: Fundus examination through a dilated pupil that may reveal gross macular changes.
- Amsler’s grid
- Rationale: Used to monitor visual field loss.
- I.V. fluorescein angiography
- Rationale: Sequential photographs that may show leaking vessels as fluorescein dye flows into the tissues from the subretinal neovascular net.
- Indirect ophthalmoscopy
- Encourage patient to see ophthalmologist at least yearly.
- Rationale: Can monitor progressive visual loss or complications. Decreases in visual acuity can increase confusion in the elderly patient.
- Provide sufficient lighting for patient to carry out activities.
- Rationale: Elderly patients need twice as much light as younger people.
- Provide lighting that avoids glare on surfaces of walls, reading materials, and so forth.
- Rationale: Elderly patient’s eyes are more sensitive to glare and cataracts diffuse and glare so that patient has more difficulty with vision.
- Provide night light for patient’s room and ensure lighting is adequate for patient’s needs.
- Rationale: Patient’s eyes may require longer accomodation time to changes in lighting levels. Provision of adequate lighting helps to prevent injury.
- Provide large print objects and visual aids for teaching.
- Rationale: Assists patient to see larger print, and promotes sense of independence.
- Provide information about laser surgery.
- Rationale: Laser surgery may be helpful for the wet type of macular degeneration if done early. An approximate of only 20% of patients will have any improvement in visual function if done later.
Nursing Diagnosis
Risk for Injury
May be related to
- macular degeneration
- decreased vision
- aging
- decreased central vision
Risk factors
- Retinal hemorrhage
- Visual distortion
- Confusions
- Presence of drusen
- Decreased visual acuity
- Decreased visual fields
- Decreased central vision
Desired Outcomes
- Patient will be free of injury and will be able to perform activities within parameters of sensory limitation.
- Patient will be able to be free of injury.
- Patient and/or family will be able to modify environment to ensure patient safety.
Nursing Interventions
- Assess patient for degree of visual impairment.
- Rationale: Increases awareness of problem, and identifies severity to allow for establishment of a plan of care.
- Inform about special devices that can be used.
- Rationale: Low-vision optical aids are available to improve the quality of life in the patient with good peripheral vision.
- Ensure room environment is safe with adequate lighting and furniture moved toward the walls. Remove all rugs, and objects that could be potentially hazardous.
- Rationale: Provides a safe environment to reduce potential for injury.
- Keep patient’s glasses and call bell within easy reach.
- Rationale: Provides for assistance for patient and for optimal visual acuity.
- Instruct patient and/or family regarding need for maintain safe environment.
- Rationale: Reduced visual acuity puts patient at risk for injury.
- Instruct patient and/or family regarding safe lighting. Patient should wear sunglasses to reduce glare. Advise family to use contrasting bright colors in household furnishings.
- Rationale: These techniques helps to enhance visual discrimination and reduce potential for injury.
After surgery to extract a cataract:
- Remind patient to attend checkup the following day after surgery.
- Rationale: Because the patient will be discharged after he recovers from anesthesia post-op. Warn him to avoid activities that increase intraocular pressure.
- Instruct patient to wear a plastic or metal shield over the eye with perforations; a shield or glasses should be worn for protection during the day.
- Rationale: To protect the eye from accidental injury.
- Teach the patient how to administer antibiotic ointment or drops; including steroids.
- Rationale: To prevent infection and inflammation.
- Instruct patient to watch out for development of complications, such as sharp pain in the eye uncontrolled by analgesics, or clouding in the anterior chamber.
- Rationale: This may indicate infection and should be reported immediately.