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.
  • 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.