Macular Degeneration Nursing Care Plan Notes

 

Definition
  • Macular degeneration is largely an age-related disease process whereby central vision gradually deteriorates.
Risk Factors
  • Increasing age
  • Smoking history
  • Hypertension
  • Overeight
  • Hyperopia
  • Familial incidence
  •  Wet AMD (more common in Caucasians than African Americans)
  • Use of thyroid hormones and hydrochlorthiazies
  • Arthritis
image by: www.nlm.nih.gov

image by: www.nlm.nih.gov

Pathophysiology
  • Age-related macular degeneration (AMD) is a painless disease where the macular gradually brakes down from the development of fatty, yellow, metabolic waste products, which accumulate in the retina. Drusen (yellowish spots associated with aging) appear in retina.

TYPES:

  1. “Dry” or nonneovascular AMD
    • Macular drusen may coalesce, causing gradual decrease in central vision. Missing letters in words, blank spots, geographic atrophy, and retinal pigment epithelial abnormalities may appear.
  2. “Wet” or neovascular AMD
    • Characterized by the development of an abnormal choroidal neovascular network beneath the macula. These vessels leak fluid and bleed, causing edema and the development of fibrosis. Visual changes can occur rapidly. Straight lines appear crooked and distorted. The resulting macular disciform scar causes a loss of central vision.
Assessment/Clinical Manifestations/Signs and Symptoms
  • Blurred vision
  • Blind spot in the middle of the visual field
  • Central vision can also be lost as small blind spot may also begin to develop
Laboratory and diagnostic study findings
  • Fluorescein angiography and indocyanine green angiography may be used to identify signs of macular degeneration.
Medical Management
Photodynamic therapy (PDT)
  • Has been developed in an attempt to ameliorate the choroid neovascularization (CNV) while causing minimal damage to the retina.
  • PDT is a two-step process. Verteporfin, a photosensitive dye is infused intravenously over 10 minutes. Fifteen minutes after the start of the infusion, a diode laser is used to treat the abnormal network of vessels.
Nursing Diagnosis
  • Disturbed sensory perception related to visual impairment
  • Ineffective health maintenance related to knowledge deficit
  • Risk for injury related to impaired vision
  • Self-care deficit related to impaired vision
Nursing Management
  • Nursing management is primarily educational. Verteporfin is a light-activated dye, and patient education is important preoperatively.
  • The patient should instructed to bring dark sunglasses, gloves, a wide-brimmed hat, long-sleeved shirt and slacks to the PDT setting.
  • The patient must be cautioned to avoid exposure to direct sunlight or bright light for 5 days after treatment. The dye within the blood vessels near the surface of the skin could become activated with exposure to strong light. This would include bright sunlight, tanning booths, halogen lights and the bright lights used in dental offices and operating rooms.
  • Gloves, shoes, socks, sunglasses and a wide-brimmed hat should also be worn if the patient has to go outdoors during daylight hours during this period. Inadvertent sunlight exposure can lead to severe blistering of the skin and sunburn that may require plastic surgery.