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Case 5

The patient complains of vision problems. The eye receives visual information from light passing through it. The optic nerve then transports the stimulus to the occipital lobe, where it is interpreted and processed. Any impairment has a significant impact on the patient (Hubert & VanMeter, 2018). Begin by inquiring about the patient’s medical history. It is necessary to rely on the patients’ statement because we don’t have access to his medical records. Eye disorders can be exacerbated by underlying conditions such as hypertension and diabetes (Ling & Bell, 2018). We can make a cataract differential diagnosis based on his symptoms.

Ask the patient if he has ever worn spectacles and if he presently wears sunglasses to shield his eyes from the sun for more subjective data. Inquire if anyone else in the patient’s family, aside from his wife, has experienced similar symptoms or has a history of vision impairment. Poor nutrition and a history of smoking are both variables to consider. Inquire about any drugs the patient is taking (Kennedy-Malone et al., 2019). A visual acuity test would provide more objective data. To test vision, use the Snellen chart or any similar eye charts. An ophthalmoscope allows the doctor to examine the inside of the eye, and the patient can be evaluated and forced to perform various tasks to measure muscle function and coordination (Hubert & VanMeter, 2018).

Corneal scarring, retinal detachment, macular degeneration, chronic glaucoma, and diabetic retinopathy are all differentiating diagnoses to consider (Kennedy-Malone et al., 2019). To identify if the patient has cataracts, no laboratory testing is required. A referral to an ophthalmologist will be required. Cataracts are usually treated with surgery. Unless contraindicated, the cataract may be removed, and a plastic implant put in the intraocular lens. Other vision problems may be accommodated using lenses. If the patient has contraindications to resting supine during the procedure, such as cardiac, respiratory, or neuromuscular disorders, complications may develop (Ling & Bell, 2018). Infection, as well as further vision loss, are major concerns. Patients using various medications may need to be properly watched as well (Kennedy-Malone et al., 2019). The surgery may or may not be successful. The degree of impairment and the patient’s lifestyle must both be established in order to decide the best timing for surgery. More conservative management alternatives, such as prescription glasses, reevaluation by an ophthalmologist, and a suitable strategy for safety and carrying out everyday activities, may be considered by the patient (Ling & Bell, 2018).

There will be a lot of patient education that will need to take place.  If the patient decides to proceed with the procedure, he must be aware of all post-operative instructions. This would involve wearing UV-blocking sunglasses to protect his eyes from the sun, eating well, avoiding cigarettes and alcohol, and keeping up with his post-operative checkups (Ling & Bell, 2018). To begin, involve family or friends in the patient’s treatment if possible. It’s likely that social services may be incorporated to help with transportation. Although the patient admits to having vision problems, he continues to drive. This is a major safety issue. The patient may be worried about losing his independence. The patient will require a lot of encouragement and reinforcement to understand.

References

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary care: The art and science of advanced practice nursing – an interprofessional approach. F.A. Davis Company.

Hubert, R. J., & VanMeter, K. (2018). Gould’s pathophysiology for the health professions. Elsevier.

Kennedy-Malone, L., Plank, L. M., & Duffy, E. G. (2019). Advanced practice nursing in the care of older adults. F.A. Davis Company. 

Ling, J. D., & Bell, N. P. (2018). Role of Cataract Surgery in the Management of Glaucoma. International ophthalmology clinics, 58(3), 87–100. https://doi.org/10.1097/IIO.0000000000000234