Reply to discussion- Melissa

Gradual Worsening of Vision 

The older adult population comprises a large heterogeneous group of age categories and ethnicity. The physiological changes that occur in the anatomy and physiological changes are inevitable. However, it is not appropriate in healthcare to tell geriatric patients that symptoms experienced are “normal or to be expected.” Many conditions can be corrected, pathological processes decelerated or prevented. A 79-year-old male with a gradual worsening of his vision in both his eyes within the last year. A visual disturbance for the geriatric patient population can be extremely debilitating. Previous research by this author has proven, Physical, mental, spiritual, environmental, and social aspects of an older adult’s life collaboratively contribute to harmonious health. If these components of an older patient’s life are not compatible or in sync, their functional ability will be disrupted   Joiner, M. (2021). Fatigue in Older Adults Discussion [Unpublished assignment submitted for NUR 612]. St. Thomas University.

The significance of this patient’s complaints is the disruption of his functional ability. Sensory impairments such as visual disturbance can contribute to delirium (McCance, Huether, & Brashers, 2019).  Subjective information should include family history, his medical history, to include hypertension and diabetes history, if patient has ever had an eye examination or previous visual diagnosis, does he wear glasses. A careful review of the patient’s medications to assess potential polypharmacy and drug to drug interactions.  Due to reduced metabolism and elimination and age-related deficits in cholinergic neurotransmission the most common pharmacological interaction and drug-related side effects for older people are from anticholinergics (Kennedy-Malone, 2019).  Objective information should include, eye testing utilizing a Snellen chart and Mini-Mental State Examination (MMSE) to assess cognitive function. Eye assessment to begin with examination of bilateral orbital positions, symmetry, skin internal and external surrounding tissue. Close assessment of patient’s sclera and conjunctiva for exophthalmos, xanthelasma, pinguecula, ptosis, edema, and lesions. Most common abnormalities assessed in the older population of the eyelid are hordeolum, chalazion, ectropion, and entropion. The cornea should be examined for pterygium, corneal arcus, and opacities.  

Differential diagnoses include cataracts, glaucoma acute or chronic or diabetic retinopathy, macular degeneration. After physical exam and vison testing a referral should be made to an Ophthalmologist. Patient should be advised to avoid driving his motor vehicle until diagnosis is made along with vison correction. This patient should be educated about the importance of wearing protective attire from exposure to UVB radiation such as sunglasses that block UV rays and a wide brim hat (Kennedy-Malone, 2019).

References

Kennedy-Malone, L. M.-P. (2019). Advanced practice nursing in the care of older adults. (2nd ed.). F.A. Davis Company.

McCance, C. K., Huether, E., & Brashers, L. &. (2019). Pathophysiology: The Biologic Basis for Disease in Adult and Children (8th ed.). . St. Louis: Elsevier.