NUR 611 Discussion 5 Case 5
University:
St. Thomas University
NUR 611 Discussion 5 Case 5
Paper Instructions
A 79-year-old male remarks on his first visit that he has noticed a gradual decrease in vision in both his eyes since last year. His old medical record has not yet arrived at your office. He states that since he moved from Florida a year ago, he has not had an eye examination and does not yet know an ophthalmologist. He is having difficulty carrying on his activities of daily living that involve his sight. He states that he cannot recognize people at some distance until they come quite close and he is often frightened by his perception of strangers speaking to him.
Watching television and reading are becoming increasingly difficult for him. He states that glare is a problem and notes that a few times he almost tripped over something on the floor. He still drives his car in the local community. He asks if you think he may have a cataract. He says his wife had two cataracts in the past and he remembers her complaining of vision problems which have now resolved.
Vital Signs
- BP 128/84
- HR 82
- RR 18
- BMI 24
Chief Complaint
- Decrease in my vision; glare is very bothersome!
Discuss the following:
- What additional subjective data are you seeking to include past medical history, social, and relevant family history?
- What additional objective data will you be assessing for?
- What are the differential diagnoses that you are considering?
- What laboratory tests will help you rule out some of the differential diagnoses?
- What radiological examinations or additional diagnostic studies would you order?
- What treatment and specific information about the prescription that you will give this patient?
- What are the potential complications from the treatment ordered?
- What additional laboratory tests might you consider ordering?
- What additional patient teaching may be needed?
- Will you be looking for a consult?
Submission Instructions
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
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Sample Answer
A 79-year-old male presents with complaints of gradual visual loss and disturbing vision for the last year. He is having difficulty carrying on his activities of daily living that involve his sight, cannot recognize people at some distance, and is often frightened by his perception of strangers speaking to him. In addition, he is experiencing challenges watching television and reading but can drive his car in the local community. He states that glare is a problem and notes that he almost tripped over something on the floor a few times.
His vital signs include BP 128/84, HR 82, RR 18, and a BMI 24. For this patient, it is crucial to ask him whether he has an underlying or a family history of diabetes mellitus or is on a corticosteroid prescription for any underlying disease. In addition, it is also crucial to determine if he has ever had any prolonged eye infections in the past years. It is also vital to ask the patient if he has ever had any perforated or blunt injury to his eyes (Sarkar et al., 2023). I would also ask the patient about his vision while driving in the local community and other activities he can do with his current vision.
While examining the patient, it is crucial to evaluate for visual acuity, field, and depth perception. Color vision, pupillary light reflex, and contrast sensitivity are crucial in evaluating vision. My differential diagnosis for this case would be cataracts and diabetic retinopathy (Blais et al., 2024). As a result, I would request random blood sugars and hemoglobin A1C. I would also request for ocular coherence tomography (OCT), slit-lamp, applanation tonometry, and ophthalmoscopy to visualize the anterior and posterior eye chambers, including the retina. Computed tomography for the orbit is also crucial in excluding orbital trauma.
The tests established a diagnosis of cataracts, whose treatment involves extracapsular cataract extraction (ECCE) followed by antibiotic and steroid use. I would prescribe topical antibiotics such as ciprofloxacin and steroids such as dexamethasone as adjuncts to the management of the patient (Grzybowski, 2020). In addition, I would inform the patient on whether he would wish to perform the surgery on both eyes simultaneously or in a spaced duration.
I would inform him of the role of post-operative antibiotics and steroids in minimizing the risk of ocular infections and inflammation in the eye. However, I would taper down on dexamethasone eye drops and avoid systemic steroids. Several complications may be associated with ECCE, including eye infections such as conjunctivitis and iritis, corneal edema, lens displacement, and vitreous loss. On the other hand, steroids predispose the patient to corneal ulcers and risk of recurrent ocular infections.
As a result, I would request complete blood counts, application tonometry, and retinoscopy to follow up on the patient for any infection, bleeding, or elevated intraocular pressure (Grzybowski, 2020). I would also tell the patient to look out for any complications and warn him that his vision may fail to recover fully, necessitating the use of spectacles. An ophthalmologist review of the patient is crucial to optimize the management of this patient.
References
- Blais, N., Tousignant, B., & Hanssens, M. (2024). Comprehensive Primary Eye Care A Comparison Between an In-Person Eye Exam and a Tele-Eye Care Exam. Clinical Optometry, 16, 17-30. https //doi.org/10.2147/OPTO.S436659
- Grzybowski, A. (2020). Recent developments in cataract surgery. Annals of Translational Medicine, 8(22). https //doi.org/10.21037/atm-2020-rcs-16
- Sarkar, D., Sharma, R., Singh, P., Verma, V., Karkhur, S., Verma, S., Soni, D., & Sharma, B. (2023). Age-related cataract – Prevalence, epidemiological pattern and emerging risk factors in a cross-sectional study from Central India. Indian Journal of Ophthalmology, 71(5), 1905-1912. https //doi.org/10.4103/ijo.IJO_2020_22
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