Age- related macular degeneration (AMD), a chronic, progressive disorder of the retina, is the most common cause of blindness in individuals over the age of 60. The macula is the part of the retina which provides high resolution color vision (Redmond &While 2008). As the macula degenerates, individuals lose their central vision and color vision. There are two types of macular degeneration: wet, or choroidal neovascularization and dry, or nonneovascular . Dry AMD is the more common of the two types, occurring roughly 80-90% of the time. The hallmark sign of dry AMD is the appearance of drusen. These are whitish-yellow lipid deposits on the macula. These deposits can lift the retinal pigmented epithelium away from the choroidal circulation, causing it to deteriorate (Redmond &While 2008). Dry AMD can progress to the wet form, which occurs in 10-20% of cases, in which new vessel growth occurs suddenly in the macular region. This displaces the retinal pigmented epithelium, disrupting its blood supply, and causes scarring. NURSING ASSESSMENT
There are several nursing diagnoses that are important considerations for the care of the patient with macular degeneration. Three of these are risk for falls related to disturbed visual sensory perception, anxiety related to threatened role change, and risk for impaired home maintenance. A patient at risk for falls related to visual changes would ideally be free of falls both in the hospital and at home. This could be achieved by the nurse educating the patient about using assistive ambulatory devices as needed. The use of assistive ambulatory devices will allow the patient to reduce the hazard of tripping by providing support for the patient while ambulating. Proper education on use of these devices is necessary to reap their benefit. The nurse could also educate the patient on keeping his environment as free of clutter as possible, including possible tripping hazards like throw rugs. The fewer obstacles a patient has to work around, the less likely he is to trip. The nurse should also be careful to orient the patient to his environment in the hospital, and make no unnecessary changes to the environment once the patient is oriented. The nurse should also encourage the patient to practice this at home. An environment that the patient is familiar with will be easier for the patient to navigate. If the nurse institutes these interventions, the patient should remain free of falls due to the changes in his vision. A patient experiencing anxiety related to threat to role functions can be aided in several ways by the nurse. The nurse should encourage the patient to acknowledge and talk about the anxious feelings. Assisting the patient to identify his anxiety will help to keep his anxiety from escalating. The nurse can then discuss anxiety relieving techniques with patient such as deep breathing and relaxation. When the patient has tools to reduce his own anxiety, he may experience less anxiety and be able to alleviate his own symptoms when they occur. The nurse can work to educate the patient and family about macular degeneration and what types of lifestyle changes the patient is likely to need to undertake. When the patient and family are educated, there is less likelihood that the family will make demands that the patient is unable to fill, and the patient will have a better sense of their own boundaries. The patient would hopefully experience fewer episodes of anxiety and have greater capability to handle to episodes that do occur. With declining visual acuity the macular degeneration patient may also be at risk for impaired home maintenance. The nurse can impact this risk by initiating discharge planning immediately after hospital admission, coordinating access to home health care services for patient. The expedient initiation of discharge planning will allow patient time to place services if necessary before returning home. The...
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(2007). Alternative therapies. Retrieved from http://www.aao.org/eyecare/treatment/alternative-therapies/index.cfm
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