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Eye disorders : Age-related macular degeneration - Coggle Diagram
Eye disorders : Age-related macular degeneration
Definition
is the most common cause of irreversible central vision loss in older patients.
2 types of AMD
Wet Macular
Dry Macular
Clinical manifestations
Dry AMD
Areas of chorioretinal atrophy
Drusen
Changes in the retinal pigment epithelium
Wet AMD
Subretinal hemorrhage in or around the macula
Exudates in or around the macula
Detachment of retinal pigment epithelium (visible as an area of retinal elevation)
Gray-green discoloration under the macula
Retinal edema
Subretinal fluid, appearing as localized retinal elevation
Pathophysiology
Dry AMD causes changes of the retinal pigment epithelium, typically visible as dark pinpoint areas. The retinal pigment epithelium plays a critical role in keeping the cones and rods healthy and functioning well. Accumulation of waste products from the rods and cones can result in drusen, which appear as yellow spots. Areas of chorioretinal atrophy (referred to as geographic atrophy) occur in more advanced cases of dry AMD. There is no elevated macular scar (disciform scar), edema, hemorrhage, or exudation.
Wet AMD occurs when new abnormal blood vessels develop under the retina in a process called choroidal neovascularization (abnormal new vessel formation). Localized macular edema or hemorrhage may elevate an area of the macula or cause a localized retinal pigment epithelial detachment. Eventually, untreated neovascularization causes a disciform scar under the macula.
Diagnostic tests
Optical coherence tomography
Fluorescein angiography
Color fundus photography
Funduscopic examination
Risk factors
Cardiovascular diseases
Hypertension
A diet low in omega-3 fatty acids and dark green leafy vegetables
Sun exposure
Obesity
Family history
Genetic variants (eg, abnormal complement factor H)
Smoking
Age
Nursing assessment
Objective data
Observe patients vital signs including the BMI and Age
Do visual acuity test
Subjective data
History of cardiovascular diseases in the family and on the patient
History of Tobacco uses, Hypertension
Nursing care plan
Desired outcome
Patient will be able to deal with potential for permanent visual loss.
Patient will be able to regain vision to the maximum possible extent with surgical procedure.
Patient will be able to verbalize understanding of visual loss and diseases of eyes.
Patient will regain optimal vision possible and will adapt to permanent visual changes
Patient will be able to use adaptive devices to compensate for visual loss.
Patient will be compliant with instructions given, and will be able to notify physician for emergency symptoms.
Nursing intervention and rationale
Assess the patient’s ability to see and perform activities.
Rationale: Provides a baseline for determination of changes affecting the patient’s visual acuity.
Amsler’s grid
Rationale: Used to monitor visual field loss.
Encourage patient to see an ophthalmologist at least yearly.
Rationale: Can monitor progressive visual loss or complications. Decreases in visual acuity can increase confusion in the elderly patient.
Provide large print objects and visual aids for teaching.
Rationale:Assists patient to see larger print and promotes a sense of independence.
Nursing diagnosis
Disturbed sensory perception may be related to age related ocular changes as evidence by distortion of central vision
Disturbed sensory perception may be related to distortion of central vision possibly evidence by macular degeneration
References
Nurseslabs. 2022. 1,000+ Nursing Care Plans: The Ultimate Guide and Database for Free. [online] Available at:
https://nurseslabs.com/nursing-care-plans/
[Accessed 10 May 2022].
Mehta, S., 2020. Vitreoretinal Diseases and Surgery service. Wills Eye hospital: Sidney Kimmel Medical College at Thomas jefferson univercity.