Mr. S, 70 years old, is seeing his ophthalmologist today because of decreasing v

Question

Mr. S, 70 years old, is seeing his ophthalmologist today because of decreasing visual acuity. His last eye exam was 10 years ago, but he reports that his glasses do not work as well as they did. He reports being on the following medications:

Lisinopril 10 mg daily

Lipitor 20 mg daily

Metformin 500 mg daily

(Learning Objectives: 22, 23, 24, and 27)

1. Based on his list of current medications, what specific health alterations does the nurse need to ask about?

He confirms the following:

Hypertension for 30 years (“somewhat controlled”)

Hypercholesterolemia for about 10 years (“I don’t know the last time my cholesterol was checked.”)

Diabetes type 2 for about 10 years (“up and down depending on my diet”)

No history of cardiac problems

2. Based on his age and medical history, what types of eye alterations may need to be considered?

The ophthalmoscopic examination was significant for microaneurysms, hemorrhages, and retinal opacity. He was diagnosed with the beginning of diabetic retinopathy.

3. Describe the two types of diabetic retinopathy.

4. What teaching would be appropriate for Mr. S?

Explanation / Answer

Q1) Health alterations based on Medications:

Lisinopril: long term side effects include, renal failure. liverfailure, severe cough hypotension. Ask for changes in reduction in urine output , lightheadedness, fainting, yellowishish discolouration of skin. Advise the patient to maintain blood pressre chart and check renal and liver function test once in a month.

Lipitor: ask for muscle pain and wasting, liver damage, uncontrolled diabetes, numbness

Metformin: Ask for kidney and liver related symptoms and gastro intestinal alterations.

Health alterations: all the medicines are liver and renal toxic, ask for any symptoms such as fainting, lighteadness, decrease urine output, yellow discolouration etc.

Q2) Vision problems:

Due to ageing:

Due to Diabetes and hypertension

Diabetic retinopathy: diabetes damage the blood vessels in the retina cause visual impairment

Hypertensive retinopathy: narrow the blood vessels in retina.

Q3) Diabetic retinopathy:

chronic diabetes damage the tiny blood vessels resulting in leak of blood into retina resulting in swelling and blurred vision

symptoms: nseeing floaters, blurred vision, hard or empty spots in the center of vision, difficult to see at night.

Diabetic retinopathy is classified into two types

1.Non poliferative diabetic retinopathy:

this is the early stage of retinopathy, sysptoms may be mild or non exsisting. The blood vessels bulge and protrude causes microaneurysms, sometimes tiny bleeding occurs. In this stage diet management, blood sgar control and continuous monitoring are the treatment measures. Steroids also are helpful. There are three types of Nonpoliferative retinopathy: mild, moderate and severe. The severe retinopathy progress to poliferative retinopathy.

2. Poliferative Diabetic retinopathy: this is the advanced stage of the disease. In this stage retina is deprived of oxygen results in formation of new blood vessels in retina and vitreous chamber, resulting in leakage of blood leads to clouding of vision, macular edema and increase pressure in the chamber (glaucoma). Only treatment is lazer therapy ( photo coagulation) in which the leaking blood vessels are sealed by small burns in retina.

Q4) Teaching

1. Diet : advice to follow diet with low carbohydrates, salt and fats. Include fruits, vegetables,whole grains, fiber rich foods, fish. Avoid sugar, starch, saturated fats, fried and sweetened foods.

2. Develop a regular exercise pattern. Walk for atleast 30 minutes dialy.

3. Monitor blood sugar frequently and maintain a diabetic chart

4. Control blood pressure and cholestrol levels

5. Routine eye checkups and discuss the changes in vision with the doctor.

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