Lippincott Certification Review Medical-Surgical Nursing

Cataracts 311 ●● In wet-type AMD, the patient has subretinal fluid accumulation or hemorrhage with a yellow-green discoloration that’s sometimes surrounded by a pigment ring; in the advanced stage, exudates and fibrovascular scarring occur. ●● Grayness, haziness, or a blind spot may appear in the area of central vision; words may look blurred on a page, straight lines may appear to have kinks in them, and colors may seem dimmer. ●● The disorder may also cause difficulty with night vision and changing light conditions. ●● Diagnosis and treatment ●● Indirect ophthalmoscopy may show changes in the macular region of the fundus. ●● The Amsler grid test may detect visual distortion. Have the patient check their monocular vision individually daily. ●● Fluorescein angiography may show leaking vessels (choroidal neovascular membranes) in the subretinal neovascular net. Note: fundus fluorescein angiography (FFA) is commonly nauseating for a short period. Prevent IV extravasation when administering the test. Counsel the patient on side effects and risk factors, including allergic reactions. ●● Indocyanine green videoangiography identifies hidden or occult choroidal neovascular membranes. ●● OCT may help identify choroidal neovascular membranes, subretinal fluid, and retinal thickening. ●● Although no known cure exists for dry-type AMD, some evidence indicates that a diet high in beta-carotene, zinc, and vitamins A, C, and E may slow the progression of the disease (AREDS supplements). ●● For wet-type AMD, treatment targets the development and progression of angiogenesis; laser treatments may be used. ●● Drug therapy may include a vascular endothelial growth factor antagonist or the monoclonal antibody bevacizumab (Avastin). Antivascular endothelial growth factor is first line of treatment for neovascular (wet) AMD. ●● Vitrectomy removes all or part of the vitreous humor. This may be done after a vitreous hemorrhage or if a posterior vitreous detachment is causing traction on the retina. ●● Photodynamic therapy (Visudyne) may also be helpful when used with other treatments to seal the exudative neovascularization of wet AMD. ●● Nursing interventions ●● Teach the patient and family about the disorder, including treatment and follow-up care. ●● Teach the patient to self-monitor for visual changes using monocular Amsler Grid testing and to promptly report any changes. ●● Determine the extent of the patient’s vision loss. ●● Help the patient obtain optical aids such as magnifiers. ●● Assist the patient with adaptations to accommodate vision changes; promote safety. ●● If the provider approves, suggest AREDS-formulated vitamin supplements. Urge the patient to use eye protection such as glasses or sunglasses that block ultraviolet light to protect the eyes from ultraviolet light. ●● Offer emotional support. ●● Encourage the patient to express fears and concerns, especially those related to vision loss and its impact on ability to function. ●● Refer the patient to local support organizations as appropriate.

●● If Visudyne photodynamic therapy (with laser) is instituted, the patient must remain out of direct sunlight for 5 days to prevent significant photosensitivity reactions. The patient must be fully protected when leaving the office, with hat, gloves, longs sleeves, and pants. ●● If fluorescein dye test is performed, the patient should be aware of the appearance of a jaundiced skin color that may last for a day. ●● The patient undergoing any ophthalmic treatment should have a designated driver. Cataracts ●● Description ●● Cataracts come in several forms (see Types of cataracts , page 313) and are caused by a gradual degradation of the optical quality of the crystalline lens. ●● It is a common cause of gradual vision loss that usually affects both eyes. Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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