2 Macular Degeneration Nursing Care Plans

Disturbed Sensory Perception: Visual

Disturbed sensory perception: visual is a common issue for patients with Macular Degeneration due to several factors. Firstly, the disease process of macular degeneration can result in changes to the macula, a part of the retina responsible for central vision, leading to visual distortions, blind spots, and central vision loss. Secondly, the presence of drusen, which are yellow deposits under the retina, can further impair visual function and lead to visual distortions. Lastly, age-related ocular changes can also contribute to disturbed sensory perception, as the aging eye becomes more susceptible to a range of ocular diseases and conditions.

Nursing Diagnosis

• Disturbed Sensory Perception

May be related to

• Macular degeneration
• Presence of drusen
• Central vision loss
• Age-related ocular changes

Possibly evidenced by

• Distortion of central vision
• Straight lines appear distorted
• Objects appearing smaller or larger than normal
• Distortion of vision noted on the grid
• Presence of drusen or yellow deposits under the retina, the light-sensitive tissue at the back of the eye
• Legal blindness
• Subretinal edema
• Retinal bleeding

Desired Outcomes

• The patient will regain the optimal vision possible and will adapt to permanent visual changes
• The patient will be able to verbalize understanding of visual loss and diseases of the eyes.
• The patient will be able to regain vision to the maximum possible extent with the surgical procedure.
• The patient will be able to deal with the potential for permanent visual loss.
• The patient will maintain a safe environment with no injury noted.
• The patient will be able to use adaptive devices to compensate for visual loss.
• The patient will be compliant with the instructions given and will be able to notify the physician of emergency symptoms.

Nursing Assessment and Rationales

1. Assess the patient’s ability to see and perform activities.
Provides a baseline for the determination of changes affecting the patient’s visual acuity.

2. Assist in diagnostic procedures and provide appropriate information:

• 2.1. Indirect ophthalmoscope
  Fundus examination through a dilated pupil may reveal gross macular changes.

• 2.2. Amsler’s grid
  Used to monitor visual field loss.

• 2.3. I.V. fluorescein angiography
  Sequential photographs may show leaking vessels as fluorescein dye flows into the tissues from the subretinal neovascular net.

Nursing Interventions and Rationales

1. Encourage the patient to see an ophthalmologist at least yearly.
Can monitor progressive visual loss or complications. Decreases in visual acuity can increase confusion in elderly patients.

2. Provide sufficient lighting for the patient to carry out activities.
Elderly patients need twice as much light as younger people.

3. Provide lighting that avoids glare on surfaces of walls, reading materials, and so forth.
Elderly patients’ eyes are more sensitive to glare and cataracts diffuse glare so the patient has more difficulty with vision.

4. Provide night light for the patient’s room and ensure lighting is adequate for the patient’s needs.
Patients’ eyes may require longer accommodation time to changes in lighting levels. The provision of adequate lighting helps to prevent injury.

5. Provide large print objects and visual aids for teaching.
Assists patient to see larger print and promotes a sense of independence.

6. Provide information about laser surgery.
Laser surgery may be helpful for the wet type of macular degeneration if done early. Approximately only 20% of patients will have any improvement in visual function if done later.