Use this nursing care plan and management guide to provide care for patients with macular degeneration. Enhance your understanding of nursing assessment, interventions, goals, and nursing diagnosis, all specifically tailored to address the unique needs of individuals with mecular degeneration.
Table of Contents
- What is Macular Degeneration?
- Nursing Care Plans and Management
- Recommended Resources
- See also
What is Macular Degeneration?
Macular degeneration is a progressive eye disease wherein the central portion of the retina gradually deteriorates. There are two types of age-related macular degeneration that occur. The dry or atrophic form is characterized by atrophic pigment epithelial changes and is most often associated with slow, progressive, and mild vision loss. The wet type is characterized by subretinal neovascularization that causes leakage, hemorrhage, and fibrovascular scar formation, which produce a significant loss of central vision.
Nursing Care Plans and Management
Nursing management of macular degeneration involves educating the patient about the condition, its progression, and the importance of regular eye exams. Nurses can also provide support in managing visual impairments through strategies such as providing low-vision aids, promoting adequate lighting, and referring patients to vision rehabilitation services.
Nursing Problem Priorities
The following are the nursing priorities for patients with macular degeneration:
- Recognize and assess macular degeneration
- Monitor visual changes
- Educate patients about macular degeneration
- Provide support for optimizing visual function
Assess for the following subjective and objective data:
- Blurred central vision
- Distorted or wavy lines
- Dark or empty areas in the central vision
- Difficulty recognizing faces or reading fine print
- Decreased color perception
- Visual hallucinations (rare)
- Straight lines appear crooked or wavy
Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with macular degeneration based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.
Goals and expected outcomes may include:
- 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.
- The patient will be free of injury and will be able to perform activities within the parameters of sensory limitation.
- The patient will be able to be free of injury.
- The patient and/or family will be able to modify the environment to ensure patient safety.
Nursing Interventions and Actions
Therapeutic interventions and nursing actions for patients with macular degeneration may include:
1. Assessing Visual Acuity and Optimizing Visual Perception
Macular degeneration is characterized by a progressive loss of central vision, resulting in decreased visual acuity. Patients may experience blurred or distorted vision, making it challenging to read, recognize faces, or see fine details. Visual perception may also be affected, resulting in difficulties with depth perception, color perception, and overall visual interpretation. These changes can significantly impact a person’s ability to perform daily activities and tasks that rely on clear and accurate vision.
Assess the patient’s ability to see and perform activities.
Provides a baseline for the determination of changes affecting the patient’s visual acuity.
Assist in diagnostic procedures and provide appropriate information:
- Indirect ophthalmoscope
Fundus examination through a dilated pupil may reveal gross macular changes.
- Amsler’s grid
Used to monitor visual field loss.
- I.V. fluorescein angiography
Sequential photographs may show leaking vessels as fluorescein dye flows into the tissues from the subretinal neovascular net.
Provide sufficient lighting for the patient to carry out activities.
Elderly patients need twice as much light as younger people.
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.
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.
Provide large print objects and visual aids for teaching.
Assists patient to see larger print and promotes a sense of independence.
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.
2. Preventing Injuries
Patients with Macular Degeneration are at prone to injury due to several factors. Firstly, decreased vision, particularly central vision, can impair a patient’s ability to navigate their environment safely and increase their risk of falls and accidents. Secondly, aging can further exacerbate vision changes and lead to decreased visual acuity, making it more difficult for patients to perceive potential hazards. Lastly, the disease process itself can impact the function of the macula, leading to progressive vision loss and further increasing the risk of injury.
Assess the patient for the degree of visual impairment.
Increases awareness of the problem, and identifies severity to allow for the establishment of a plan of care.
Inform about special devices that can be used.
Low-vision optical aids are available to improve the quality of life in patients with good peripheral vision.
Ensure the room environment is safe with adequate lighting and furniture moved toward the walls. Remove all rugs, and objects that could be potentially hazardous.
Provides a safe environment to reduce the potential for injury.
Keep the patient’s glasses and call bell within easy reach.
Provides assistance for the patient and for optimal visual acuity.
Instruct the patient and/or family regarding the need to maintain a safe environment.
Reduced visual acuity puts the patient at risk for injury.
Instruct patient and/or family regarding safe lighting. The patient should wear sunglasses to reduce glare. Advise family to use contrasting bright colors in household furnishings.
These techniques help enhance visual discrimination and reduce the potential for injury.
After surgery to extract a cataract:
- Remind the patient to attend a checkup the following day after surgery.
Because the patient will be discharged after he recovers from anesthesia post-op. Warn him to avoid activities that increase intraocular pressure.
- Instruct the patient to wear a plastic or metal shield over the eye with perforations; a shield or glasses should be worn for protection during the day.
To protect the eye from accidental injury.
Instruct the patient to watch out for the development of complications, such as sharp pain in the eye uncontrolled by analgesics, or clouding in the anterior chamber.
This may indicate infection and should be reported immediately.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other ophthalmic nursing care plans: