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 significant loss of central vision.
Nursing Care Plans
Nursing management of macular degeneration involves supportive lifestyle changes to adapt to the decrease in vision, unless the degeneration is new and caused by abnormal blood vasculature, then laser surgery can sometimes slow or halt the deterioration by sealing off the leaking vessels. Reversal of damage that has already occurred is not possible.
Here are two nursing care plans (NCP) for Macular Degeneration:
Disturbed Sensory Perception: Visual
Disturbed Sensory Perception: Change in the amount or patterning of incoming stimuli accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli.
- 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 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
- Patient will regain optimal vision possible and will adapt to permanent visual changes
- Patient will be able to verbalize understanding of visual loss and diseases of eyes.
- Patient will be able to regain vision to the maximum possible extent with surgical procedure.
- Patient will be able to deal with potential for permanent visual loss.
- Patient will maintain a safe environment with no injury noted.
- 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.
|Assess patient’s ability to see and perform activities.||Provides baseline for determination of changes affecting the patient’s visual acuity.|
|Assist in diagnostic procedures and provide appropriate information:|
|Fundus examination through a dilated pupil that may reveal gross macular changes.|
|Used to monitor visual field loss.|
|Sequential photographs that may show leaking vessels as fluorescein dye flows into the tissues from the subretinal neovascular net.|
|Encourage patient to see ophthalmologist at least yearly.||Can monitor progressive visual loss or complications. Decreases in visual acuity can increase confusion in the elderly patient.|
|Provide sufficient lighting for 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 patient’s eyes are more sensitive to glare and cataracts diffuse and glare so that patient has more difficulty with vision.|
|Provide night light for patient’s room and ensure lighting is adequate for patient’s needs.||Patient’s eyes may require longer accomodation time to changes in lighting levels. 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 sense of independence.|
|Provide information about laser surgery.||Laser surgery may be helpful for the wet type of macular degeneration if done early. An approximate of only 20% of patients will have any improvement in visual function if done later.|