VCE Lesson 21, Exercise 2 1. What problems of the eye does Clarence Hughes have? Clarence is experiencing problems related to his diagnosis of glaucoma. 2. How would this be diagnosed? Briefly explain the procedure and expected results. Some of the diagnostic tests that could be performed to diagnose glaucoma could be any of the following: Fundus Photography, Exophthalmomerty, Opthalmic Radiography, Magnetic Resonance Imaging, Ultrasonography, Opthalmodynamometry, Electroretinography, Visual Evoked Response, Fluorescein Angiography. All of the above listed procedures involve measuring the eye's pressure, inspecting for foreign bodies, as well as assessing for pain in the eye. 3. What signs and symptoms do you think Clarence Hughes had prior to diagnosis? Some signs and symptoms that Clarence could have been experiencing could be: Pain in the ocular region, patchy peripheral vision, hypertension, and reduced contrast sensitivity. 4. For what clinical manifestations and/or history should you assess Clarence Hughes related to this diagnosis? Some clinical manifestations that should be assessed for in relation to this diagnosis would have to be a family history of glaucoma, African descent, history of hypertension or coronary artery disease, ocular pain, changes in vision or hearing, and finally history of myopia. 5. The H&P does not identify the type of glaucoma Clarence Hughes has. Based on his history and the information in the textbook, which type do you think Clarence most likely has? Explain why you came to this conclusion. Based on the information in the textbook and a comparison to Clarence's record, his diagnosis should be revised and rewritten as open angle glaucoma, a his previous assessments show few clinical manifestations or complaints of ocular pain, changes in vision or hearing, or any other factor that would be indicative of glaucoma. 6. Medication Classification MOA Side Effects Timolol Maleate Antiglaucoma agent; Blocks Beta 1 and Beta Decreased sexual Beta adrenergic blocker 2 adrenergic receptors function, drowsiness, difficulty sleeping, unusual tiredness or weakness, eye irritation, visual disturbances, diarrhea, constipation, nausea, vomiting. Pilocarpine Antiglaucoma agent; Acts as a cholinergic Diaphoresis, headache, Cholinergic agent parasympathomimetic, dizziness, urinary and stimulates frequency, flushing, cholinergic receptors in dyspepsia, nausea, the PSNS. fatigue, weakness, lacrimation, visual disturbances. 7. For what side effects should you monitor Clarence Hughes related to these medications? See chart above. 8. If you were to administer the prescribed antiglaucoma medication to Clarence Hughes, how would you correctly apply the eye drops? Explain the step-by-step procedure. The first step before any medication is administered is the appropriate checking of the wristband, that way the correct patient is identified. Second, assessment is required to determine if the medication is appropriate to be given. For Timolol, the assessments include checking the apical pulse and blood pressure. If the pulse is less than 60 BPM, the medication is held, and if the systolic blood pressure is less than 90 mmHg the medication is also held. The correct administration of this med is performed (while wearing gloves) by pulling back the eyelids, and administering one drop on the eyeball unless otherwise prescribed. Careful monitoring of side effects should also be included in this post medication administration. 9. What would you expect Clarence Hughes tonometry reading to be prior to the beginning treatment for glaucoma? What would you expect the reading to be during treatment? I would expect Clarence to have a reading of higher then 22 mmHg in both eyes, as this is the landmark for ocular hypertension. During treatment, I would expect to see a steady fall in these readings, and eventually within normal limits while the medication is continued. 10. Identify an appropriate outcome for Clarence Hughes related to his glaucoma. An appropriate outcome for Clarence would be: Patient will demonstrate the appropriate administration of eye drop prior to discharge from the hospital. 11. What educational goals would you add for Clarence Hughes related to his glaucoma? Some educational goals that I would add for Clarence related to his glaucoma would be the correct administration of his eye drops, when to administer the eye drops, and when to contact a health professional related to medication side effects, or an ocular emergency. Additionally, I would cover the side effects of the medications that Clarence would be taking, so that he knows what to look for. 12. What teaching would you provide for Clarence regarding his glaucoma? I would teach Clarence everything he needs to know about the disease, how it is diagnosed, what it is, what brings it on, and how it is treated. This way, Clarence has a thorough understanding of his diagnosis and what he is being treated for. 13. Medication Teaching Points Timolol Caution patient against abruptly stopping medication use, inform of the importance of therapy compliance, avoid tasks that require mental alertness or motor skills until drug effects are known, warn the patient to notify the physician if he or she experiences excessive fatigue, prolonged dizziness, headache, or shortness of breath, avoid alcohol intake, take pulse before dose, and note potential stinging or burning upon administration. Pilocarpine Instruct the patient to drink several glasses of water between meals, caution the patient that he/she may experience visual changes (especially at night), warn patient to avoid tasks that require mental alertness and motor skills until drug effect is known. 14. What teaching methods would you use to teach medication administration? Some good teaching methods that can be used to increase the patient's understanding of the medication and how it works are demonstration, written material, verbal instruction and electronic media. All of these can be used and repeated if necessary to help the patient understand correct usage and administration of the drug. 15. How would you evaluate Clarence Hughes' understand of correct application? The best way to evaluate the patient for accurate teaching is a verbal explanation to the nurse, and a demonstration of appropriate administration when the next dose is due. 16. If Clarence Hughes' opthalmic medications fail to maintain his IOP within normal limits, what other therapy might he expect to undergo? Briefly explain these procedures. Some treatments for this condition include: Canaloplasty, Laser Surgery, Trabeculectomy, Glaucoma drainage implants. All of the above treatments are ways to remedy glaucoma, as they mechanically intervene with the IOP, and work to correct it.
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