VCE Lesson 21 Exercise 2 by 3o04PG


									                                        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

         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.

      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,
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

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.


                    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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