psoriasis, AMD & Glaucoma

21. A patient has just been diagnosed with psoriasis and frequently has lesions around his right eye. What should the nurse teach the patient about topical corticosteroid use on these lesions? A) Cataract development is possible. B) The ointment is likely to cause weeping. C) Corticosteroid use is contraindicated on these lesions. D) The patient may develop glaucoma.

Ans: A Feedback: Patients using topical corticosteroid preparations repeatedly on the face and around the eyes should be aware that cataract development is possible. Weeping and glaucoma are less likely. There is no consequent risk of glaucoma.

What is the action of miotics in the client with glaucoma? A. Decrease the inflammatory process B. Enhance aqueous outflow C. Increase the production of vitreous humor D. Vasoconstrict the blood vessels in the eye

Answer: B

A client with glaucoma is being assessed for new symptoms. Which symptom indicates a high priority need for reassessment of intraocular pressure? A. Burning in the eye B. Inability to differentiate colors C. Increased sensitivity to light D. Gradual vision changes

Answer: D

When writing a plan of care for a patient with psoriasis, the nurse would know that an appropriate nursing diagnosis for this patient would be what A) Impaired Skin Integrity Related to Scaly Lesions B) Acute Pain Related to Blistering and Erosions of the Oral Cavity C) Impaired Tissue Integrity Related to Epidermal Shedding D) Anxiety Related to Risk for Melanoma

Impaired Skin Integrity Related to Scaly Lesions An appropriate diagnosis for a patient with psoriasis would include Impaired Skin Integrity as it relates to scaly lesions.

The nurse is assessing a client with macular degeneration. Identify the illustration that best depicts what clients with this disorder typically see.

In macular degeneration the center vision is blackened out and only the outer visual fields are clear.

10. A nurse performs an assessment of a client with a diagnosis of macular degeneration of the eye. The nurse would expect the client to report which of the following symptoms? a) loss of peripheral vision b) blurred central vision c) increased clarity when looking at objects d) clear vision when reading

B- The most common symptom of macular degeneration is blurred central vision that often occurs suddenly. Clients complain of difficulty with reading and seeing fine detail. Formation of a central scotoma (blind spot) occurs in some clients. Clients might complain of visual distortion, usually described as a bending or irregularity of straight lines. Peripheral vision is spared, so although affected persons cannot see to read, drive, watch television clearly, or distinguish faces, they do have the ability to walk.

1. Which statement below is CORRECT about glaucoma? A. "The vision loss that occurs with glaucoma is reversible with eye drop medications." B. "Glaucoma occurs due to decreased intraocular pressure, which damages the optic nerve." C. "Surgery can cure glaucoma." D. "A normal intraocular pressure is about 10-21 mmHg and is elevated in most patients with glaucoma."

D

The 65-year-old client is diagnosed with macular degeneration. Which statement by the nurse indicates the client needs more discharge teaching? 1. "I should use magnification devices as much as possible." 2. "I will look at my Amsler grid at least twice a week." 3. "I am going to use low-watt light bulbs in my house." 4. "I am going to contact a low-vision center to evaluate my home."

#3 1. Magnifying devices used with activities such as threading a needle will help the client's visual sight; therefore, this statement does not indicate the client needs more teaching. 2. An Amsler grid is a tool to assess macular degeneration that often provides the earliest sign of a worsening of the condition. If the lines of the grid become distorted or faded, the client should call the ophthalmologist. *3. Macular degeneration is the most common cause of visual loss in people older than age 60 years. Any intervention that can help increase vision should be included in the teaching such as bright lighting, not decreased lighting.* 4. Low-vision centers will send representatives to the client's home or work to make recommendations about improving lighting, thereby improving the client's vision and safety. TEST-TAKING HINT: The test taker must be sure what the question is asking prior to looking at the answer options. This question is asking which statement indicates more teaching is needed. Therefore three (3) options will indicate that the client understands appropriate discharge teaching and only one (1) will indicate the client does not understand the teaching.

The nurse should assess an older adult with macular degeneration for: ■ 1. Loss of central vision. ■ 2. Loss of peripheral vision. ■ 3. Total blindness. ■ 4. Blurring of vision.

1. Macular degeneration generally involves loss of central vision. Gradual blurring of vision can occur as the disease progresses and may result in blindness; however, loss of central vision is the most common fi nding. Tiny yellowish spots, known as drusen, develop beneath the retina. Loss of peripheral vision is characteristic of glaucoma.

A 75-year-old male client has a history of macular degeneration. While he is in the hospital, the priority nursing goal will be: ■ 1. To provide education regarding community services for clients with adult macular degeneration (AMD). ■ 2. To provide health care related to monitoring his eye condition. ■ 3. To promote a safe, effective care environment. ■ 4. To improve vision.

3. AMD generally affects central vision. Confusion may result related to the changes in the environment and the inability to see the environment clearly. Therefore, providing safety is the priority goal in the care of this client. Educating him regarding community resources or monitoring his AMD may have been done at an earlier date or can be done after assessing his knowledge base and experience with the disease process. Improving his vision may not be possible.

When the nurse enters the client's room, the nurse perceives that the client is staring straight ahead. Which of the following is the best course of action for the nurse to take next? ■ 1. Hold an interdisciplinary meeting on the client's behalf promptly. ■ 2. Consult with psychiatry. ■ 3. Listen to the client and observe the body language. ■ 4. Address the client by fi rst name upon entering the room.

3. By listening to the client should they speak and by noting body language, the nurse may be better able to ascertain the client's physical and cognitive status. The nurse should not utilize the first name of a client unless a client provides permission to do so. To consult with psychiatry would not be appropriate unless ordered by the primary care physician. An interdisciplinary meeting would not enable the nurse to understand why the client is staring straight ahead. Perhaps the client is only deep in thought.

Although all of the following measures might be useful in reducing the visual disability of a client with adult macular degeneration (AMD), which measure should the nurse teach the client primarily as a safety precaution? ■ 1. Wear a patch over one eye. ■ 2. Place personal items on the sighted side. ■ 3. Lie in bed with the unaffected side toward the door. ■ 4. Turn the head from side to side when walking.

4. To expand the visual field, the partially sighted client should be taught to turn the head from side to side when walking. Neglecting to do so may result in accidents. This technique helps maximize the use of remaining sight. A patch does not address the problem of hemianopsia. Appropriate client positioning and placement of personal items will increase the client's ability to cope with the problem but will not affect safety.

The clinic nurse assesses the skin of a client with a diagnosis of psoriasis. The nurse understands that which characteristic is associated with this skin disorder? 1. Clear, thin nail beds 2. Red-purplish scaly lesions 3. Oily skin and no episodes or pruritus 4. Silvery-white scaly patches on the scalp, elbows, knees, and sacral regions.

4.Psoriasis patches are covered with silvery white scales. Affected areas include the scalp, elbows, knees, shins, sacral area, and trunk. Thickening, putting, and discoloration of the nails occur. Pruritus may occur.

A nurse is providing care for a patient who has psoriasis. The nurse is aware of the sequelae that can result from this health problem. Following the appearance of skin lesions, the nurse should prioritizeA) Assessment of the patient's stool for evidence of intestinal sloughing B) Assessment of the patient's apical heart rate for dysrhythmias C) Assessment of the patient's joints for pain and decreased range of motion D) Assessment for cognitive changes resulting from neurologic lesions

Ans: C Feedback: Asymmetric rheumatoid factornegative arthritis of multiple joints occurs in up to 30% of people with psoriasis, most typically after the skin lesions appear. The most typical joints affected include those in the hands or feet, although sometimes larger joints such as the elbow, knees, or hips may be affected. As such, the nurse should assess for this musculoskeletal complication. GI, cardiovascular, and neurologic function are not affected by psoriasis.

A nurse is caring for a patient who has been diagnosed with psoriasis. The nurse is creating an education plan for the patient. What information should be included in this plan) Use caution when taking nonprescription medications. B) Avoid public places until symptoms subside. C) Wash skin frequently to prevent infection. D) Liberally apply corticosteroids as needed.

Use caution when taking nonprescription medications. The patient should be cautioned about taking nonprescription medications because some may aggravate mild psoriasis.

Priority Decision: What nursing action is most important for the patient with age-related macular degeneration (AMD)? a. Teach the patient how to use topical eyedrops for treatment of AMD. b. Emphasize the use of vision enhancement techniques to improve what vision is present. c. Encourage the patient to undergo laser treatment to slow the deposit of extracellular debris. d. Explain that nothing can be done to save the patient's vision because there is no treatment for AMD.

b. The patient with AMD can benefit from low-vision aids despite increasing loss of vision and it is important to promote a positive outlook by not giving patients the impression that "nothing can be done" for them. Laser treatment may help a few patients with choroidal neovascularization and photodynamic therapy is indicated for a small percentage of patients with wet AMD but there is no treatment for the increasing deposit of extracellular debris in the retina.