OUR LADY OF FATIMA UNIVERSITY

REGALADO, FAIRVIEW QUEZON CITY

SUBJECT : NCM 104 – MEDICAL SURGICAL NURSING

DEPARTMENT : NURSING
INSTRUCTOR : DR. ANTHONY P. TOLEDO
TOPIC : EYE DISORDERS
TERM : MIDTERM
WEEK NUMBER : 9TH
NAME : MARA KRISTAL M. TAYO

CASE STUDY

AGE RELATED MACULAR DEGENERATION

One elderly lady had complaints of diminished vision in the right eye of 15 days duration. She was 69
years old and had already lost vision in the left eye 3 years back. She was not a diabetic or
hypertensive. Visual acuity in the right eye was 6/24 and in the left was counting fingers 2 meters.
She had Pseudophakia (Intraocular Lens) in both the eyes, having undergone cataract surgery 5
years back. Fundus examination right eye showed a whitish lesion in the macula with surrounding
thickening and hemorrhage, while the left eye showed a large scar in the central area (macula).

She underwent Fundus Fluorescein Angiography that showed a well-defined leak in the right eye.
The patient was diagnosed as having Choroidal Neovascular Membrane in the right eye and
Macular scar in the left eye due to Age Related Macular Degeneration.

It was explained to her that the treatment is aimed only at preventing further visual loss by trying to
close the Neovascular Membrane and not at improving vision. The need for regular post treatment
follow-ups was also emphasized to detect any recurrences, which are quite common. She was offered
the best treatment available for this condition i.e. Photodynamic Therapy (PDT) with the drug
Verteporfin. She underwent the same the next day and 3 months later the hemorrhage had resolved
and the vision was slightly better at 6/18p. Subjectively she was feeling much better with the
reduction in distortion and haziness of vision.

QUESTIONS:

1. The most common cause of visual loss in people older than 60 years of age is:

a. Macular degeneration
b. Ocular trauma
c. Retinal vascular dse.
d. Uveitis

Answer: A. Age related macular degeneration is a medical condition which usually

affects older adults that results in a loss of vision in the center of the visual field (the macula)
because of damage to the retina. It is a major cause of visual impairment in older adults
(>50 years)
2. It results from atrophy to the retinal pigment epithelial layer below the retina.

a. Dry AMD
b. Wet AMD
c. Ocular tauma
d. Uvietis

Answer: A. Central geographic atrophy, the “dry” form of advanced AMD, results from
atrophy to the retinal pigment epithelial layer below the retina, which causes vision loss
through loss of photoreceptors (rods and cones) in the central part of the eye.

3. The following are signs and symptoms of Age Macular disease, except:

a. Blurred vision
b. Drusen
c. Visual acuity
d. Elevated intraocular pressure

4. It is a diagnostic test used to allow the identification and localization of abnormal vascular
processes?

a. Optical coherence tomography

b. Fluorescein angiograph
c. MRI
d. SPECT

Answer: B. Fluorescein angiograph allows for the identification and localization of

abnormal vascular processes

5. Term known as nearsightedness.

a.hyperopia
b.myopia
c.astimagtism
d.cataracts

Answer. B. myopia see near objects clearly but far away objects appear blurred. With
myopia, the eyeball is too long, or the cornea is too steep, so images are focused in the
vitreous inside the eye rather than on the retina at the back of the eye.

6. Also known as farsightedness.

a.hyperopia
b.hypermetropia
c.both
d.none of the above

Answer:C. Hyperopia and hypermetropia is both medical term which means farsightedness.
7. It is a condition that causes optical defect in which vision is blurred due to the inability of
the optics of the eye to focus a point object into a sharp focused image on the retina. This
may be due to an irregular or toric curvature of the cornea or lens?

a. Cataract
b. Myopia
c. Blindness
d. Astigmatism

e. Answer: D. Astigmatism causes optical defect in which vision is blurred due to the
inability of the optics of the eye to focus a point object into a sharp focused image on
the retina

8. A 25-year-old man reports losing his sight in both eyes. He’s diagnosed as having
conversion disorder and is admitted to the psychiatric unit. Which nursing intervention would
be most appropriate for this client?

a. Not focusing on his blindness

b. Providing self-care for him
c. Telling him that his blindness isn’t real
d. Teaching eye exercises to strengthen his eyes

Answer A. Focusing on the client’s blindness can positively reinforce the blindness and further
promote the use of maladaptive behaviors to obtain secondary gains. The client should be
encouraged to participate in his own care as much as possible to avoid fostering dependency.
To promote self-esteem, give positive reinforcement for what the client can do. Blindness and
other physical symptoms in a conversion disorder aren’t under the client’s control and are real
to him. Eye exercises won’t resolve the client’s blindness because no organic pathology is
causing the symptoms.

9.It is a symptom caused by the natural course of aging.

a. Presbyopia
b. Myopia
c.hyperopia
d.glaucoma

Answer: A. Similar to grey hair and wrinkles, presbyopia is a symptom caused by the natural
course of aging.

10.   Mrs. Parker, a 70-year-old woman with severe macular degeneration, is admitted to the
hospital the day before scheduled surgery. The nurse’s preoperative goals for Mrs. M. would
include:

a.    independently ambulating around the unit.

b.    reading the routine preoperative education materials.
c.    maneuvering safely after orientation to the room.
d.    using a bedpan for elimination needs.

Answer: B.

11. Using Snellen's E chart, the nurse assesses the visual acuity of a 5-year-old as
approximately 20/60. The nurse determines that the findings at this age indicate:

a. Myopic
 b. Hyperopic
c. Emmetropic
d. Blind

Answer: A. Normal vision (emmetropic) for a 5-year-old is approximately 20/30. Hyperopic

vision is farsightedness, or inability to focus on close objects. Visual acuity findings of 20/60
indicate myopic vision or nearsightedness, the inability to focus on far away objects.

12. You are the nurse assigned to perform an eye assessment on an 80-year-old client. Which
of the following findings during the assessment?

a. Absence of the red reflex

b. Equal pupillary constriction in response to light
c. Edematous eyelids with matted eyelashes
d. Inflamed conjunctiva

Answer: B. Pupils are small in old age, and the pupillary light reflex can be slowed, but
pupillary constriction should be symmetrical. There should be a red reflex, and the eyelids and
conjunctivae should not be edematous or inflamed.

13. Which of the following physiologic changes would be expected in a patient with
presbyopia?

a. Degeneration of the cornea

b. Loss of lens elasticity
c. Decreased adaptation to darkness
d. Decreased distance vision abilities
Answer: B. The lens loses elasticity or pliability, decreasing its ability to change shape in order to accommodate for
near vision. Response 4 is indicative of cataracts, 3 is myopia, and 1 is due to corneal changes.

14.A patient has a question about a recent eye exam. Which of the following statements would
be an accurate response to inquiry?

a. "If the eyeball is too long for the power of the lens, it is called hypermetropia."
b. "A shortened eyeball is called myopia."
c. "The lens is normally transparent."
d. "Refraction is when the eyes adjust to seeing objects at various distances."

Answer:C. The lens is made of layers of epithelial cells that are closely packed and organized
so that the lens is clear and transparent. Hypermetropia is a shortened eyeball, and
myopia is an elongated eyeball. Refraction refers to bending the light rays so they are
focused at a certain point on the retina.

15. Which of the following is true of presbycusis? (Select all that apply.)

a. Dysfunction with the cochlea and auditory nerve

b. Ménière’s disease and tumors
c. Changes due to accumulation of cerumen
d. Infections of the inner ear

Answer: A, B, D. Presbycusis is hearing loss associated with aging, and affects approximately
75% of people over the age 60. Loss of hair cells in the cochlea (sensory loss) and
degradation of neurons (neural loss) result in this form of hearing loss. Presbycusis occurs
gradually, and usually is bilateral. Answer 3 describes a conductive hearing loss.

16. A client has undergone surgery for retinal detachment. Which of the following goal should
be prioritized?

a. Prevent an increase intraocular pressure

b. Alleviate pain
c. Maintain darkened room
d. Promote low-sodium diet