Anne is a 60-year-old, slightly obese, white female who isbrought to the ED by her husband at 2 o’clock in the morning. Shehas been experiencing severe, deep, boring pain; decreased visionacuity: and redness and photophobia of her left eye (OS) for thelast 7 to 8 hr. A private physician had seen her earlier when shewas having mild to moderate ocular complaints, and she wasdiagnosed with having viral conjunctivitis. She was advised toapply cool compresses to OS and take Tylenol two tablets every 4 hrfor eye pain. Over the next few hours her OS pain has rapidlyincreased in intensity and her vision has become worse.
Triage Assessment. Acuity Level IV: sudden decrease in vision,severe eye pain
In the treatment area. Anne reports that she has had foursimilar episodes of ocular problems in the last 5 weeks but thather vision had improved and the pain had disappeared spontaneouslyafter 1 to 2 hr.
Anne is alert and oriented x3. and her skin is warm and dry.Her respirations are deep and regular. Peripheral pulses are strongand regular.
Anne reports having a fairly active life-style and denies anymedical problems except a history of upper respiratory tractinfection 2 to 3 weeks ago, which has completely resolved. Shestates she has been very upset over the death of her only daughterfrom an automobile accident 2 weeks ago.
The physician’s ocular findings are reported as follows: Righteye (OD) vision 20/20, OS vision 20/100 PHNI (no improvement overpinhole). OD shows a shallow anterior chamber (AC) and narrowangle, otherwise within normal limits. OS shows a 5- to 6-mmdilated and non reactive pupil. Extra ocular movements (EOMs. arefull, and external exam is normal. The left eye slitlamp exam (SLE)shows the conjunctiva 2+ injected: the cornea has moderate stromaledema; the A C is shallow, with trace cells or flare; the iris isvery convex; lens is clear. Funduscopic exam of the left eyereveals poor view of the fundus. Tension by applanation tonometershows the right eye at 12 mm Hg and the left eye at 60 mm Hg.Gonioscopy of the right eye shows a narrow angle: the left eyeangle is closed x360°.
The medical diagnosis is acute angle-closure glaucoma of theleft eye.
QUESTIONS
What is the pathophysiological basis for Anne’s ocularproblem?
What are the predisposing as well as precipitating factors forAnne’s ocular problems?
What are the special tools used to confirm Anne’s medicaldiagnosis?
What are the current medical interventions used to treatAnne’s problems and the nursing implications in the use of thesemeasures?
What nursing diagnoses are of high priority in the care ofthis patient?
What nursing interventions are appropriate for Anne based onher diagnoses?
(Visited 5 times, 1 visits today)
