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CHAPTER 20.docx

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NURS 287
Rick Nilson

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CHAPTER 20: AGE-RELATED MACULAR DEGENERATION  Age-related macular degeneration (AMD) is the most common cause of irreversible central vision loss in older adults.  AMD is related to retinal aging. Family history is another strong predictor of risk.  AMD has two forms: dry (nonexudative) and wet (exudative). o Dry AMD is more common, with close vision tasks becoming more difficult. Atrophy of macular cells leads to slow, progressive, and painless vision loss. o Wet AMD is more severe, with rapid onset and development of abnormal blood vessels related to the macula. Symptoms are blurred, distorted, and darkened vision with visual field blind spots. o Wet AMD treatment includes laser photocoagulation, photodynamic therapy, and intravitreous injectable drugs. Vitamin and mineral supplements may be considered. GLAUCOMA  Glaucoma is associated with increased intraocular pressure (IOP), optic nerve atrophy, and peripheral visual field loss.  Glaucoma often occurs with advanced age and is a major cause of permanent blindness.  Etiology is due to consequences of elevated IOP. Glaucoma is largely preventable with early detection and treatment.  Two types of glaucoma include: primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG), which is the more common. o With POAG, few symptoms exist and it is often not noticed until peripheral vision is severely compromised. o Symptoms of PACG include sudden, excruciating eye pain along with nausea and vomiting. o Therapy is to lower IOP to prevent optic nerve damage through drugs, argon laser trabeculoplasty, trabeculectomy, and iridotomy. The nurse should teach about glaucoma risk and the importance of early detection and treatment. PROBLEMS OF THE EAR EXTERNAL OTITIS  External otitis involves inflammation or infection of the auricle and ear canal epithelium due to infection.  Symptoms are pain, ear canal swelling, and drainage.  Therapy is analgesics, antibiotics, and compresses. ACUTE OTITIS MEDIA  Untreated or repeated attacks of acute otitis media in early childhood may lead to chronic middle ear infection.  Symptoms include purulent exudate and inflammation that can involve the ossicles, eustachian tube, and mastoid bone.  It is often painless.  Treatment may include antibiotics and surgery. MÉNIÈRE’S DISEASE  Ménière’s disease is cha
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