D5
\nCase 5
\n________________________________________<\/p>\n
A 79-year-old male remarks on his first visit that he has noticed a gradual decrease in vision in both his eyes since last year. His old medical record has not yet arrived at your office. He states that since he moved from Florida a year ago, he has not had an eye examination and does not yet know an ophthalmologist. He is having difficulty carrying on his activities of daily living that involve his sight. He states that he cannot recognize people at some distance until they come quite close and he is often frightened by his perception of strangers speaking to him. Watching television and reading are becoming increasingly difficult for him. He states that glare is a problem and notes that a few times he almost tripped over something on the floor. He still drives his car in the local community. He asks if you think he may have a cataract. He says his wife had two cataracts in the past and he remembers her complaining of vision problems which have now resolved.
\nVital Signs: BP 128\/84; HR 82; RR 18; BMI 24.
\nChief Complaint: Decrease in my vision; glare is very bothersome!
\nDiscuss the following:
\n1) What additional subjective data are you seeking to include past medical history, social, and relevant family history?
\n2) What additional objective data will you be assessing for?
\n3) What are the differential diagnoses that you are considering?
\n4) What laboratory tests will help you rule out some of the differential diagnoses?
\n5) What radiological examinations or additional diagnostic studies would you order?
\n6) What treatment and specific information about the prescription that you will give this patient?
\n7) What are the potential complications from the treatment ordered?
\n8) What additional laboratory tests might you consider ordering?
\n9) What additional patient teaching may be needed?
\n10) Will you be looking for a consult?<\/p>\n
Submission Instructions:
\n\u2022\tYour initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
\n\u2022\tPlease post your initial response by 11:59 PM ET Thursday<\/p>\n
Grading Rubric
\n________________________________________
\nYour assignment will be graded according to the grading rubric.
\nDiscussion Rubric
\nCriteria\tRatings\tPoints
\nIdentification of Main Issues, Problems, and Concepts\tDistinguished – 5 points
\nIdentify and demonstrate a sophisticated understanding of the issues, problems, and concepts.\tExcellent – 4 points
\nIdentifies and demonstrate an accomplished understanding of most of issues, problems, and concepts.\tFair – 2 points
\nIdentifies and demonstrate an acceptable understanding of most of issues, problems, and concepts.\tPoor – 1 point
\nIdentifies and demonstrate an unacceptable understanding of most of issues, problems, and concepts.\t5 points
\nUse of Citations, Writing Mechanics and APA Formatting Guidelines\tDistinguished – 3 points
\nEffectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.\tExcellent – 2 points
\nEffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.\tFair – 1 point
\nIneffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.\tPoor – 0 points
\nIneffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention.\t3 points<\/p>\n
________________________________________
\nAdditional subjective data that can be sought include:
\nDetailed information about the patient’s visual symptoms, such as the exact nature of the decrease in vision (blurry vision, double vision, etc.), any associated pain or discomfort, and whether the symptoms are present in both eyes or one eye.
\nHistory of any eye diseases or conditions, such as glaucoma, macular degeneration, or diabetic retinopathy.
\nHistory of any eye surgeries or procedures.
\nAny systemic diseases or conditions that could affect vision, such as diabetes or hypertension.
\nMedications the patient is currently taking, including over-the-counter medications and supplements, as some medications can have ocular side effects.
\nOccupational history and hobbies, as certain activities or exposures may contribute to visual problems.
\nSocial history, including smoking and alcohol use, as these factors can impact eye health.
\nFamily history of eye diseases, especially cataracts or other hereditary eye conditions.
\nAdditional objective data to be assessed for:
\nVisual acuity testing using an eye chart.
\nExternal examination of the eyes, looking for any abnormalities, such as redness, swelling, or discharge.
\nPupillary examination to assess the reaction of the pupils to light.
\nEvaluation of visual fields to check for any peripheral vision loss.
\nAssessment of intraocular pressure to rule out glaucoma.
\nSlit-lamp examination to examine the structures of the anterior segment of the eye, including the lens, cornea, and iris.
\nFundus examination to evaluate the retina and optic nerve.
\nThe differential diagnoses to consider in this case include:
\nCataracts: Given the patient’s symptoms, history of gradual vision loss, and his wife’s history of cataracts, cataracts are a likely possibility.
\nAge-related macular degeneration: This condition can cause central vision loss and difficulty recognizing faces.
\nGlaucoma: Increased intraocular pressure can lead to peripheral vision loss and difficulty with glare.
\nDiabetic retinopathy: If the patient has a history of diabetes, this condition should be considered.
\nRefractive errors: Myopia, hyperopia, or astigmatism can cause blurred vision and difficulty with distance vision.
\nOther ocular conditions: Retinal detachment, uveitis, or optic neuritis could also present with similar symptoms.
\nLaboratory tests that can help rule out some of the differential diagnoses include:
\nFasting blood glucose or HbA1c levels to assess for diabetes.
\nComplete blood count (CBC) to check for any systemic abnormalities.
\nErythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) to evaluate for systemic inflammation associated with certain ocular conditions.
\nRadiological examinations or additional diagnostic studies that may be ordered include:
\nOptical coherence tomography (OCT) to assess the structures of the retina and macula.
\nVisual field testing to evaluate the patient’s peripheral vision.
\nUltrasound biomicroscopy or A-scan ultrasound to assess the structures within the eye, such as the lens and anterior chamber.
\nThe treatment for cataracts typically involves surgical intervention. The specific information about the prescription that can be given to the patient includes:
\nReferral to an ophthalmologist for further evaluation and confirmation of the diagnosis.
\nExplaining the surgical procedure for cataract removal, such as phacoemulsification with intraocular lens implantation.
\nDiscussing the potential benefits of surgery, including improved vision, reduced glare, and enhanced quality of life.
\nInforming the patient about the risks and potential complications of surgery, such as infection, bleeding, or retinal detachment.
\nAdvising the patient to continue with current visual aids, such as glasses or contact lenses,<\/p>\n","protected":false},"excerpt":{"rendered":"
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