History of Present Illness
The patient is a 32-year-old female referred to the ER with a major decrease of vision in one eye. The patient is also unable to determine colors. The condition is not associated with trauma or injury. The vision has worsened during the day. The patient reports pain when attempting to move the eye. She denies exposure to chemicals, tearing, redness, and swelling. The patient reports the occurrence of a similar incident one month prior. The relief is associated with the decreased temperature of the environment (conditioned air).
The patient is alert, uncomfortable, anxious due to the condition, cooperative with the examination. Heart rate 64 bpm., regular. Blood pressure 135/85. Respiratory rate 16 bpm. No signs of alcohol, tobacco, or drug intake.
Head: no weaknesses or involuntary movements.
Eyes: visual acuity 20/30 in the right eye and 20/200 in the left eye. Swollen optic disc. Sclera white. Intact visual fields on the right side, unable to access visual fields on the left side. Brisk pupil response to light in the right eye, diminished in the left eye.
Ears: no pain, no lesions.
Nose: normal mucosa, no deformities.
Neck: no rash, no lesions.
Chest and lungs: clear, no abnormal noises.
Heart: BP 135/85, no abnormalities.
Abdomen: no abnormalities, no stiffness, no pain.
Skin: no rash, no lesions. Normal color and elasticity.
Musculoskeletal system: normal bulk and tone, no abnormalities, no swelling. Normal motion range.
Neurological system: oriented x3, cranial nerves I-XII intact; horizontal nystagmus present.
There are two most likely nursing diagnoses for the patient’s condition. The first one is excessive anxiety related to the change of perception due to the inability to see well. The patient may feel scared because of the newly acquired health condition. She may feel depressed and unable to think clearly and logically, being overwhelmed with thoughts about possible complications such as multiple sclerosis (Klistorner et al., 2012).
The second nursing diagnosis is despair and hopelessness caused by the ambiguity of the illness. Because the patient needs to get accustomed to the new life regime, she may feel desperate. She needs a lot of care and support from her close ones who should do their best to make her feel more relaxed.
Special attention is necessary for regards to these diagnoses to note and avert the progression of complications in the patient’s condition.
Nursing Care Plan
Prevent further aggravation of condition: optic neuritis can resolve on its own with no pharmaceutical intervention required. Therefore, monitoring of the patient’s condition is necessary for timely detection of the turn of an event requiring clinical intervention.
Prevent environmental hazards: the decline of vision can introduce the risk of tripping over a small object even in a familiar environment. The patient’s family members need to ensure that common hazards such as cords and clutter are removed from the house. This risk is especially grave in the case of glaucoma in which the sharp decline prevents adaptation.
Maintain medication intake: in some cases, optic neuritis requires intravenous and oral steroid treatment for a more rapid recovery. Steroids have adverse effects on health when administered inappropriately, requiring close supervision.
Manage anxiety: the sudden impairment and associated lifestyle changes can have detrimental effects on a patient’s psychological state. Effective coping techniques should be made available to the patient.
Pharmaceutical intervention: self-administration of eye drops require basic skills. In addition, steroids used for optic neuritis treatment have a range of side effects the patient must be aware of.
Multiple sclerosis: optic neuritis is strongly associated with multiple sclerosis, which can be successfully prevented or delayed if timely detected (Malik et al., 2014). The patient should be educated on the benefits of early detection and ways of prevention of the related condition.
Klistorner, A., Garrick, R., Barnett, M. H., Graham, S. L., Arvind, H., … Yiannikas, C. (2012). Axonal loss in non-optic neuritis eyes of patients with multiple sclerosis linked to delayed visual evoked potential. Neurology, 80(3), 242-245.
Malik, M. T., Healy, B. C., Benson, L. A., Kivisakk, P., Musallam, A., Weiner, H. L., & Chitnis, T. (2014). Factors associated with recovery from acute optic neuritis in patients with multiple sclerosis. Neurology, 82(24), 2173-2179.
Mayo Clinic. (2015). Glaucoma. Web.