signs of trauma, irritation, swelling, asymmetry, discharge, and cloudy lens.
This week I continued my seventh and final week of adult gerontology preceptorship at my clinical site. It is a primary care family practice clinic, where they care for patients across the lifespan. However, they do not address the needs of babies and infants. I completed my previous clinical rotations there and continued for this rotation. I didn’t experience any notable challenges this week. I have learned the importance of speed and efficiency in addressing patient concerns/needs.
This week a 75-year-old male presents to the clinic for follow up. He is a patient of another provider in the clinic. He has a previous medical history of hypertension, prediabetes, hyperlipidemia, and glaucoma. He presents with complaints with worsening eye vision in his right eye. He complains of vision loss and the sensation of having a veil over the eye. He complains of double vision and seeing halos over his eye. He admits having trouble with performing his regular daily activities. Patient admits to taking Lumigan, Pilocarpine, and Lisinopril/HCTZ. Today he is due for labs we ordered CBC, CMP, Lipid panel, HBA1C, FOBT, Free T4, TSH, and UA.
An assessment was conducted to look for signs of trauma, irritation, swelling, asymmetry, discharge, and cloudy lens. Upon examination, both eyes appear symmetrical, but particularly red sclera in the right eye, no signs of trauma noted. The patient denies allergies, pain in the right eye, and abnormal drainage. He admits to taking his medications as prescribed. Differential diagnoses include cataracts, allergic conjunctivitis, worsening of his previous glaucoma diagnosis, and macular degeneration. Cataracts can interfere with an individual’s vision (Shiels & Hejtmancik, 2019). Cataracts and glaucoma have similar clinical manifestations such as blurred vision, reduced night vision, and halos around lights. Glaucoma is a neurodegenerative ocular disease that occurs when there is an imbalance between aqueous humor production and outflow (Kumar et al., 2023). There are closed and open-angle glaucoma (Kumar et al., 2023).
This patient needs a dilated exam to be performed with the use of an ophthalmoscope. This patient is to call to make an appointment with his ophthalmologist as soon as possible. This patient may require cataract surgery. This patient may be prescribed steroids and antibiotics prophylactically prior to surgery if surgery is indicated. The patient may be provided with glasses and protective sunglasses are recommended. Potential complications of cataract surgery include worsening sight, swelling, redness, and pain (Shiels & Hejtmancik, 2019). Other complications include posterior capsular opacification, retinal detachment, and vision loss (Shiels & Hejtmancik, 2019).
The patient is to follow up in 1-2 weeks after diagnostic and labs are completed and ready for review. He is to follow up with his primary care physician, an earlier visit will be scheduled if his results indicate the need. Today we educated him on dietary and lifestyle modifications that he must begin to implement.
A beneficial take-away that I learned this week is that time management is imperative to the overall success of the nurse practitioner. It was evident the importance of continuous monitoring of routine labs and medication review of elderly patients. This final week was great, and I am looking forward to the learning experiences of the next course.
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