P.J. is a 74-year-old female who has been seen multiple times
in the past with a complex medical history. Most recently, she was
discharged one month ago after a 14-day stay for gangrenous open
cholecystectomy. The gangrene extended into the common bile duct
and she suffered a bile leak postoperatively. On this visit to the
emergency room, she is complaining of diminished vision in the left
eye for the past seven days. She is currently taking the following
medications:
valsartan 160 mg/25 mg PO daily
amitriptyline 25 mg PO daily
aspirin 81 mg PO daily
alprazolam 0.25 mg every 6 hours PRN for anxiety
Subjective Data
States her vision has become “fuzzy and distorted” in the left
eye
States, “I survived that horrid ordeal with my gallbladder and
now I have trouble with my vision.”
Never married; has a good support system with friends and
caretakers
Objective Data
Physical Examination
Blood pressure 119/79, pulse 82, temperature 97.7° F,
respirations 16
Alert and oriented to person, place, and time
Diminished breath sounds bilateral lower lobes
posteriorly
Oxygen saturation 96% on room air
Discussion Questions
Name six potential causes of P.J.’s blurry vision.
Case Study Progress
A consult is sent to the on-call ophthalmologist. The initial
exam results show a scar in the central area (macula), suggesting
age-related macular degeneration. The ophthalmologist feels at this
point that the treatment should be aimed at preventing further
vision loss and schedules P.J. for photodynamic therapy.
2. What are the early signs of age-related macular
degeneration (AMD)?
3. What tests can be done to determine if P.J. has age-related
macular degeneration
4. What risk factors are associated with macular
degeneration?
5. What diet related teaching will you provide P.J.?