Question: Age Related Macular Degeneration

[xiongmao]

Practice question from Kaplan:

Patient has a sudden visual loss in a portion of the visual field and is diagnosed with ARMD. It's MOST important for nurse to assess which of the following:

1. Client's feelings about permanent loss of vision. (ANSWER)

2. Hx of HTN.

3. Hx of smoking.

Rationales:

1. CORRECT--because loss of vision is permanent, it's important for the nurse to allow the client to verbalize fears about the future and to assist the client to maximize remaining vision.

2. HTN is not related to macular degeneration.

3. smokers have a significantly higher risk of developing ARMD; important info to obtain when counseling public about how to decrease the risk developing macular degeneration.

*** My question ***

Cardiovascular disease, including high blood pressure, stroke, heart attack and CAD are all risk factors for ARMD. Right? I'm confused, not about why the answer is #1, but why they said HTN is not r/t ARMD. Can anyone explain please?

[Daytonite, BSN, RN]

the question is asking what is most important to assess when the patient has lost a portion of their vision. we assess in order to ferret out abnormal data that helps us determine the patient's nursing problems. that's part of the nursing process. macular degeneration, the medical disease, is a permanent degenerating condition. once a patient has it, they are stuck with it. permanent loss of vision is the patient response to that medical diagnosis. our nursing practice is based upon the patient's response to their disease process. the patient's feelings about what will happen to them as a result of having the disease is their response and therefore something that we would assess. of the 3 things listed, it is the most important of them to assess (as well as the only one listed).

how would assessing their history of hypertension or smoking have any relevance to the nurse's assessment of the sudden visual loss in a portion of the visual field? i could see a patient getting angry with someone questioning them about these things when they are probably very upset (feelings) over the sudden visual loss.

this article on emedicine supports the causes of armd suggested by the kaplan study question: http://emedicine.medscape.com/article/1223154-overview - nonexudative armd. what is the source of your information that cardiovascular disease, including high blood pressure, stroke, heart attack and cad may be risk factors for armd? in any case, the question is not asking you about the causes of armd so those answer choices would be incorrect anyway.

[xiongmao]

Daytonite:

Yep I understood why the correct answer is 1 (but your explanation was a lot better than what i was thinking :nuke:). I just thought HTN was a risk factor, I found this info on the mayoclinic website: http://www.mayoclinic.com/health/macular-degeneration/DS00284/DSECTION=risk-factors

But I read your source and it says "Large studies have not shown hypertension or heart disease to increase the odds of developing AMD." So now I know it isn't a risk factor! So the Mayoclinic info is wrong then?

[Daytonite, BSN, RN]

I don't understand the importance of this to you. We are nurses. What is important for us to know is about the disease process, its pathophysiology and how it affects the patient rather than the cause of the disease. Are these risk factors something you have to worry about for a test? I would be more worried about learning the nursing process.

[xiongmao]

I do understand what you are saying and I understand the question, answer, and rationale for the answer.

But I was not questioning why the correct answer was number 1. I just thought (incorrectly) that HTN was a risk factor so I was confused when I saw that the rationales here stated otherwise.

I guess it may seem insignificant to some people, but I still want to learn other aspects of diseases too, such as risk factors and whatnot. It just helps me understand better and perhaps provide better patient education in the future. I appreciate your help.