Radiation therapy is going to be indicated for most patients…
Questions
Rаdiаtiоn therаpy is gоing tо be indicated for most patients because tumors in the head and neck region are often inaccessible for surgery.
The nursing is cаring fоr а 72-yeаr-оld client in the urgent care center. Nurses Nоtes 1000: Client is sitting on examination table with spouse at side. Client is tearful and appears anxious; states, “I can’t see out of my right eye. I’m so scared.” Facial features are symmetric, speech is clear and appropriate, follows all commands and moves all extremities equally. Conjunctival erythema present in right eye. Left pupil round, 2 mm, and reactive to light. Right pupil round, 6 mm, and nonreactive. Central vision present and consistent for both eyes. Left eye peripheral vision is normal. Loss of right eye peripheral vision noted. VS: T 98.2°F (36.7°C); HR 88 beats/min; RR 18 breaths/min; BP 142/68 mm Hg; SpO2 98% on RA. Client reports a frontal headache rated 6/10 on a scale of 0–10.1015: NIH Assessment• Level of consciousness = 0, Alert; keenly responsive• Orientation = 0, Oriented to month and age• Commands = 0, Performs two tasks correctly• Horizontal extraocular movement = 0, Normal• Visual = +1, Partial hemianopia• Facial palsy = 0, Normal symmetry• Upper extremity motor = 0, No drift in left arm or right arm for 10 seconds• Lower extremity motor = 0, No drift in left leg or right leg for 5 seconds• Limb ataxia = 0, No ataxia• Sensation = 0, Normal; no sensory loss• Language = 0, Normal; no aphasia• Dysarthria = 0, Normal• Inattention (neglect) = 0, No abnormalityScore = +1 History and Physical History of Present Illness: Client is a 77-year-old who is married and lives with spouse, who is at the bedside. Client reports sudden loss of vision in right eye, stating, “I haven’t felt comfortable driving at night for the past year because the lights look a bit foggy to me, but I didn’t realize there was an issue with my vision until this morning. I feel like I’m looking through a narrow tunnel.” Ophthalmoscopic examination of right eye reveals shallow anterior chamber, cloudy aqueous humor, and a moderately dilated, nonreactive pupil. Client reports right eye pain and headache, and shares, “I had a headache like this last night. It lasted a little over an hour and was accompanied by blurry vision, but I didn’t think much about it since it resolved quickly.”Past Medical History• Asthma• Environmental allergies• Chronic depression• Peripheral vascular diseaseDrug Allergies• PenicillinCurrent Medications• Albuterol MDI 2 puffs every 6–8 hours PRN for bronchospasm• Amitriptyline 75 mg orally every night before bed Diagnostic Test Results Right Eye Left Eye Intraocular pressure(Normal range: 10–20 mm Hg) 32 mm Hg 14 mm Hg Gonioscopy Iridocorneal angle width narrowed; inflammation present in anterior chamber Within Normal Limits Select whether the following potential nursing actions are indicated or not indicated for the client at this time. Potential Nursing Actions Indicated Not Indicated Teach the client to properly instill prescription eyedrops on time and to not skip doses. [answer1] Assist the client with ambulation by offering an arm and walking a step ahead. [answer2] Obtain a signed consent form for a trabeculoplasty procedure. [answer3] Keep the eyedrop container tip clean and avoid touching the tip to the client’s eye. [answer4] Communicate the client’s reduced vision to all staff caring for the client. [answer5] Stress the need for good handwashing. [answer6] Teach the client that use of ophthalmic drugs will improve lost vision.