Introduction
Human eyes are important organs in the body system. A healthy eye is responsible for converting light into electrical signals (Laha et al., 2017). Sudden vision problems make people anxious. Regular checkups are necessary for people of all ages. Health promotion is based on assessing nursing processes and peer-reviewed evidence. In this paper, attention will be paid to the human eye as one of the crucial organs in the body system. Its functions vary, including the possibility to convert light into important electrical signals to the brain (Laha et al., 2017). In case a person experiences vision problems, anxiety and panic occur. To avoid sudden vision changes, people have to check their eyes regularly and improve their awareness of health promotion.
Patient’s Case
The case under consideration introduces a 32-year-old female who is presented to the ER with her friend. The main complaint is a sudden vision problem in her left eye. The patient is a math teacher; she is alert and reports no recent traumas or injuries that could influence her health condition. In addition to vision problems, she seems to be anxious as it is hard for her to understand the reason for her situation. To provide the woman with comprehensive help and diagnosis, an analysis of her history and physical examination are required.
Comprehensive History
The first step is to pay attention to the patient’s comprehensive history. According to a Celebrity Group Company (2019), it includes four main issues – reasons for admission, review of systems, history of present illness, and past/family/social history. Organized interviews and personal communication are the main sources of information to formulate the historical data for further analysis. In the table, Jessica’s history is introduced and explained from the point of view of her present and past complaints.
Reasons for admission
Sudden vision decrease (left eye only), Blurring of vision.
Review of systems (ROS)
Visual activity: 20/200 (left eye) and 20/30 (right eye); horizontal nystagmus; muscles normal; sclera white; visual fields – unable to assess (left) and intact (right)
History of present illness (HPI)
Decrease in vision started this morning and progressively worsened within a few hours; pain during movement an eye; no redness, no tearing; inability to determine colors
Past, family, and social history (PFSH)
Blurring of vision due to overheating one month ago (improved by getting in a cool environment)
Physical Examination
As soon as the doctor is done with communication, it is high time to complete a physical examination and identify the potential causes of pain and vision change. In addition, a physical exam is an excellent opportunity to identify if there are any threats that could lead to visionary complications. The review of systems that are directly related to the problem of the patient is critically important. In this case, it includes the examination of the eyes. Although the sclera is white with conjunctivae clear, her vision activity is low in the left eye (20/200) and medium in the right eye (20/30). Visual fields vary (intact in the right eye and unable to assess in the left eye), as well as the response of the pupil to light (diminished in the left eye and brisk in the right eye). Finally, optic disc swelling is observed, talking about the possibility of intrinsic ocular disease, intracranial lesions, or other systematic diseases (as cited in Hata & Miyamoto, 2017). Medical care is required because the causes of this condition might include reduced blood flow and the development of new diseases.
In addition to the review of the problematic area, the analysis of the patient’s general condition is required (to investigate her anxiety causes). The respiration rate (RR) and heart rate (HR) are normal for a female of her age. However, the blood pressure (BP) level is increased, which signalizes the patient’s hypertension and the necessity to focus on blood tests. High blood pressure is one of the red flags in neuro-ophthalmology and sudden vision decrease (Ogun, 2016). Jessica’s mental status is normal (oriented in person, place, and time). The situation and the reasons for her vision decrease remain poorly investigated, which causes anxiety. The absence of additional problems, pain, and complications, along with normal reflexes, creates a solid background for several nursing diagnoses.
Nursing Diagnosis
Taking into consideration the current condition of the patient, the results of her physical examination, and the analysis of her health and social history, several diagnoses may be given. One of them is a visual impairment that is caused by the swollen optic disc, which results in vision changes in the left eye. Pain in the eye or headache may be explained by infection or inflammation in the organ that has been remarkably swollen (Ogun, 2016). Optic disc swelling is also caused by intracranial pressure that is hardly recognized without a specific neuro-imaging examination (Hata & Miyamoto, 2017). To exclude the impact of other diseases on the patient (e.g., cataract, glaucoma, or retinal detachment), it is possible to ask additional questions and look for new physical signs and evaluate findings.
Physical Findings
To determine a presumptive nursing diagnosis of visual impairment due to optic disc swelling, which results in vision decrease in the left eye, several physical findings have to be identified and investigated. First, the patient could have an early stage of diabetes that provokes sudden and irregular cases of blurred vision (Ogun, 2016). In addition, the fact that Jessica has high blood pressure cannot be ignored because it influences the brain and blood flows. Finally, a swollen optic disc may be a sign of a serious infection or an inflammation process, which causes pain during movement and relief in the cool environment (Hata & Miyamoto, 2017). Visual acuity, vital signs, and reflexes must be regularly checked to predict complications and provide the patient with effective treatment.
Conclusion
To assess health promotion, the analysis of nursing processes and evidence-based research are required. Human health is complex, and its maintenance is never simple. In this presentation, the case of a female patient with a sudden decrease in vision in one eye is discussed to prove that health promotion could depend on the following factors:
- Communication (a comprehensive history cannot be ignored);
- Environment (the improvement of the patient condition is expected);
- Assessment (physical examination shows what goes wrong and why);
- Education (clear explanation and cooperation predict the growth of complications).
References
A Celerian Group Company. (2019). CPT Code 99285: Emergency Department Visit. CGS Medicare. Web.
Hata, M., & Miyamoto, K. (2017). Causes and prognosis of unilateral and bilateral optic disc swelling.Neuro-Ophthalmology, 41(4), 187-191. Web.
Laha, B., Stafford, B. K., & Huberman, A. D. (2017). Regenerating optic pathways from the eye to the brain.Science, 356(6342), 1031-1034. Web.
Ogun,O. (2016). Red flags in neuro-ophthalmology. Community Eye Health Journal, 29(96), 64-65.