Read the case study scenario below carefully and answer ALL the discussion questions below.

Refer to your textbook as a resource.

Patient Profile

J.K. is a 68-year-old African American woman who has been diagnosed with osteoarthritis and type 2 diabetes mellitus for the past 15 years. She now has diabetic retinopathy. She returns to the eye clinic with her daughter for the continued care of primary open-angle glaucoma (POAG) and reexamination for changes in diabetic retinopathy. Her current medical regimen for POAG includes topical timolol maleate 0.5% extended (Timoptic-XE) once daily OU and latanoprost (Xalatan) 0.005% OU hs. At her last examination, it was noted that she had microaneurysms and hard exudates of the retina.

Subjective Data

• She can no longer read the newspaper and reports that medication labels are difficult to read.
• States she is not always successful in getting the eyedrops instilled because her hands are gnarled and painful from osteoarthritis.

Objective Data

• Distant and near visual acuity are stable at 20/60 (Right eye) and 20/50 (Left eye). This is a reduction from 20/40 (Both eyes) at her last visit.
• Intraocular pressures are stable at 20mm Hg (OU). There is a new scotoma on visual field testing in the OS.
• Fluorescein angiography reveals diabetic macular edema OU.
• Optic disc cupping is seen on direct ophthalmoscopy
• Cryotherapy suggested for the treatment of diabetic retinopathy.

Discussion Questions

1. Explain the etiology of glaucoma.
2. Why might cryotherapy be an appropriate intervention for J.K.?
3. What is the purpose of the eyedrops before and immediately after ALT?
4. What are the priority topics that should be discussed in discharge teaching with J.K.?
5. Explain the etiology of optic disc cupping in glaucoma.
6. What is the etiology of the vision loss from diabetic retinopathy?
7. Identify some clinical manifestations of diabetic retinopathy?
8. Identify the medications that are used in the treatment of primary open-angle glaucoma
9. What are the priority nursing interventions for J.K.?
10. Based on the assessment data, what are the priority nursing diagnoses? Are there any collaborative problems?
11. J.K. wants to know if her glaucoma is related to her diabetes. How would you respond to her question?