DHS 2018 shift 1st
Medical & Surgical Nursing
Hard
The nurse is teaching a patient with glaucoma regarding self care. Which of the following teachings is appropriate?
Appeared in: DHS 2018 shift 1st
Explanation
- The core principle of glaucoma management is to control intraocular pressure (IOP) to prevent optic nerve damage.
- Lifting heavy objects, straining, and bending cause the Valsalva maneuver, which leads to a sudden and significant increase in IOP.
- This acute rise in pressure can further damage the delicate optic nerve fibers, accelerating progressive and irreversible vision loss.
- Therefore, instructing the patient to avoid heavy lifting is a critical, proactive self-care measure to protect their remaining vision.
Why Other Options Were Wrong
- Option A: Watching television is a light activity that does not increase intraocular pressure. There is no medical reason to limit this activity for glaucoma patients.
- Option C: Moderate consumption of caffeinated or carbonated beverages is not contraindicated in glaucoma. The primary concern is the rapid ingestion of very large volumes of any fluid in a short time, which can temporarily raise IOP.
- Option D: This is a reactive measure, not a proactive self-care teaching to prevent damage. While essential for monitoring, the goal of teaching is to empower the patient to prevent the progression of the disease and worsening of symptoms.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Self-care management and patient education for glaucoma to guide bedside assessment, documentation, and the next nursing action.
- Patient education is a cornerstone of nursing care for chronic conditions like glaucoma, empowering patients to actively participate in managing their disease and preventing complications.
- Emphasizing lifestyle modifications that prevent IOP spikes is a key patient-safety intervention to preserve vision and quality of life.
- What if? If the patient's job involved manual labor, the nurse's priority would be to initiate a discussion about workplace accommodations, alternative duties, or an occupational therapy referral to prevent consistent IOP elevation and disease progression.
How to Approach the Question
- First, identify the core pathophysiology of the disease in the question. For glaucoma, the key issue is elevated intraocular pressure (IOP) leading to optic nerve damage.
- Next, analyze each option to determine its direct effect on the pathophysiology. Ask yourself, 'How does this action affect IOP?'
- Evaluate the options based on whether they represent proactive prevention or reactive management. The question asks for 'appropriate teaching,' which often favors preventative actions.
- Eliminate options that are not based on evidence or are less critical. Watching TV (Option A) and moderate caffeine intake (Option C) do not significantly impact IOP.
- Compare the remaining options. Avoiding heavy lifting (Option B) is a direct, preventative action to avoid IOP spikes. Following up when symptoms worsen (Option D) is a necessary but reactive step. Therefore, the preventative action is the more appropriate self-care teaching.
Concept Tested & Keywords
- Concept Tested: Self-care management and patient education for glaucoma.
- Stem keywords: glaucoma, patient teaching, self care
- Lead-in keywords: appropriate
Question ID
QvW7kLnc_lNZM4kM3_t_Go
Reference Book
E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 pp. 101-103, 98-100
Practise the full DHS 2018 shift 1st
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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