Glaucoma or Increased intraocular pressure (IOP) is the result of inadequate drainage of aqueous humor from the anterior chamber of the eye. It is a condition that causes damage to your eye’s optic nerve and gets worse over time. The increased pressure causes atrophy of the optic nerve and, if untreated, blindness. Glaucoma tends to be inherited and may not show up until later in life.
There are two primary categories of glaucoma: (1) open-angle and (2) closed-angle (or narrow angle). Chronic open-angle glaucoma is the most common type, accounting for 90% of all glaucoma cases. It develops slowly, may be associated with diabetes and myopia, and may develop in both eyes simultaneously. Chronic glaucoma has no early warning signs, and the loss of peripheral vision occurs so gradually that substantial optic nerve damage can occur before glaucoma is detected.
Narrow-angle, or angle-closure, glaucoma is the less common form and may be associated with eye trauma, various inflammatory processes, and pupillary dilation after the instillation of mydriatic drops. Acute angle-closure glaucoma is manifested by sudden excruciating pain in or around the eye, blurred vision, and ocular redness. This condition constitutes a medical emergency because blindness may suddenly ensue.
Nursing Care Plans
Nursing care planning and management for patients with glaucoma includes: preventing further visual deterioration, promote adaptation to changes in reduced visual acuity, prevent complications and injury.
Here are three (3) nursing care plans for glaucoma:
Disturbed Visual Sensory Perception
Disturbed Sensory Perception: Change in the amount or patterning of incoming stimuli accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli.
May be related to
- Altered sensory reception: altered status of sense organ
Possibly evidenced by
- Progressive loss of visual field
- Participate in therapeutic regimen.
- Maintain current visual field/acuity without further loss.
|Determine type and degree of visual loss.||Affects choice of interventions and patient’s future expectations.|
|Allow expression of feelings about loss and possibility of loss of vision.||Although early intervention can prevent blindness, patient faces the possibility or may have already experienced partial or complete loss of vision. Although vision loss cannot be restored (even with treatment), further loss can be prevented.|
|Implement measures to assist patient to manage visual limitations such as reducing clutter, arranging furniture out of travel path; turning head to view subjects; correcting for dim light and problems of night vision.||Reduces safety hazards related to changes in visual fields or loss of vision and papillary accommodation to environmental light.|
|Demonstrate administration of eye drops (counting drops, adhering to schedule, not missing doses).||Controls IOP, preventing further loss of vision.|
|Assist with administration of medications as indicated:||These direct-acting topical myotic drugs cause pupillary constriction, facilitating the outflow of aqueous humor and lowering IOP. Note: Ocusert is a disc (similar to a contact) that is placed in the lower eyelid, where it can remain for up to 1 wk before being replaced.|
|Stress the importance of meticulous compliance with prescribed drug therapy.||To prevent an increase in IOP, resulting in disk changes and loss of vision.|
||[Beta]-blockers decrease formation of aqueous humor without changing pupil size, vision, or accommodation. Note: These drugs may be contraindicated or require close monitoring for systemic effects in the presence of bradycardia or asthma.|
||Carbonic anhydrase inhibitors decrease the rate of production of aqueous humor. Note: Systemic adverse effects are common, including mood disturbances, GI upset, and fatigue.|
||Contracts the sphincter muscles of the iris, deepens anterior chamber, and dilates vessels of outflow tract during acute attack or before surgery.|
|Decreases secretion of aqueous humor and lowers IOP.|
||Adrenergic drops also decrease formation of aqueous humor and may be beneficial when patient is unresponsive to other medications. Although free of side effects such as miosis, blurred vision, and night blindness, they have potential for additive adverse cardiovascular effects in combination with other cardiovascular agents. Note: Light-colored eyes are more responsive to these drugs than dark-colored eyes, necessitating added considerations when determining appropriate dosage.|
|Provide sedation, analgesics as necessary.||Acute glaucoma attack is associated with sudden pain, which can precipitate anxiety and agitation, further elevating IOP. Medical management may require 4–6 hr before IOP decreases and pain subsides.|
|Prepare for surgical intervention as indicated:
||Filtering operations (laser surgery) are highly successful procedures for reducing IOP by creating an opening between the anterior chamber and the subjunctival spaces so that aqueous humor can bypass the trabecular mesh block. Note: Apraclonidine (Lopidine) eye drops may be used in conjunction with laser therapy to lessen or prevent postprocedure elevations of IOP.|
||Surgical removal of a portion of the iris facilitates drainage of aqueous humor through a newly created opening in the iris connecting to normal outflow channels. Note: Bilateral iridectomy is performed because glaucoma usually develops in the other eye.|
|Postoperative care after peripheral iridectomy includes cycloplegic eyedrops.||To relax the ciliary muscle and to decrease inflammation, thus preventing adhesions. Cycloplegics must be used only in the affected eye. the use of these drops in the normal eye may precipitate an attack of acute angle-closure glaucoma in this eye, threatening the patient’s residual vision.|
||Separates ciliary body from the sclera to facilitate outflow of aqueous humor.|
||Used in intractable glaucoma.|
||If other treatments fail, destruction of the ciliary body reduces formation of aqueous humor|
||Experimental ocular implant device corrects and prevents scarring over or closure of drainage sac created by trabeculectomy.|
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Recommended books and resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans