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 include: preventing further visual deterioration, promote adaptation to changes in reduced visual acuity, prevent complications and injury.
Here are three (3) nursing care plans (NCP) and nursing diagnosis for glaucoma:
Deficient Knowledge
Nursing Diagnosis
May be related to
- Lack of exposure/unfamiliarity with resources
- Lack of recall, information misinterpretation
Possibly evidenced by
- Questions; statement of misconception
- Inaccurate follow-through of instruction
- Development of preventable complications
Desired Outcomes
- Client will verbalize understanding of the condition, prognosis, and treatment.
- Client will identify the relationship of signs/symptoms to the disease process.
- Client will verbalize understanding of treatment needs.
- Client will correctly perform necessary procedures and explain reasons for the actions.
| Nursing Interventions | Rationale |
|---|---|
| Stress the importance of glaucoma screening. | For early detection and prevention. All people older than age 35, especially those with family histories of glaucoma, should have an annual tonometric examination. |
| Review pathology and prognosis of the condition and lifelong need for treatment. | Provides an opportunity to clarify and dispel misconceptions and present condition and something that is manageable. |
| Discuss the necessity of wearing identification (MedicAlert bracelet). | Vital to provide information for caregivers in case of emergency to reduce the risk of receiving contraindicated drugs (atropine). |
| Demonstrate proper technique for administration of eye drops, gels, or discs. Have the patient perform a return demonstration. | Enhances the effectiveness of treatment. Provides an opportunity for the patient to show competence and ask questions. |
| Review the importance of maintaining drug schedule like eye drops. Discuss medications that should be avoided such as mydriatic drops (atropine, propantheline bromide), overuse of topical steroids, and additive effects of [beta]-blocking when systemic [beta]-blocking agents are used. | This disease can be controlled, not cured, and maintaining a consistent medication regimen is vital to control. Some drugs cause pupil dilation, increasing IOP and potentiating additional loss of vision. Note: All [beta]-blocking glaucoma medications are contraindicated in patient with greater than first-degree heart block, cardiogenic shock, or overt heart failure. |
| Identify potential side effects and adverse reactions of treatment such as decreased appetite, nausea, and vomiting, diarrhea, fatigue, “drugged” feeling, decreased libido, impotence, cardiac irregularities, syncope, heart failure (HF). | Drug side and adverse effects range from uncomfortable to severe or health-threatening. Approximately 50% of patients develop sensitivity or allergy to parasympathomimetics (pilocarpine) or anticholinesterase drugs. These problems require medical evaluation and a possible change in therapeutic regimen. |
| Encourage patient to make necessary changes in lifestyle. | A tranquil lifestyle decreases the emotional response to stress, preventing ocular changes that push the iris forward, which may precipitate an acute attack. |
| Reinforce avoidance of activities such as heavy lifting and pushing, snow shoveling, wearing tight or constricting clothing. | May increase IOP, precipitating the acute attack. Note: If the patient is not experiencing pain, cooperation with drug regimen and acceptance of lifestyle changes are often difficult to sustain. |
| Discuss dietary considerations (adequate fluid, bulk or fiber intake). | Measures to maintain consistency of stool to avoid constipation and straining during defecation. |
| Stress importance of routine checkups. | Important to monitor progression and maintenance of disease to allow for early intervention and prevent further loss of vision. |
| Advise patient to immediately report severe eye pain, inflammation, increased photophobia, increased lacrimation, changes in the visual field, veil-like curtain, blurred vision, flashes of light and particles floating in the visual field. | Prompt action may be necessary to prevent further vision loss and other complications (detached retina). |
| Recommend family members be examined regularly for signs of glaucoma | Hereditary tendency to shallow anterior chambers places family members at increased risk for developing the condition. Note: African-Americans in every age category should have frequent examinations because of increased incidence and more aggressive course of glaucoma in these individuals. |
| Identify strategies and resources for socialization like support groups, Visually Impaired Society, local library, and transportation services. | Decreased visual acuity may limit the patient’s ability to drive and cause the patient to withdraw from usual activities. |
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use. - Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively. - NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales. - Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates. - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing. - Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans. - Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you. - Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023. - All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other ophthalmic nursing care plans:
Hello, just wanted to alert you that the description for meds are switched up. Timolol is beta blocker (not carbonic anhydrase inhibitor) pilocarpic is cholinergic which contracts the iris (not beta blocker) and acetazolamide is carbonic anhydrase inhibitor. There must have been a mix up when creating the table. My prof shared this with the class and I was like wait a min but she didnt believe me because nursing profs act like they know everything and are infallible and students are never right. This type of toxic culture that exists in nursing education can really be discouraging. One day I will be the nursing prof who is different and treats everyone with empathy, compassion, and respect.
I completely understand. I am in the final months of nursing school. It’s not that easy to just switch instructors. I wish it was. Anyway thank you for wanting to be that better person/Instructor. I have the same plan.
Thank you for sharing BeAnon, I feel you in so many levels. The good thing is that not every professor is/has been like that, but there are a few that are. I’m happy to hear you want make it to a Nurse educator and be a better professor, that those who just “know it all”. Good luck in your nursing journey.
Sir, not all professors act alike. As with ethnic groups, generalizations about anyone are very damaging and borne of ignorance.
If you have a professor who “acts like they know everything,” I suggest you find a new professor. Even those of us with doctoral degrees continue to learn every day. That’s why the NLN espouses the Spirit of Inquiry.
Thanks sir for your easily understandable nursing care plan of Glaucoma.