3 Glaucoma Nursing Care Plans

Disturbed Visual Sensory Perception

Glaucoma is a condition that damages the optic nerve, which is responsible for transmitting visual information to the brain. As a result, patients with glaucoma may experience disturbed visual sensory perception due to the altered status of their sense organs, the eye, and the impaired transmission of visual signals to the brain.

Nursing Diagnosis

• Disturbed Sensory Perception

May be related to

• Altered sensory reception: altered status of sense organ

Possibly evidenced by

• Progressive loss of visual field

Desired Outcomes

• The client will participate in the therapeutic regimen.
• The client will maintain the current visual field/acuity without further loss.

Nursing Assessment and Rationales

1. Determine the type and degree of visual loss.
Affects the choice of interventions and the patient’s future expectations.

2. Allow expression of feelings about loss and the possibility of a loss of vision.

Although early intervention can prevent blindness, the patient faces the possibility or may have already experienced a partial or complete loss of vision. Although vision loss cannot be restored (even with treatment), further loss can be prevented.

Nursing Interventions and Rationales

1. Implement measures to assist patients to manage visual limitations such as reducing clutter, arranging furniture out of travel path; turning heads 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.

2. Demonstrate administration of eye drops (counting drops, adhering to the schedule, not missing doses).
Controls IOP, preventing further loss of vision.

3. Assist with the 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 contact) that is placed in the lower eyelid, where it can remain for up to 1 wk before being replaced.

4. Stress the importance of meticulous compliance with prescribed drug therapy:
To prevent an increase in IOP, resulting in disk changes and loss of vision.

• 4.1. Chronic, open-angle glaucoma Pilocarpine hydrochloride (Isopto Carpine, Ocusert [disc], Pilopine HS gel)
  Beta-blockers decrease the 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.

• 4.2. Timolol maleate (Timoptic), betaxolol (Betoptic), carteolol (Ocupress), metipranolol (OptiPranolol), levobunolol (Betagan)
  Carbonic anhydrase inhibitors decrease the rate of production of aqueous humor. Note: Systemic adverse effects are common, including mood disturbances, GI upset, and fatigue.

• 4.3. Acetazolamide (Diamox), methazolamide (Neptazane), dorzolamide (Trusopt)
  Contracts the sphincter muscles of the iris, deepens the anterior chamber and dilates vessels of the outflow tract during an acute attack or before surgery.

• 4.4. Narrow-angle (angle-closure) type Myotics (until the pupil is constricted); Carbonic anhydrase inhibitors like acetazolamide (Diamox); dichlorphenamide (Daranide); methazolamide (Neptazane)
  Decreases secretion of aqueous humor and lowers IOP.

• 4.5. Sympathomimetics: dipivefrin (Propine), brimonidine (Alphagan), epinephrine (Epifrin), apraclonidine (Iopidine), latanoprost (Xalatan)
  Adrenergic drops also decrease the formation of aqueous humor and may be beneficial when the patient is unresponsive to other medications. Although free of side effects such as miosis, blurred vision, and night blindness, they have the 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 the appropriate dosage.

5. Provide sedation, and 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.

6. Prepare for surgical intervention as indicated:

• 6.1. Laser therapy such as argon laser trabeculoplasty (ALT), trabeculectomy, or trephination
  Filtering operations (laser surgery) are highly successful procedures for reducing IOP by creating an opening between the anterior chamber and the subconjunctival 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.

• 6.2. Iridectomy
  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.
  
• 6.3. Postoperative care after peripheral iridectomy includes cycloplegic eye drops.
  To relax the ciliary muscle and 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.

• 6.4. Malento valve implant
  Separates ciliary body from the sclera to facilitate outflow of aqueous humor.

• 6.5. Cyclocryotherapy
  Used in intractable glaucoma.

• 6.6. Diathermy or cryosurgery
  If other treatments fail, the destruction of the ciliary body reduces the formation of aqueous humor

• 6.7. Aqueous-venous shunt
  Experimental ocular implant device corrects and prevents scarring over or closure of drainage sac created by trabeculectomy.