Download Chapter_022_Glaucoma

(Relates to Chapter 22,
“Nursing Management:
Visual and Auditory Problems,”
in the textbook)
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• A group of disorders characterized by
 Increased IOP and consequences of
elevated pressure
 Optic nerve atrophy
 Peripheral visual field loss
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• Second leading cause of blindness
• Leading cause of blindness in African
Americans
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• Balance between aqueous production
and reabsorption needed for normal
level of IOP
• Glaucoma related to elevation of IOP
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• Primary open-angle glaucoma (POAG)
 Most common type of glaucoma
 Outflow of aqueous humor is ↓ in
trabecular meshwork
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• Primary angle-closure glaucoma
(PACG)
 Angle closure ↓ the flow of aqueous
humor
 Caused by age, pupil dilation
 Possibly drug induced
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• Secondary glaucoma
 Results from other ocular or systemic
conditions that block outflow
 Associated with inflammatory processes
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• POAG
 Develops slowly
 No symptoms
 Unnoticed until all peripheral vision is lost
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• Acute angle-closure glaucoma
 Sudden excruciating pain around eyes
 Nausea and vomiting
 Seeing colored halos around lights
 Blurred vision
 Ocular redness
 Corneal edema
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Clinical Manifestations
• IOP elevated in glaucoma
• Normal IOP 10 to 21 mm Hg
• Open-angle glaucoma 22 to 32 mm Hg
• Acute angle-closure glaucoma >49 mm
Hg
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• Gonioscopy
• Peripheral and central vision test
• Ophthalmoscopy
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Ophthalmoscopy
Fig. 22-8. A, In the normal eye, the optic cup is pink with little cupping. B, In glaucoma, the optic disc is
bleached and optic cupping is present. (Note the appearance of the retinal vessels, which travel over the
edge of the optic cup and appear to dip into it.)
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• Chronic open-angle glaucoma
 Drug therapy
 Argon laser trabeculoplasty
 Therapeutic option to lower IOP
 Laser stimulates scarring and contraction of
trabecular meshwork
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• Chronic open-angle glaucoma (cont'd)
 Trabeculectomy
 Removal of part of iris and trabecular
meshwork
 Aqueous humor percolates out area of missing
iris
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• Chronic open-angle glaucoma (cont’d)
 Implant
 Reserved for patients in whom filtration
surgery has failed
 Permanent surgical placement of small
drainage tube and reservoir
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• Acute angle-closure glaucoma
 Miotics
 Oral/IV hyperosmotic
 Laser peripheral iridotomy
 Surgical iridectomy
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• Secondary glaucoma
 Managed by treating underlying problems
 Antiglaucoma medication
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• Assess patient’s ability to understand
and comply with treatment.
• Assess patient’s psychologic reaction
to sight-threatening disorder.
• Assess family for patient care.
• Assess visual acuity, visual fields, IOP.
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• Risk for injury
• Self-care deficits
• Acute pain
• Noncompliance
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Expected Goals
 No progression of visual loss
 Understanding of disease process and
rationale
 Compliance with all aspects of therapy
 No postoperative complications
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Health Promotion
 Teach patient and family risks of
glaucoma.
 Stress importance of early detection.
 Provide ophthalmologic examination.
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Acute Intervention
 Administer medication to lower IOP.
 Darken the environment.
 Apply cool compresses.
 Provide quiet space.
 For surgical patients
 Provide postop instructions.
 Relieve discomfort.
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Ambulatory and Home Care
 Encourage patient to follow therapy.
 Educate on disease process and
treatments.
 Discuss follow-up appointments.
 Provide verbal and written instructions.
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Expected Outcomes
 No further loss of vision
 Compliance with recommended therapy
 Safe functioning in the environment
 No pain from disease and surgery
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Audience Response Question
When teaching a patient with primary open-angle glaucoma
about the disorder, the nurse explains that:
1. The retinal nerve is damaged by an abnormal increase in
the production of aqueous humor.
2. Aqueous humor cannot drain from the eye, causing
pressure damage to the optic nerve.
3. As the lens enlarges with aging, it pushes the iris forward,
covering the outflow channels of the eye.
4. The lens blocks the pupillary opening, preventing the flow
of aqueous humor into the anterior chamber.
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• 67-year-old woman comes to a
community health screening
complaining of “tunnel vision.”
• Sometimes she has very bad shooting
pain in her eyes.
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• She has a history of hypertension, type
2 diabetes, and hyperlipidemia.
• You insist that she see an
ophthalmologist, but she insists that
she sees “just fine” if she turns her
head a lot.
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1. What can you teach the patient about
the importance of seeing an
ophthalmologist?
2. What other factors may influence her
decision to seek treatment?
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3. If she is diagnosed with glaucoma,
what can you tell her about possible
treatments?
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