Download Glaucoma report PM group

I. Concept: Sensory-Glaucoma
A. Definition:
Glaucoma [Brunner]
The term glaucoma is used to refer to a group of ocular conditions characterized by optic nerve
damage. Increased IOP damages the optic nerve and nerve fiber layer, but the degree of harm is
highly variable. The optic nerve damage is related to the IOP caused by congestion of aqueous
humor in the eye. A range of IOPs are considered “normal,” but these may also be associated
with vision loss in some patients. There is no cure for glaucoma, but the disease can be
controlled.
B. Signs & Symptoms:
Rapid visual impairment
Conjunctival hyperemia
Corneal edema
Elevated IOP
Congestion
Pupil is vertically oval, semi-dialated, unreactive to light and accommodation.
Periocular pain, can be associated with nausea, vomiting, bradycardia, and profuse sweating.
C. Diagnostic Exams/Tests:
Visual acuity test-Snellen Chart
Visual field test
Tonometry-Pressure measure
Laser scanning-optic nerve, and thickness of nerve fiber
D. Treatments/Interdisciplinary:
Lowest dose of topical therapy is used first which consists of beta blockers. Then gradually increased or
advanced to miotics, which cause pupillary constriction, alpha2-agonists, carbonic anhydrase-inhibitors
and prostaglandins.
Filtering procedures- used for chronic glaucoma, creates an opening or fistula in the trabecular meshwork.
This allows the aqueous humor to flow and exit by different routes.
Trabedulectomy- standard filtering technique used to remove part of the trabecular meshwork.
Drainage implants or shunts- tubes that are implanted in the anterior chamber to shunt aqueous humor to
the episcleral plate into the conjunctival space.
Trabectome surgery-used in patients in which pharmacologic therapy or laser trabeculoplasty does not
control the IOP sufficiently. It is specifically designed to improve fluid drainage from the eye to balance
IOP.
II. Nursing Interventions*:
A. Independent:
-teach patient how to instill eye medications
-explain how medications work
-create a self-management program to help patients with treatment
-help teach client how to perform ADLS
-discuss the medication program with the client
-recommend yearly eye exams
-assess family history of glaucoma
-encourage patient to develop coping techniques
B. Dependent
-give prescribed medications to lower intraocular pressure
-help patient prepare for potential surgery
C. Medications
Beta blockers- Decrease aqueous humour production
Side effects- bradycardia, hypotension, exacerbation or pulmonary disease.
Alpha-Andrenergic agonists- decreases aqueous humor production
Side effects- eye redness, dry mouth/nasal passages.
Prostaglandin analogues-increases uveoscleral outflow
Side effects- darkening of iris, conjunctival redness and rash.
D. Patient Education
Limit caffeine intake- large amounts can increase eye pressure.
Sip fluids frequently- Drinking large quantities of water quickly can temporarily increase eye pressure.
Sleep with head elevated-sleeping with a wedge pillow that keeps head slightly raised has been shown to
reduce intraocular eye pressure.
Take prescribed medication- Using prescribed eye drops or other medications can help get the best
possible result from the treatment.
Surgical treatmentsTrabeculopasty- laser burns are applied to inner surface of the trabecular meshwork to open intrabecular
spaces and widen canal of schlemm, promoting outflow of aqueous humor.
If surgery is scheduled Pre op teachingDo not wear eye make up
Educate on the management of glaucoma, specify that surgery will not cure it.
Bring all eye drops to each appointment
Inform about potential side effects of the surgery.
Post-operative teachingSensitivity to light.
Proper hygiene to reduce infection
Vision fluctuations for the first few days after.
III. Other
References:
Glaucoma. (n.d.). Retrieved March 06, 2016, from http://www.mayoclinic.org/diseasesconditions/glaucoma/basics/lifestyle-home-remedies/con-20024042
Taylor, C. (2011). Fundamentals of nursing: The art and science of nursing care (8th ed.).
Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth's Textbook of Medical-surgical Nursing, 13th
Ed. Docucare Package (13th ed.). Chapter 63