Nursing care plan glaucoma

I. Pathophysiology
a. Irreversible process in which the retinal ganglion cells—nerve
cells in front of the optic nerve—die
b. Death of retinal cells and degeneration or atrophy of the
optic nerve fibers initially causes loss of peripheral vision,
eventually leading to blindness if untreated.

II. Classification
a. Chronic open-angle glaucoma, also called primary open-angle
glaucoma (POAG)—most common type
i. The drainage system becomes clogged, and aqueous
humor fluid is unable to drain properly, causing a
backup of fluid.
ii. Develops slowly and may be associated with type
2 diabetes and severe myopia; usually develops in both
eyes simultaneously or in one eye, followed by the other
within a short period of time.
iii. No early warning signs; loss of peripheral vision occurs
so gradually that substantial optic nerve damage can
occur before glaucoma is detected.
iv. Usually responds well to medication if detected and
treated early.
b. Primary narrow-angle (or closed-angle) glaucoma: May
be associated with eye trauma, various inflammatory
processes, and pupillary dilation after the instillation of
mydriatic drops.
c. Acute angle-closure glaucoma: manifested by sudden
excruciating pain in or around the eye, blurred vision, and
ocular redness.
i. Constitutes a medical emergency because blindness may
ensue suddenly.
ii. Surgical treatment usually successful and long lasting.

III. Etiology
a. Risk factors: over age 45, diabetes, myopia, long-term
steroid use, family history of glaucoma, African American
descent (Glaucoma Foundation, 2009)
b. Increased intraocular pressure (IOP) may be a factor in
some individuals.
i. The result of inadequate or obstructed drainage of
aqueous humor from the anterior chamber of the eye
ii. Compresses the nerve or impairs blood supply to the
axons of the retinal ganglion
c. Secondary glaucoma can occur as a result of an eye
injury—direct trauma to the eye (blow to the head or a
direct blow to eye), inflammation, tumor, or can occur in
advanced cases of cataract or diabetes.
i. May be mild or severe
ii. Treatment depends on whether it is open-angle or
angle-closure glaucoma.
d. Pigmentary glaucoma: form of secondary glaucoma in
which pigment granules in the back of the iris break into
the aqueous humor and clog the drainage canals
i. Treatment usually includes drug therapy or surgery.
e. Normal-tension glaucoma (NTG)—also known as
low-tension or normal-pressure glaucoma—occurs when
the optic nerve is damaged even though IOP is not elevated.
i. Has been linked to systemic heart disease; higher
incidence in people of Japanese descent.
ii. Treatment aimed at keeping eye pressures as low as
possible with medication, laser therapy, or filtering
surgery.

IV. Statistics
a. Morbidity: Approximately 3 million people in the United
States (Brown University, n.d.); estimated 8.7 million
physician visits annually (Schappert, 1995); return visits
primarily middle-aged and elderly Americans, emphasizing
chronic nature of condition (NAMCS, 2007)
b. Cost: Estimated to be greater than $1.5 billion annually to
United States government (Brown University, n.d.).

Care Setting
Glaucoma is treated in a community setting, unless sudden
pain and increased IOP requires emergency intervention and
close monitoring.

Related Concerns
Psychosocial aspects of care

Nursing Priorities
1. Prevent further visual deterioration.
2. Promote adaptation to changes in reduced visual acuity.
3. Prevent complications.
4. Provide information about disease process, prognosis,
and treatment needs.

Discharge Goals
1. Vision maintained at highest possible level.
2. Client coping with situation in a positive manner.
3. Complications prevented or minimized.
4. Disease process, prognosis, and therapeutic regimen
understood.
5. Plan in place to meet needs after discharge.

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