Unit 1: Glaucoma Flashcards
Week 1
Glaucoma
group of eye conditions that present with increased IOP
- increased intraocular pressure (IOP) and damage to the optic nerve leading to vision loss
- leading cause of blindness
- anyone can develop
Causes of Increased Intraocular Pressure (IOP)
(>21 mm Hg)
can be a result of:
-inadequate drainage of aqueous humor from the canal of schlemn or
-an overproduction of aqueous humor
Risk Factors for Glaucoma
- African Americans over 40
- Family Hx of glaucoma
- Over age of 50
- Hx of Diabetes or Hypothyroidism
- Hx of Ocular Hypertension
- Hx of myopia
- Prolonged corticosteroid use
Pathophysiology of Glaucoma
damages optic nerve resulting in vision loss and blindness
- drainage canal blocked; too much fluid stays in the eye; this increases pressure
- high pressure damages optic nerve
Types of Glaucoma
- Primary open-angle Glaucoma
- Angle-closure Glaucoma
Primary-Open Angle Galucoma
- most common form
- chronic
- no symptoms/ no warning signs (silent thief)
- gradual loss of peripheral vision
- usually in both eyes
- tunnel vision in advanced stage
Angle-Closure Glaucoma
“acute glaucoma”, “narrow-angle glaucoma”
- rare; medical emergency
- eye pressure rises quickly
- severe eye pain
- nausea and vomiting
- headache
- sudden onset of blurred vision/ halo vision
- reddening of the eye
- no way for fluid to drain; angle closure
- eye drops instilled immediately to try to reduce the rising IOP
Best Prevention
regularly scheduled eye exams
Treatments: Medications
- eye drops or oral medications
- medications that cause the eye to make less aqueous humor or
- help to drain fluid from the eye
- Oral medications: carbonic anhydrase inhibitor to reduce IOP
Surgical Management
used if medications are not effective
- Laser Trabeculoplasty
- Trabeculotomy
- Drainage implants
Laser Trabeculoplasty
- treats primary-open angle glaucoma
- anesthetic eye drops given
- high-energy laser beam is used to open clogged drainage canals, allowing aqueous humor to drain more easily from the eye
- performed in providers office or clinic
- one eye treated at a time
Trabeculotomy
“Filtering Surgery”
- done in outpatient surgery center or hospital
- under local sedation
- surgeon uses specialized instruments and places an opening in the sclera of the patient, removing a small piece of the trabecular meshwork to allow for aqueous humor to freely exit the eye and lower IOP
Drainage Implants
- hospital or outpatient clinic
- surgeon inserts a small silicone tube in the eye to help drain the aqueous humor
Nursing Management: Assessment and Analysis
- clinical manifestations are r/t the damage and complications associated with increased IOP:
- decreased visual acuity
- nausea and vomiting
- headache
- eye pain
- multicolored halos around lights
Clinical Manifestation: Vision Loss
- can be sudden or gradual
- may not be noted until vision loss more pronounced
- associated with pressure on the optic nerve caused by increased IOP preventing transfer of nerve signals to the brain
Clinical Manifestation: Nausea and Vomiting
increased pressure building in the eye causes this
-in acute-closure glaucoma
Clinical Manifestation: Headache
abrupt increase in IOP causes pain, which can be severe
-in acute closure-glaucoma
Nursing Diagnoses
- Disturbed visual sensory perception r/t disturbance in optic nerve function secondary to increased intraocular pressure (IOP)
- Anxiety r/t decreasing visual field presence
- Knowledge deficit regarding the progressive nature of glaucoma
- Impaired home maintenance r/t activity restrictions and impaired vision
Nursing Assessments
- Physical Assessment via ophthalmoscope and use of a tonometer
- Diagnostic Results
- Visual Acuity
- Age-related consideration
Nursing Assessments: Physical Assessment via ophthalmoscope and use of tonometer
- increased ocular pressures (> 10 to 22 mm Hg, verified with tonometer)
- bulging vessels in the internal eye seen with ophthalmoscope
Nursing Assessments: Diagnostic Results
- intraocular pressures registering above 10 to 22 mmHg
- visual acuity tests reveals decreases in visual acuity
Nursing Assessments: Visual Acuity
- decreases in visual acuity
- fogginess of vision
Nursing Actions
- Administer medications to decrease IOP
- Follow proper procedure for instillation of eye drops
- Elevate HOB 35 to 45 Degrees
- Avoid bending at the waist for the first 48 hours Post-operative procedure
- Administer stool softeners; fluid and fiber intake
Nursing Actions: Administer medications to decrease IOP
- to decrease the production of aqueous humor or
- increase the outflow of aqueous humor
Nursing Actions: Follow proper procedure for instillation of eye drops
aseptic technique
Nursing Actions: Elevate HOB 35 to 45 Degrees
- promotes intraocular (aqueous humor) drainage
- decreases IOP
Nursing Actions: Avoid Bending at the Waist for the first 48 Hours Post-operative Surgery
bending at the waist may increase IOP
Nursing Actions: Administer Stool Softeners; fluid and fiber intake
constipation or straining to have a BM can increase intraocular pressure
Teachings for the Patient
- Progressive nature of the disease process
- Medication Instructions
- Specific Post-OP instructions
Post-OP Instructions
-restriction on strenuous activities
-bending at the waist for first 48 hours
-lifting of heavy objects (> 25 lbs)
-avoid constipation for first 2 weeks
>all cause damage to the newly repaired eye
>constipation/ straining increases chances of post-op bleeding within the eye
-report increased pain or drainage
Medication Instructions
- name and type of drops
- simple, understandable explanations
- instruct not to take OTC meds w/o contacting eye care provider first (anticholinergic meds can cause worsening glaucoma by constricting the drainage of aqueous humor)
- chart of times, eye, and number of drops/ doses
