Increased intraocular pressure (IOP) is the result of inadequate drainage of aqueous humor from the anterior chamber of the eye. The increased pressure causes atrophy of the optic nerve and, if untreated, blindness.
There are two primary categories of glaucoma: (1) open-angle and (2) closed-angle (or narrow angle). Chronic open-angle glaucoma is the most common type, accounting for 90% of all glaucoma cases. It develops slowly, may be associated with diabetes and myopia, and may develop in both eyes simultaneously. Chronic glaucoma has no early warning signs, and the loss of peripheral vision occurs so gradually that substantial optic nerve damage can occur before glaucoma is detected.
Narrow-angle, or angle-closure, glaucoma is the less common form and may be associated with eye trauma, various inflammatory processes, and pupillary dilation after the instillation of mydriatic drops. Acute angle-closure glaucoma is manifested by sudden excruciating pain in or around the eye, blurred vision, and ocular redness. This condition constitutes a medical emergency because blindness may suddenly ensue.
Nursing Care Plan for Glaucoma: Nursing Diagnosis
Here is a Sample of Nursing Care Plan for Glaucoma.Nursing Care Plan for Glaucoma | Nursing Diagnosis of Glaucoma
- Sensory Perception, disturbed: visual May be related to:
- Altered sensory reception: altered status of sense organ
- Progressive loss of visual field
DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:
- Sensory Function: Vision (NOC)
- Participate in therapeutic regimen.
- Maintain current visual field/acuity without further loss.
Nursing Care Plan for Glaucoma: Nursing Intervention & Rationale
Nursing Care Plan for Glaucoma | Nursing Interventions of Glaucoma with Rationale
Communication Enhancement: Visual Deficit (NIC)
Nursing Interventions of Glaucoma with Rationale: Independent
- Ascertain type/degree of visual loss. Rationale: Affects choice of interventions and patient’s future expectations.
- Encourage expression of feelings about loss/possibility of loss of vision.
- Recommend measures to assist patient to manage visual limitations, e.g., reducing clutter, arranging furniture out of travel path; turning head to view subjects; correcting for dim light and problems of night vision. Rationale: Reduces safety hazards related to changes in visual fields/loss of vision and papillary accommodation to environmental light.
Nursing Care Plan for Glaucoma
Medication Administration: Eye (NIC)
Nursing Interventions of Glaucoma with Rationale: Independent
- Demonstrate administration of eye drops, e.g., counting drops, adhering to schedule, not missing doses. Rationale: Controls IOP, preventing further loss of vision.
Nursing Care Plan for Glaucoma
Nursing Interventions of Glaucoma with Rationale: Collaborative
- Assist with administration of medications as indicated:
Chronic, open-angle glaucoma
- Pilocarpine hydrochloride (Isopto Carpine, Ocusert [disc], Pilopine HS gel); Rationale: 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 a contact) that is placed in the lower eyelid, where it can remain for up to 1 wk before being replaced.
- Timolol maleate (Timoptic), betaxolol (Betoptic), carteolol (Ocupress), metipranolol (OptiPranolol), levobunolol (Betagan); Rationale: [Beta]-blockers decrease 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.
- Acetazolamide (Diamox), methazolamide (Neptazane), dorzolamide (Trusopt). Rationale: Carbonic anhydrase inhibitors decrease the rate of production of aqueous humor. Note: Systemic adverse effects are common, including mood disturbances, GI upset, and fatigue.
Narrow-angle (angle-closure) type
- Myotics (until pupil is constricted); Rationale: Contracts the sphincter muscles of the iris, deepens anterior chamber, and dilates vessels of outflow tract during acute attack or before surgery.
- Carbonic anhydrase inhibitors, e.g., acetazolamide (Diamox); dichlorphenamide (Daranide); methazolamide (Neptazane); Rationale: Decreases secretion of aqueous humor and lowers IOP.
Medication Administration: Eye (NIC)
Nursing Care Plan for Glaucoma
Nursing Interventions of Glaucoma with Rationale: Collaborative
- Sympathomimetids, e.g., dipivefrin (Propine), bromonidine (Alphagan), epinephrine (Epifrin), apraclonidine (Lopidine), latanoprost (Xalatan); Rationale: Adrenergic drops also decrease formation of aqueous humor and may be beneficial when patient is unresponsive to other medications.
- Hyperosmotic agents, e.g., mannitol (Osmitrol), glycerin (Ophthalgan, Osmoglyn oral); isosorbide (Ismotic). Rationale: Used to decrease circulating fluid volume.
- Provide sedation, analgesics as necessary. Rationale: Acute glaucoma attack is associated with sudden pain, which can precipitate anxiety/agitation, further elevating IOP. Medical management may require 4–6 hr before IOP decreases and pain subsides.
- Prepare for surgical intervention as indicated, e.g.:
- Laser therapy, e.g., argon laser trabeculoplasty (ALT) or trabeculectomy/trephination; Rationale: Filtering operations (laser surgery) are highly successful procedures for reducing IOP by creating an opening between the anterior chamber and the subjunctival 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/prevent postprocedure elevations of IOP.
- Iridectomy; Rationale: 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.
- Malento valve implant; Rationale: Experimental ocular implant device corrects or prevents scarring over/closure of drainage sac created by trabeculectomy.
- Cyclocryotherapy; Rationale: Separates ciliary body from the sclera to facilitate outflow of aqueous humor.
- Aqueous-venous shunt; Rationale: Used in intractable glaucoma.
- Diathermy/cryosurgery. Rationale: If other treatments fail, destruction of the ciliary body reduces formation of aqueous humor.
