Nursing Care Plan (NCP) for Glaucoma
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Study Tools For Nursing Care Plan (NCP) for Glaucoma
Outline
Lesson Objectives for Glaucoma
- Definition and Types:
- Define glaucoma as a group of eye conditions characterized by increased intraocular pressure (IOP) leading to optic nerve damage and vision loss. Understand the different types of glaucoma, including primary open-angle glaucoma and angle-closure glaucoma.
- Pathophysiology:
- Explore the underlying pathophysiology of glaucoma, focusing on the impaired drainage of aqueous humor, increased IOP, and progressive damage to the optic nerve. Understand the role of risk factors in its development.
- Risk Factors:
- Identify and comprehend the risk factors associated with glaucoma, such as age, family history, elevated IOP, race (higher prevalence in African Americans), and certain medical conditions. Recognize the importance of regular eye examinations for early detection.
- Clinical Manifestations:
- Recognize the clinical manifestations of glaucoma, including gradual peripheral vision loss, tunnel vision, halos around lights, and increased IOP. Understand that glaucoma is often asymptomatic in the early stages, emphasizing the need for routine eye screenings.
- Prevention and Management:
- Explore preventive measures and management strategies for glaucoma, including the use of medications, laser therapy, and surgical interventions. Emphasize the importance of patient education, adherence to treatment plans, and lifestyle modifications for optimal eye health.
Pathophysiology of Glaucoma
- Impaired Aqueous Humor Drainage:
- Glaucoma often results from impaired drainage of aqueous humor, the fluid that nourishes the eye. This impaired drainage leads to a gradual increase in intraocular pressure (IOP).
- Increased Intraocular Pressure (IOP):
- Elevated IOP puts pressure on the optic nerve, affecting its blood supply and causing gradual damage. This increased pressure is a key factor in the development and progression of glaucoma.
- Optic Nerve Damage:
- Prolonged elevated IOP leads to optic nerve damage, specifically at the optic nerve head. This damage results in the loss of retinal ganglion cells and their axons, leading to irreversible vision loss.
- Peripheral Vision Loss:
- The initial impact of glaucoma often manifests as peripheral vision loss. Patients may not notice these changes until the condition has advanced, emphasizing the importance of regular eye examinations.
- Cupping of Optic Disc:
- As optic nerve damage progresses, the optic disc may develop a characteristic cupping or excavation. This cupping is a visible sign of structural changes in the optic nerve head associated with glaucoma.
Etiology of Glaucoma
- Impaired Aqueous Humor Drainage:
- Primary open-angle glaucoma, the most common type, occurs when the drainage angle formed by the cornea and iris remains open but becomes less efficient over time, leading to increased IOP.
- Angle-Closure Mechanisms:
- Angle-closure glaucoma results from an abrupt or gradual closure of the drainage angle, obstructing the outflow of aqueous humor. This closure can be caused by anatomical factors, such as a shallow anterior chamber angle.
- Age and Genetic Factors:
- Advancing age is a significant risk factor for glaucoma, with an increased prevalence in older populations. Genetic factors also play a role, as individuals with a family history of glaucoma may be at a higher risk.
- Race and Ethnicity:
- Glaucoma has a higher prevalence in certain racial and ethnic groups, with African Americans, Hispanics, and Asians at an increased risk. The reasons for these disparities are not fully understood.
- Medical Conditions and Medications:
- Conditions such as diabetes, hypertension, and hypothyroidism, as well as the long-term use of corticosteroids, are associated with an increased risk of glaucoma. These conditions may impact the balance of aqueous humor production and drainage.
Desired Outcome for Glaucoma
- Maintained Visual Acuity:
- Preserve and maintain visual acuity to the greatest extent possible, preventing further deterioration of vision and enhancing the patient’s overall quality of life.
- Stabilized Intraocular Pressure (IOP):
- Achieve and maintain stable IOP within the target range to prevent ongoing damage to the optic nerve and reduce the risk of progression in glaucoma.
- Patient Education and Adherence:
- Ensure patient understanding of glaucoma, its management, and the importance of adherence to prescribed medications and follow-up appointments. Empower patients to actively participate in their eye care.
- Prevention of Complications:
- Prevent complications associated with glaucoma, such as visual field loss and optic nerve damage. Timely intervention and patient education contribute to effective complication prevention.
- Improved Quality of Life:
- Enhance the patient’s overall quality of life by addressing the impact of glaucoma on daily activities and providing support for emotional well-being and coping.
Glaucoma Nursing Care Plan
Subjective Data:
- Hazy vision
- Rainbow-colored halos around lights
- Sudden vision loss
- Severe eye pain/pressure
- Slow vision changes (blurred vision, narrowed vision (tunnel vision), blind spots
- Nausea
Objective Data:
- Vomiting
Nursing Assessment for Glaucoma
- Visual Acuity:
- Regularly assess visual acuity using standardized eye charts to monitor any changes or deterioration in vision. Identify the presence of visual disturbances reported by the patient.
- Intraocular Pressure (IOP):
- Measure and monitor intraocular pressure to assess for fluctuations. Elevated IOP is a key indicator of glaucoma progression.
- Medication Adherence:
- Evaluate the patient’s adherence to prescribed eye drops or oral medications. Identify barriers to adherence, such as difficulty instilling eye drops or concerns about side effects.
- Symptom Assessment:
- Inquire about symptoms related to glaucoma, such as blurred vision, halos around lights, eye pain, or changes in peripheral vision. Document any reported symptoms for further evaluation.
- Visual Field Testing:
- Conduct regular visual field testing to assess for the presence and progression of visual field defects associated with glaucoma.
- Patient Education:
- Assess the patient’s level of understanding about glaucoma, its causes, and the importance of treatment adherence. Identify educational needs and provide information to address misconceptions.
- Emotional Well-Being:
- Assess the patient’s emotional well-being and coping mechanisms related to the diagnosis of glaucoma. Provide emotional support and facilitate access to counseling or support groups if needed.
- Lifestyle Factors:
- Explore lifestyle factors that may impact glaucoma management, such as smoking, caffeine intake, and physical activity. Provide guidance on healthy lifestyle choices to support overall eye health.
Implementation for Glaucoma
- Medication Administration:
- Instruct the patient on the proper administration of prescribed eye drops or oral medications to reduce intraocular pressure. Ensure the patient understands the importance of consistent medication use and the potential side effects.
- Patient Education:
- Provide thorough education on glaucoma, its progression, and the significance of adherence to treatment plans. Emphasize lifestyle modifications, regular eye examinations, and strategies for managing potential complications.
- Regular Follow-Up Appointments:
- Schedule and reinforce the importance of regular follow-up appointments with the ophthalmologist to monitor intraocular pressure, assess visual field changes, and adjust the treatment plan as needed.
- Lifestyle Modifications:
- Collaborate with the patient to implement lifestyle modifications, including advising on a healthy diet, maintaining a normal body weight, and avoiding excessive caffeine intake. Encourage smoking cessation if applicable.
- Supportive Care:
- Provide emotional support and counseling to address the psychological impact of glaucoma. Discuss coping strategies and connect the patient with support groups or resources to enhance overall well-being.
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| Assess patients vision | knowing where the patients vision was previous to what you assess currently so you know how much their vision has changed from before |
| Educating on proper eye drop administration | Post-procedure or during long-term management, patients are frequently on various eye drops. It’s essential they understand thoroughly which drops to administer when, how to do so appropriately. They may need additional intervention with color-coding bottles because they may not be able to clearly read labels. Ensure support systems are equally aware of regimen. |
| Educate on importance of F/U care with provider | Compliance is key! Patients must follow be compliant with their treatment regimen to prevent further deterioration.
Also to immediately report any new changes that may happen |
| Manage pain | Patients can have sudden pain, which will increase their intraocular pressure, making the problem even worse. |
| Manage anxiety | A sudden inability to see or the new knowledge that you will have a degree of blindness is upsetting. Provide as much education and emotional support as possible, and if necessary, administer medications. |
Evaluation for Glaucoma
- Intraocular Pressure (IOP):
- Regularly assess and monitor intraocular pressure to evaluate the effectiveness of prescribed medications and interventions. Adjust the treatment plan if needed to maintain stable IOP within the target range.
- Visual Acuity and Field Testing:
- Evaluate changes in visual acuity and visual field testing results over time. Compare current results to baseline assessments to determine the progression or stabilization of the disease.
- Medication Adherence:
- Assess the patient’s adherence to prescribed medications during follow-up appointments. Address any issues or concerns related to medication use and collaborate with the healthcare team to modify the treatment plan if necessary.
- Patient Education:
- Measure the patient’s understanding of glaucoma and its management during follow-up visits. Reinforce educational components as needed and address any misconceptions or questions.
- Quality of Life:
- Evaluate the impact of glaucoma and its management on the patient’s overall quality of life. Consider emotional well-being, ability to perform daily activities, and any reported improvements or challenges.
References
https://www.mayoclinic.org/diseases-conditions/glaucoma/symptoms-causes/syc-20372839
https://my.clevelandclinic.org/health/diseases/4212-glaucoma
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Transcript
Hey guys. Today, we are going to be creating a nursing care plan for glaucoma. So let’s get started. We’re going to first go over the pathophysiology of glaucoma. It’s a group of eye conditions that damage the optic nerve – the health of that is vital for good vision. Nursing considerations: You want to assess a patient’s vision, educate on eyedrop, use, follow-up care and compliance in managing the patient’s pain and anxiety. Desired outcome: you want to decrease intraocular pressure as quickly as possible and prevent further visual damage.
So we’re going to go into our care plan. We’re going to be looking for some subjective data and some objective data that you’re going to see in your patient. So one of the main things you’re going to see are vision changes. So vision changes that you’re going to have, or the patient will state that they have a sort of blurred vision, narrowed vision, or what they call tunneled vision and blind spots. The patient can also have some nausea and vomiting. Some interventions that we’re going to be looking for are going to want to assess the patient’s vision and assess their eyes. Is that a little pretty eye? So you want to look into their eyes. You want to know where the patient’s vision was previous to having come in to see the physician, and you want to see how much that’s changed since the last time that they were in.
Another thing that we’re going to be doing is we want to educate on proper eye drop use and administration. So eyedrops: with eye drops, you want to make sure whether it was post-procedure or during long-term management, that the patient is administering in different eyes. So you want to make sure that they understand which eye drops they’re to be administering, when, and how to do so appropriately. They’ll need additional interventions with color cording bottles, especially if they’re not able to read the labels clearly. So ensure support systems are equally aware of this regimen to make sure that they are giving drops properly. One of the things to keep in mind with the eyedrops is making sure that they’re not touching the eye when they administer and making sure that they have washed their hands properly prior to administering the drops.
Next intervention that we’re going to look into is the importance of education on follow-up care. So follow-up with the provider; it is very, very important that we’re making sure that these patients are complying with using the medications as needed, like the eye drops. So you want to make sure that they’re keeping with that compliance because unfortunately, if they don’t, it can make the condition much worse.
Another thing we’re going to want to do is manage pain. Patients can have sudden pain, which will increase their intraocular pressure. So making this a priority for them will just help decrease pressure. Another intervention that we’re going to want to make sure that we’re doing is easing their anxiety. With these patients, having that sudden inability to see things properly or having a certain degree of blindness, can be very, very upsetting. So you want to provide as much education and emotional support as possible and if necessary administer any sort of medications. Okay?
So we’re going to go over some key points. For pathophysiology: it is a group of eye conditions that damage the optic nerve. The exact cause is unknown, but many causes do include a buildup of drainage in a system that becomes insufficient, genetics, family history, or any sort of eye injury. Any subjective or objective that you’re going to see with the patient: they’re going to have hazy vision, rainbow colored, halos, and lights, sudden vision loss (which is very common), severe eye pain, pressure, vision changes, and nausea and vomiting. You want to make sure you’re assessing the patient’s eye and doing plenty of education. So you want to assess their vision. You want to make sure you’re educating them on the eye drop usage and educate them on the importance of follow-up and compliance with the medication. You want to make sure that these patients are using these eye drops accordingly, because otherwise it can make their condition worse and can cause blindness. You want to manage pain. You want to manage anxiety. So administer pain medication as needed and provide as much emotional support for these patients as possible. And, if needed, administer medication for the anxiety.
Awesome job, it was a great care plan for today. We love you guys. Go out, be your best self today and as always happy nursing.
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