What is glaucoma?
A group of eye disorders
3 characteristics of glaucoma?
1. Increased IOP and consequences of elevated pressure2. Optic nerve atrophy 3. Peripheral visual field loss
What is the second leading cause of blindness?
Glaucoma
Leading cause of blindness in what racial group?
African Americans
Etiology of glaucoma is related to the ____________ of __________ ________
Consequences of elevated IOP.
Balance between _______ _______ and __________ needed for normal level of IOP
Aqueous production and reabsorption
Glaucoma is related to elevation of?
IOP
What is Primary open-angle glaucoma (POAG)?
Outflow of aqueous humor is ? in trabecular meshwork
POAG represents what % of primary glaucoma cases?
90%
What is Primary angle-closure glaucoma (PACG)?
Angle closure ?the flow of aqueous humor
PACG represents what % of primary glaucoma cases?
10%
What are the clinical manifestations of POAG (3)
No symptomsUnnoticed until all peripheral vision is lostUsually noted with increase in MVA�s
What are the Clinical Manifestations of POAG?
Sudden pain around eyesNausea and vomitingSeeing colored halos around lightsBlurred visionOcular rednessCorneal edema
What is the application goniometry measurement of IOP?
10-22 mm/Hg
What are the diagnostic test for glaucoma?
Gonioscopy Peripheral and central vision testOphthalmoscopy
What is the collaborative care for chronic open-angle glaucoma?
Drug therapyArgon laser trabeculoplastyTrabeculectomyCyclocryotherapy
What are the drug therapies for glaucoma?
Beta Blockers, miotics, CAI�s
What drug reduces IOP?
Betoptic
What is the MOA of Miotics?
Causes pupil to constrict, draws iris away from cornea, allowing drainage out of Canal of Schlemm
what drug decreases aqueous humor, decreases IOP?
CAI
When is Argon Laser Trabeculoplasty used for?
Therapeutic option to lower IOPLaser stimulates scarring and contraction of trabecular meshwork,increases outflow of aqueous humorOption when meds ineffective
What is a Trabeculectomy
Removal of part of iris and trabecular meshworkAqueous humor percolates out area of missing iris
What is cyclocryotherapy?
the procedure that freezes part of a ciliary tissue causing local destruction and lowers aqueous production?
What are the drug treatments used for Acute angle-closure glaucoma?
Miotics - PilocarpineOral/IV hyperosmotic diureticsDiamox, Mannitol
List 2 procedures used for acute angle-closure glaucoma
Laser peripheral iridotomy Surgical iridectomy: restores drainage of aqueous humor
List Nursing Assessments for clients with glaucoma
Assess patient�s ability to understand and comply with treatment Assess patient�s psychologic reaction to sight-threatening disorderAssess family for patient careAssess visual acuity, visual fields, IOP
List Nursing Diagnoses for glaucoma patients
NoncomplianceRisk for injury Self-care deficitsAcute pain
What are some of the expected goals for treating pts with glaucoma?
No progression of visual lossNo injuryUnderstand disease process and rationale Comply with all aspects of therapy No postoperative complications
List 3 Nursing Implementations for glaucoma pts.
Teach patient and family risks of glaucomaStress importance of early detectionOphthalmologic examination
4 acute interventions for glaucoma patients
Administer medication to lower IOPDarken the environmentApply cool compressesProvide quiet space
3 Ambulatory and home care nursing interventions
Encourage patient to follow therapy Educate on disease process and treatmentsDiscuss follow-up appointments
List 4 Expected outcomes
No further loss of visionComply with recommended therapySafely function in environmentNo pain from disease and surgery
How long does a glaucoma patients need to have medical supervision?
for the rest of their life
Can a patient stop using his eye drops when the symptoms go away?
No
How long will a glaucoma patient need to be treated?
Tx is usually lifelong
List pt teaching used for eye drops
May have blurred vision initially Improves with useAvoid driving for 1-2 hours after miotics Press lacrimal duct for 1 minute after insertion�prevents systemic absorption
Do not use these drugs if you have glaucoma.
Avoid use of mydriatics or cyclopegic drugsAtropine, belladonna, dilates pupil