Nursing Care Plan Glaucoma

CARE SETTING

Community, unless sudden increase in IOP requires emergency intervention and close monitoring.

RELATED CONCERNS

1. Psychosocial aspects of care
2. Patient Assessment Database

ACTIVITY/REST

May report: 
Change in usual activities/hobbies due to altered vision

FOOD/FLUID

May report:
Nausea/vomiting (acute glaucoma)

NEUROSENSORY

May report: 

1. Gradual loss of peripheral vision, frequent change of glasses, difficulty adjusting to darkened room, halos around lights, mild headache (chronic glaucoma)
2. Cloudy/blurred vision, appearance of halos/rainbows around lights, sudden loss of peripheral vision, photophobia (acute glaucoma)
3. Glasses/treatment change does not improve vision

May exhibit: 

1. Dilated, fixed, cloudy pupils (acute glaucoma)
2. Fixed pupil and red/hard eye with cloudy cornea (glaucoma emergency)
3. Increased tearing
4. Intumescent cataracts, intraocular hemorrhage (glaucoma secondary to trauma)

PAIN/DISCOMFORT

May report: 

1. Mild discomfort or aching/tired eyes (chronic glaucoma)
2. Sudden/persistent severe pain or pressure in and around eye(s), headache (acute glaucoma)

SAFETY

May report: 

1. History of hemorrhage, trauma, ocular disease, tumor (secondary to trauma)
2. Difficulty seeing, managing activities

May exhibit: 
Inflammatory disease of eye (glaucoma secondary to trauma)

TEACHING/LEARNING

May report: 

1. Family history of glaucoma, diabetes, systemic vascular disorders
2. History of stress, allergies, vasomotor disturbances (e.g., increased venous pressure), endocrine imbalance, diabetes
3. History of ocular surgery/cataract removal; steroid use
4. Discharge plan
5. May require assistance with transportation, meal preparation, self-care, homemaker/ maintenance tasks
6. Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES

1. Ophthalmoscopy examination: Assesses internal ocular structures, noting optic disc atrophy, papilledema, retinal hemorrhage, and microaneurysms. Slit-lamp examination provides three-dimensional view of eye structures, identifies corneal abnormalities/change in shape, increased IOP, and general vision deficits associated with glaucoma.
2. Visual acuity tests (e.g., Snellen, Jayer): Vision may be impaired by defects in cornea, lens, aqueous or vitreous humor, refraction, or disease of the nervous or vascular system supplying the retina or optic pathway.
3. Visual fields (e.g., confrontation, tangent screen, perimetry): Reduction of peripheral vision may be caused by glaucoma or other conditions such as cerebrovascular accident (CVA), pituitary/brain tumor mass, or carotid or cerebral artery pathology.
4. Tonography measurement: Assesses intraocular pressure (normal: 12–20 mm Hg). In acute angle-closure glaucoma,
5. IOP may be 50 mm Hg or higher.
6. Gonioscopy measurement: Helps differentiate open-angle from angle-closure glaucoma.
7. Provocative tests: May be useful in establishing presence/type of glaucoma when IOP is normal or only mildly elevated.
8. Glucose tolerance test/fasting blood sugar (FBS): Determines presence/control of diabetes, which is implicated at times in secondary glaucoma.

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. Patient coping with situation in a positive manner.
3. Complications prevented/minimized.
4. Disease process/prognosis and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.