Question

System disorder: Glaucoma---

A. Alterations in
Health (Diagnosis)

B. Pathophysiology Related
to Client Problem

C. Health Promotion and
Disease Prevention

D. Risk Factors

E. Expected Findings

F. SAFETY
CONSIDERATIONS

G. Laboratory Tests

H. Diagnostic Procedures

I. Nursing Care

J. Medications

K. Client Education

L. Complications

M. Therapeutic Procedures

N. Interprofessional Care

Answer 1

A. Glaucoma or Increased intraocular pressure (IOP) is the result of inadequate drainage of aqueous humor from the anterior chamber of the eye. It is a condition that causes damage to your eye’s optic nerve and gets worse over time. The increased pressure causes atrophy of the optic nerve and, if untreated, blindness. Glaucoma tends to be inherited and may not show up until later in life.

1.Distubed sensory perception related to visual impairment

2.Anxiety related to possible vision loss

B.pathophysiology

The main problem or pathology in glaucoma is caused by raised intraocular pressure. It is this raised pressure that compresses and damages the optic nerve. Once the optic nerve is damaged, it fails to carry visual information to the brain and this results in loss of vision.It is believed that the raised pressure on the retina causes the cells and nerve ganglions in the sensitive retina to die off (retinal ganglion apoptosis) and in addition the small blood vessels of the retina are also compressed depriving it of nutrients. This results in a clinically progressive loss of peripheral visual field and ultimately vision.two types are there closed angle glaucoma and acute openangle glaucoma.

C.health promotion and prevention

If the patient is ahigh risk people should evaluate their eyes periodically to rule out any vision loss.

Even if you are not in a high-risk group, getting a comprehensive dilated eye evaluation by the age of 40 can help catch glaucoma and other eye diseases early.

Maintaining a healthy weight, controlling your blood pressure, being physically active, and avoiding smoking will help you avoid vision loss from glaucoma. These healthy behaviors will also help prevent type 2 diabetes and other chronic conditions.

If the patient is diabetic, control the blood sugar level to prevent optical nerve damage

Know your family's eye health history. Glaucoma tends to run in families. If you're at increased risk, you may need more frequent screening.
Exercise safely. Regular, moderate exercise may help prevent glaucoma by reducing eye pressure. Talk with your doctor about an appropriate exercise program.
Take prescribed eyedrops regularly. Glaucoma eyedrops can significantly reduce the risk that high eye pressure will progress to glaucoma. To be effective, eyedrops prescribed by your doctor need to be used regularly even if you have no symptoms.
Wear eye protection. Serious eye injuries can lead to glaucoma. Wear eye protection when using power tools or playing high-speed racket sports in enclosed courts.

D. Risk factors

Sometimes may not produce any signs and symptoms. So should know some risk factors to prevent the disease

•Having high internal eye pressure (intraocular pressure)
•Being over age 60
•Being black, Asian or Hispanic
•Having a family history of glaucoma
•Having certain medical conditions, such as diabetes, heart disease, high blood pressure and sickle cell anemia
•Having corneas that are thin in the center
•Being extremely nearsighted or farsighted
•Having had an eye injury or certain types of eye surgery
•Taking corticosteroid medications, especially eyedrops, for a long time

E. Expected findings.

Open-angle glaucoma
•Patchy blind spots in your side (peripheral) or central vision, frequently in both eyes
•Tunnel vision in the advanced stages
Acute angle-closure glaucoma
•Severe headache
•Eye pain
•Nausea and vomiting
•Blurred vision
•Halos around lights
•Eye redness

F. Safety consideration

•Maintain a healthy weight.
•Keep your blood pressure at a normal level and •control other medical conditions.
•Don’t smoke.
•Limit caffeine intake to moderate levels, because some evidence suggests that high amounts of caffeine may increase eye pressure.
•Try to exercise daily by doing physical activities such as walking, swimming, or working in the yard.
•Prevent overexposure to sunlight by wearing sunglasses and hats when you’re outdoors.

G. Laboratory Studies
Blood tests in low-tension glaucoma (LTG) that may be considered depending on the clinical presentation include the following:

•cbc count to rule out anemia

•Erythrocyte sedimentation rate (ESR) rarely is elevated in low-tension

•Order rapid plasma reagent (RPR) and fluorescein treponema antibody (FTA) testing.
•Checking for the presence of antinuclear antibody (ANA) is recommended to rule out collagen-vascular and autoimmune diseases.

•Anticardiolipin antibody (ACA) testing should be performed, and an increased level is considered a risk factor for visual-field defect progression.

H. Dignostic procedures

Tonometry. This test measures the pressure inside the eye
Pupil Dilation.
Visual Field Testing.
Visual Acuity Test.
Pachymetry.
Ophthalmoscopy.
Gonioscopy.
Optic Nerve Imaging.

I. Nursing care planning and management for patients with glaucoma include: preventing further visual deterioration, promote adaptation to changes in reduced visual acuity, prevent complications and injury.nursig diagnosis

Disturbed sensory perception related to loss of vision

anxiety related to vision loss

Knowledge deficit related to the disease condition.

J. Medications

Eye drops used in managing glaucoma decrease eye pressure by helping the eye’s fluid to drain better and/or decreasing the amount of fluid made by the eye.

Drugs to treat glaucoma are classified by their active ingredient. These include: prostaglandin analogs, beta blockers, alpha agonists, carbonic anhydrase inhibitors, and rho kinase inhibitors. In addition, combination drugs are available for patients who require more than one type of medication. An older class of medications, the cholinergic agonists (such as pilocarpine) are not commonly used these days due to their side effects.

K. Client education

Client education about the healthy diet, regular exercise, vontrol of blood pressure and diabetes mellitus.

Provide awareness about the risk and evaluation of eye.

Regular use of medication prevent further eye damage.

L. Complication

glaucoma goes undiagnosed and untreated, then as it gets worse, high pressure inside the eye damages the optic nerve. This damage impairs vision. It cannot be reversed. Vision loss begins around the edges of the visual field. Eventually, a person’s central vision will become blurry, and then the person will go blind.

Treatment is to reduce the iop. Complications of cyclocryotherapy include severe pain, elevated IOP, hyphema (common in eyes with neovascular glaucoma), visual loss (wipeout fixation in patients with advanced optic nerve damage), choroidal detachment, retinal detachment, chronic hypotony, cystoid macular edema, anterior segment necrosis.

M. Therapeutic procedure

Glaucoma damage is permanent—it cannot be reversed. But medicine and surgery help to stop further damage. To treat glaucoma,medication and laser surgery and other operating surgeries

Trabeculoplasty. This surgery is for people who have open-angle glaucoma. The eye surgeon uses a laser to make the drainage angle work better. That way fluid flows out properly and eye pressure is reduced.
Iridotomy. This is for people who have angle-closure glaucoma. The ophthalmologist uses a laser to create a tiny hole in the iris. This hole helps fluid flow to the drainage angle.

Other operating surgery

Trabeculectomy

Glaucoma drainage devices. Your ophthalmologist may implant a tiny drainage tube in your eye. The glaucoma drainage implant sends the fluid to a collection area (called a reservoir)

N. Interprofessional care

This provides a framework for collaboration between ophthalmologists and optometrists in glaucoma care to try to improve eye care access and delivery as well as patient outcomes. It highlights an evidence-based approach to the care of glaucoma patients and glaucoma suspects and the necessity for a complementary partnership relationship between the professionals including effective communication between professionals. All of these are critical for continuity of care and efficient utilization of available resources within a health system.it helpsfor early identification and treatment.it is beneficial to the patient.