1. The client/caregiver can define glaucoma.
    1. It is increased fluid pressure within the eyeball.
    2. It is caused by increased production or decreased outflow of aqueous humor.
    3. The optic nerve can be damaged as the result of increased pressure.
  2. The client/caregiver can list signs and symptoms of glaucoma.
    1. Chronic or open-angle glaucoma (gradual onset)
      1. Reduced peripheral vision
      2. Intermittent and temporary blurred vision
      3. Halos around lights
      4. Dull eye pain or headache, especially in morning
      5. Difficulty adjusting to dark rooms
    2. Acute or closed angle (rapid or sudden onset)
      1. Severe eye pain
      2. Headache
      3. Nausea or vomiting
      4. Loss of sight
      5. Cornea that appears cloudy
      6. Considered medical emergency
  3. The client/caregiver can list factors that increase the risk.
    1. Blacks over the age of 40 years. Blacks are five times more likely to have glaucoma than whites.
    2. People with family history of glaucoma
    3. Everyone over the age of 60 years, especially Mexican Americans
    4. Trauma to the eye, or eye abnormalities
    5. Prolonged corticosteroid use
    6. Nearsightedness also increases risk of glaucoma.
  4. The client/caregiver can list possible treatments.
    1. Medications
    2. Surgery
  5. The client/caregiver can list measures to prevent or manage glaucoma.
    1. Obtain early detection with compre- hensive dilated eye exam routinely. Comprehensive eye exam includes the following:
      1. Visual acuity testing measures how well you see at various distances.
      2. A dilated eye exam can reveal any damage to retina or optic nerve.
      3. Tonometry uses an instrument to measure pressure inside the eye.
    2. Medication teaching should include the following:
      1. Take medications as ordered.
      2. Teach proper technique to administer medication for eye drops or ocular therapeutic system.
      3. Arrange for assistance in administering medication if client has difficulty in medication administration.
      4. Keep an extra supply of prescribed drugs on hand.
      5. Avoid all drugs that contain atropine.
      6. Check with the physician before using any nonprescription medications. Be cautious about herbal supplements and check with physician before using.
      7. Stress the importance of ongoing need for medication use.
    3. Nutritional considerations are as follows:
      1. Maintain a healthy diet that includes plenty of fruits and vegetables.
      2. Your physician may suggest supple- ments of vitamins A, C, and E and minerals such as zinc and copper.
      3. Drink fluids in small amounts but frequently over the course of a day.
      4. Use caffeine in low to moderate amounts.
    4. Exercise regularly. Consult with physician regarding an appropriate exercise program.
  6. The client/caregiver can list measures to promote safety, as decreased peripheral vision can be detrimental.
    1. Clear pathways.
    2. Provide adequate lighting.
    3. Turn head to visualize either side.
    4. Ask for a referral to a specialist in low vision for help with adaptive equipment or low vision rehabilitation.
    5. Learn relaxation techniques. Stress can trigger an attack of acute-angle glaucoma. Avoid emotional upsets, especially crying.
    6. Learn relaxation techniques. Stress can trigger an attack of acute-angle glaucoma. Avoid emotional upsets, especially crying.
    7. Avoid factors that increase pressure in eye:
      • Coughing, sneezing, aggressive nose blowing
      • Strenuous exercise
      • Straining when having bowel movement
      • Bending at the waist
      • Lifting heavy objects
    8. Prevent overuse and strain of eyes.
    9. Wear identification tag or bracelet.
    10. Seek medical attention immediately if pain or visual changes occur.

Resources

National Eye Institute, National Institutes of Healthwww.nei.nih.gov/health/glaucoma/glaucoma_facts.asp
American Academy of Family Physicians
Occupational consult for activities of daily living

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Inc.Cohen, B. J., & Taylor, J. J. (2005). Memmler’s the human body in health and disease (10th ed.). Philadelphia: Lippincott Williams & Wilkins.Hunt, R. 2005. Introduction to community based nursing. Philadelphia: Lippincott Williams & Wilkins.Lutz, C., & Przytulski, K. (2001). Nutrition and diet therapy. Philadelphia: F. A. Davis Company.National Eye Institute. (2007). Glaucoma resource guide. Bethesda, MD. Available from: www.nei.nih.gov/health/glaucoma/glaucoma_facts.asp.Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott

Credits

Client Teaching Guides for Home Health Care, 2nd ed.© 2008 Jones and Bartlett Publishers, Inc.www.jbpub.com

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