GLAUCOMA

Nursing Case Presentation

Alvaran, Birondo, Bolo, Burgos, Calamay, Canlas, Castro, Costelo, de los Reyes
BSN-3G Group 1
 Introduction
a group of eye conditions that damage the optic nerve, the health of which
is vital for good vision (Mayo Clinic,2020) .
caused by an abnormally high pressure in the eye
5 Types of glaucoma includes open-angle glaucoma, angle-closure
glaucoma, normal-tension glaucoma, glaucoma in children and pigmentary
glaucoma.
Open-angle glacoma is the most common form of the disease.
Many forms of glaucoma have no warning signs.
If the damage worsens, glaucoma can cause permanent vision loss or even
total blindness within a few years.
ALVARAN, ANGELOU FRANCE
 Introduction
age of 60.
It can occur at any age but is more common in older adults.
According to the Centers for Disease Control and Prevention (CDC),certain
groups are at higher risk. include African Americans over age 40, all
people over age 60, people with a family history of glaucoma, and people
who have diabetes.
Globally, glaucoma is a leading cause of irreversible blindness.
In the Philippines, in 2017 the Department of Health (DOH) estimated the
number of persons who are bilaterally blind is 332,150 which 14%
(46,501) is due to glaucoma.
ALVARAN, ANGELOU FRANCE
 Objectives
After 20 minutes of Case Discussion, the BSN-3G
Students will be able to:

Define the Identify the Discuss the

nature of different factors different
the (physical, nursing
condition psychological, management in
and its environmental, managing the
ALVARAN, ANGELOU FRANCE
type. social) that led to condition.
the condition
Baseline data
Name: L.M.
Address: Prk. Mars, Brgy. Singcang Airport,
Bacolod City
Age: 40 years old
Sex: Female
Civil Status: Married
Date of Birth: October 18, 1981
Number of Siblings: 2 siblings, 1 boy, 1 girl
Number of dependents/children: 4 children

CALAMAY, KYLE JOHN

Baseline data
Religion: Roman Catholic
Highest Educational Attainment: College
Graduate
Occupation: Teacher
The person next to kin (Informant): Husband
Date of admission: April 5, 2022, 6 AM
Date of Care: April 5-7, 2022
Attending Physician: Dr. Robert Fernandez
Admitting Diagnosis: Open-Angle Glaucoma
Chief complaint: Blurred vision and headache

CALAMAY, KYLE JOHN

Problems at Birth
No problems or disease at birth
Pt. was delivered normally
(according to her mother)
Past Health
Childhood Illness
History
Rarely got sick and never was
hospitalized
Headaches and flu
Anemic (claimed by the Pt.)
Takes non-prescribed OTC
drugs
CALAMAY, KYLE JOHN
Immunizations to Date
Hep B
MMR
Influenza
Chickenpox infection - 12 years old Past Health
2 doses - COVID-19 immunization
History
Adult Illness
6 months ago - open angle glaucoma and
ocular hypertension
Advanced eye disease - advised for
surgery
Prone to headaches and poor vision
Claimed diagnosis of hypertension and
diabetes 3 years ago - takes maintenance
medication CALAMAY, KYLE JOHN
Surgeries
No known history/ previous surgeries

Pregnancies
Gravida 4, Para 4, NSVD
Past Health
Accidents
History
No past accidents

Prolonged pain or Pain patterns

Eye pain started 6 months ago
“Lain-lain nga sakit kag indi ko
maagwanta.”
8/10, constant, throbbing, radiating to
the head CALAMAY, KYLE JOHN
Allergies
No known allergies to food and
medications

Physical, Emotional, Social, or Spiritual

Past Health
Weaknesses or Strengths
Not physically active
History
Feels shy about opening up to her
family
Opens up to her friends only
Feels the need to appear "strong" to
her family
Perceives self as a joyous and
optimistic person
CALAMAY, KYLE JOHN
 Family / Social History

Grandparents from Mother's Side

Type 2 DM
Hypertension

Grandparents from Father's Side

Type 2 DM & Hypertension
Glaucoma
Cataracts

Extended Family
T2DM
Hypertension
CASTRO, ANN THERESE
 Family / Social History

Parents
Father - hypertension
Mother - hypertension and T2DM

Children
4 children
Eldest - 23 years old
Second - 20 years old
Third - 15 years old
Youngest - 13 years old
No major illnesses during childhood
CASTRO, ANN THERESE
Nursing History (Gordon's)

Health Perception Maintenance

The overall health of the patient for the recent years has been
determined because of the onset of her diabetes and hypertension.
The patient claimed to suffer from slight eye pain from time to time
long before her hospital admission now. Nowadays, she gets
migraine or feel particularly fatigued. She has been doing her best
in taking her maintenance medications though she admitted to not
being able to monitor her glucose level and blood pressure
regularly. According to her, this was probably one of the reasons
why her health led to this or it might also be because of skipping
some days of her maintenance.

BOLO, LARRA MAE

Nursing History (Gordon's)

Nutritional/ Metabolic Pattern

Patient’s nutritional intake consists of fish, vegetables,
fruits, and small amounts of meat and a cup of rice. She
eats 3 meals a day but has control on what she eats
nowadays. She takes vitamin A and C everyday. She drinks
water religiously with 8-10 glasses of water. She likes to
eat sweets such as cookies and donuts . The patient has not
gained weight for the past few days. She drinks beer and
wine occasionally. She likes to have coffee two times a
day with milk and sugar.

BOLO, LARRA MAE

Nursing History (Gordon's)

Elimination Pattern
The patient usually urinates 5 times a day. Her bowel
movements vary between three times a day to three times
a week, and she describes the color of stool as brown.
She does not encounter any discomfort or problem in
urinating. The color of her urine usually pale yellow to
deep amber, odorless, and around 1,500 ml per 24 hours.
Patient does not have any drainage or suction.

BOLO, LARRA MAE

Nursing History (Gordon's)

Activity and Exercise Pattern

Patient has the energy to perform activities of daily living
independently but has difficulty performing well due to her
clinical condition as she cannot see properly. She only
performs minor exercise activities such as stretching or
walking around the house. She rarely has spare time as she
works almost everyday for long hours. She does not have any
problems with her range of motion and hand grip. Pulse rate
is normal and respiratory rate is above normal level.

BOLO, LARRA MAE

Nursing History (Gordon's)

Cognitive and Perceptual Pattern

Patient does not have any difficulty in hearing or any hearing
aid. She has been diagnosed with open-angle glaucoma and
ocular hypertension 6 months ago and is experiencing blurry
vision. She does not wear any glasses. Her memory is highly
superior and there has not been any changes in memory lately.
Patient has not experienced any difficulty learning new things
and discomfort. She has a very wide knowledge in vocabulary
and can speak different languages.

BOLO, LARRA MAE

Nursing History (Gordon's)

Sleep and Rest Pattern

The patient's sleeping patterns indicate that she usually
sleeps by 12 or 1 am, and she wakes up early at 5 am. She does
not have difficulty sleeping but rather forcibly stays up late
to prepare and make her lesson plans. Usually, she wakes up
comfortably but sometimes still feeling drowsy, and reports
that she doesn't experience nightmares. She usually takes a
nap during her lunch break from 11:30AM to 1:00PM and
relaxes by eating and watching tv. She doesn't use sleeping
aids or sleeping pills of any kind.

BOLO, LARRA MAE

Nursing History (Gordon's)

Self-Perception/ Self-Concept Pattern

The patient described herself as hardworking and determined. She does not
see herself as overly optimistic, but she attests that she has hopes that her
health will be restored and improved. For now, she feels somewhat
powerless as she cannot use her vision the same as before. She is also
anxious and worried about losing her eyesight completely. Ever since she
was diagnosed, her optimism about her health has decreased a little. Most
of it was because of her constant worry about their finances and supporting
their family’s needs. During the interview, the patient somehow maintained
eye contact from time to time, shifting and fidgeting at times when she
spoke about her feelings. She speaks in a soft voice with no difficulty. The
patient was calm but somehow nervous in opening up.

BOLO, LARRA MAE

Nursing History (Gordon's)

Role-Relationship Pattern
The family of the patient consists of six members in total including herself,
her husband, and their four children residing in one house. She was deeply
troubled at how her illness might affect the financial status of their
household. Her family depends solely on her since her husband is unemployed.
She expressed her concern about her husband because their role as providers
and relationship as husband-and-wife have become somewhat strained since
the onset of her illness. The couple would argue about financial problems.
When it comes to her children, she expressed no significant worries because
she has entrusted them to neighbors and friends. The patient claims that most
of her closest friends are her fellow teachers whom she talks to and vents
whenever she feels anxious, as well as share good memories with.

BOLO, LARRA MAE

Nursing History (Gordon's)

Sexuality and Reproduction

The patient had her menarche when she was 12 years old. She is still
having her regular menstrual period which lasts for 3-5 days. The
patient is familiar with the contraceptive products. The patient
reports that they are only using natural family planning methods like
the calendar method. She also claimed that she did not experience
any sexual problems like loss of libido and that she is sexually
active. She claimed that she had difficulty in delivering her 4
children, all of which had undergone normal birthing. Moreover, she
is familiar with sexually transmitted diseases and HIV and how to
avoid acquiring them.

BOLO, LARRA MAE

Nursing History (Gordon's)

Coping Stress Pattern

The patient is stressed due to the nature of her work as well as supporting
her whole family. Patient has been talking to her friends at her workplace
whenever she feels drained or stressed. Usually, she talks about her
problems in her home such as her husband’s unemployment and her worries
about their financial status. She claims that venting to her friends makes
her feel a little better afterwards. New environment, new face, new rules,
new study patterns makes her stressed. She sometimes listens to songs and
watches pictures/photos on her phone. If the stress is too severe and cannot
be controlled, she cries silently and lets the stress burst out with tears and
feel relaxed after. Since she is a jovial person, she tends to suppress her
sadness at times rather than expressing it.
BOLO, LARRA MAE
Nursing History (Gordon's)

Values and Beliefs Pattern

The patient is a Roman Catholic. She considers herself to be
faithful in following God as she constantly prays and attends
church services. She also stated that her faith helps her go
through tribulations in life, trusting that the Lord gives her and
her family strength and courage. Although it is hard for her to be
joyful right now, she has not given up on her condition yet. She
admits that she can also be a little bit of an overthinker, and this
is heightened because of her present condition. She also
perceives herself as a forgiving person especially when she and
her husband fought and offended each other.
BOLO, LARRA MAE
Assessment (Cephalocaudal)

BIRONDO, DENISE DOMINIQUE

 Assessment (General Appearance)
DAY 1
Pale appearance and looks tired and agitated.
The patient had a normal gait, with a normal body appearance and looked stressed.
Looks only in limited direction due to loss of side (peripheral) vision and central vision based on visual field tests.
The patient’s head moves forward and eyes blinks a bit when reading on a paper or recognizing people.

DAY 2
Pale appearance, tries to smile and looks tired.
The patient was observant and slowly responsive, when endorsed.

DAY 3 DAY 4
The patient regained some color on her The patient appears to be
skin; she does not appear pale. energetic and well-rested.
The patient appears to be well-rested
and no longer agitated.
She looks well-groomed.
BIRONDO, DENISE DOMINIQUE
 Assessment (HEENT)
DAY 1 DAY 4
Pale appearance and DAY 2 Examination reveals that she
looks tired and agitated. Blurred or foggy vision. has a substantial loss of her
The patient had a normal Difficulty focusing on close objects, peripheral visual field and
gait, with a normal body Hard to adjust to dark rooms, and seeing her vision has deteriorated
appearance and looked rainbow-colored rings around lights. further.
stressed. Excessively pale sclera of the eyes.
Looks only in limited Visual field smaller than normal
direction due to loss of Visual acuity decreases and becomes
side (peripheral) vision more opaque and less elastic
and central vision based Peripheral vision diminishes.
on visual field tests.
The patient’s head moves DAY 3
forward and eyes blinks a Same findings as Day 2
bit when reading on a
paper or recognizing
people.

BIRONDO, DENISE DOMINIQUE

 Assessment (Cardiovascular)
DAY 1
Consistently high blood
pressure of 150/ 90 upon
taking her BP.
Heart beats are noted to be in
irregular patterns; too quickly
or sometimes too slowly based
on ECG.
No lower extremity edema, no
ulcer but has a wound on the
lower right of the leg.
Upon inspection and palpation,
there are no pulsations and
heaves or lifts in the the
tricuspid area
Decrease in cardiac output and
strength of contraction
DAY 2
Her blood pressure was taken with 140/80 bpm
Upon auscultation, an arrhythmia has been noted.
Cardiac output was decreased and the strength of contraction
DAY 3
BP = 130/80 mmHg
No chest pain or pressure felt.
Decreased cardiac Output;
Strength of contraction = 80 bpm
DAY 4
BP = 120/70 mmHg
No lower extremity edema, syncope, no
ulcer. Wound on lower right of the leg.
Improved in cardiac output and
strength of contraction
BIRONDO, DENISE DOMINIQUE
 Assessment (Respiratory)
DAY 1
Spirometry measurement
of 70%
The patient breathes faster
and seems to have
difficulty breathing when
asked questions.
Respiratory rate of 22 cpm
at 8 AM, and 21 cpm at 12
PM.
Oxygen saturation of 96%
Chest wall intact; no
tenderness; no masses
Spinal column is straight,
right and left shoulders
and hips are at same
height.
Normal percussion sounds
on the posterior thorax.
DAY 2
Rhythm of breathing is steady and with equal intervals.
The patient does not use accessory muscles when breathing.
Respiratory rate of 21 cpm at 8 AM and 12 PM.
Oxygen saturation of 97%
Chest wall intact; no tenderness; no masses
Spinal column is straight, right and left shoulders and hips are at same height.
Normal percussion sounds on the posterior thorax.
DAY 3
Rhythm of breathing is steady and with
equal intervals.
The patient does not use accessory
muscles when breathing.
Respiratory rate of 20 cpm at 8 AM and 12
PM.
Oxygen saturation of 98%
Normal percussion sounds on the posterior
thorax.
BIRONDO, DENISE DOMINIQUE
 Assessment (Respiratory)

DAY 4
Rhythm of breathing is steady and with equal intervals.
The patient does not use accessory muscles when
breathing.
Respiratory rate of 19 cpm at 8 AM and 12 PM.
Oxygen saturation of 98%
Nothing was too deviated, and no changes noted.

BIRONDO, DENISE DOMINIQUE

 Assessment (Breast)
DAY 1
No tenderness, masses,
nodules, or nipple
discharge
Rounded shape; slightly
unequal in
size; generally symmetric
Skin uniform in color.
Skin is smooth and intact
Nipples are round, everted,
and equal in size; similar in
color; soft and smooth; both
nipples point
in same direction
(downward)
No discharge
DAY 2 DAY 4
No tenderness, masses, nodules, or No tenderness, masses,
nipple discharge nodules, or nipple
Rounded shape; slightly unequal in discharge
size; generally symmetric
Skin uniform in color.
Skin is smooth and intact
DAY 3
No tenderness, masses, nodules, or
nipple discharge
Rounded shape; slightly unequal in
size; generally symmetric
Skin uniform in color.
Skin is smooth and intact
BIRONDO, DENISE DOMINIQUE
 Assessment (Gastrointestinal)
DAY 2 DAY 4
DAY 1 Symmetric abdominal movements No tenderness; relaxed abdomen
No evidence of caused by respiration with smooth, consistent tension
enlargement of the liver No evidence of enlargement of the Nothing was too deviated, and no
or liver or Spleen changes were noted.
Spleen The abdomen is uniform in color
The abdomen is uniform Audible bowel sounds
in color
Absence of arterial bruits
and friction rub
No tenderness; relaxed DAY 3
abdomen with smooth, Symmetric abdominal
consistent tension movements caused by
respiration
No evidence of enlargement of
the liver or Spleen
The abdomen is uniform in color

BIRONDO, DENISE DOMINIQUE

 Assessment (Genitourinary)
DAY 1
Pubic skin is intact, no lesions upon physical examination.
Skin of vulva area slightly darker than the rest of the body
Labia round, full, and relatively symmetric
Upon palpation of the inguinal lymph nodes, there is no enlargement or tenderness

DAY 2
No enlargement or
tenderness upon
palpation of the inguinal
lymph nodes.
Pubic skin is intact, no
lesions upon physical
examination.
Skin of vulva area
slightly darker than the
rest of the body
DAY 3
Pubic skin intact, no lesions
Skin of vulva area slightly darker than
the rest of the body
No enlargement or tenderness upon
palpation of the inguinal lymph nodes.
DAY 4
Nothing was too deviated, and no
changes were noted upon assesment.
BIRONDO, DENISE DOMINIQUE
 Assessment (Musculoskeletal)
DAY 1
Muscle is equal size on both sides
of body
No muscle contractures or tremors
noted.
Altered sense of balance and
limits her movement.
Needs assistance when moving or
walking.
DAY 2
Same findings with Day 1.
DAY 3
Muscle is equal size on both sides of body
No muscle contractures or tremors noted.
Altered sense of balance and limits her movement.
Can move or walk on her own but with assistive devices or holding
on to a strong objection to her side.
DAY 4
No muscle contractures or
tremors noted.
Moves carefully and limits her
movement.
Can move or walk on her own
but with assistive devices or
holding on to a strong
objection to her side.
Can hold and grab objects
BIRONDO, DENISE DOMINIQUE
 Assessment (Neurologic)
DAY 1
The patient has poor
concentration and is restless.
The patient limits her response,
cohesive and a bit anxious based
on posture and frowning when
endorsed.
DAY 3
The patient looks down and tries
to cooperate with the nurse.
Speech is slow pace; quality of
voice is soft
DAY 2
Tense, slouched, bent posture; uncoordinated movement; tremors,
unbalanced gait.
The patient tries to respond and smile.
Speech is not in moderate pace, sometimes rapid or slow pace;
quality of voice is soft
DAY 4
Cooperative, able to follow
instructions
Speech is slow pace; quality
of voice is soft
Calm, erect posture;
coordinated movement
BIRONDO, DENISE DOMINIQUE
 Assessment (Integumentary)
DAY 1
The patient’s hair is
evenly distributed, thin,
dry, with no scratches or
wounds.
No presence of infections
on the several areas of
hair,
behind the ears and along
the hairline at the neck.
No rashes, bumps or lumps
on the skin surface
Nail texture is smooth and
thick. Highly vascular and
pink in color.
No cyanosis noted in the
nail beds, lips, and buccal
mucosa
DAY 2 DAY 4
No scratches or wounds on the Nothing serious symptoms
scalp and hair. and no changes of the
No rashes, bumps or lumps on condition of hair, skin, and
the skin surface and no signs nails were noted.
of jaundice.
No cyanosis noted in the nail
beds, lips, and buccal mucosa
DAY 3
Nothing was too deviated and no
changes were noted.
No cyanosis noted in the nail
beds, lips, and buccal mucosa
BIRONDO, DENISE DOMINIQUE
 Pathophysiology
Predisposing factors:
Least resistance pressure OPEN-ANGLE
GLAUCOMA
(lamina)
Advanced age

Genetics (family hx)

Increased Pressure on
Bulbular Wall
Precipitating factors:
Poor dietary habits
Sedentary lifestyle
Stress from working too much
Increased Intraocular
Hypertension + T2DM
Pressure (IOP)
Poor adherence to
maintenance medications

COSTELO, CHEZKA
Anatomy & Physiology

CASTRO, ANN THERESE

 Actual Nursing Diagnosis
Disturbed visual sensory perception related to the altered
status of the eye and vision AEB blurry vision and
progressive loss of visual field

Acute pain related to increase in intraocular pressure and

optic nerve damage AEB verbalizations of severe headache
and eye pain, and a pain of 8/10.

Risk for injury related to body weakness and

impaired vision secondary to open-angle glaucoma.
CANLAS, JENNY ANN
 Desired Outcomes
Short term goals: After 8 hours of nursing intervention, the client
will be able to:
Participate in the therapeutic plan of treatment.
Reduce signs and symptoms of intraocular pressure and headache.
Identify factors that contribute to alterations in the field of
vision.
Verbalize diminished pain in the eye
Verbalize relief from headache
Display an improvement in their facial expression.
Remain free from injury throughout her hospital stay;
Demonstrate how to use the call light in calling
for help to get out of bed;

CANLAS, JENNY ANN

 Desired Outcomes

Long term goals: After 3 days of nursing intervention, the client will be
able to:
Maintain current visual field/acuity without further loss.
Be free from risk of injury.
Demonstrate sufficient knowledge of glaucoma and its management.
Modify factors that contribute to alterations in the field of vision
Report satisfaction with pain control;
Verbalize improvement of physical condition;
Demonstrate knowledge of pain symptoms and preventive
measures.
Discuss how to prevent injury;
Verbalize understanding about asking for help in ambulation

CANLAS, JENNY ANN

HEALTH TEACHING PLAN

Exercise
Brisk walk every other
day (20-30 minutes)
Aerobic exercises
Yoga
Strength training

Beatriz Millette Burgos

HEALTH TEACHING PLAN

Alternate
Treatment
Eyedrops
Laser treatment
Surgery

Beatriz Millette Burgos

HEALTH TEACHING PLAN

Hygiene
Brush,
floss,
and visit the dentist
regularly.

Beatriz Millette Burgos

HEALTH TEACHING PLAN

Diet
Foods high in antioxidants
Fish
Fruits
Vegetables
Moderate consumption of dairy products
No fatty and oily food
Low-salt food and meals
Healthy snacks 3x a day

Beatriz Millette Burgos

HEALTH TEACHING PLAN

Outpatient
Careful with contact lenses.
Wear shades to protect your
eyes from the sun.
Avoid inverted postures in
yoga.

Beatriz Millette Burgos

 CONCLUSIONS/
RECOMMENDATIONS
Glaucoma therapy must control both the level
and fluctuations of IOP for improved
outcomes.
Surgical intervention in early stage patients
Nicole De los Reyes
may be beneficial in reducing the risk for
vision loss due to glaucoma.
There is a need for awareness raising and
training of health workers in general and
specialists in ophthalmology in glaucoma
management to compete with the challenge of
reducing glaucoma blindness.