GLAUCOMA

BY GROUP 3
■ GENERAL OBJECTIVES
To further understand and gain extensive knowledge regarding Glaucoma, this case presentation output is accomplished for a
comprehensive analysis concerning the disease.
■ SPECIFIC OBJECTIVES
Knowledge:
1. To understand the different assessment parameters involving the function of each system
involved.
2. To recognize the rationale of the medical management to the patient with Glaucoma.
3. To figure out the reference values and the implications or interpretations of the diagnostic
procedures done to the patient with Glaucoma.
4. To understand the disease process of Glaucoma, diagnostic criteria, treatment and
management of the disease.
■ Skills:
5. Be able to discuss the pathophysiology of Glaucoma.
6. To formulate drug study or drug rationale.
7. To devise an effective nursing care plan to a patient with Glaucoma based from the assessment
data gathered.
8. Provide health teaching to patients with Glaucoma.
■ Attitude:
9. To improve effective behavior between the group and the clinical instructors; and
10. To develop understanding about patient’s behavior in relation to the condition
which will be
useful in clinical settings.
 INTRODUCTION

Glaucoma is a group of eye conditions that cause damage to the optic nerve, which is
essential for good vision. This damage is frequently caused by abnormally high eye pressure.
For
people over the age of 60, glaucoma is one of the leading causes of blindness. It can happen at
any age, but it is more common in older people. Many types of glaucoma have no symptoms.
Because the effect is so gradual, you may not notice a change in vision until the condition is
advanced. Because glaucoma vision loss cannot be restored, it is critical to have regular eye
exams that include measurements of your eye pressure so that a diagnosis can be made and
appropriate treatment can be provided. Vision loss can be slowed or prevented if glaucoma is
detected early. If you have the condition, you will almost certainly require treatment for the rest
of your life
.
 INTRODUCTION
Glaucoma is caused by damage to the optic nerve. Blind spots appear in your visual field
as this nerve deteriorates. This nerve damage is usually associated with increased eye pressure
for reasons that doctors do not fully understand. Elevated eye pressure is caused by a buildup of
a fluid (aqueous humor) that flows inside your eye. This internal fluid normally drains through a
tissue called the trabecular meshwork at the iris-cornea junction. When fluid is overproduced or
the drainage system fails, the fluid cannot flow out at its normal rate, causing eye pressure to
rise.
EPIDEMIOLOGY AND ETIOLOGY

Glaucoma comprises a group of diseases characterized by progressive optic nerve injury that
results in visual field loss and potentially permanent blindness. Initially the damage to neural
cells may go undetected as the disease is typically asymptomatic, but, left untreated, it can cause
severe vision loss. The damage to the optic nerve is irreversible: so far, regenerative attempts
have been unsuccessful, so early diagnosis is essential. More than 64 million people globally are
believed to have glaucoma and it is expected that more than 111 million will have it by 2040,
due to population aging. In the United States approximately 2.9 million individuals have
glaucoma. Throughout the world, approximately 8.4 million cases of irreversible bilateral
blindness are attributed to glaucoma and it accounts for an estimated 9% to 12% of all blindness
in the United States.
EPIDEMIOLOGY

The traditional paradigm of glaucomatous damage is that biomechanical damage, namely from
elevated intraocular pressure (IOP), occurs to the optic nerve head. Pressure on the optic nerve
head appears to be the mechanism through which pressure in the front of the eye causes damage
to the nerve itself. However, several studies have provided evidence of mechanisms other than
IOP that may contribute to nerve damage in glaucoma. According to Dr. Grace Richter, Assistant
Professor of Ophthalmology in the Glaucoma Division at the USC Roski Eye Institute,
“Reduction or fluctuations in ocular blood flow, increased susceptibility to nerve damage from
inflammatory diseases, and having an abnormally low intracranial pressure have all been
implicated in contributing to glaucomatous damage.”
The etiology of normal-pressure glaucoma may be multifactorial, but persons with a family
history, vascular dysfunction, and/or Japanese ancestry appear to be at greater risk for this
condition. Although glaucoma mainly occurs with aging, younger adults can also get the
disease. Moreover, both juvenile and congenital glaucoma exist: according to the American
Glaucoma Foundation, approximately 1 of every 10,000 babies born in the United States
has glaucoma at birth. In short, while some individuals may be at higher risk for glaucoma,
no one is exempt from risk. This is why regular eye examinations are critical.
PATIENT’S PROFILE
ANATOMY AND PHYSIOLOGY

CORNEA
The cornea is your eye's clear, protective outer layer. Along with the sclera (the white
of your eye), it serves as a barrier against dirt, germs, and other things that can cause
damage.
SCLERA

The sclera, or white of the eye, is a protective covering that wraps over most of the eyeball.
It extends from the cornea in the front to the optic nerve in the back. This strong layer of
tissue, which is no more than a millimeter thick, gives your eyeball its white color. It also
protects and supports your eye
IRIS
the colored part of your eye. Muscles in your iris control your pupil — the small black
opening that lets light into your eye. The color of your iris is like your fingerprint. It's
unique to you, and nobody else in the world has the exact same colored eye
LENS
The lens enables the changing of focus. The lens can alter its refractive power by
changing its shape, a process called accommodation.
ZONULES
The zonules are the tiny thread-like fibers that hold the eye's lens firmly in place. The
zonules also work with the ciliary muscles to help the lens accommodate (change
focus). The zonule fibers tighten and pull the lens for near vision. They relax as the
lens flattens for distance vision.
CILIARY MUSCLE
The ciliary body is a circular structure that is an extension of the iris, the colored part
of the eye. The ciliary body produces the fluid in the eye called aqueous humor. It also
contains the ciliary muscle, which changes the shape of the lens when your eyes focus
on a near object.
CILIARY EPITHELIUM
The ciliary epithelium bilayer forms a barrier between a part of the body that is one of
the most densely vascularized and a part of the body that has no blood vessels at all.
PATHOPHYSIOLOGY
PHYSICAL ASSESSMENT
III. DISCHARGE PLANNING/RECOMMENDATION
Medications
➢ Advised the patient to take all the prescribed medications (eye drops) by his doctor; having a
written reminder of the correct medication, time to take, and the right frequency of the
medicine on the way home to establish assurance of medication compliance.
➢ Encouraged patients to tell to the healthcare provider about any side effects or problems they
have with her medicines.
➢ Advised the patient about protecting her eye. The protective eyewear should be kept clean.
Environment/Exercise:
➢ Advised the family of the patient to provide a comfortable and clean bedroom to avoid
infection.
➢ Encouraged the family and patient to always have a clean environment.
➢ Advised the patient to do some exercises like walking for 10 minutes everyday.
Treatment
➢ Advised the patient to get regular eye exams. This will help healthcare providers monitor her
glaucoma.
➢ Educated the patient to avoid behaviors that increase eye pressure. Try not to strain when
she have a bowel movement.
➢ The patient may need to return every 3 to 6 months to have her eye pressure checked.
Advised the patient to write down her questions so she remember to ask them during her
Visits.
Health Teaching
➢ Educated the patient to keep her face clean and avoid touching her eye.
➢ The patient may bathe and shower, taking extra care not to bend forward orto touch the
operated eye (which may also be protected with an eye shield).
➢ Educated the patient that her hands should be washed before instilling any eye drops.
➢ Told the patient to do not wear tight clothing around her neck or chest.
➢ Recommended the patient too not push or lift anything heavier than 5 pounds.
➢ Encouraged the patient to avoid strenuous activity.
Observation/Outpatient
➢ Advised the patient to seek care immediately if:
-She have a sudden loss of vision.
-She have blurry vision and a severe headache.
-She have severe eye pain or a change in your vision.
-She have nausea and are vomiting.
➢ Advised the patient to call herr doctor or ophthalmologist if:
-Her symptoms get worse, even after treatment.
-She have questions or concerns about your condition or care.
Diet
➢ The foods researchers claim are important for eye health and possibly prevent glaucoma
include:
-Dairy foods such as milk and cheese
-Leafy greens such as spinach, cabbage and kale
-Fruits and vegetables, and more specifically, orange fruits and vegetables such as carrots
and peaches
-Foods and liquids high in antioxidants, such as green tea, red wine and chocolate
-Foods rich in a type of vitamin A known as retinol
-Eggs, nuts, and citrus
➢ Educated the patient to know the foods to avoid:
-Keep salt consumption to a minimum. Everyone needs a little salt, but moderation is
key.
-Don’t overdo the caffeine. While coffee does contain antioxidants, too much caffeine
can increase blood pressure, which is especially bad if you already have glaucoma.
-Drink small amounts of liquid throughout the day instead of large quantities at one
time.
-Try to maintain a low-calorie diet.
➢ Avoid smoking
Spiritual
➢ Advised patients to express feelings to family members.
➢ Respect clients' religious belief.
➢ Encouraged the client to pray and have time to communicate with God.
➢ Advised the family to protect the client’s safety
THANK YOU!