Improper drainage d/t trabecular meshwork being clogged which causes damage to the ocular nerve ◻ Angle closure (narrowed angle) glaucoma ◻ Angle is closed and doesn’t allow it to drain ◻ MEDICAL EMERGENCY; increased intraocular pressure increases very quickly ◻ If not treated immediately they will be blind ◻ Symptoms ◻ Usually asymptomatic until there is loss of vision ◻ Halos around lights ◻ Blurred vision ◻ Difficulty in focusing ◻ Loss of peripheral vision (1 st signs) ◻ Aching or discomfort around the eyes or HA are late signs ◻ Diagnostic testing: tonometry; funduscopy; gonioscopy; visual field testing DON’T WORRY ABOUT THE DIAGNOSTICS FOR EYE/EAR Intraocular Pressure 5
NURS400: Chp. 58,59,60,61,64,65,12 Exam #6 Loss of Peripheral Vision with Open-Angle Glaucoma GLAUCOMA: COLLABORATIVE CARE 6
NURS400: Chp. 58,59,60,61,64,65,12 Exam #6 ◻ Medications are treatment of choice: to control IOP and prevent optic nerve damage; usually lifelong therapy; cannot be cured, just controlled ◻ Table 58-4 **KNOW MEDS** ⬜ Beta blockers (topical – 1 st preferred treatment) (-LOL) ◻ MOA: Decreases aqueous humor production ◻ S/E: ◻ Bradycardia ◻ Hypotension ◻ Asthma and COPD patients cannot receive Beta Blockers d/t it causing severe respiratory problems ◻ Contraindicated for HF and 2 nd or 3 rd degree Heart Block ◻ If they have Bradycardia → you need to block the lacrimal sac (punctal occlusion)to prevent systemic absorption ⬜ Cholinergics (Miotics, Pilocarpine, Carbachol) ◻ MOA: Increases aqueous humor OUTFLOW ◻ S/E: ◻ Periorbital Pain ◻ Blurred Vision ◻ Difficulty seeing in the Dark ◻ CAUTION PATIENTS ABOUT DIMINISHED VISION IN DIMLY LIT AREAS ⬜ Adrenergic agonists (Dipivefrin, Epinephrine) (-RIN, -RINE) ◻ MOA: Reduces the production of aqueous humor & increases outflow ◻ S/E: ◻ Eye Redness & Burning ◻ Systemic Effects: ◻ Anxiety ◻ Palpitations ◻ HA ◻ Increased B/P ⬜ Alpha-adrenergic agonists (Apraclonidine, Brimonidine) (- ONIDINE) ◻ MOA: Increase aqueous humor outflow decreases aqueous humor production ◻ S/E: ◻ Eye Redness ◻ Dry Mouth and Nasal Passages ◻ Use Punctal Occlusion when administering ⬜ Carbonic anhydrase inhibitors (Acetazamide, Methaeolamide, Dorzolomide) (-MIDE) ◻ MOA: decreases production of aqueous humor and decrease intraocular pressure ◻ S/E: ◻ Anaphylactic Rx ◻ Electrolyte loss 7
NURS400: Chp. 58,59,60,61,64,65,12 Exam #6 ◻ Lethargy ◻ GI ◻ Impotence ◻ Weight loss (PO) ◻ DO NOT ADMINISTER WITH SULPHA ALLERGIES ◻ MONITOR ELECTROLYTE LEVELS ⬜ Prostaglandin analogs (Lantanoprost, Bimatoprost) (-PROST) ◻ MOA: Increases aqueous humor outflow ◻ S/E: ◻ DARKENING OF THE IRIS ◻ Conjunctival Redness ◻ Possible Rash ⬜ ADMINISTERING EYE DROPS (PG. 1773) ◻ Apply pressure on the inner canthus for 1-2 minutes after instilling drops ◻ Wait 5-10 minutes before instilling another eye drop medication ◻ Surgery: trabeculoplasty; trabeculectomy; gonioplasty; laser iridotomy; peripheral iridectomy ⬜ PURPOSE IS TO INCREASE DRAINAGE OF AQUEOUS HUMOR AND DECREASE INTRAOCULAR PRESSURE Glaucoma: Nursing Management ◻ Diagnoses: ◻ Disturbed Sensory Perception: Visual 8
NURS400: Chp. 58,59,60,61,64,65,12
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