Glaucoma is a group of eye conditions that damage the optic nerve, often caused by abnormally high pressure in the eye (intraocular pressure). This condition can lead to permanent vision loss if untreated. This nursing diagnosis focuses on identifying symptoms, preventing complications, and managing the condition effectively.
Causes (Related to)
Glaucoma can develop due to various factors that affect eye pressure and optic nerve health:
- Increased intraocular pressure
- Family history of glaucoma
- Age-related changes (especially over 60)
- Medical conditions such as:
- Diabetes
- High blood pressure
- Heart disease
- Sickle cell anemia
- Risk factors including:
- Prolonged use of corticosteroids
- Previous eye injury or surgery
- Thin corneas
- African American or Asian ancestry
Signs and Symptoms (As evidenced by)
Glaucoma presents with various signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Gradual loss of peripheral vision
- Blurred vision
- Eye pain or pressure
- Headaches
- Halos around lights
- Difficulty adjusting to dark rooms
- Eye fatigue
- Nausea and vomiting (in acute cases)
Objective: (Nurse assesses)
- Increased intraocular pressure (>21 mmHg)
- Decreased visual acuity
- Reduced peripheral vision
- Redness of the eye
- Fixed, mid-dilated pupil (in acute cases)
- Corneal cloudiness
- Changes in optic nerve appearance
- Impaired night vision
Expected Outcomes
The following outcomes indicate successful management of glaucoma:
- The patient will maintain stable intraocular pressure
- The patient will demonstrate proper medication administration
- The patient will report no further vision loss
- The patient will verbalize understanding of glaucoma management
- The patient will maintain independence in daily activities
- The patient will demonstrate proper eye care techniques
- The patient will attend regular follow-up appointments
Nursing Assessment
Monitor Eye Health
- Check visual acuity
- Assess peripheral vision
- Monitor intraocular pressure
- Document eye appearance
- Note any changes in vision
Evaluate Medication Compliance
- Review medication schedule
- Assess proper administration technique
- Monitor for side effects
- Document effectiveness
- Check medication supply
Assess Knowledge Level
- Evaluate understanding of the condition
- Check medication knowledge
- Assess lifestyle modifications
- Document learning needs
- Review safety measures
Monitor for Complications
- Assess for vision changes
- Check for medication side effects
- Monitor for eye inflammation
- Document any new symptoms
- Evaluate coping mechanisms
Review Risk Factors
- Document family history
- Assess related conditions
- Note demographic risks
- Review lifestyle factors
- Check occupational hazards
Nursing Care Plans
Nursing Care Plan 1: Risk for Injury
Nursing Diagnosis Statement:
Risk for Injury related to visual impairment as evidenced by decreased peripheral vision and difficulty adjusting to lighting changes.
Related Factors:
- Impaired vision
- Altered depth perception
- Environmental hazards
- Reduced adaptation to darkness
Nursing Interventions and Rationales:
- Conduct an environmental safety assessment
Rationale: Identifies and eliminates potential hazards - Implement safety measures
Rationale: Prevents falls and injuries - Teach compensatory techniques
Rationale: Promotes safe mobility and independence
Desired Outcomes:
- The patient will remain free from injury
- The patient will demonstrate safe navigation techniques
- The patient will maintain independence in daily activities
Nursing Care Plan 2: Deficient Knowledge
Nursing Diagnosis Statement:
Deficient Knowledge related to complex treatment regimen as evidenced by incorrect medication administration and missed appointments.
Related Factors:
- Complex medication schedule
- Limited health literacy
- New diagnosis
- Information overload
Nursing Interventions and Rationales:
- Provide structured education
Rationale: Ensures understanding of condition and treatment - Demonstrate medication administration
Rationale: Promotes proper technique and compliance - Develop written schedule
Rationale: Supports medication adherence
Desired Outcomes:
- The patient will verbalize understanding of glaucoma management
- The patient will demonstrate proper medication administration
- The patient will maintain follow-up appointments
Nursing Care Plan 3: Disturbed Sensory Perception
Nursing Diagnosis Statement:
Disturbed Sensory Perception (Visual) related to increased intraocular pressure as evidenced by decreased visual acuity and peripheral vision loss.
Related Factors:
- Progressive optic nerve damage
- Elevated intraocular pressure
- Altered sensory reception
- Disease process
Nursing Interventions and Rationales:
- Monitor visual changes
Rationale: Tracks disease progression - Implement vision conservation strategies
Rationale: Preserves remaining vision - Teach adaptive techniques
Rationale: Promotes independence
Desired Outcomes:
- The patient will report no further vision loss
- The patient will use adaptive devices effectively
- The patient will maintain the current visual function
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to the threat of vision loss as evidenced by expressed concerns and increased tension.
Related Factors:
- Chronic condition
- Progressive symptoms
- Impact on independence
- Fear of blindness
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Reduces anxiety and promotes coping - Teach stress management techniques
Rationale: Helps manage anxiety - Connect with support resources
Rationale: Builds support network
Desired Outcomes:
- The patient will demonstrate reduced anxiety
- The patient will utilize effective coping strategies
- The patient will verbalize a positive outlook
Nursing Care Plan 5: Ineffective Health Management
Nursing Diagnosis Statement:
Ineffective Health Management related to the complexity of the therapeutic regimen as evidenced by inconsistent medication adherence.
Related Factors:
- Complex treatment plan
- Financial constraints
- Side effects of medications
- Lack of support system
Nursing Interventions and Rationales:
- Develop medication schedule
Rationale: Promotes adherence - Identify barriers to compliance
Rationale: Addresses specific challenges - Connect with resources
Rationale: Provides necessary support
Desired Outcomes:
- The patient will demonstrate medication adherence
- The patient will maintain regular follow-up care
- The patient will utilize available resources
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Dietze J, Blair K, Zeppieri M, et al. Glaucoma (Nursing) [Updated 2024 Mar 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568748/
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Latif K, Nishida T, Moghimi S, Weinreb RN. Quality of life in glaucoma. Graefes Arch Clin Exp Ophthalmol. 2023 Oct;261(10):3023-3030. doi: 10.1007/s00417-023-06050-z. Epub 2023 Apr 5. PMID: 37017741.
- Lusthaus J, Goldberg I. Current management of glaucoma. Med J Aust. 2019 Mar;210(4):180-187. doi: 10.5694/mja2.50020. Epub 2019 Feb 14. PMID: 30767238.
- Newman-Casey PA, Weizer JS, Heisler M, Lee PP, Stein JD. Systematic review of educational interventions to improve glaucoma medication adherence. Semin Ophthalmol. 2013 May;28(3):191-201. doi: 10.3109/08820538.2013.771198. PMID: 23697623; PMCID: PMC3992247.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
