NCM 116: Care of Clients with Problems in

Nutrition and Gastrointestinal, Metabolism and Endocrine,

Perception & Coordination, Acute and Chronic

WILFREDO ADORIO, RN, MSN

CLINICAL INSTRUCTOR
 FOCUS CONCEPTS
Care of Patient with Neuro-
sensory Disorders
- Cataract
- Glaucoma
- Retinal Detachment
- Macular Degeneration
- Blindness
- Hearing Loss
- Meniere’s Disease
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Glaucoma

Edyss Eli B. Gaspar

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 Is a condition characterized by high intraocular pressure (IOP) that causes optic nerve damage.
 Glaucoma is a group of eye conditions that cause damage to the optic nerve, which is essential for good 
vision. 
 An abnormally high pressure in your eye is frequently the cause of this damage.
 For people over the age of 60, glaucoma is one of the leading causes of blindness.

TYPES:
1. In open-angle glaucoma, the iris is in the right position, and the uveoscleral drainage canals are clear. But the
trabecular meshwork isn’t draining properly.

2. In closed-angle glaucoma, the iris is squeezed against the cornea, blocking the uveoscleral drains and the trabecular
meshwork.

CLOSED-ANGLE GLAUCOMA
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Nursing Management
1. Provide information on glaucoma management.
 Discuss preoperative and postoperative teaching for immediate surgical eye chamber opening.
 Prepare to give carbonic anhydrase inhibitors IV or IM to limit aqueous humor production.
 Prepare to use osmotic agents.
 After the acute episode has passed/ relieved, discuss and prepare the client for surgical or laser peripheral
iridectomy.

2. If medication therapy is ineffective, provide information on laser trabeculoplasty.

3. Teach the client about the importance of following specific safety precautions.

 Instruct the client to avoid mydriatics like atropine, which can cause acute glaucoma in people
 with closed-angle glaucoma.
 Instruct the client to keep all prescribed medications on hand at all times.
 Instruct the client to carry a medical identification card or wear a bracelet indicating the type of 
glaucoma he has and the medication he requires.
 Instruct the client to exercise extra caution at night (use of handrails, provide extra lighting to 
compensate for impaired pupil dilation from miotic use).

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 THANK
YOU!!
Reference: https://www.slideshare.net/sunnymumu/cataract-easy-ppt-for-nursing-students
CASE SCENARIO: GLAUCOMA

Ms. Y.T. is an 79-year-old female who has been

diagnosed with open-angle glaucoma and ocular
hypertension. She presents to the ophthalmology clinic
for a follow-up appointment. Her medical history is
positive for hypertension, depression, arthritis, and
atrial fibrillation. She staes that she has been “doing
pretty good, I guess.” She denies any specific
complaints except some blurred vision. She self
administers solution 2 gtt q8h.
Guide Questions:
a. What is open angle glaucoma?
b. How is open angle glaucoma different than closed-
angle glaucoma?
c. What type of drug is Timolol, and hos does it work?
d. Are these eyedrops administered? (Specify your
answer)
e. Is the above dose of Timolol appropriate for the
patient? Why or why not??
 NCM 116: Care of Clients with Problems in
Nutrition and Gastrointestinal, Metabolism and Endocrine,
Perception & Coordination, Acute and Chronic

WILFREDO ADORIO, RN, MSN

CLINICAL INSTRUCTOR
 FOCUS CONCEPTS
Care of Patient with Neuro-
sensory Disorders
- Cataract
- Glaucoma
- Retinal Detachment
- Macular Degeneration
- Blindness
- Hearing Loss
- Meniere’s Disease
Retinal Detachment
Retinal detachment is a medical emergency in which a thin layer of tissue at
the back of the eye (the retina) pulls away from its normal position.
Retinal detachment occurs when the retinal cells become detached from the
layer of blood vessels that supplies oxygen and nourishment. The longer you
wait to treat a retinal detachment, the greater your risk of permanent vision
loss in the affected eye.
The sudden appearance of floaters and flashes, as well as reduced vision, are
all warning signs of retinal detachment.
Nursing Management

1. Get the patient ready for surgery.

 Instruct the patient to remain quiet in the prescribed (dependent) position in order to keep
the detached retina in the dependent position.
 Both eyes should be patched.
 Antibacterial solution should be applied to the patient's face.
 To avoid contamination, instruct the patient not to touch his or her eyes.
 Preoperative medications should be administered as directed.

2. Take precautions to avoid postoperative complications.

 Warn the patient not to bump his or her head.
 Encourage the patient not to cough or sneeze, or to engage in any other strain-inducing
activities that will cause intraocular pressure to rise.

3. Encourage ambulation and independence to the extent that it is tolerated.

4. As directed, administer pain, nausea, and vomiting medication.
5. Provide quiet diversional activities such as radio listening or audio
books.
6. Teach proper eye medication administration technique.
7. For several weeks, advise the patient to avoid rapid eye movements, as
well as straining or bending the head below the waist.
8. Inform the patient that driving will be restricted until the
ophthalmologist clears them.
9. Teach the patient to recognize and report symptoms of recurring
detachment, such as floating spots, flashing lights, and progressive
shadows, as soon as they occur.
10. Advise the patient to return for a follow-up appointment.

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CASE SCENARIO

Mr. Black is a 42-year-old Mexican-American who was diagnosed with glaucoma after a
screening event sponsored by his fraternity. His healthcare provider prescribed
latanoprost (Xalatan) 1 drop (1.5 mcg) in both eyes once daily. As he was leaving the
room, he mentioned that he just could not believe he had glaucoma because "only old
people get glaucoma." You are concerned about his willingness to adhere to his treatment
plan.

Guide questions:

1. What is Glaucoma?
2. What are the risk factors for glaucoma?
3. Latanoprost belongs to which class of glaucoma drugs?
4. What are some common side effects of latanoprost?
5. What information will you give to Mr. Brown to encourage adherence to his treatment
plan?
 THANK
YOU!!
Reference: https://www.slideshare.net/sunnymumu/cataract-easy-ppt-for-nursing-students