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Other Drugs: Epinephrine and dipivefrin hydrochloride reduce aqueous humor production (not for use in closed-angle glaucoma), osmotic agents such as oral glycerin or mannitol in emergencies to reduce IOP rapidly.

Independent

Blindness from glaucoma can frequently be prevented by early detection and lifelong treatment. Patients are informed that vision loss is permanent, but further vision loss may be prevented if IOP is controlled through medications or surgery.

To prevent injury that is related to reduced peripheral vision, arrange the environment to ensure safety. Place frequently used items where the patient can view them through central visual fields. Administer miotics, which cause pupillary constriction, blur vision for 1 to 2 hours after installation, and reduce adaptation to darkness. Miotics are often given four times a day to fit the patient's schedule, or have the physician order the gel form (pilocarpine HS gel), which can be given once a day at night. Some patients benefit by the use of Ocusert, a pilocarpine time-released wafer. The wafer is inserted weekly and is helpful to patients who cannot insert eyedrops.

To minimize self-care deficits, encourage independence with activities of daily living, and assist the patient as necessary. Encourage the patient to express anxiety, grieving, and concerns

374 Glomerulonephritis, Acute about glaucoma or blindness. Listen supportively, and explore coping strategies. Reinforce compliance with the recommended treatment plan and follow-up care.

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