Primary Nursing Diagnosis

Sensory and perceptual alterations (visual) related to nerve fiber destruction caused by increased IOP

OUTCOME. Body image; Anxiety control; Neurological status; Safety behavior: Fall prevention and Personal; Safety status: Physical injury; Self-care: Activities of daily living

INTERVENTIONS. Activity therapy; Communication enhancement: Visual deficit; Environmental management; Fall prevention; Reality orientation; Surveillance: Safety; Eye care; Medication management

U PLANNING AND IMPLEMENTATION Collaborative

Glaucoma is often treated medically. Surgery is required when medications are ineffective in reducing IOP. Argon laser trabeculoplasty is preferred because it has an 80% success rate in reducing IOP. Surgical filtering treatment produces a permanent fistula from the anterior chamber and the subconjunctival space. Filtering procedures include trabeculectomy, cyclodialysis, peripheral iridectomy, sclerectomy, and ocular implantation devices such as the Molento implant.

After surgical filtering, postoperative care includes dilation and topical steroids to rest the pupil. Postoperative care after peripheral iridectomy includes cycloplegic eyedrops in only the affected eye to relax the ciliary muscle and to decrease inflammation, thus preventing adhesions. When other surgical procedures have failed, cyclocryotherapy may be performed. Parts of the ciliary body are destroyed by the freezing effect of the probe, which reduces aqueous humor production.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Miotic eyedrops

Varies with

Pilocarpine hydrochloride,

Constrict pupil and contract ciliary

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