Glaucoma and Pain Nursing Diagnosis Care Plan: A Comprehensive Guide for Nurses

What is Glaucoma?

Glaucoma, characterized by increased intraocular pressure (IOP), arises from inadequate drainage of aqueous humor in the eye’s anterior chamber. This condition damages the optic nerve and can worsen over time, potentially leading to blindness if untreated. While glaucoma is often inherited and may manifest later in life, understanding its types and symptoms is crucial for effective nursing care.

There are primarily two categories: open-angle and closed-angle glaucoma. Chronic open-angle glaucoma, the most prevalent, develops slowly, often without early symptoms, and is associated with diabetes and myopia. The gradual loss of peripheral vision may go unnoticed until significant optic nerve damage has occurred.

Narrow-angle or angle-closure glaucoma, though less common, can result from eye trauma, inflammation, or pupillary dilation. Acute angle-closure glaucoma presents as a medical emergency, marked by sudden, severe eye pain, blurred vision, and redness. This acute form demands immediate attention to prevent rapid vision loss. Recognizing the distinctions between these types is essential for targeted nursing interventions, especially when addressing pain associated with glaucoma.

Nursing Care Plans and Management for Glaucoma with Pain

Nursing care for glaucoma focuses on preventing further visual decline, aiding adaptation to vision changes, and averting complications and injury. In cases of acute angle-closure glaucoma, pain management becomes a critical priority alongside these goals.

Nursing Problem Priorities

For patients experiencing glaucoma, particularly those with pain, nursing priorities include:

Recognizing and promptly assessing signs and symptoms of glaucoma, with specific attention to pain characteristics.
Monitoring intraocular pressure and optic nerve function to evaluate disease progression and treatment efficacy.
Administering prescribed medications, including eye drops and analgesics, to manage IOP and alleviate pain.
Educating patients about glaucoma, emphasizing pain management strategies, treatment adherence, and the necessity of regular eye examinations.
Providing comprehensive support and guidance to optimize eye health, prevent disease advancement, and cope with pain.
Coordinating referrals to ophthalmologists or glaucoma specialists for advanced evaluation and management, especially for pain that is difficult to control.
Offering emotional support and counseling to patients and their families, addressing anxieties related to vision loss and chronic pain.

Nursing Assessment

Assess for the following subjective and objective data, with a focus on pain assessment for glaucoma patients:

Reports of sudden, severe eye pain, particularly in angle-closure glaucoma. Characterize pain using PQRST (Provocation, Quality, Region, Severity, Timing).
Gradual loss of peripheral vision, a common symptom in chronic glaucoma.
Increased intraocular pressure (IOP) measured via tonometry.
Blurred or hazy vision, halos around lights, indicative of visual disturbances.
Vision loss or blindness, reflecting disease severity.
Headaches or eye strain, which can accompany glaucoma, though severe pain is more typical of acute forms.
Ocular redness, nausea, and vomiting in acute angle-closure glaucoma.

Nursing Diagnosis for Glaucoma and Pain

Based on thorough assessment, nursing diagnoses are formulated to address glaucoma-related challenges, especially concerning pain. While various diagnoses may apply, Acute Pain is particularly relevant in acute angle-closure glaucoma.

Common Nursing Diagnoses for Glaucoma:

Risk for Injury related to visual field deficits.
Anxiety related to the threat of vision loss and uncertainty about prognosis.
Deficient Knowledge regarding glaucoma management and treatment regimen.
Disturbed Sensory Perception: Visual related to optic nerve damage.
Acute Pain related to increased intraocular pressure in acute angle-closure glaucoma.

Focus Nursing Diagnosis:

Acute Pain related to increased intraocular pressure secondary to angle-closure glaucoma, as evidenced by patient report of sudden, severe eye pain, ocular redness, and possible nausea and vomiting.

Nursing Goals for Glaucoma and Pain Management

Goals and expected outcomes for patients with glaucoma, especially those experiencing pain, may include:

The client will report pain is managed or reduced to a tolerable level (using a pain scale).
The client will participate in the prescribed therapeutic regimen, including medication administration and follow-up appointments.
The client will maintain current visual field and acuity without further loss.
The client will demonstrate reduced anxiety and appear relaxed.
The client will verbalize understanding of their condition, prognosis, and treatment plan, including pain management strategies.
The client will correctly perform necessary procedures, such as eye drop instillation, and explain the rationale behind these actions.

Nursing Interventions and Actions for Glaucoma and Pain

Therapeutic interventions and nursing actions for glaucoma patients, with a focus on pain management, include:

1. Monitoring Intraocular Pressure, Visual Sensory Perception, and Pain Levels

Managing IOP is crucial in glaucoma, and in acute cases, addressing pain is paramount.

Determine the type and degree of visual loss. This informs intervention strategies and patient expectations.

Assess and document pain characteristics using a pain scale (e.g., 0-10), PQRST. Crucial for effective pain management and monitoring treatment effectiveness.

Allow expression of feelings about vision loss and pain. Acknowledge the emotional impact of both vision impairment and pain experience.

Implement safety measures to manage visual limitations: Reduce clutter, arrange furniture, improve lighting, and advise on head-turning techniques. Minimizes injury risk due to visual field changes.

Demonstrate and reinforce correct eye drop administration: Emphasize adherence to schedule and dosage. Controls IOP and prevents vision loss.

Administer prescribed medications as indicated:

Eye drops (miotics, beta-blockers, alpha-agonists, prostaglandin analogs, carbonic anhydrase inhibitors): To lower IOP.
Analgesics (oral or IV as prescribed): For pain relief, particularly in acute angle-closure glaucoma.

Stress meticulous compliance with prescribed drug therapy. Consistent medication use is vital for IOP control and pain management.

Provide sedation and analgesics as necessary for acute glaucoma attacks. Acute pain can exacerbate anxiety and IOP elevation. Prompt pain relief is crucial.

Prepare for surgical intervention as indicated:

Laser therapy (ALT, trabeculectomy): To improve aqueous humor outflow and reduce IOP.
Iridectomy: To facilitate drainage in angle-closure glaucoma.
Postoperative care: Includes cycloplegic eye drops and pain management.
Malento valve implant, cyclocryotherapy, diathermy, aqueous-venous shunt: For intractable glaucoma.

Illustration of glaucoma affecting the optic nerve, emphasizing the importance of early diagnosis.

2. Providing Emotional Support and Counseling to Reduce Anxiety and Pain-Related Distress

Glaucoma, especially with pain or potential vision loss, can cause significant anxiety.

Evaluate anxiety and pain levels, and current understanding of the condition. These factors influence patient’s perception of threat and anxiety levels.

Provide accurate, honest information about glaucoma and pain management. Discuss the effectiveness of monitoring and treatment in preventing further vision loss and controlling pain.

Allow patient to express concerns and feelings. Provides an opportunity to address fears and misconceptions.

Promote a calm, soothing environment: Ensure adequate lighting, minimize noise and distractions. Reduces anxiety and discomfort.

Teach relaxation techniques: Deep breathing, progressive muscle relaxation, guided imagery, mindfulness meditation. Helps manage anxiety and pain.

Provide clear, concise information about procedures and treatments, including pain management strategies. Reduces uncertainty and fear.

Identify support groups and resources. Offers guidance, reassurance, and additional coping strategies.

3. Initiating Patient Education and Health Teachings, Including Pain Management

Patient education is vital for adherence and managing glaucoma effectively, including pain management.

Identify potential side effects of glaucoma medications and pain relievers. Ensures patient awareness and prompt reporting of adverse effects.

Stress the importance of glaucoma screening and regular eye exams. Early detection is key to preventing severe vision loss and managing pain effectively.

Review pathology, prognosis, and lifelong treatment needs. Clarifies misconceptions and promotes understanding of the chronic nature of glaucoma.

Discuss the necessity of wearing a MedicAlert bracelet. Provides vital information for emergency care.

Demonstrate proper technique for eye drop administration and pain medication use. Enhances treatment effectiveness and patient competence.

Review the importance of maintaining medication schedules and avoiding contraindicated medications. Consistent medication use is crucial for IOP and pain control.

Encourage lifestyle modifications: Stress reduction, avoiding heavy lifting, and tight clothing, especially in angle-closure glaucoma to prevent IOP spikes and potential pain exacerbation.

Discuss dietary considerations: Adequate fluids and fiber to prevent constipation and straining, which can increase IOP.

Stress the importance of routine checkups and prompt reporting of new or worsening symptoms, including pain changes. Enables timely intervention and prevents complications.

Recommend family members undergo regular eye exams. Glaucoma has a hereditary component.

Identify socialization strategies and resources. Addresses potential social isolation due to vision loss and chronic pain.

4. Administer Medications and Provide Pharmacologic Support for IOP and Pain Control

Medications are central to glaucoma management, targeting IOP reduction and pain relief.

For Chronic Open-Angle Glaucoma:

Pilocarpine, beta-blockers (Timolol), carbonic anhydrase inhibitors (Acetazolamide), prostaglandin analogs (Latanoprost), alpha-adrenergic agonists (Brimonidine). These medications lower IOP through different mechanisms.

For Narrow-Angle (Angle-Closure) Glaucoma:

Miotics (Pilocarpine): To constrict pupil and open angle.
Carbonic anhydrase inhibitors (Acetazolamide): To reduce aqueous humor production.
Sympathomimetics (Epinephrine, Apraclonidine, Brimonidine): To decrease aqueous humor formation.
Analgesics (as prescribed): For pain management.

Pain Management Specifics:

Mild to Moderate Pain: Over-the-counter analgesics like acetaminophen or NSAIDs may be considered under physician guidance.
Severe Pain (Acute Angle-Closure Glaucoma): Opioid analgesics may be necessary for short-term management in conjunction with IOP-lowering medications. Prompt ophthalmologic intervention is crucial.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources:

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care Evidence-based approach to nursing interventions.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) Evidence-based guidelines, ICNP diagnoses, LGBTQ health issues, electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool for efficient patient care planning, updated nursing diagnoses and interventions.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care Interventions to plan, individualize, and document care for over 800 diseases and disorders.

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health Over 100 care plans, interprofessional “patient problems” focus.