Case Study – Chronic Open-Angle glaucoma Patient Profile A.G., a 52-yr-old African American woman, was seen in her ophthalmologist’s office for a routine eye examination. Her last examination was 5 years ago. Subjective Data • Has no current ocular complains • Has not kept annually scheduled examinations because her eyes have not bothered her • Takes metoprolol tartrate (Lopressor) for hypertension • Has a family of glaucoma • Uses over-the-counter diphenhydramine for her seasonal allergies Objective Data • BP 130/78 • HR 72 bpm Ophthalmic Examination • Visual acuity: OD 20/20, OS 20/20 • Intraocular pressure: OD 25, OS 28; by Tono-Pen tonometry • Direct and indirect ophthalmoscopy: small, scattered retinal hermorrhages; optic discs appear normal with no cupping • Perimetry (visual field) testing: early open-angle glaucomatous changes, OU Interprofessional Care The HCP prescribes betaxolol (Betoptic) gtt 1 OU. The nurse instructs A.G. on the reasons for the drug and how to do punctual occlusion. Discussion Questions Answer the following questions: 1. Why should A.G. have been seeing an ophthalmologist on a yearly basis even though she had no ocular complains? 2. Patient-Centered Care: What should the nurse teach A.G. about administering the eyedrops? 3. Why is permissible for A.G. to use her antihistamine? What would the nurse have told her if gonioscopy had revealed angle-closure glaucoma? 4. Will A.G. be able to discontinue her eyedrops once her intraocular pressures are within the normal range? Explain your answer. 5. If topical therapy does not control A.G.’s intraocular pressures, what should she be told about alternative therapies? 6. Describe the probable appearance of A.G.’s optic discs in the future if her glaucoma is left untreated. What would her visual complaints be? 7. Patient-Centered Care: What discharge teaching would the nurse include for A.G.? 8. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses. Are there any collaborative problems?
1. Answer.
A.G should be seen an opthalmologist on yearly basis as she has complaint of hypertension as evidenced by the drug metaprolol which is an antihypertensive drug , hypertensive patients are more prone to develope retinal damage which causes damage to the capillaries or blood vessels of retina (it is the region where image focuses) , as she takes antihypertensive medications to control her raised blood pressure but , to avoid complications she should visit an opthalmologist yearly.
2. Answer.
As patient's family history says her family has history of glaucoma and also her perimetry test reveals that she has open angles glaucomatous changes , betaxolol is the drug used to control raised blood pressure in the eye , it has various side effects such as swollen lips and face, blurred vision, headache, etc , if side effect occurs tell your doctor or HCP immediately, if signs of heart failure or respiratory distress occurs , it should be administered cautiously and it should be discontinued if any sign of heart failure appears.
3. Answer.
Openangles glaucoma is different from narrow angle glaucoma or angle closure glaucoma, antihistamines usually has no effect on pupils in open angle glaucoma but it may cause pupillary dilation in narrow angle glaucoma and can cause angle closure , if gonioscopy would have revealed narrow angle glaucoma then administration of antihistamines should have been avoided.
4.Answer.
It can be discontinued but not for a longer period of time , if discontinuation is for a longer period then eye rebounding can be occured which may worsen the condition.
5. Answer.
Oral medication can be used instead of topical therapy , TIMILOL can be used orally to control intraoccular pressure, if topical therapy doesn't work, it can be taken once in a day to control intraocular pressure.
6.Answer.
If glaucoma will be left untreated then occular pressure will be increased that can cause vision loss complete or partial in one or both the eyes, permanent blindness can also occur if no treatment will be done at acute phase that is called open angle glaucoma and the chronic phase is called narrow angle glaucoma or angle closure glaucoma.
7.Answer.
Teach patient regarding medication that it should be taken on time as directed or prescribed,
Tell patient to visit opthalmologist for regular follow up.
Instruct client to avoid being with people with respiratory disorders as sneezing and coughing increases pressure in the eyes.
Tell the client to always carry her medical card and if symptoms get worse contact hospital immediately.
8.Answer.
Diagnosia can be
1. Disturbed sensory perception
As it damages optic nerve and blurring of vision or partial visual impairment can occur .
2. Anxiety.
Anxiety can arise as sudden visual changes occur.
Collaborative problems are open angle glaucomatous and hypertension as hypertension may lead to increased intraocular pressure and cause retinal damage, in order to cure open angle glaucoma one must control hypertension as well.
Case Study – Chronic Open-Angle glaucoma Patient Profile A.G., a 52-yr-old African American woman, was seen...