PATIENTS WITH GLAUCOMA CASE STUDY

Introduction

Glaucoma is a condition in which the optic nerve is liable to harm typically, yet not generally, given exorbitantly high intraocular pressure likewise called IOP. On the off chance that untreated, the optic nerve harm results in progressive, perpetual vision loss, beginning with unnoticeable blind spots in the vision field, advancing to vision tunnel, and afterwards to blindness. Glaucoma can result in irreversible harm to the optic nerve. It is one of the primary sources of irreversible blindness in the U.S and globally, and causing leading blindness in among African Americans, and the aged population in the U.S. Since there are generally no early-stage symptoms in the illness, averagely half of the glaucoma patients are unaware of their condition. As indicated by the American Institute of Ophthalmology (2015)  people aged above forty are at risk of developing glaucoma, a family with glaucoma history, a person with Hispanic, Asian or African heritage, (angle-closure glaucoma is a  high risk in this populace, and low-tension glaucoma is high in Japanese). People with high-eye pressure, persons with an eye injury, thin –centre corneas in the centre, migraines, history of high blood pressure, diabetes, and poor circulation of blood.

This case study demonstrates the care administered to a patient who when going to for another patient check was found to have glaucoma. It proves the medical attendants’ inclusion in the essential consideration setting in perceiving glaucoma and how importantly organized appraisal can be helping patient with this sort of condition.

The first day of clinical, I met Ms. Hernandez, and I could develop compatibility with her and this made correspondence process simpler. The following day of clinical, I conversed with Ms. Hernandez and inquired as to whether I could utilize her condition to my case study and she concurred in one situation which is to secure her personality. I guaranteed her to privacy, and I will share what is expected to finish my case study. That day was the ideal time to assemble data about her condition since Ms. Hernandez shared that she’s going home in two days. She is so excited about going home.

Ms. Hernandez is a seventy-five-year-old female patient who was suspected to have glaucoma as indicated by her optometrist who performed air puff tonometry as a significant aspect of routine screening when she went to purchase another match of glasses. She was then followed up and given latanoprost eye drops. She was experiencing issues in utilizing the eyedrops as his eyes appear to keep running with tears when she used the drops.

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Assessment

According to Pt. no restorative condition, or history of meds being taken. Pt. satisfied that it had been one year as of now that she had been feeling that something odd is occurring with her eye particularly after longer long stretches of instructing. Upon appraisal Pt. displayed likewise obscured vision. Pt. was AAOX3, her VS were an inside normal limit, BP 120/75 mmHg, and P-90 bpm, T-98.7, and R-18 for each min. Visual acurity were tried. Pt was not able to recognize a letter at a separation of 5 feet. Intra Visual Pressure was likewise taken; the weight in the left eye was 15 mmHg while the IOP in the right eye was raised at 60mmHg. After those discoveries, the ophthalmologist was informed. Pt. was determined to have closed-Acute Angle Glaucoma. Pt was put in prostrate position; prescription was regulated as a request to bring down the IOP. The ophthalmologist endorsed steroids to diminish irritation and further drug the executives like Pilocarpina to open the edge. Pt was a plan for a subsequent arrangement inside seven days.

 

Pathophysiology

 

Glaucoma infection exists in two fundamental structures; for the most part, open-angle glaucoma and point conclusion glaucoma. Open-angle glaucoma is a broadly spread kind of glaucoma additionally called glaucoma. In this condition, the depleted eye structure called the trabecular meshwork may seem ordinary although the liquid does not stream regularly. The angle-closure glaucoma is anything but a typical issue in the west when contrasted with Asia. It might likewise be called intense or ceaseless narrow-angle glaucoma (Aref and Varma, 2015). The angle-closure glaucoma condition doesn’t deplete the eye because of a keen edge between the iris and cornea which may prompt sudden weight development in the eye. This is related with farsightedness and waterfalls, a condition portrayed by focal point obfuscating inside the eye. The condition is essential to grown-ups of 40 years or more yet additionally may happen in youthful adults, kids, and babies which may prompt more noteworthy vision loss.

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An eye with glaucoma disorder has an obstructed seepage framework. This keeps the waste of the intraocular liquid. The working up of the liquid causes developing of the weight inside the eye. This high weight prompts touchy optic nerve harm which prompts loss of vision (Ignatavicius & Workman, 2013).

The retinal gangling cell axons travel through the optic nerve containing visual data acquired from the eye transmitting it to the cerebrum. At the point when such axons are harmed, they cause the passing of gangling cells which results in the decay of optic nerve and sketchy vision loss (Ackley & Ladwig, 2014). Hoisted IOP encourages axon harm through direct nerve pressure or bloodstream reduction, which gives a convoluted connection between remotely estimated weight and nerve harm. The remotely estimated IOP factor that may not reflect IOP is that the eye might have a more thin cornea than ordinary. The assurance of IOP is by the watery discharge and harm balance.

Nursing Diagnosis

My nursing diagnosis that I connected with Ms. Hernandez was: Hazard for damage r/t macular degeneration AEB visual alteration. My nursing intercession was Evaluate patient for level of visual hindrance. Advise about extraordinary gadgets that can be utilized. Guarantee room condition is protected with sufficient lighting and furniture advanced toward the dividers. Expel all floor coverings, and articles that could be possibly risky. Keep patient’s glasses and call ringer inside simple reach. Educate patient as well as a family concerning the requirement of keeping up safe condition. The objective was Patient will be free of damage and will have the capacity to perform exercises inside parameters of physical restriction. A patient will have the capacity to be free of suffering. Patient, as well as family, will have the ability to change the condition to guarantee patient security (Barton & Hitchings, 2013).

My second nursing diagnosis was Nervousness r/t Physiological components, change in wellbeing status; nearness of agony; probability/truth of loss of vision AEB Communicated concern concerning changes in life occasions. My nursing mediation was Assess nervousness level, level of pain experienced or suddenness of beginning of side effects, and current information of condition. Give exact, legitimate data. Talk about the likelihood that watchful observing and treatment can keep other visual misfortune. Enable the patient to recognize concerns and express sentiments. Recognize accommodating assets and individuals. Suggest relatives be analyzed routinely for indications of AMD. My objective was pt. will seem loose and report tension is diminished to a sensible dimension. Exhibit critical thinking abilities. Use assets viable.

My patient education was Teach Ms. Hernandez to use prescribed drugs consistently. Educate Ms. Hernandez to convey a therapeutic recognizable proof card or wear a wristband expressing his sort of glaucoma and requirement for the drug. Educate Ms. Hernandez to avoid potential risk during the evening (e.g. utilization of handrails, give additional lighting to repay to weakened understudy expansion from miotic use).

Labs and Treatment

The accompanying lab results were requested for Ms. Hernandez.

  RESULT NORMAL RANGE
WBC 7.46 4.00-11.00
RBC 2.79 3.93-5.22
Haemoglobin 8.5 11.2-15.7
intraocular pressure 23mmHg 12mmHg to 21mmHg
Platelet Count 379 130-440

 

 

Ms. Hernandez results displayed that her intraocular pressure is raised. Whatever is left of her blood lab result were in typical range demonstrate no hazard for bleeding. The reason for complete blood count (CBC) test Ms. Hernandez case is to gauge the accompanying things: the white Platelets (WBC) which battles diseases. If you have high WBC levels, it tells that you have aggravation or disease someplace in your body. If it’s low, you could be in danger of contamination. RBC tally is the number of red platelets you have. These are vital because they help oxygen through your body. The blood– fluid boundary (ciliary epithelium and iris capillary) and the blood-retinal obstruction (non-fenestrated vessels of the retinal course and tight intersections of retinal epithelium) are in charge of the control of medication/particle transport from the fundamental dissemination to the front and back visual tissues, separately.

Resources

Primary care doctors are the primary purpose of contact for some glaucoma patients, and they have an essential job in the conclusion and treatment of this condition. The decent variety of the potential manifestations in glaucoma may imply that the state will stay unrecognized in numerous patients for a considerable length of time or year after the medical procedure.

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A surgeon has a critical job in treating a glaucoma understanding. They are the ones who settle on judgment choice either previously or amid the real activity. At the point when the specialist feels that it’s most secure to change over the Latanoprost eyedrops use to a surgery. This isn’t confusion, yet rather a sound careful judgment. The choice to change over to a medical procedure is entirely founded on patient security.

The role of a nurse is progressively comprehensive for the inpatient setting. The patient’s medical attendant would give quick mind expected to the patient in trouble and making the necessary calls expected to caution the doctor to answer to the bedside.

The role of the Occupational therapist is to help with the exercises of everyday living and guarantee the patient’s condition doesn’t hinder those exercises. They remain as advisors to the doctor who are creating and executing the patient activity plan. Their ability is required for a patient who can’t regulate tranquilizes freely.

The role of the pharmacists is guaranteeing appropriate dosing routine, checking for medication interaction, and observing for potential medication terrible quality. When directing patients, pharmacists should audit ideal organization times and possible reactions to verify that the patient has a far-reaching comprehension of how to deal with the manifestations.

Family and companions give social help and consolation. A relative has the critical job in patient’s recuperation. They can screen the patient’s drug taking calendar. They can help with directing drops and reminding the patient to hold fast to treatment.

Interesting Aspects of Care

The main thing that I saw with Ms. Hernandez is that she is a sweet woman. She was agreeable, and I could speak with her effectively. The most intriguing thing about her will be her substantial identity and uplifting frame of mind. Ms. Hernandez said she carried on with a decent life paying little thought to the glaucoma diagnosis.

I picked Ms. Hernandez for my contextual analysis since her condition is equivalent to my aunt’s. Working with Ms. Hernandez helped me to take in more about glaucoma and how to entirely manage this condition. By chance, Ms. Hernandez is an exceptionally decent woman, and that made it simple to work with her. She addressed every one of my inquiries.

Patient Safety

To assess patient safety and care quality, the Joint Commission builds up National Patient Security Objectives every year. What’s more, as a healthcare team member, understanding the National Patient Safety Objectives is vital in promoting the safety of the patient.  The lists of objectives are correct identification of the patient, use something like two different ways to recognize patients to ensure that every patient gets the drug and treatment implied for them, forestall contaminations, and utilize the CDC cleanliness rules. Guarantee the patient take medicine by observing the patient hourly.

As Ms. Hernandez healthcare team member, I ensured that I gave the consideration that she required each time I worked with her. I trained her to call for help each time she uses hands when contacting close cut site to counteract contamination. Abstain from stressing with defecations by expending high-fibre diet, for example, entire grain bread, dried organic products, peas, sweet corn, strawberries, prepared potato with skin, apples, plums, and broccoli. Try not to lift things more substantial than ten pounds or do strenuous activity, and utilize assistive gadgets, for example, stick, a walker to build portability or request help to counteract fall or damage.

Medication

Ms. Hernandez list of drugs is acetazolamide which lessens the liquid in the eye. My nursing suggestion is to evaluate torment type preceding 30-60 min following organization and survey for tingling intermittently amid treatment. My recommendation for understanding is to cease acetazolamide and tell therapeutic services experts if tingling happens and encourage the patient to abstain from taking more than one item containing acetazolamide at an opportunity to avoid danger. Beta blockers, which bring down the measure of liquid your eye produces (Turkoski, 2012). Painkillers as a solace measure. My patient instructing is to illuminate tolerant that may cause discombobulation and laziness. Alert patient to abstain from driving or different exercises requiring readiness until the reaction to the drug is known. Pilocarpine used to open the edge between your iris and cornea. My nursing suggestion is to survey pt. for any side effects of bothering. My patient instructing is to exhortation patient to tell social insurance proficient quickly if indications of aggravation.

Conclusion

Human services experts including nurses must be proficient of the infections and states of glaucoma as a result of the entanglements that may happen. It’s almost imperative that a medical attendant give wellbeing lessons to patients so they will have the capacity to reestablish their wellbeing to be completely practical and furnished with self-control so they will anxiously adhere to the guidelines that are given to them.

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References

Ackley, B. J., & Ladwig, G. B. (2014). Nursing Diagnosis Handbook (Tenth ed., pp. 55).

Aref, A. A., & Varma, R. (2015). Advanced Glaucoma Surgery: An Overview. Essentials in Ophthalmology. Doi: 10.1007/978-3-319-18060-1_1

Barton, K., & Hitchings, R. A. (2013). Introduction. In Medical Management of Glaucoma (pp. 1-32). Springer Healthcare. http://dx.doi.org/0.1007/978-907673-44-3_1

             Collaborative Care (7th ed., pp. 1062-1067). St. Louis, MO: Elsevier Inc.

Edward, D. P. V. T. S. (2012). Glaucoma. Cary: Oxford University Press, USA.

Ignatavicius, D. D., & Workman, L. M. (2013). Medical-Surgical Nursing Patient-Centered

Maryland Heights, MO: Mosby.

Turkoski, B. B. (2012). Glaucoma and glaucoma medications. Orthopaedic Nursing, 31(1), 37-41.

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