Glaucoma is a chronic, progressive eye disorder characterized by elevated intraocular pressure (IOP) that leads to damage of the optic nerve and irreversible vision loss. Early identification, comprehensive nursing assessment, and structured care planning are essential to prevent complications, maintain visual function, and improve patient quality of life. This article provides a detailed nursing assessment and care plan for glaucoma patients based on Gordon’s 11 Functional Health Patterns, integrating clinical evidence and practical examples for nursing students and practitioners.
Understanding Glaucoma
Definition of Glaucoma
Glaucoma is a disease characterized by increased intraocular pressure and optic nerve damage resulting in visual field loss. Sidarta Ilyas (2000) defines glaucoma as a clinical condition marked by elevated eyeball pressure and destruction of the optic nerve papilla, leading to visual field defects. Long Barbara (1996) describes it as a group of disorders associated with increased intraocular pressure.
In simple terms, glaucoma occurs when high pressure inside the eye damages the optic nerve—the structure that connects the retina to the brain. Without proper treatment, this damage can lead to permanent blindness.
Types of Glaucoma
- Primary Open-Angle Glaucoma (POAG) – slow onset, often asymptomatic.
- Angle-Closure Glaucoma – sudden elevation of IOP, medical emergency.
- Secondary Glaucoma – related to trauma, diabetes, hypertension, or medications.
- Congenital Glaucoma – present at birth.
Common Symptoms
- Eye pain or pressure
- Blurred or hazy vision
- Halos around lights
- Nausea and vomiting (especially in acute glaucoma)
- Headache
- Reduced peripheral vision
Nursing Assessment for Glaucoma
A comprehensive nursing assessment includes identifying patient history, medical conditions, physical assessment findings, and diagnostic results. Nursing assessment helps determine the degree of visual impairment, patient needs, and potential risks.
1. Client Identity
Includes the patient’s:
- Name
- Age
- Gender
- Occupation
- Address
- Religion
2. Chief Complaint
The most common complaints include:
- Pain around or inside the eyeball
- Blurred vision
- Headache
- Difficulty seeing in bright light
3. Current Medical History
Assess symptoms that disrupt daily activity such as:
- Persistent eye pain
- Sudden vision changes
- Nausea or vomiting
- Photophobia
4. Past Medical History
- History of ocular trauma
- Use of corticosteroids
- Previous eye diseases
- Systemic diseases (diabetes, hypertension)
5. Family Health History
Glaucoma has a strong genetic component. Assess history of glaucoma among:
- Parents
- Siblings
- Grandparents
Physical Examination for Glaucoma
1. Ophthalmoscopic Examination
- Enlarged and deepened optic cup (cupping)
- Optic disc atrophy
- Shallow anterior chamber (acute glaucoma)
- Cloudy aqueous humor
2. Peripheral Visual Field Examination
In acute glaucoma: rapid decrease in visual field.
In chronic glaucoma: progressive, gradual loss of peripheral vision.
3. Inspection Findings
- Red, inflamed sclera
- Cloudy cornea
- Dilated, non-reactive pupil
4. Palpation
The affected eye may feel harder than the normal eye due to increased IOP.
5. Diagnostic Testing
- Tonometry: Measures IOP. Chronic glaucoma ranges 22–32 mmHg. Acute glaucoma ≥ 30 mmHg.
- Gonioscopy: Determines whether the angle is open or closed.
- Optic nerve imaging: OCT to assess nerve fiber loss.
- Visual field testing: Assesses peripheral vision loss.
Gordon’s 11 Functional Health Patterns for Glaucoma Nursing Assessment
1. Health Perception–Health Management Pattern
Assess how the patient perceives their health and understanding of glaucoma. Ask:
- “What do you know about your condition?”
- “Do you adhere to medication schedules?”
- “Any family history of diabetes or hypertension?”
2. Nutritional–Metabolic Pattern
- Eating habits: breakfast, lunch, dinner
- Daily fluid intake
- Weight changes in past 6 months
- Appetite level
- Healing process and nutritional status
Patients may experience nausea and vomiting, especially in acute glaucoma.
3. Elimination Pattern
- Bowel movement frequency
- Consistency and color of stool
- Urinary frequency and characteristics
Glaucoma typically doesn’t affect elimination unless secondary to diabetes or hypertension.
4. Activity–Exercise Pattern
Assess activity levels, exercise habits, respiratory and cardiovascular responses:
- Daily activities
- Difficulty walking or moving due to vision impairment
- Muscle strength assessment
Patients with glaucoma may avoid outdoor activities due to sunlight sensitivity and blurred vision.
5. Sleep–Rest Pattern
Glaucoma patients may experience sleep disruption due to eye pain and headache.
- Hours of sleep
- Sleep quality
- Pre-sleep habits
6. Cognitive–Perceptual Pattern
- Vision status (central and peripheral)
- Pain characteristics (location, intensity)
- Hearing, smell, taste
- Mental status
- Anxiety related to vision loss
7. Self-Perception–Self-Concept Pattern
Vision impairment can significantly affect self-esteem. Assess:
- Feelings about self-image
- Fear or anxiety about blindness
- Emotional stability
8. Roles–Relationships Pattern
Vision impairment may affect social interactions and occupational roles.
- Family relationships
- Employment status
- Economic concerns
9. Coping–Stress Tolerance Pattern
Assess how patients respond to stress:
- Support systems
- Coping strategies
- Use of substances when stressed
10. Se_uality–Reproductive Pattern
Glaucoma generally does not directly impact sexual function, but emotional distress may influence intimacy.
11. Value–Belief Pattern
Assess how illness affects religious practices and life priorities.
- Spiritual beliefs
- Life purpose and goals
Example Nursing Diagnoses for Glaucoma
- Acute Pain related to increased intraocular pressure
- Disturbed Sensory Perception (visual) related to optic nerve damage
- Anxiety related to potential vision loss
- Self-care deficit related to impaired vision
- Risk for Injury related to decreased visual acuity
Nursing Interventions for Glaucoma
LSI Keywords
- Glaucoma nursing care plan
- Assessment for glaucoma patients
- Gordon functional health patterns
- Intraocular pressure management
- Optic nerve damage
- Visual field loss
- Eye pain and vision impairment
Conclusion
Glaucoma is a progressive and potentially blinding condition that requires comprehensive nursing assessment and structured care planning. Using Gordon’s 11 Functional Health Patterns helps nurses gather holistic data, identify patient needs, and create individualized care plans. Early recognition of symptoms, continuous monitoring, proper medication adherence, and emotional support are essential to prevent irreversible vision loss and maintain patient quality of life.
References
- Ilyas, S. (2000). Ilmu Penyakit Mata.
- Long, B. (1996). Medical-Surgical Nursing.
- Smeltzer & Bare. (2010). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing.
- Gordon, M. (1994). Functional Health Patterns.
- American Academy of Ophthalmology (AAO). (2023). Glaucoma Guidelines.
