Glaucoma is a disease that provides a clinical picture in the form of elevation of eyeball pressure, the integration of the optic nerve papyrus with a field defect in the eye (Sidarta Ilyas, 2000).
Glaucoma is a group of eye disorders characterized by increased intraocular pressure (Long Barbara, 1996).
So, glaucoma is a group of eye diseases caused by high eye pressure which causes damage to the optic nerve that forms parts of the retina behind the eyeball. The optic nerve connects the recipient tissues of light (retina) to the part of the brain that processes visual information.
Nursing Assessment
- Client identity, including: name, age, gender, occupation, address, religion.
- The main complaints include: what is the main reason the client enters the hospital. Usually the client will complain of pain around or inside the eyeball.
- Current medical history: includes; what are the symptoms experienced by the client at this time that disrupt the activity.
- Past medical history: includes; what diseases have been experienced by the client before, whether related to illness or not.
- Family health history: includes; history of illness experienced by family members.
- Physical examination
Physical examination is done using an ophthalmoscope to find out about cupping and optic disc atrophy. The optic disc becomes wider and deeper. In primary acute glaucoma, the anterior camera is shallow, the humor is cloudy and the blood vessels radiate out of the iris.
Peripheral visual field examination, in acute circumstances, the rapid field of vision decreases significantly and the chronic condition will gradually decrease.
Physical examination by inspection to determine the presence of eye inflammation, reddish sclera, cloudy cornea, moderate dilation of pupils and failure to react to light. Whereas with palpation to examine the eyes that have increased IOP, it feels harder than the other eye.
Diagnostic tests using tonometry, in chronic or open angle conditions, have a value of 22-32 mmHg, whereas acute or angle closure ≥ 30 mmHg. Tests using gonioscopy will get a normal angle in chronic glaucoma. At an advanced stage, if goniosinecia has arisen (the edge of the iris to the cornea / trabecula), the angle can be closed. In acute glaucoma when IOP increases, the angle of COA will be closed, while at normal IOP the angle is narrow.
Gordons 11 Functional Health Patterns
- Health Perception and Management
- Perception of disease; ask how clients perceive health. How clients see glaucoma, how adherence to treatment.
- It should be asked of the client, whether the client has a family history of DM, hypertension, and vascular system disorders, as well as a history of stress, allergies, vasomotor disorders, and radiation.
- Nutrition / Metabolism
- Ask for a breakfast, lunch and dinner menu
- Ask how many glasses of water the client drinks in a day
- Ask how the process of wound healing (fast / slow)
- How is the client's appetite
- Ask if there are difficulties and complaints that affect eating and appetite
- Also ask if there has been weight loss in the past 6 months
- Usually clients with glaucoma will complain of nausea and vomiting
- Elimination
- Assess for defecation habits
- How many times of defecation in a day, number, consistency, smell, color and characteristics of defecation
- Assess urination habits
- How many times does the client urinate in a day, the amount, color, and whether there is difficulty / pain when the micturition and whether to use a tool to urinate
- Clients with glaucoma usually do not have a pattern of elimination, except in patients who have secondary type of glaucoma (DM, hypertension).
- Activities - Exercises
- Describes activity patterns and exercises, respiratory functions and circulation
- Ask how daily activities and sports (use table curtains)
- What activities do clients do in their spare time
- Assess whether the client has difficulty breathing, weakness, coughing, chest pain. Data can be obtained by interviewing direct clients or their families (note the client's verbal and nonverbal responses)
- Assess the strength of muscle tone
- Glaucoma usually interferes with daily client activities. Because, clients experience blurred eyes and pain when exposed to sunlight.
- Rest - Sleep
- Ask how long to sleep at night, is sleep effective?
- Also ask if the client has a habit before going to bed
- Glaucoma usually disrupts sleep patterns and client breaks everyday because the client experiences severe headaches and pain so that the client's sleep patterns are not normal.
- Cognitive - Perception
- Describes the pattern of hearing, sight, taste, smell. Pain perception, language and memory
- Mental status
- Talk: whether the client can talk normally / unclear / nervous
- Communication skills and understanding abilities and interaction skills
- Also examine the client's anxiety regarding his illness and degree
- Hearing: normal / not
- Vision: normal / not
- Is there pain: acute / chronic. Ask the location of pain and the intensity of pain
- How to treat pain, what the client does to reduce pain when pain occurs
- Do clients experience insensitivity to heat / cold / pain
- Clients with glaucoma must experience interference with their sense of sight. The client's mindset is also disrupted but still in the usual stages.
- Self Perception - Self Concept
- Describing attitudes toward self and perceptions of abilities, self-esteem, self-image and feelings of self
- Assess how the client describes himself, is there anything that makes him change the image of himself
- Ask what the client is most often thinking about, does the client often feel angry, anxious, depressed, afraid, telling the client to describe it.
- On clients with glaucoma, there is usually a disruption in self-concept because the client's eyes are disrupted so that the client is not confident in their daily lives. But, in the case of clients not experiencing interference with the perception and self-concept.
- Roles - Relationships
- Describe the effectiveness of relationships and roles with other families.
- Ask the job and the client's employment status
- Also ask for support systems such as wives, husbands, children and grandchildren etc.
- Ask how the financial situation has been since the client was sick.
- What about decision making and conflict resolution
- Also ask whether the client is active in social activities
- Clients with glaucoma will usually be a little disturbed in dealing with other people when there is a disturbance in their eyes which results in the client being embarrassed to connect with other people.
- Usually clients with glaucoma will experience a slight disruption in carrying out their roles
- Coping - Stress Tolerance
- Describe the ability to deal with stress and use a support system
- Ask if there have been major changes in life in recent months
- Ask what the client is doing in the face of the problem at hand, is it effective?
- Do clients like to share problems / confide in family / other people
- Ask whether the client is a person who is relaxed or easily panic
- Also ask whether the client is using drugs in the face of stress
- Usually clients with glaucoma will be a little stressed out with their illness because this is related to the concept of themselves where clients experience diseases that interfere with their visual organs.
- Reproductive Patterns / Se.uality
- What is the client's se.ual life, whether active / passive
- If a female client reviews her menstrual cycle
- Usually clients do not experience too much interference with reproductive patterns of se.uality. However, the outpouring of love in the family will be disrupted when family members do not accept one of them who has eye disease.
- Value - Beliefs
- Describing spirituality, values, systems of belief and purpose in life
- Review client goals, ideals and plans in the future.
- Does religion influence, is religion important in life
- Clients will experience interference when carrying out daily worship activities because clients experience eye pain and headaches that will interfere with their worship.
