Nanda - Nursing Care Plan

Nursing Diagnosis and Intervention for Glaucoma


Nursing Care Plan for Glaucoma

1. Chronic Pain
related to an increase in intra-ocular pressure (IOP)
characterized by: nausea and vomiting.
Goal: Pain is lost or reduced
Expected outcomes:
  • demonstrate knowledge of assessment and how to control the pain.
  • patients say the pain is reduced / lost
  • relaxed facial expression

Intervention:
  • Assess the type and location of pain intensity.
  • Assess the level of pain scale to determine the analgesic dose.
  • Encourage rest in bed in a quiet room.
  • Set Fowler position 30 degrees or in a comfortable position.
  • Avoid nausea, vomiting, as this will increase the IOP.
  • Divert attention to the things that are fun.
  • Give analgesics as directed.

2. Impaired sensory perception: visual
related to interference admission; disorders organ status
characterized by: progressive visual field loss.
Goal: The use of optimum vision.
Expected outcomes:
  • Patients will participate in a treatment program.
  • Patients will maintain visual acuity field without further loss.

Intervention:
  • Make sure the degree / type of vision loss.
  • Encourage express feelings about losing / possible loss of vision.
  • Indicate giving eye drops, instance count drops, follow the schedule, not one dose.
  • Take action to help the patient deal with limited vision, for example, reduce clutter, arrange furniture, turning the head to remind the subject looks, fix dim light and night vision problems.
  • Collaboration drugs in accordance with indications.

3. Anxiety
related to physiological factors, changes in health status, presence of pain, the possibility / reality of vision loss
characterized by fear, doubt, expressed concerns about changes in life events.
Goal: lost or reduced anxiety
Expected outcomes:
  • Patients seemed relaxed and report anxiety levels decreased to overcome.
  • Patients demonstrated problem-solving skills.
  • Patients using resources effectively

Intervention:
  • Assess the level of anxiety, the degree of experience of pain / symptoms develop suddenly and the current state of knowledge.
  • Provide accurate information and honest. Discuss the possibility that monitoring and treatment to prevent additional vision loss.
  • Encourage the patient to recognize the problem and expressing feelings.
  • Identify sources / people who helped.
4. Knowledge Deficit (learning need) regarding condition, prognosis, and treatment
related to low exposure / do not know the source, less given, one interpretation
characterized by: a question, a statement misperception, not follow instructions accurately, a complication that can be prevented.
Goal: The client knows about the condition, prognosis and treatment.
Expected outcomes:
  • The patient expressed understanding of the condition, prognosis, and treatment.
  • Identify the relationship between symptoms / signs with the disease process.
  • Perform the procedure correctly and explain the reason for the action.

Intervention:
  • Discuss the need to use identification.
  • Indicate the correct techniques ophthalmic administration.
  • Allow the patient to repeat the action.
  • Assess the importance of maintaining a medication schedule, eg eye drops. Discuss medications that should be avoided.
  • Identify side effects / adverse reactions from treatment (decreased appetite, nausea / vomiting, weakness,
  • irregular heart etc..
  • Encourage patients to make necessary changes in lifestyle.
  • Push avoid activities such as heavy lifting / pushing, wearing a tight and narrow.
  • Discuss considerations diet, adequate fluids and canola.
  • Emphasize routine inspection.
  • Encourage family members to check regularly sign of glaucoma.