LESSON PLAN ON GLAUCOMA

Programme Course Topic Group No of students Venue Date Duration Method of teaching Av aids

: Bsc(N) : Medical Surgical Nursing : GLAUCOMA : Bsc(N) III year : 50 : Lecture hall- 5 : 13/11/2010 : 1 hrs : Lecture cum discussion : black board, OHP, Chart. : Radhika.A.B.

Name of the student teacher

Central objectives: At the end of the class the students will be able to gain in-depth knowledge on Glaucoma & develop desirable skill & attitude while taking care of Glaucoma patients Contributory objectives: At the end of the class the students will be Define Glaucoma Discuss the incidence of Glaucoma List down the types of Glaucoma Enumerate the causes of Glaucoma Describe the pathophysiology of Glaucoma. Explain the clinical manifestation of Glaucoma Identify the diagnostic investigation of Glaucoma Elaborate the management of Glaucoma.

SL N O

TIME

SPECIFIC OBJECTIVE

CONTENT

TEACHERS ACTIVITY Writes the topic on the black board. & Introduces the topic by narration.

LEARNERS ACTIVITY Listens

AV.AID S Black board

EVALUATION

GLAUCOMA
1 5min

What is Glaucoma ?

- introduce the topic Glaucoma and Its incidence

Introduction Glaucoma is optic nerve damage (often, but not always, associated with increased eye pressure) that leads to progressive, irreversible loss of vision.

Incidence Almost 3 million people in the United States and 14 to the students. million people worldwide have glaucoma. Glaucoma is the third leading cause of blindness worldwide and the second leading cause of blindness in the United States, where it is the leading cause of blindness among blacks and Hispanics. - enumerate the types of glaucoma . Types of glaucoma There are many forms of adult and childhood glaucomas. Most glaucomas fall into two categories: open-angle or closedangle glaucomas.

Explains the classification of glaucoma by using OHP

Listening & Notes taking

OHP

What are the classification of glaucoma?

5min

Open-angle glaucoma is more common. In open-angle glaucoma, the drainage canals in the eyes become clogged gradually over months or years. Pressure in the eye rises slowly because fluid is produced at a normal rate but drains sluggishly. Closed-angle glaucoma is less common than open-angle glaucoma. In closed-angle glaucoma, the drainage canals in the eyes become blocked or covered because the angle between the iris and cornea is too narrow. The blockage
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can occur suddenly or slowly. If the blockage occurs suddenly, pressure in the eye rises rapidly. If the blockage occurs slowly, the pressure in the eye rises slowly like in open-angle glaucoma. -To explain in
5min

Causes detail In most people, the cause of glaucoma is not known, although both open-angle and closed-angle glaucomas Regarding the tend to run in families. Cause and risk In others, damage to the eye caused by infection, inflammation, factor of tumor, glaucoma large cataracts or surgery for cataracts, or other conditions keeps the fluid from draining freely and leads to increased eye pressure and optic nerve damage (secondary glaucoma). People at highest risk are those with any of the following:

Explains the cause and risk factors of glaucoma

Listening and taking notes.

Blackbo ard.

What are the causes of glaucoma?

Age older than 40 African-American race Family members who have (or had) the disease Farsightedness or nearsightedness Diabetes Long-term use of corticosteroid drugs Previous eye injury

5min

-To describe in Pathophysiology In glaucoma, the drainage canals become clogged, blocked, or detail about covered. Fluid cannot leave the eye even though new fluid is pathophysiolo being produced in the posterior chamber. In other words, the sink backs up while the faucet is still running. Because there is gy of nowhere in the eye for the fluid to go, pressure in the eye
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Explains the pathophysiolo gy of

Listens and discusses

OHP

Explain in detail about The

glaucoma

increases. When the pressure becomes higher than the optic nerve can tolerate, damage to the optic nerve occurs. This damage is called glaucoma. Sometimes eye pressure increases within the range of normal but is nonetheless too high for the optic nerve to tolerate (called low tension glaucoma). Anatomical narrowing of anterior chamber Blockage of acquios humor Accumulation of acquios humor Increased intra ocular pressure Damage to the optic nerve Blindness

glaucoma

pathophysiol ogy of Glaucoma?

-To explain in
5min

Signs and Symptoms Open-Angle Glaucoma: detail about signs and Open-angle glaucoma is painless and causes no early symptoms of symptoms. The most important symptom of open-angle glaucoma. glaucoma is the development of blind spots, or patches of vision loss, over months to years. The blind spots slowly grow larger and coalesce.
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Explains the signs and symptoms of glaucoma

Listens and takes notes.

Chart

What are signs and symptoms of Glaucoma

 Peripheral vision is usually lost first. Vision loss occurs so gradually that it is often not noticed until much of it is lost. Because central vision is generally lost last, many people develop tunnel vision: they see straight ahead perfectly but become blind in all other directions. If glaucoma is left untreated, eventually even tunnel vision is lost, and a person Closed-Angle Glaucoma: If eye pressure rises rapidly in closed-angle glaucoma (acute closed-angle glaucoma), people typically notice an abrupt onset of severe eye pain and headache, redness, blurred vision, rainbow-colored halos around lights, and sudden loss of vision. They may also have nausea and vomiting as a response to the increase in eye pressure. Acute closed-angle glaucoma is considered a medical emergency, because people can lose their vision as quickly as 2 to 3 hours after the appearance of symptoms if the condition is not treated. People who have had open-angle or closed-angle glaucoma in one eye are likely to develop it in the other. -To enumerate Screening and Diagnosis
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In detail about
5min

Diagnosis of Glaucoma.

Because the most common types of glaucoma can cause slow and silent loss of vision over years, early detection of the disease is extremely important. All people at high risk of glaucoma should have a comprehensive eye examination every 1 to 2 years.

Explains the investigation technique for glaucoma .

Listens and discusses

Black board

What are the diagnostic measures of Glaucoma?

There are four parts to a comprehensive eye examination for glaucoma. First, pressure in the eye is measured. This measurement is taken painlessly with an instrument called a tonometer . In general, eye pressure readings of greater than 20 to 22 millimeters of mercury (mm Hg) are considered higher than normal. But measuring eye pressure is not enough, because a third or more of people with glaucoma have eye pressure in the average range. So doctors also use an ophthalmoscope and a slit lamp to look for changes in the optic nerve that indicate damage caused by glaucoma In addition, visual field (peripheral vision) testing allows a doctor to detect blind spots. Most often, visual field testing is done with a machine that determines the person's ability to see small dots of light in all areas of the visual field. Finally, doctors may also use a special lens to examine the drainage channels in the eye, a procedure known as gonioscopy. The gonioscope allows the doctor to determine whether the glaucoma is of the open-angle or closed-angle type. -To discuss in Treatment
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detail about
15min

the treatment modalities of glaucoma.

Once a person loses vision because of glaucoma, the loss is permanent. But if glaucoma is detected, proper treatment can prevent further vision loss. So the goal of glaucoma treatment is to prevent the onset of vision loss or stop its progression. Treatment of glaucoma is lifelong. It involves decreasing eye pressure by increasing fluid drainage out of the eyeball or by reducing the amount of fluid produced inside the eyeball. Some people with high eye pressure who do not have signs of optic nerve damage (known as glaucoma suspects) can be monitored closely without treatment. Eye drops and surgery are the main treatments for openangle and closed-angle glaucomas. Eye drops containing beta-blockers, prostaglandin-like compounds, alpha-adrenergic agonists, carbonic anhydrase inhibitors, or cholinergic drugs are commonly used to treat glaucoma. Most people with open-angle glaucoma respond well to these drugs. These drugs are also used for people with closed-angle glaucoma, although surgery, not eye drops, is the main treatment. Glaucoma eye drops are generally safe, but they may cause a variety of side effects. People need to use them for the rest of their lives, and regular check-ups are necessary to monitor eye pressure, optic nerves, and visual fields. Sometimes a kind of diuretic (osmotic diuretic) given by mouth or by vein is also used briefly to help decrease eye pressure rapidly in acute closed-angle glaucoma.
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Explains

Listens Notes taking.

chart

Explain the treatment modalities of Glaucoma.

Surgery may be needed if eye drops cannot effectively control eye pressure, if a person cannot take eye drops, or if people develop intolerable side effects from the eye drops. Laser surgery can be used to increase drainage in people with open-angle glaucoma (laser trabeculoplasty) or to make an opening in the iris (laser peripheral iridectomy or iridotomy) in people with acute closed-angle glaucoma. Laser surgery is done in the doctor's office or in a hospital or clinic. Anesthetic eye drops are used to prevent pain. People are usually able to go home the same day of any of these surgical procedures. Glaucoma filtration surgery is the other form of surgery doctors use to treat glaucoma. With traditional glaucoma filtration surgery, doctors manually create a new drainage system (trabeculectomy or tube shunt) to allow fluid to bypass the clogged or blocked canals and filter out of the eye. Glaucoma filtration surgery is generally performed in a hospital. Newer filtration procedures (viscocanalostomy and Trabectome) remove only part of the drain to enhance the outflow of fluid. People are usually able to return home the day of the procedure.

The most common complication of glaucoma laser surgery is a temporary increase in eye pressure, which is treated with glaucoma eye drops.
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Rarely, the laser used in laser surgery may burn the cornea, but these burns usually heal quickly. With laser and glaucoma filtration surgery, inflammation and bleeding within the eye may occur but are usually short-lived. Glaucoma filtration surgery may occasionally lead to double vision, cataracts, or infection. Because severe closed-angle glaucoma is a medical emergency, doctors may use very strong and fast-acting drugs that affect the eye pressure more rapidly than the standard eye drops or surgery. Doctors may use glycerin or acetazolamide or DIAMOX pills or drugs given by vein (such as mannitol) if they think the eye is vulnerable to high pressure. Eye drops are also given as soon as possible. Emergency surgery is performed if necessary. The treatment of glaucoma caused by other disorders depends on the cause. For infection or inflammation, antibiotic, antiviral, or corticosteroid eye drops may provide a cure. A tumor obstructing fluid drainage should be treated, as should a cataract that is so large it causes eye pressure to rise. High eye pressure that results from cataract surgery is treated with glaucoma eye drops that reduce eye pressure. If eye drops do not work, glaucoma filtration surgery can be performed.

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Drugs Used to Treat Glaucoma

Drug Selected Side Effects Comments

Beta-blockers Betaxolol Shortness of breath in people with asthma or other lung disorders that cause wheezing Slow heart beat Prostaglandin-like compounds Bimatopr ost Lumigan Increased eye and skin pigmentation Elongated and thickened eyelashes Muscle, joint, and back pain How they work: Increase aqueous humor outflow Given as: Eye drops How they work: Decrease aqueous humor production Given as: Eye drop

KERLO NE

Alpha-adrenergic agonists Apraclon idine Iopidine Increase in blood pressure or heart rate Abnormal heart rhythm How they work: Decrease aqueous humor production and increase aqueous humor outflow

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Carbonic anhydrase inhibitors Acetazola mide Diamox Acetazolamide Diamox and methazolamide: Fatigue Altered taste Loss of appetite How they work: Decrease aqueous humor production Given as: Acetazolamide Diamox

Cholinergic drugs Carbacho l Miostat Hinder the eyes' ability to adapt to darkness Pupil constriction How they work: Increase aqueous humor outflow Given as: Eye drops

Osmotic diuretics Glycerin Mannitol Increase urine production Can cause serious effects in some people (for example, dysfunction of the brain or nerves) by changing body salt (electrolyte) levels or may cause dehydration How they work: Increase concentration of salts in the blood, which draws fluid from the eye by osmosis Given: By mouth or by vein

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5min

NURSING MANAGEMENT OF GLAUCOMA Administer medicine in time Take precaution before administering medication Assist the patient in daily living activities. SUMMARY

3min

Glaucoma is optic nerve damage (often, but not always, associated with increased eye pressure) that leads to progressive, irreversible loss of vision. Almost 3 million people in the United States and 14 million people worldwide have glaucoma. Glaucoma is the third leading cause of blindness worldwide and the second leading cause of blindness in the United States, where it is the leading cause of blindness among blacks and Hispanics. 2min

CONCLUSION At the end of the class the student have gain knowledge about pre eclampsia and its types, risk factors,clinical features, diagnosis, and its management. EVALUATION Short answer question 5 x 3 = 15. 1) Glaucoma 2) Management of patient with glaucoma. 3) Treatment and nursing management of glaucoma.

3min

2min

ASSIGNMENT Write an assignment on ophthalmic medication BIBLIOGRAPHY

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1. Students bibliography Brunner and suddarths, TEXT BOOK OF MEDICAL SURGICAL NURSING, 10TH edition, Lippincott Williams and Wilkins. Lippincott, MANNUAL OF NURSING PRACTICE, 8th edition, Lippincott Williams and Willkins.

2. Teachers bibliography Brunner and suddarths, TEXT BOOK OF MEDICAL SURGICAL NURSING, 10TH edition, Lippincott Williams and Wilkins. Lippincott, MANNUAL OF NURSING PRACTICE, 8th edition, Lippincott Williams and Willkins. Long & Phipps -Medical Surgical Nursing Luckman &Sorenson -Medical Surgical Nursing

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