Dan Easton

Background

Glaucoma is a group of degenerative eye diseases with various causes that leads to progressive optic neuropathy, in which the optic nerve is damaged by high intraocular pressure (IOP), resulting in blindness. Glaucoma is a leading cause of visual impairment and the second leading cause of blindness in the United States; it occurs more often in those over 40, with an increased incidence with age (3% to 4% in those over age 70) (Fingeret, 2010; Kennedy-Malone et al., 2000; Podolsky, 1998).

Risk factors

Unlike cataracts, there are some ethnic distinctions with the development of glaucoma. African Americans tend to develop it earlier than Caucasians, and females more often than males. Glaucoma is more common in African Americans, adults over age 60 (especially Mexican Americans), and people with a family history (NIH, 2013). Other contributing factors include eye trauma, small cornea, small anterior chamber, cataracts, and some medications.

Signs and symptoms

Although the cause is unknown, glaucoma results from blockage that limits the flow of aqueous humor, causing a rise in intraocular pressure (IOP). Two major types are noted here: acute and chronic. Acute glaucoma is also called closed angle or narrow angle. Signs and symptoms include severe eye pain in one eye, blurred vision, seeing colored halos around lights, red eye, headache, nausea, and vomiting.

Symptoms may be associated with emotional stress. Acute glaucoma is a medical emergency and persons should seek emergency help immediately. Blindness can occur from prolonged narrow angle glaucoma.

Chronic glaucoma, also called open angle or primary open angle, is more common than acute (90% of cases are this type), affecting over 2 million people in the United States. One million people probably have glaucoma and don’t know it, and 10 million people have above normal intraocular pressure that may lead to glaucoma if not treated (University of Washington, Department of Ophthalmology, 2008). This type of glaucoma occurs gradually. Peripheral vision is slowly impaired. Signs and symptoms include tired eyes, headaches, misty vision, seeing halos around lights, and worse symptoms in the morning. Glaucoma often involves only one eye, but may occur in both.

Treatment

Since there is no scientific evidence of preventative strategies, early detection in those at risk is important. Treatment is essential to prevent loss of vision, because once vision has been lost to glaucoma, it cannot be restored. Diagnosis is made using a tonometer to measure IOP. Normal IOP is 10–21 mm Hg. Ophthalmologic examination will reveal changes in the color and contour of the optic nerve when glaucoma is present. Gonioscopy (direct exam), which is performed by an optometrist or ophthalmologist, provides another means of evaluation. Older persons and those at higher risk should have a yearly eye exam to screen for glaucoma.

Treatment is aimed at reducing IOP. Medications to decrease pressure may be given, and surgical iridectomy to lower the IOP may prevent future episodes of acute glaucoma. In chronic glaucoma, there is no cure, so treatment is aimed at managing IOP through medication and eye drops. Consistent use of and correct administration of eye drops is important. Older adults should be assessed for safety related to visual changes and also reminded to schedule and attend regular visits with their ophthalmologist.

Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L.
Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.

Glaucoma Symptoms

Many people become caregivers with little or no warning. Unless this happens to be your field of expertise then you will not be ready for the challenges which will lie ahead and how best to deal with them. Even if this is something that you have trained to do and are happy to dedicate your life to caring for others there are some basic things which should always be avoided:

1.      Stealing

This is probably the most obvious statement to make but it is essential to remember that this is one of the biggest fears of many older people. You not only need to not steal, you should also be aware of any situations that might leave you either open to temptation or open to an accusation of stealing.

2.      Texting and web posting

Mobile phones are everywhere and you will probably have one with you whilst you are performing your caring duties. However, when you are providing care your focus should be on your patient and not on the latest web posting. The phone should only be used in times of emergency; otherwise leave it alone and focus on your patient.

3.      Services outside the contract

The more you care for a client the more you will become attached to them and this can then lead to ethical problems.  You may wish to help them and are happy to provide additional services for free. It is vital for your professional career to ensure that anything over the original contract is agreed in writing and signed off.

4.      Making decisions for the client

Your client is still a person and should be involved in any decision concerning his or her well-being or healthcare requirements. You should never leave them out of the loop when faced with a decision. It may be preferable to limit their choices in order to make it easier for them to make a choice, but you should never rush them to make a decision. You are on their time and they will probably not be worrying about time. It is also essential to accept their decision if your client says no to something you know they should have, such as medication. You will simply need to try a different approach later or speak to your manager concerning it.

5.      Shaming

It is quite possible that as your client ages they will ask you to help them with something more personal. This request may shock you or make you feel uncomfortable. It will probably have been very hard for them to ask you to assist with something that they used to do independently. Always keep a neutral, professional approach.

6.      Stubbornness

It can be tempting to refuse to do something that you do not consider to be your job or that you are not comfortable with. A good caregiver will not be stubborn, but will demonstrate to the client that she is flexible in her approach. This will help you to build a good level of communication, which is essential to providing good care and to learning from any mistakes. Additionally, you will build a relationship with your client which will make your life and theirs easier.

7.      Not respecting boundaries

Your client will have expectations of what service you are offering and what they expect you to do. You should also have an idea of your role and what behavior and tasks are appropriate and what is not. It is important to define these boundaries and to maintain your boundary even if your client wants more. You need to know what you can do and what you cannot do; this will ensure you provide the best care possible.

By Edward Francis and Foresthc.com!