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GLAUCOMA |
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青光眼 |
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Definition |
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說明 |
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Glaucoma is a disorder characterized by increased intraocular pressure (IOP) that ultimately damages the optic nerve, leading to visual field loss. Glaucoma may occur congenitally, as a primary disease, or secondary to other ocular or systemic conditions. |
青光眼的特征是眼內(nèi)壓增高，最終損壞視神經(jīng)，導(dǎo)致視野喪失。青光眼可以是先天性的，即原發(fā)性青光眼，也可以由其他眼科或系統(tǒng)性疾病引起。 | |
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Pathophysiology |
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Increased IOP results from a decrease in aqueous humor outflow and in some cases may be related to an increase in production of aqueous humor. The outflow of aqueous humor can be decreased by several mechanisms. |
眼房水流出減少造成眼內(nèi)壓增高，有的則與房水增多有關(guān)。引起房水外流減少的原因有下列幾種。 | |
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l In open-angle or chronic glaucoma, decreased aqueous outflow is probably caused by increased resistance to outflow in the trabecular meshwork. The increased pressure affects nerve tissue of the optic disc, causing ischemia, and the patient begins to lose peripheral vision. |
在開角或慢性青光眼中，房水外流減少很可能是由小梁網(wǎng)外流阻力增加引起的，壓力增加影響視神經(jīng)乳頭的神經(jīng)組織，造成局部缺血，病人漸漸失去周邊視覺。 | |
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l In closed-angle, or narrow-angle glaucoma, the iridocorneal angle closes, blocking aqueous outflow. This change may occur with normal lens enlargement throughout life and can be acute, subacute, or chronic. |
在閉角或狹角性青光眼中，前房角閉合，阻斷房水外流。它是由正常晶體增大引起，有急性，有亞急性或慢性。 | |
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l In secondary glaucoma, increased IOP results from other ocular or systemic conditions that may block outflow channels in some way such as the inflammatory process. |
在繼發(fā)性青光眼中，某些眼科或系統(tǒng)性疾病造成眼內(nèi)壓增高，某種程度地阻塞了房水外流通道，如炎癥等。 | |
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Clinical Manifestations |
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臨床表現(xiàn) |
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l Open-angle (chronic) glaucoma develops slowly with symptoms of pain or pressure, usually noticed when peripheral vision is severely compromised (tunnel vision). |
開角（慢性)青光眼發(fā)展緩慢，伴有疼痛或壓迫感，通常在周邊視覺嚴(yán)重受損（視野收縮)時(shí)才會(huì)注意到。 醫(yī)學(xué) 全在.線提供 | |
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l Acute angle-closure glaucoma causes definite symptoms of sudden excruciating pain in or around the eye and can be accompanied by nausea and vomiting. Visual symptoms include seeing colored halos around lights, blurred vision, and ocular redness. |
急性閉角型青光眼的明顯癥狀為眼內(nèi)或眼睛周圍突然極痛，并伴有惡心和嘔吐。視覺癥狀包括看燈光時(shí)出現(xiàn)色圈、視力模糊及眼睛紅腫。 | |
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The acute pressure rise may also cause corneal edema, giving the cornea a steamy appearance. |
眼壓急性升高也可以引起角膜水腫，使角膜呈現(xiàn)出篜汽樣外觀。 | |
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l Manifestations of subacute or chronic angle-closure glaucoma appear gradually. The patient who has had a previously unrecognized episode of subacute angle-closure glaucoma may report a history of blurred vision, colored halos around lights, ocular redness, or eye or brow pain. |
亞急性或慢性閉角性青光眼癥狀出現(xiàn)緩慢，有未確認(rèn)性亞急性閉角青光眼發(fā)作史的病人通常會(huì)有視力模糊、燈光色圈、眼睛紅腫，或眼睛、眉毛 疼痛等。 | |
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Diagnostic Studies |
診斷檢查 | |
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l IOP with tonometry |
眼壓計(jì)測(cè)量眼內(nèi)壓 | |
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l Visual acuity measurement and visual field perimetry |
視敏度檢查、視野檢查 | |
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l Slit-lamp microscopy: in open-angle glaucoma, reveals a normal angle; in angle-closure glaucoma, reveals markedly narrow or flat anterior chamber angle, edematous cornea, and a fixed, moderately dilated pupil |
裂隙燈鏡檢：開角青光眼顯示為正常角；閉角青光眼顯示為前房角的明顯狹窄或扁平狀、角膜水腫、瞳孔固定或中度散大 | |
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l Ophthalmoscopy (direct and indirect) for optic disc cupping |
視神經(jīng)乳頭檢眼鏡檢查 | |
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Therapeutic Management 醫(yī).學(xué) 全,在.線,提供www.med126.com |
治療 | |
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If not recognized and treated, glaucoma may cause blindness that could have been prevented in most patients. The primary focus of therapy is to keep the IOP low enough to prevent the patient from developing optic nerve damage. Specific therapies vary with the type of glaucoma. |
多數(shù)青光眼病人是可以治療的， 但是，如果沒有及時(shí)識(shí)別和治療，青光眼也可以致盲。治療的基本點(diǎn)是使眼內(nèi)壓保持較低水平，防止視神經(jīng)損壞。根據(jù)青光眼類型可以采取不同的具體療法。 | |
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l In open-angle (chronic) glaucoma, initial pharmacologic management can include β-adrenergic receptor blocking agents, adrenergic agents, cholinergic agents (miotics), and carbonic anhydrase inhibitors. |
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治療開角（慢性)青光眼的初始藥物包括β－腎上腺素能受體阻斷劑、腎上腺素能藥、膽堿能藥（縮瞳藥)和碳酸酐酶抑制劑。 |
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l Surgical management may include argon laser trabeculoplasty, trabeculectomy, cyclocryotherapy, and Molteno implant. |
外科手術(shù)包括氬激光小梁成形術(shù)、小梁切除術(shù)、睫狀體冷凍療法、Molteno植入法。 | |
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l Acute angle-closure glaucoma is an ocular emergency that requires immediate management, including topical cholinergic and hyperosmotic agents with laser peripheral iridotomy or surgery iridectomy. |
急性閉角青光眼屬于眼科急診，需要立即進(jìn)行治療，包括膽堿能和局部用藥，配合激光周邊虹膜切開術(shù)或手術(shù)虹膜切除術(shù)。 | |
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l Secondary glaucoma is managed by treating the underlying problem and using antiglaucoma drugs. |
繼發(fā)性青光眼可以通過治療潛在疾病及用抗青光眼藥物進(jìn)行治療。 | |
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Nursing Management |
護(hù)理 | |
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Nursing management needs to focus on the chronicity of the disease and preventing visual impairment. |
護(hù)理重點(diǎn)是疾病的長(zhǎng)期性和防止視力受損。 | |
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Goals |
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目標(biāo) |
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l The patient with glaucoma will have no progression of visual impairment, understand the disease process and therapeutic rationale, comply with all aspects of therapy (including medication administration and follow-up care), and have no postoperative complications. |
青光眼病人視力損傷不再加劇，了解疾病過程和治療原理，順應(yīng)治療（包括給藥和隨訪護(hù)理)，無術(shù)后并發(fā)癥。 | |
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Nursing Diagnoses |
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護(hù)理診斷 |
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Risk for noncompliance related to the inconvenience and side effects of glaucoma medications |
有不順應(yīng)危險(xiǎn) 與不便和青光眼藥物副作用有關(guān) | |
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Risk for injury related to visual acuity deficits |
有受傷危險(xiǎn) 與視敏度缺陷有關(guān) | |
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Risk for self-care deficits related to visual acuity deficits |
自我護(hù)理缺乏 與視敏度缺陷有關(guān) | |
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Pain related to pathophysiologic process and surgical correction |
疼痛 與病理生理過程和手術(shù)矯治有關(guān) | |
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Nursing Interventions |
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護(hù)理措施 |
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The patient with acute angle-closure glaucoma requires immediate medication to lower the IOP. This patient may also be uncomfortable, and nursing comfort interventions may include darkening the environment, applying cool compresses to the patient's forehead, and providing a quiet and private space. |
急性閉角青光眼病人必須立即應(yīng)用藥物降低眼內(nèi)壓。病人也可能很不舒服，應(yīng)對(duì)病人進(jìn)行安慰，包括弄暗環(huán)境，前額冷敷，提供安靜的私密空間。 | |
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l Most surgical procedures for glaucoma are done on an outpatient basis. The patient needs postoperative instructions and nursing comfort measures to relieve discomfort. |
多數(shù)青光眼手術(shù)是在門診進(jìn)行的，病人需要有術(shù)后指導(dǎo)和進(jìn)行護(hù)理安慰，減輕不適。 | |
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l The patient with glaucoma needs encouragement to follow therapy recommendations, including information about the disease processes, normal course of the condition, and treatment options, including the rationale underlying each option. |
應(yīng)鼓勵(lì)青光眼病人遵守治療建議，包括疾病過程信息，正常病程和治療方案及其原理。 | |
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Patient Teaching |
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病人宣教 |
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l It is important to educate the patient and family about the risk of glaucoma. In addition, stress the importance of early detection and treatment in preventing visual impairment. |
對(duì)病人及其家屬進(jìn)行青光眼危險(xiǎn)教育很重要，還要強(qiáng)調(diào)早期發(fā)現(xiàn)和治療對(duì)防止視力受損的重要性。 | |
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l The patient should know that the incidence of glaucoma increases with age and that a comprehensive ophthalmic examination is invaluable in identifying persons with glaucoma or at risk for developing glaucoma. |
病人應(yīng)該知道青光眼發(fā)病率是隨著年齡增長(zhǎng)面而增加的，全面的眼科檢查對(duì)發(fā)現(xiàn)青光眼病人或有青光眼危險(xiǎn)的病人非常有價(jià)值。 | |
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l The patient with glaucoma needs information about prescribed antiglaucoma agents. |
青光眼病人需要了解抗青光眼處方藥相關(guān)信息。 |
