Rajiv Gandhi University of Health Sciences s95
Ms. KUMARI SHEELA
1STYEAR MSc NURSING
MEDICAL AND
SURGICAL NURSING
2012-2014
SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B.H.ROAD,
TUMKUR-572102
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Ms. KUMARI SHEELAI YEAR M.SC.NURSING
SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B.H.ROAD, TUMKUR-572 102
2 / NAME OF THE INSTITUTION / SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B.H.ROAD, TUMKUR.-572 102.
3 / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
MEDICAL AND SURGICAL NURSING
4 / DATE OF ADMISSION / 10-07-2012
5 / STATEMENT OF THE PROBLEM / ‘A STUDY TO ASSESS THE KNOWLEDGE REGARDING GLAUCOMA AND ITS MANAGEMENT AMONG PATIENTS WITH GLAUCOMA IN SELECTED HOSPITALS AT TUMKUR WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET’
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
“Its coincidence that four of the six letters in health are “heal”.
-Ed north strum
Person’s orientation to the world is primarily visual. People will learn much about their environment and themselves through their eyes practically every behavior is affected by the visual sense.1
Because so much sensory information research the brain through the eyes. Eye problems and resultant visual interfere with patient’s ability to function independently, to perceive meaning in the world, to enjoy aesthetic pleasure, and to communicate. Although fewer people today lose their sight from infections, the incidence of blindness is rising.
The ability to see the world clearly can easily be taken for granted .The eye is a sensitive, highly specialized sense organ subject to various disorders, many of which lead to impaired vision. Impaired vision affects an individual’s independence in self-care, work and lifestyle choices, sense, self-esteem, safety, ability to interact with society and the environment, and overall quality of life. Many of the leading causes of visual impairment are associated with aging glaucoma and two thirds of the visually impaired population is older than 65 years of age.2
Glaucoma is a disease of the major nerve of vision, called the optic nerve. The optic nerve receives light-generated nerve impulses from the retina and transmits these to the brain, where we recognize those electrical signals as vision. If glaucoma is not diagnosed and treated, it can progress to loss of central vision and blindness. Glaucoma is usually, but not always, associated with elevated pressure in the eye. Generally, it is this elevated eye pressure that leads to damage of the eye (optic) nerve. In some cases, glaucoma may occur in the presence of normal eye pressure. This form of glaucoma is believed to be caused by poor regulation of blood flow to the optic nerve.3
Early glaucoma in adults is often vague and variable, making it hard to detect. As glaucoma disease advances, symptoms such as blurred vision or a gradual loss of peripheral vision can occur. A major risk factor for glaucoma is a family history of the disease. If a parent with glaucoma, risk of glaucoma is three to five times the average risk. If have a sibling with glaucoma, risk is seven to nine times the average risk. The incidence of glaucoma also increases with age. Other risk factors for glaucoma include previous eye injuries, exposure to steroid medications, short-sightedness, diabetes, history of migraines, and high blood pressure.4
As of 2010, there were 44.7 million people in the world with open angle glaucoma. The same year, there were 2.8 million people in the United States with open angle glaucoma. By 2020, the prevalence is projected to increase to 58.6 million worldwide and 3.4 million the United States. WHO has estimated that 4.5 million people are blind due to glaucoma.5
The modern goals of glaucoma management are to avoid glaucomatous damage and nerve damage, and preserve visual field and total quality of life for patients, with minimal side effects. This requires appropriate diagnostic techniques and follow-up examinations, and judicious selection of treatments for the individual patient. Although intraocular pressure is only one of the major risk factors for glaucoma, lowering it via various pharmaceuticals and/or surgical techniques is currently the main stay of glaucoma treatment.6
All management options have potential complications, especially surgery, which yields the best success rate. In United States, medical management is the common approach, and surgical management is the last resort.
Surgical techniques may be used to increase drainage. These techniques include using lasers (laser trabeculectomy) to treat the trabecular meshwork implanting artificial drainage valves, and surgically cutting additional passageways to drain the fluid. Risks associated with these surgical procedures include infection, cataracts, bleeding, and hypotony. Even if the surgery is initially successful, scarring may close the drainage channels at the surface layers in the course of months to years.7
The surgery will normally recommend to relieve the internal pressure. But this does not remove the cause of the excess fluid. Hence the operation does not guarantee that the trouble does not recure or will not affect the other eye. The natural treatment of the glaucoma, which is the same as that for any other condition arising from toxicity and is targeted toward preserving the remaining sight. Glaucoma cannot cure in the advanced stages but proper nutrition and other natural methods can control the problem and taking care of the remaining sight.8
The patients suffering from glaucoma want to avoid certain foodstuffs. Coffee is the main food to avoid due to its high caffeine content. Drink moderate amount of tea. Do not take excess fluids like juice, milk or water. Instead have small amounts many times with a gap of one hour. Diet should be mainly of seeds, nuts and grains, vegetables and fruits. Plenty of vitamin C-rich foods, fresh fruits and vegetables. Breakfast should consist of oranges or grapes or any other juicy fruits of the season and a small amount of nuts or seeds. Raw vegetable salad with olive oil and lemon juice dressing, two or three whole wheat chapattis and a glass of buttermilk for lunch. Steamed vegetables, butter and cottage cheese should form your dinner.9
The success of treatment for glaucoma depends on patients learning about the disease using their medicines as prescribed, and getting routine check-ups to monitor the condition and prevent complications. By doing so, patients can decrease their chance of losing their eyesight.10
An exploratory study was conducted to assess Knowledge on Glaucoma Prevention and treatment among Patients in a Public Hospital in São Paulo, Brazil. A structured questionnaire was prepared. The sample was formed by 405 patient, 72.6% female; age range 20 and 92 years, average 66.2 years old. The result shows that Out of the patients who declared they have received explanations about glaucoma’s control, 95.8% stated they know the disease well. The majority stated that glaucoma leads to blindness (89.4%), that it is “high pressure in the eye” (83.2%) and that provokes eye blurring (71.1%). Patients referred to the eye doctor specialist a source of explanations on glaucoma (49.9%). The study concluded that Patients demonstrated lack and inadequacy of knowledge in relation to glaucoma, its prevention and control. This fact suggests the need for educational actions aiming at spreading information on glaucoma among patients and the population as an attempt to prevent visual loss.11
In researcher opinion, the patients should know about what glaucoma is, how it comes about, depending upon the type of glaucoma that particular patient may have. The vast majority of cases can be controlled but not cured, and that best shot at keeping vision is to prevent further damage because it can’t reverse damage once it has occurred. At last it will cause blindness.12
. 6.2 NEED FOR THE STUDY
Glaucoma is a group of ocular conditions characterized by optic nerve damage. There is a range of pressures that have been considered “normal” but that may be associated with vision loss in some patients. Glaucoma is one of the leading causes of irreversible blindness in the world and is the leading cause of blindness among adults in the United States. It is estimated that at least 2 million Americans have glaucoma and that 5to 10 million more are at risk. Glaucoma is more prevalent among people older than 40 years of age, and the incidence increases with age. It is also more prevalent among men than women and in the African American and Asian populations.13
The Eye Foundation’s Australian and New Zealand Registry of Advanced Glaucoma (ANRAG) is a research project looking at ways to identify people at high risk of developing glaucoma so that they can be diagnosed early and treated before they start losing vision. To help find out what puts people in a high-risk category for glaucoma, the project is establishing the world’s largest registry of advanced glaucoma cases. The project team is researching DNA to identify new genes linked to glaucoma and gain a better understanding of glaucoma and its management.14
A study was conducted o estimate the prevalence of glaucoma among people worldwide. Glaucoma prevalence reviewed to determine the relation of open angle and angle closure glaucoma with age in people of European, African, and Asian origin. A comparison was made with estimated world population data for the year 2000. The number of people with primary glaucoma in the world by the year 2000 is estimated at nearly 66.8 million, with 6.7 million suffering from bilateral blindness. In developed countries, fewer than 50% of those with glaucoma are aware of their disease. In the developing world, the rate of known disease is even lower. Glaucoma is the second leading cause of vision loss in the world. Improved methods of screening and therapy for glaucoma are urgently needed.15
According to World Health, Dr. Robert beagle hole, Director of Chronic Diseases and Health Promotion in Geneva. Gathered a new statistics in 2002, show that glaucoma is now the second leading cause of blindness globally, after cataracts. WHO officials are looking into ways to address the problems caused by glaucoma which was until now estimated to be the third leading cause of blindness. 16
WHO has estimated that 4.5 million people are blind due to glaucoma. Published projections indicate that 4.5 million people will be blind due to open-angle glaucoma and 3.9 million due to primary angle closure glaucoma in 2010. Furthermore, about 60.5 million people will have glaucoma by the year 2010 (44.7 million with open-angle glaucoma and 15.7 million with angle-closure glaucoma). Given the ageing of the world’s population, this number may increase to almost 80 million by 2020. The published projections also indicate that nearly half of the bilateral blindness attributable to glaucoma by 2020 will be caused by angle-closure glaucoma (11.2 million people).17
The prevalence of glaucoma has been reported by the Vellore Eye Survey, Andhra Pradesh Eye Disease Study, Aravind Comprehensive Eye Survey, Chennai Glaucoma Study, and West Bengal Glaucoma Study. There are approximately 11.2 million persons aged 40 years and older with glaucoma in India. Primary open angle glaucoma is estimated to affect 6.48 million persons. The estimated number with primary angle-closure glaucoma is 2.54 million. Those with any form of primary angle-closure disease could comprise 27.6 million persons. Most of those with disease are undetected and there exist major challenges in detecting and treating those with disease. In the light of the existing manpower and resource constraints. The evaluated options are used for improving case detection rates in the country.18
A cohort study was conducted to assess the 12-year incidence of glaucoma- related visual field loss in Italy. Primary open-angle, primary angle –closure and secondary glaucoma were diagnosed according to the 3-tier system of evidence developed by the international society, geographical and epidemiological ophthalmology. The 12-year incidence of definite PAOG was 3.8%, annual rate of 0.32%, PACG and PEX glaucoma were 0.5% 0.8%. The annual average incidence of definite PAOG in ponzas lower then that reported in persons of African ancestry and higher than that observed in certain other white populations.19
The medical and surgical management of glaucoma slows the progression of glaucoma but does not cure it. The lifelong therapeutic regimen mandates patient education for patients with severe glaucoma and impaired function, referral to services that assist the patient in performing customary activities may be needed. Reassurance and emotional support are important aspects of care. A lifelong disease involving a possible loss of sight has psychological, physical, social, and vocational ramifications.20
Generally, Glaucoma is an insidious condition. it is often without symptom and very difficult to diagnose. Because of its insidious nature, the disease does not inspire patients to urgent action to control it. Therefore, inadequate knowledge, incorrect beliefs, negative feelings and attitudes as well as poor social relationships and contacts, could inhibit treatment compliance and lead to incurable blindness.
An information booklet is one of the effective teaching strategies which consist of figures which will help to draw the attention of the clients. The contents of this information booklet depend on the results of the study. Information Booklet is not only effective for patients; it can be used by any person in the community.
In the light of above, I found it desirable to evaluate the knowledge of patients about Glaucoma and its management. The decision for selecting the topic on glaucoma for the study grew out of my clinical experience during my study period with patients who had limited awareness regarding the origin, treatment, and prevention and control measures of glaucoma. Therefore it is very clear that the patients must need to update their knowledge regarding Glaucoma and its management.
6.3 REVIEW OF LITERATURE
A descriptive study was conducted to assess the awareness and knowledge level about glaucoma and its determinants in an urban population of Chennai in south India. A total of 3850 subjects aged 40 years or above were participated in the urban. A systematic random sample of 1926 (50.0%) subjects completed a questionnaire that assessed their awareness and knowledge level of glaucoma. The result shows that 13.5% were aware of glaucoma; the age-gender adjusted rate for awareness was 13.3%. Overall 8.7% had some knowledge about glaucoma. Among those who had knowledge 0.5% had good knowledge about glaucoma, 4% had fair knowledge and 4.2% had poor knowledge. Awareness and knowledge about glaucoma was very low among the urban population of Chennai. The study concluded that younger subjects and men were less aware of glaucoma. The study findings stress the need for health education for effective prevention of blindness due to glaucoma.21