Cataracts

Cataracts 150 150 Tony Guo

Cataracts

 

  • Opacity within the lens
    • May occur in one or both eyes
  • Cataract removal is most common surgical procedure in United States

 

Etiology and Pathophysiology

  • Influencing factors
    • Age 
    • Blunt trauma
    • Congenital factors
    • Radiation/UV light exposure
    • Long-term corticosteroid use
    • Ocular inflammation

 

  • Clinical manifestation
    • Decrease in vision
    • Abnormal color perception
    • Glaring of vision
  • Nursing Diagnostics
    • History and physical examination
    • Visual acuity measurement
    • Ophthalmoscopy
    • Slit lamp microscope
    • Glare testing

 

Interprofessional care

  • Nonsurgical therapy
    • Visual aids
      • Changing eyewear prescription
      • Reading glasses
      • Magnifiers 
      • Increased lighting
  • Surgical therapy
    • Preoperative phase
      • History and physical assessment
      • Eye drops
      • Nonsteroidal anti-inflammatory 
      • Dilating
      • Dark glasses minimize photophobia
      • Monitor for systemic toxicity
    • Intraoperative phase
      • Cataract extraction is an intraocular procedure
      • An operating microscope is used
    • Phacoemulsification
      • Most common form of cataract surgery
      • Ultrasonic vibrations dissolve lens into fragments that are suctioned out
      • Sutures are not usually required
    • Extracapsular cataract extraction procedure
      • Used for advanced cataracts
      • Entire cataract is removed
      • Sutures are required
      • Recovery is often slower
  • Implementation of intraocular lens
  • Almost all patients have an intraocular lens (IOL) implanted at the time of cataract extraction surgery. 
  • The lens of choice is a posterior chamber lens that is implanted in the capsular bag behind the iris. 
  • Antibiotics and corticosteroids may be administered after surgery.
  • Postoperative phase
    • Outpatient procedure unless complications occur
    • Antibiotic and corticosteroid eye drops
    • Limiting activities
    • Follow-up visits

 

Nursing assessment

  • Visual acuity 
  • Psychosocial impact of visual disability
  • Level of knowledge of disease
  • Comfort and ability to comply with postoperative treatment

Nursing diagnosis 

  • Self-care deficits related to visual deficit
  • Anxiety related to lack of knowledge about the surgical and postoperative experience

Planning

  • Preoperative goals
    • Make informed decisions regarding therapeutic options
    • Experience minimal anxiety
  • Postoperative goals
    • Understand and comply with postoperative therapy
    • Maintain level of comfort
    • Remain free of infection and other complications

Implementation

  • Health Promotion
    • Wear sunglasses
    • Avoid unnecessary radiation
    • Ensure adequate antioxidant vitamins (e.g., vitamins C and E)
    • Ensure good nutrition
  • Acute Care
    • Teach about disease process and treatment options
    • Administer medication
    • Inform those with patch that they will not have depth perception
    • Teach signs and symptoms of infection
  • Ambulatory Care
    • Activity restrictions
    • Medications
    • Follow-up visits
    • Signs and symptoms of possible complications

Evaluation

  • Have improved vision
  • Be better able to take care of self
  • Have minimal to no pain
  • Be optimistic about expected outcomes

Gerontologic considerations

  • Tend to the special needs of the older adult
    • Sensitivity to self-esteem
    • Promote independence
    • Provide support and encouragement
    • Address safety issues

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