Nursing_Care_Patient_Eastern_Prognosis.ppt

It contains details of various different types of diseases and its pRognosis. Some relevant case studies are also highlighted to further the ongoing researches in COmmunity Medicine

1. NURSING CARE OF A PATIENT WITH CATARACT
PRESENTED BY
NASALLAH ABUBAKAR
MSc. Nursing (UNN), BNSc. (ABU), RNT,
Regtd.Ophthalmic Nurse, RN.
ATTHE
NONA ANNUAL SCIENTIFIC CONFERENCE
HELD AT GOMBE
2NDOCTOBER, 2017

2. INTRODUCTION
•A cataract is opacity of the lens that distorts image projected
onto the retina and that can progress to blindness.
•The lens opacity reduces visual acuity. In that, the lens loses
water and increases in size and density, causing compression of lens
fibers.
•A cataract then forms as oxygen uptake is reduced, water content
decreases, calcium content increases, and soluble protein
becomes insoluble.
•Over time, compression of lens fibers causes a painless,
progressive loss of transparency that is often bilateral.
•Surgical removal of the opacified lens is the only cure for
cataracts.
•Intervention is indicated when visual acuity has been reduced to a
level that the client finds to be unacceptable or adversely
affects lifestyle.

3. OBJECTIVES
•This Paper seeks to:
•Define Cataract
•Explain the causes of Cataract
•Highlight on the clinical manifestations of
Cataract
•Briefly explain the Medical/Surgical
Management of Cataract and
•Discuss the Nursing Care of a Patient with
Cataract.

4. Definition of Cataract
•A cataract is a lens opacity or cloudiness.
•On visual inspection, the lens appears gray or
milky and it is one of the most common eye
disorders.
•According to the World Health Organization,
cataract is the leading cause of blindness in the
world.
•Almost one in five people between the ages of
65 and 74 develop cataract severe enough to
reduce vision.

5. CAUSES
Cataracts have several causes and may be:
•Age-related,themostcommon
cataract cataract).
(senile
•Present at birth (hereditary),
•Trauma (develops after a foreign body injures the
lens).
•Complicated cataracts develop as secondary effects in
patients with metabolic disorders (e.g., diabetes
mellitus),
•Radiation damage (x-ray or sunlight),
•Eye inflammationor
disease
(e.g.,
retinitispigmentosa,detachedretina,
glaucoma,
recurrent
uveitis).

6. CAUSES Cont.
•Exposure to a toxic substance e.g from drug e.g
steroids or chemical toxicity.
•Congenital cataract due to maternal infection
(e.g., German measles, mumps, hepatitis) during
the first trimester of pregnancy.
•Lifestyle. Factors that increase the risk of
cataracts include cigarette smoking, obesity, high
­
triglyceride levels in men e.t.c.
•Low socio-economic status: Recent studies have
linked cataract risk to lower income and
educational level.

7. Clinical Manifestations
•Opaque or cloudy white pupil
•Gradual loss of vision
•Blurred vision
•Decreased color perception: increasing
density of the lens tissue results in its
yellowing, and this can lead to loss of some
colour perception - objects appear more
yellow and less blue than they did.
•Vision that is better in dim light with pupil
dilation

8. Clinical Manifestations Cont.
•'Ghosting'ofimages(where one distinct
image
is seen with the shadow of another next to it) and the
patient may interpret this as 'double' vision.
•Photophobia
•Absence of the red reflex
•Glare: Glare refers to the pain felt when the
patient looks directly into the light.
•Halos: Halos are formed when the patient looks at
a bright light and there is still the vision of the
light after looking away.

9. Assessment and Diagnostic Findings
•Diagnosis is made by:
•History,
•Visual acuity test, and
•Direct ophthalmoscope or
•Slit lamp examination: Ophthalmoscope or slit
lamp examination allows detailed
visualization of anterior segment of the eye to
identify lens opacities and other eye
abnormalities.

10. Assessment and Diagnostic Findings Cont.
•Tests include:
•History and Physical Examination
•Snellen's visual acuity test:measures the
degree of visual acuity in the patient.
•Ophthalmoscope: is used to view the extent
of cataract.
•Slit-lamp biomicroscopic examination:is
used to establish the degree of cataract
formation.

11. Medical Management
•There is no medical treatment for
cataracts, although use of vitamin C and E
and beta-carotene is being investigated.
•Glasses or contact, bifocal, or magnifying
lenses may improve vision.
•Mydriatics can be used short term, but
glare is increased.
•In fact no nonsurgical treatment cures
cataracts or prevents age-related cataracts.

12. Surgical Management
•Surgical removal of the opacified lens is the only cure for
cataracts. Cataracts occur bilaterally, the more advanced
cataract is removed first.
•Extracapsular cataract extraction: the most common
procedure, removes the anterior lens capsule and cortex,
leaving the posterior capsule intact.
•A posterior chamber intraocular lens is implanted where the
patient's own lens used to be.
•Intracapsular cataract extraction: removes the entire
lens within the intact capsule.
•An intraocular lens is implanted in either the anterior or the
posterior chamber, or the visual deficit is corrected with
contact lenses or cataract glasses.

13. Surgical Management Cont.
•Phacoemulsification: has become a preferred technique.
•It involves making a small incision (2-3mm) at the
limbus into the anterior chamber, or a little further away from
the cornea, in the sclera.
•Through this, a tunnel is formed, diagonally, into the
anterior chamber.
•Next, a single continuous circular tear is made in the
anterior capsule (capsulorrhexis).
•The 'phaco' probe is then directed through the incision and
the lens nucleus is emulsified and removed from the eye by an
irrigation/aspiration technique.
•Finally, a small or foldable lens is placed in the remaining
capsular 'bag' of the lens.

14. NURSING MANAGEMENT
•Preoperative Nursing Care of the Patient
undergoing Cataract Surgery:
•The eye is a delicate and important organ, and
its care and protection are of the utmost
importance.
•The patient with cataract should receive the
usual preoperative care for ambulatory
surgical patients undergoing eye surgery.

15. medical history.
Vital signs: Stable vital signsare neededbeforethe
patient is subjected to surgery.
□
Preoperative Nursing Care of the Patient
undergoing Cataract Surgery Cont.
The nurse should assess:
□Nursing Assessment before surgery:
□Recent medication intake: It is a commonpractice to
withholdanyanticoagulanttherapyto
reduce the
risk of retro bulbar hemorrhage.
□Medicalevaluationincludesrecording
detailsof current medication and history of any
allergy.
□Preoperativetests:suchascompleteblood
count,
electrocardiogram, and urinalysis are
prescribed especiallyiftheyare
indicatedbythepatient's

16. medical history.
Vital signs: Stable vital signsare neededbeforethe
patient is subjected to surgery.
□
Preoperative Nursing Care of the Patient
undergoing Cataract Surgery Cont.
The nurse should assess:
□Nursing Assessment before surgery:
□Recent medication intake: It is a commonpractice to
withholdanyanticoagulanttherapyto
reduce the
risk of retro bulbar hemorrhage.
□Medicalevaluationincludesrecording
detailsof current medication and history of any
allergy.
□Preoperativetests:suchascompleteblood
count,
electrocardiogram, and urinalysis are
prescribed especiallyiftheyare
indicatedbythepatient's

17. medical history.
Vital signs: Stable vital signsare neededbeforethe
patient is subjected to surgery.
□
Preoperative Nursing Care of the Patient
undergoing Cataract Surgery Cont.
The nurse should assess:
□Nursing Assessment before surgery:
□Recent medication intake: It is a commonpractice to
withholdanyanticoagulanttherapyto
reduce the
risk of retro bulbar hemorrhage.
□Medicalevaluationincludesrecording
detailsof current medication and history of any
allergy.
□Preoperativetests:suchascompleteblood
count,
electrocardiogram, and urinalysis are
prescribed especiallyiftheyare
indicatedbythepatient's

18. medical history.
Vital signs: Stable vital signsare neededbeforethe
patient is subjected to surgery.
□
Preoperative Nursing Care of the Patient
undergoing Cataract Surgery Cont.
The nurse should assess:
□Nursing Assessment before surgery:
□Recent medication intake: It is a commonpractice to
withholdanyanticoagulanttherapyto
reduce the
risk of retro bulbar hemorrhage.
□Medicalevaluationincludesrecording
detailsof current medication and history of any
allergy.
□Preoperativetests:suchascompleteblood
count,
electrocardiogram, and urinalysis are
prescribed especiallyiftheyare
indicatedbythepatient's

19. medical history.
Vital signs: Stable vital signsare neededbeforethe
patient is subjected to surgery.
□
Preoperative Nursing Care of the Patient
undergoing Cataract Surgery Cont.
The nurse should assess:
□Nursing Assessment before surgery:
□Recent medication intake: It is a commonpractice to
withholdanyanticoagulanttherapyto
reduce the
risk of retro bulbar hemorrhage.
□Medicalevaluationincludesrecording
detailsof current medication and history of any
allergy.
□Preoperativetests:suchascompleteblood
count,
electrocardiogram, and urinalysis are
prescribed especiallyiftheyare
indicatedbythepatient's

20. medical history.
Vital signs: Stable vital signsare neededbeforethe
patient is subjected to surgery.
□
Preoperative Nursing Care of the Patient
undergoing Cataract Surgery Cont.
The nurse should assess:
□Nursing Assessment before surgery:
□Recent medication intake: It is a commonpractice to
withholdanyanticoagulanttherapyto
reduce the
risk of retro bulbar hemorrhage.
□Medicalevaluationincludesrecording
detailsof current medication and history of any
allergy.
□Preoperativetests:suchascompleteblood
count,
electrocardiogram, and urinalysis are
prescribed especiallyiftheyare
indicatedbythepatient's

21. medical history.
Vital signs: Stable vital signsare neededbeforethe
patient is subjected to surgery.
□
Preoperative Nursing Care of the Patient
undergoing Cataract Surgery Cont.
The nurse should assess:
□Nursing Assessment before surgery:
□Recent medication intake: It is a commonpractice to
withholdanyanticoagulanttherapyto
reduce the
risk of retro bulbar hemorrhage.
□Medicalevaluationincludesrecording
detailsof current medication and history of any
allergy.
□Preoperativetests:suchascompleteblood
count,
electrocardiogram, and urinalysis are
prescribed especiallyiftheyare
indicatedbythepatient's

22. Nursing Assessment before surgery cont.
□Preoperative
medications: Preoperatively,
Medications may include:
□Dilating
drops:
administeredevery10minutes
for four doses at least 1 hour before surgery.
prophylactically to
□Antibiotic drugs:may be
administered
prevent
postoperative infection and inflammation.
□sedation: maybeusedtominimize
anxietyand
discomfort before surgery.
□Documentation: all the preoperative care given is
recorded for future reference.

23. Nursing Assessment before surgery cont.
□Preoperative
medications: Preoperatively,
Medications may include:
□Dilating
drops:
administeredevery10minutes
for four doses at least 1 hour before surgery.
prophylactically to
□Antibiotic drugs:may be
administered
prevent
postoperative infection and inflammation.
□sedation: maybeusedtominimize
anxietyand
discomfort before surgery.
□Documentation: all the preoperative care given is
recorded for future reference.

24. Nursing Assessment before surgery cont.
□Preoperative
medications: Preoperatively,
Medications may include:
□Dilating
drops:
administeredevery10minutes
for four doses at least 1 hour before surgery.
prophylactically to
□Antibiotic drugs:may be
administered
prevent
postoperative infection and inflammation.
□sedation: maybeusedtominimize
anxietyand
discomfort before surgery.
□Documentation: all the preoperative care given is
recorded for future reference.

25. Postoperative Nursing Care of the Patient
undergoing Cataract Surgery
□ Return from Surgery:
□ The patient must be lifted off the litter; he is not to move
himself.
□ He shouldbe in recumbent
position in bed oras hiscondition
necessitates.
□ Sandbags shouldbe usedwherenecessary
to immobilizethe
patient's head.
□ The side rails must be raised at all times to protect the
patient in
the event he becomes disoriented and attempts to get out of bed.
□ Place the call bell within easy reach of the patient's
head and let
the patient know exactly where it is located.
□ Remind thepatient that he should not cough, sneeze, or
blow his
nose. Instruct him toinform the staffif he feels theurge,
since
these actions will increase intraocular pressure.

26. Acetaminophenisprescribedformilddiscomfort;
tropicamide is prescribed to induce ciliary paralysis.
Postoperative Nursing Care of the Patient
undergoing Cataract Surgery cont.
•Pharmacologic Highlights:
Acetazolamide a carbonic anhydrase inhibitor is used to
reduce intraocular pressure.
•Phenylephrine a Sympathomimetic agent causes
abnormal dilation of the pupil constriction of
conjunctiva! arteries.
•Other
Medications:
Postoperatively,medications
areprescribedtoreduceinfection
neomycin)and
(gentamicin
or
inflammation(dexamethasone),
to reduce
takingtheformof
eye drops.

27. Acetaminophenisprescribedformilddiscomfort;
tropicamide is prescribed to induce ciliary paralysis.
Postoperative Nursing Care of the Patient
undergoing Cataract Surgery cont.
•Pharmacologic Highlights:
Acetazolamide a carbonic anhydrase inhibitor is used to
reduce intraocular pressure.
•Phenylephrine a Sympathomimetic agent causes
abnormal dilation of the pupil constriction of
conjunctiva! arteries.
•Other
Medications:
Postoperatively,medications
areprescribedtoreduceinfection
neomycin)and
(gentamicin
or
inflammation(dexamethasone),
to reduce
takingtheformof
eye drops.

28. (dexamethasone),
Acetaminophen
takingtheformofeyedrops.
isprescribedformilddiscomfort;
tropicamide is prescribed to induce ciliary paralysis.
Postoperative Nursing Care of the Patient
undergoing Cataract Surgery cont.
•Pharmacologic Highlights:
Acetazolamide a carbonic anhydrase inhibitor is used to
reduce intraocular pressure.
•Phenylephrine a Sympathomimetic agent causes
abnormal dilation of the pupil constriction of
conjunctiva! arteries.
•Other
Medications:
Postoperatively,medications
areprescribedtoreduceinfection
neomycin)andtoreduce
(gentamicin
or
inflammation

29. Acetaminophenisprescribedformilddiscomfort;
tropicamide is prescribed to induce ciliary paralysis.
Postoperative Nursing Care of the Patient
undergoing Cataract Surgery cont.
•Pharmacologic Highlights:
Acetazolamide a carbonic anhydrase inhibitor is used to
reduce intraocular pressure.
•Phenylephrine a Sympathomimetic agent causes
abnormal dilation of the pupil constriction of
conjunctiva! arteries.
•Other
Medications:
Postoperatively,medications
areprescribedtoreduceinfection
neomycin)and
(gentamicin
or
inflammation(dexamethasone),
to reduce
takingtheformof
eye drops.

30. Acetaminophenisprescribedformilddiscomfort;
tropicamide is prescribed to induce ciliary paralysis.
Postoperative Nursing Care of the Patient
undergoing Cataract Surgery cont.
•Pharmacologic Highlights:
Acetazolamide a carbonic anhydrase inhibitor is used to
reduce intraocular pressure.
•Phenylephrine a Sympathomimetic agent causes
abnormal dilation of the pupil constriction of
conjunctiva! arteries.
•Other
Medications:
Postoperatively,medications
areprescribedtoreduceinfection
neomycin)and
(gentamicin
or
inflammation(dexamethasone),
to reduce
takingtheformof
eye drops.

31. (dexamethasone),
Acetaminophen
takingtheformofeyedrops.
isprescribedformilddiscomfort;
tropicamide is prescribed to induce ciliary paralysis.
Postoperative Nursing Care of the Patient
undergoing Cataract Surgery cont.
•Pharmacologic Highlights:
Acetazolamide a carbonic anhydrase inhibitor is used to
reduce intraocular pressure.
•Phenylephrine a Sympathomimetic agent causes
abnormal dilation of the pupil constriction of
conjunctiva! arteries.
•Other
Medications:
Postoperatively,medications
areprescribedtoreduceinfection
neomycin)andtoreduce
(gentamicin
or
inflammation

32. Discharge and Home Care Guidelines
□Before discharge:thepatientreceivesverbaland
written
instructionsabout how to protect the eye, administer medications,
andrecognize signs of complications.
□Review installation technique of eye drops: into the conjunctiva!
sac.Teachthe patient to avoidover-the-
countermedications,
particularly those with aspirin.
□Activities. Activities to be avoided are instructed by the nurse.
□Protective eye patch. To prevent accidental rubbing or poking of
theeye, the patient wearsa protective
eye patch for24 hours
after surgery, followed by eyeglassesworn during the day
and a metal shield worn at night for 1 to 4 weeks.
□Expectedside effects.Slightmorningdischarge,
someredness,
and a scratchy feeling may be expected for a few days, and a clean,
dampwashcloth maybe used to remove
slight morningeye discharge.

33. Discharge and Home Care Guidelines cont.
•Recommend that the patient avoid reading for some time after
surgery to reduce eye strain and unnecessary movement so that
maximal healing occurs.
•Advise the patient not to shampoo for several days after surgery.
•The face should be held away from the shower head with the head
tilted back so that water spray and soap avoid contact with the eye.
•Vacuuming should be avoided because of the forward flexion and
rapid, jerky movement required.
•Driving, sports,andmachine operationcan
beresumedwhen permission is granted by the eye surgeon.
•Clientsfittedwithcataracteyeglassesneedinformation
about altered spatial perception.
•The eyeglasses should be first used when the patient is seated, until the
patient adjusts to the distortion.

34. Discharge and Home Care Guidelines cont.
•Recommend that the patient avoid reading for some time after
surgery to reduce eye strain and unnecessary movement so that
maximal healing occurs.
•Advise the patient not to shampoo for several days after surgery.
•The face should be held away from the shower head with the head
tilted back so that water spray and soap avoid contact with the eye.
•Vacuuming should be avoided because of the forward flexion and
rapid, jerky movement required.
•Driving, sports,andmachine operationcan
beresumedwhen permission is granted by the eye surgeon.
•Clientsfittedwithcataracteyeglassesneedinformation
about altered spatial perception.
•The eyeglasses should be first used when the patient is seated, until the
patient adjusts to the distortion.

35. NURSING CARE PLAN FOR PATIENT WITH CATARACT:
•Nursing Interventions
•Assesspatient's
ability
toseeandperform
activities.
•Encourag
e ordered.
patienttoseeophthalmologistas
•Provide sufficient lighting for patient to carry out
activities.
•Provide lighting that avoids glare on surfaces of
walls, reading materials, and so forth. Prepare
patient for cataract surgery as warranted etc.

36. NURSING CARE PLAN FOR PATIENT WITH CATARACT:
•Nursing Interventions
•Assesspatient's
ability
toseeandperform
activities.
•Encourag
e ordered.
patienttoseeophthalmologistas
•Provide sufficient lighting for patient to carry out
activities.
•Provide lighting that avoids glare on surfaces of
walls, reading materials, and so forth. Prepare
patient for cataract surgery as warranted etc.

37. NURSING CARE PLAN FOR PATIENT WITH CATARACT:
•Nursing Interventions
•Assesspatient's
ability
toseeandperform
activities.
•Encourag
e ordered.
patienttoseeophthalmologistas
•Provide sufficient lighting for patient to carry out
activities.
•Provide lighting that avoids glare on surfaces of
walls, reading materials, and so forth. Prepare
patient for cataract surgery as warranted etc.

38. household furnishings.
NURSING CARE PLAN FOR PATIENT WITH
CATARACT cont.
•Nursing Interventions
•Assess patient for degree of visual impairment.
•Ensure room environment is safe with adequate
lighting and furniture moved toward the walls.
Remove all rugs, and objects that could be potentially
hazardous.
•Keep patient's glasses and call bell within easy reach.
•Instruct patient and/or family regarding need for
maintain safe environment.
•Instruct patient and/or family regarding safe lighting.
Patient should wear sunglasses to reduce glare.
Advise family to use contrasting bright colors in

39. household furnishings.
NURSING CARE PLAN FOR PATIENT WITH
CATARACT cont.
•Nursing Interventions
•Assess patient for degree of visual impairment.
•Ensure room environment is safe with adequate
lighting and furniture moved toward the walls.
Remove all rugs, and objects that could be potentially
hazardous.
•Keep patient's glasses and call bell within easy reach.
•Instruct patient and/or family regarding need for
maintain safe environment.
•Instruct patient and/or family regarding safe lighting.
Patient should wear sunglasses to reduce glare.
Advise family to use contrasting bright colors in

40. NURSING CARE PLAN FOR PATIENT WITH
CATARACT cont.
•Nursing Interventions
•Assess patient for degree of visual impairment.
•Ensure room environment is safe with adequate
lighting and furniture moved toward the walls.
Remove all rugs, and objects that could be potentially
hazardous.
•Keep patient's glasses and call bell within easy reach.
•Instruct patient and/or family regarding need for
maintain safe environment.
•Instruct patient and/or family regarding safe lighting.
Patient should wear sunglasses to reduce glare.
Advise family to use contrasting bright colors in
household furnishings.

41. □Thank you
or listening