Cataracts: 6 Flashcards
What is a cataract?
Usually develops in?
If it develops in one?
What can cause cataract? 2
Cloudy lens
Usually develops bilaterally, although it can occur in just one eye.
If it occurs in both eyes, the vision in one eye may be affected more
Age and Long term cortecosteroid use
What field of vision is affected by cataracts?
Entire visual field
Explain the clinical manifestations associated with cataracts.
How does glare affect vision?
May be worse at?
Glare- As the lens becomes opaque, it scatters light instead of transmitting a sharply focused image.
This results in a disabling glare, dimmed or blurred vision with distorted images.
May be significantly worse at night when the pupil dilates
No what during eye exam?
Pupils may appear?
Abnormal?
As cataract worsens?
No visualization of the retina with an ophthalmoscope.
Pupil may appear yellowish, gray, or white (ordinarily black)
Abnormal color perception
As cataract worsens, stronger corrective lenses no longer improve sight
Explain the non-surgical treatment strategies for cataracts.
a. What are some things a patient may do to improve their vision with cataracts (lifestyle modifications)
Increasing the amount of light to read or do other near-vision tasks
Adjusting lifestyle to adjust to visual decline (driving at night)
Providing information, reassurance, and comfort
Strong reading glasses or magnifiers may help with near vision
Explain the surgical treatment strategies for cataracts.
Explain the nursing implications/action during the pre-operative phase.
What occurs during the pre-op phase?
Why is it necessary for someone to accompany the patient to surgery?
Before surgery, obtain a history and physical exam.
Most patients receive local anesthesia and will not require an extensive preop physical exam
However, most patients with cataracts are older with pre-existing medical conditions that need to be evaluated and controlled before surgery.
The patient usually arrives several hours before the actual surgery to allow time for preoperative procedures (eye exams).
*Will require someone who can drive them home.
Why are NSAID’s eye drops used in pre op?
The patient may receive?
What does mydriatics do?
Cycloplegics?
NSAID eye drops to reduce inflammation.
The patient may receive antianxiety
medication before surgery
Mydriatic- (Phenylephrine) Dilates the pupil by constricting the conjunctival dilator muscle.
Cycloplegic-tropicamide (Mydriacyl)-
Paralyzes the eye and also causes pupillary dilation (mydriasis).
Explain the nursing implications/action during the intra-operative phase.
Phacoemulsification
What happens?
How is it healed?
Requires? and?
Preserves?
A very small incision is made in or near the cornea.
A thin ultrasound probe is inserted into the eye, which dissolves the clouded lens into small pieces via ultrasonic vibrations
The pieces are then suctioned out through the same probe.
The incisions are self-sealing and usually dont need sutures.
Requires less recovery time and decreases the incidence of post-op astigmatism
Preserves posterior capsule, which is used to support an intraocular lens (IOL)
Extracapsular Cataract Extraction
The lens is?
A larger?
Sutures?
Visual recovery?
The lens is too dense to dissolve into fragments.
A larger incision is required to remove the cataract in one piece without being fragmented inside the eye.
Sutures are needed to close the larger wound.
Visual recovery is often slower
Intraoperative Phase
The lens of choice?
What meds may be given at the end?
The lens of choice is a posterior chamber lens placed in the capsular bag behind the iris.
antibiotics and corticosteroids
What is an IOL?
IOL contraindications?
Artificial Lens Implants
Recurrent uveitis
Proliferative diabetic retinopathy
Neovascular glaucoma
Complications for IOL? 5
Uveitis?
2 more?
Corneal damage / Pupillary block
Glaucoma
Hemorrhage
Wound fistula
-Uveitis- inflammation in the middle layer of
the eye (uvea)
-Malpositioning of the IOL.
-Formation of secondary membranes (scar tissues)
Post-operative phase.
Unless complications occur?
Post op meds?
Unless complications occur, patient is ready to go home as long as sedative agents have worn off.
Post-op meds:
-Antibiotic drops to prevent infection
-Corticosteroid drops to decrease the inflammatory response.
The eyedrops are gradually reduced and then stopped when eye has healed.
Explain discharge instructions for a patient after surgical procedures are performed.
Avoid?
No?
Wear what in night and day?
Avoid activities that increase the IOP
NO Bending and lifting heavy objects for 7 days
Wear eye shield at night
Sunglasses when outdoor in bright light
Nursing Considerations
Why should need for safety be emphasized?
Usually given new prescription?
Because many patients are older, have increased risk for falling, leading to blunt trauma to the eye which could rupture the
globe, causing loss of vision.
Usually given new prescription for
eyeglasses within 6-8 weeks after surgery
Explain the gerontological considerations related to a patient who has cataracts.
They often need?
A well as?
Assure?
They often need emotional support and encouragement
As well as specific suggestions to allow a maximum level of independent function.
Assure the older patient that cataract surgery can be done safely and comfortably with minimal sedation
