Download cataract AM group

Sensory Group Presentation - CATARACT
Each group must submit an outline of the teaching plan to the instructor and bring a hard
copy to class. Your presentation outline will be made available to your peers.
Mrs. Ashbe is having surgery for cataract removal OS. Although her ophthalmologist told her
she needed the surgery, Mrs. Ashbe doesn’t understand what a cataract is,
A cataract is a lens opacity that interferes with the transmission of light to the retina.
what is done during the procedure? and why it will improve her vision?
In
cataract surgery, the lens inside your eye that has become cloudy is removed and replaced
with an artificial lens (called an intraocular lens, or IOL) to restore clear vision. The procedure
typically is performed on an outpatient basis and does not require an overnight stay in a hospital
or other care facility.
In preparation for Mrs. Ashbe’s surgical date, what preoperative patient teaching should the
nurse include?
There are various preoperative teaching the patient should keep in mind. The patient should
arrange for transportation, applying necessary eye drops in a timely manner before and after
surgery. Dilating drops are administered prior to surgery. Also be sure not to eat solid foods or
drink any liquids before surgery. Also do not wear any makeup or cosmetics.One of the most
critical patient teaching points should be that Mrs. Ashbe will need someone to care for her.
Mrs. Ashbe states that her daughter will be helping her instill eye drops prior to surgery, but after
the surgical procedure she will be alone because her daughter is going on vacation for 2 weeks.
Mrs. Ashbe informs you that she is “not sure how to put in the eye drops that the doctor said will
be prescribed after the surgery”.
What patient teaching regarding the postoperative period should the nurse provide? Include information
about the eye drops that are commonly used pre and post op (action, desired effect, cautions, patient
directions)
She will need another person to help her as she can not do anything by herself the first 24 hours
after the surgery. She will need someone to stay with her for the first 24 hours after the surgery
at minimum. She should find someone else to take care of her for the first 24 hours. Mrs. Ashbe
should consider either postponing her surgery or asking her daughter to postponing her vacation
if they are unable to find someone to help Mrs. Ashbe for the first 24-hours. In regards to the
medication, Always wait 5 minutes in between each eye drop (The order does not matter).
Always wash hands before caring for your eye. If using glaucoma drops, resume them unless
otherwise instructed by your physician. A typical prescription following cataract surgery is as
follows Week One: Vigamox, Pred Forte, acular/ketorolac Q.I.D. (breakfast, lunch, dinner, and
bedtime).Week two/three: Pred Forte and acular/ketorolac B.i.D. (breakfast and bedtime).Week
four/five/six: Pred Forte and acular/ketorolac Q.D. (breakfast). Pred Forte is a glucocorticoid. It
inhibits the edema, fibrin deposition, capillary dilation, and phagocytic migration of the acute
inflammatory response, as well as capillary proliferation, deposition of collagen, and scar
formation. Advise her to consult physician if inflammation or pain persists >48 hrs or becomes
aggravated. Instruct to use caution to avoid touching the bottle tip to eyelids or to any other
surface to prevent contamination. Inform that the use of the bottle by more than 1 person may
spread infection. Instruct to keep the bottle tightly closed when not in use. Acular is an NSAID.
It is used to reduce inflammation postoperatively. Advise her to administer at least 5 min apart
since more than one ophthalmic medication is being used. Vigamox is an antibiotic. It inhibits
topoisomerase II (DNA gyrase) and topoisomerase IV to prevent infection. Instruct her not to
touch the dropper tip to any surface to avoid contaminating the contents. Instruct her to
immediately discontinue medication and contact physician at the 1st sign of rash or allergic
reaction. Instruct her not to wear contact lenses if signs and symptoms of bacterial conjunctivitis
develop.
Mrs. Ashbe’s surgery for cataract removal has been performed without complications. Two days
later, she calls the ophthalmologist’s office and tells the nurse that her eye is itching, and feels
“gritty.” She has no vision change, pain, bruising, or swelling in her eye.
What patient teaching should the nurse provide at this time?
The nurse would tell Mrs. Ashbe that the eye itching and feeling gritty is a normal during postoperative surgery. She shouldn’t rub or put pressure in her eye, tell her she needs to be wearing
her eye shield to protect her eye at bedtime, she needs to avoid sleeping on her operated eye, she
shouldn’t be bending with her head below her waist, and to not strain in anyway.
4. The Wills Eye Institute is a National Center for Eye Disorders. Explore this website, Lippincott and
additional resources to gather information about the diagnosis of cataract to include the treatment,
prognosis, and potential complications.
According to The WIlls Eye Institute National Center for Eye Disorders
cataract formation is a
normal process of aging and is likely to begin after the age of 60 years. However, there are other
factors that contribute to cataract formation such as injury to the eye , infection, certain
medications (corticosteroids and diuretics), or previous eye surgery. Congenital cataracts is an
example of when babies are born with cloudiness of the eyes because of poor development.
Secondary cataracts are caused from other health conditions such as diabetes. Traumatic events
or injury to the eye may also cause cataracts. Sometimes vision can be enhanced with change of
prescription of eyeglasses or contacts despite the cataracts. If the cataracts are interfering with
activities of daily life, treatment is suggested, or surgery. Two common surgeries performed to
remove cataract are phacoemulsification and extracapsular cataract extraction. Without surgery,
the patient puts their safety at risk and may impede communication with others. Potential
complications after surgery are corneal scarring, painful corneal bullae, and infection.
Submit a copy of your teaching plan/outline to your instructor prior to your presentation and bring a hard
copy of it to class. A copy of your plan will be made available to your peers. One person from your
group is to present the teaching plan or each can present different portions of it. Your group will also will
role play as the patient, daughter and the nurse.
One actual nursing diagnosis, one risk diagnosis and a goal statement for each of the diagnoses
are to be included for Mrs. Ashbe in your teaching plan.
Nurse diagnosis
Anxiety related to impending surgery secondary to lack of knowledge as evidenced by
questions and concerns from patient.
Goal
Demonstrate a reduced level of anxiety prior to surgery.
Risk diagnosis
Risk for infection related to inability to self administer
Goal
Demonstrate the ability to instill eye drops post-operatively.
Each member of the group must participate in some way to complete the in class presentation/role play.
. BE CREATIVE!!
Outline
I. Concept: Cataract
A. Definition:
A cataract is a lens opacity that interferes with the transmission of light into the retina
due to protein buildup on the lens of the eye leading to impaired vision.
B. Signs & Symptoms:
Blurred vision, decreased color perception, diplopia (double
vision), cloudiness on the eye, problems with glare during the day, problems driving at
night, and sudden change in prescription such as myopic shift.
C. Diagnostic Exams/Tests:
Snellen visual acuity test, ophthalmoscopy, and slit-lamp biomicroscopic examinations.
D. Treatments/Interdisciplinary:
Phacoemulsification and lens replacement are two common surgical procedures
performed to remove cataracts.
II. Nursing Interventions*:
A. Independent:
Prior to surgery, obtain drug history from the patient. Administer dilating drops prior to
surgery. Begin patient education about eye medications that need to be self
administered. Have the patient repeat the information back to you, so you know they
understand and can give opportunity for clarification. Always wash hands before
touching or cleaning postoperative eye. Give oral and written education about eye care
after surgery. Teach patient how to recognize complications, activities to avoid, and
seeking ophthalmologist immediately if injury, redness, swelling, or pain occurs in the
eye. Remind the patient to administer eyes drops in a timely manner and complies with
prescription. Explain the importance of keeping follow up appointment
B. Dependent Team-work
and collaborations of ophthalmologist (eye surgeon). The
actual cataract surgery. Prescriptions and checking vision post operatively are also
dependent as an ophthalmologist is needed for it.
C. Medications
Eye drops such as cycloplegic mydriatic. This medication prevents pupil constriction for
prolonged periods of time. It relaxes the muscles in the eye. It dilates the eye
preoperatively and for visualization of the eye's internal structures. This medication has
long duration and fast onset. May cause photosensitivity.
D. Patient Education
Wear sunglasses, report signs of infection, avoid certain activities such as bending over,
sneezing, coughing ,straining, avoid driving, avoid certain sports, report decreased
vision or discharge, sharp or sudden pains in the eye.
III. Other
References
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http://www.allaboutvision.com/conditions/cataract-surgery-recovery.htm
Carpenito, L. J. (2013). Nursing diagnosis: Application to clinical practice. Philadelphia:
Wolters Kluwer/Lippincott Williams & Wilkins.
Facts About Cataract. (2009, September). Retrieved March, 2016, from
https://nei.nih.gov/health/cataract/cataract_facts
Farid, M., Garg, S., Gaster, R., & Steinert, R. (n.d.). POST-OPERATIVE INSTRUCTIONS
FOR CATARACT PATIENTS. Retrieved March 1, 2016, from
http://www.eye.uci.edu/downloads/cataractpostop.pdf
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Nursing Journals | NursingCenter. (n.d.). Retrieved from
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Pred Forte (prednisolone acetate) dose, indications, adverse effects, interactions... from
PDR.net. (n.d.). Retrieved from http://www.pdr.net/drug-summary/Pred-Forteprednisolone-acetate-2305#12
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Vigamox (moxifloxacin hydrochloride) dose, indications, adverse effects, interactions... from
PDR.net. (n.d.). Retrieved from http://www.pdr.net/drug-summary/Vigamoxmoxifloxacin-hydrochloride-2486