Tuesday, February 10, 2009

Nursing Care Plans For Cataract

Nursing Care Plans For Patient With Cataract
Cataracts are the leading cause of preventable blindness among adults in the United States. The incidence of cataracts in the United States is 1.2 to 6.0 cases per 10,000 people. A cataract is defined as opacity of the normally transparent lens that distorts the image projected on the retina. The lens opacity reduces visual acuity. As the eye ages, 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. The rate of cataract formation in each eye is seldom identical. Without surgery, a cataract can lead to blindness.
Cataract a common cause of gradual vision loss is opacity of the lens or the lens capsule of the eye. The clouded lens blocks light shining through the cornea. This block, in turn, blurs the image cast onto the retina. As a result, the brain interprets a hazy image. Cataracts commonly affect both eyes, but each cataract progresses independently. Exceptions are traumatic cataracts, which are usually unilateral, and congenital cataracts, which may remain stationary. Cataracts are most prevalent in people older than age 70. Surgery restores vision in about 95% of patients.

Cataracts have several causes and may be age-related, present at birth, or formed as a result of trauma or exposure to a toxic substance, Cataracts are classified by the cause:
  • Senile cataracts develop in elderly people
  • Congenital cataracts occur in neonates from inborn errors of metabolism or from maternal rubella infection during the first trimester
  • Traumatic cataracts develop after a foreign body injures the lens with sufficient force to allow aqueous or vitreous humor to enter the lens capsule
  • Complicated cataracts occur secondary to uveitis, glaucoma, retinitis pigmentosa, or retinal detachment
  • Toxic cataracts result from drug or chemical toxicity with prednisone, ergot alkaloids, naphthalene, and phenothiazines.
Genetic Considerations; Epidemiological studies indicate that cataracts have strong genetic components. Several loci have been identified for an autosomal dominant form of cataracts. Congenital cataracts occur with galactosemia and these can appear within just a few days of birth. The specific genetic contributions of the more common age-associated cataracts are still unclear. Ethnicity and race have no known effect on the risk of cataracts.

Complications may include retinal disorders, pupillary block, adhesions, acute glaucoma, macular edema, and retinal detachment. Following extracapsular cataract extraction, the posterior capsule may become opacified. This condition, called a secondary membrane or after-cataract, occurs when subcapsular lens epithelial cells regenerate lens fibers, which obstruct vision. After-cataract is treated by yttrium-aluminum-garnet (YAG) laser treatment to the affected tissue. Without surgery, a cataract eventually causes complete vision loss.

Assessment Nursing Care Plans For Cataract
Typically, the patient complains of painless, gradual vision loss. He may also report a blinding glare from headlights when he drives at night, poor reading vision, and an annoying glare and poor vision in bright sunlight. If he has a central opacity, the patient may report seeing better in dim light than in bright light, because this cataract is nuclear and, as the pupil dilates, the patient can see around the opacity.
Physical examination. Cataract formation causes blurred vision, a loss measured by Use of the snellen chart. Color perception of blue, green, and purple is reported as varying Shades of gray. If the cataract is advanced, shining a penlight on the pupil reveals the white area Behind the pupil. A dark area in the normally homogeneous red reflex confirms the diagnosis.

Surgical lens extraction

Diagnoses that may occur in Nursing Care Plans For Cataract
  • Anxiety
  • Deficient knowledge (diagnosis and treatment)
  • Disturbed sensory perception: Visual
  • Risk for infection
  • Risk for injury

Key outcomes Nursing Care Plans For Cataract
  • patient and his family will voice their feelings and concerns.
  • patient will verbalize understanding of the disease and treatment.
  • patient will regain normal visual functioning.
  • patient will show no signs or symptoms of infection.
  • patient will avoid injury
  • Body image; Safety behavior: Personal; Safety behavior: Fall prevention; Safety behavior: Home physical environment; Anxiety control; Neurological status; Rest; Sleep

Interventions Nursing Care Plans For Cataract
  • Postoperatively, monitor the patient until he recovers from the effects of the anesthetic. Keep the side rails of the bed up, monitor vital signs, and assist him with early ambulation.
  • Apply an eye shield or eye patch postoperatively as ordered
  • Communication enhancement: Visual deficit; Activity therapy; Cognitive stimulation; Environmental management; Fall prevention; Surveillance: Safety

Nursing Care Plans For Cataract Home Health:
  • Caution him to avoid activities that increase intraocular pressure, such as straining with coughing, bowel movements, or lifting
  • Clients fitted with cataract eyeglasses need information about altered spatial perception. The eyeglasses should be first used when the patient is seated, until the patient adjusts to the distortion. Instruct the client to look through the center of the corrective lenses and to turn the head, rather than only the eyes, when looking to the side. Clear vision is possible only through the center of the lens. Hand-eye coordination movements must be practiced with assistance and relearned because of the altered spatial perceptions.
  • Teach the patient or family member how to instill ophthalmic ointment or drops.
  • Driving, sports, and machine operation can be resumed when permission is granted by the eye surgeon.
  • If the patient has increased eye discharge, sharp eye pain , or deterioration in vision, instruct him to immediately notify the physician.
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