Nursing Care Plan | NCP 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.
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. The most common cataract is age-related (senile cataract). Traumatic cataracts develop 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), or eye inflammation or disease (e.g., glaucoma, retinitis pigmentosa, detached retina, recurrent uveitis). Toxic cataracts result from drug or chemical toxicity. Congenital cataracts are caused by maternal infection (e.g., German measles, mumps, hepatitis) during the first trimester of pregnancy.
Nursing care plan assessment and physical examination
Changes in vision go unnoticed for a long time because of the slow progression. Patients frequently complain of problems with reading and night driving. Ask if the patient is color blind, has always worn glasses or contacts, has a history of cataracts, or is under the treatment of an eye doctor or optometrist. Generally, patients with cataracts report decreasing visual acuity with painless, increasingly blurred vision; visual distortion such as glare, dazzling effects, or dimness; or decrease in color perception and discoloration brought about by changes in lens color to yellow, amber, and finally to brown. The presence of other risk factors, such as trauma, radiation exposure, metabolic disorders, eye infection, and medication history, is important. Ascertain if the patient’s mother contracted German measles, mumps, or hepatitis during pregnancy.
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 cataractt 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.
Because the loss of vision is usually gradual, the patient may deny visual dysfunction until it affects the actions of daily life, reading, or driving. Anxiety and fear of losing one’s eyesight are common emotional responses. Social isolation may also occur because visual difficulties impede easy movement away from the home and because of possible embarrassment caused by impaired vision.
Nursing care plan primary nursing diagnosis: Sensory and perceptual alterations (visual) related to decreased visual acuity.
Nursing care plan intervention and treatment
There is no known medical treatment that cures, prevents, or reduces cataract formation. Surgical removal of the opacified lens is the only cure for cataracts. The lens can be removed when the visual deficit is 20/40. If cataract 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.
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.
If nursing care is provided in the patient’s home, structure the environment with conducive lighting and reduce fall hazards. Suggest magnifying glasses and large-print books. Explain that sunglasses and soft lighting can reduce glare. Assist the patient with the actions of daily living as needed to remedy any self-care deficit. Encourage the patient to verbalize or keep a log on his or her fears and anxiety about visual loss or impending surgery. Help plan events to solve the problems with social isolation.
Nursing care plan discharge and home health care guidelines
Be sure the patient understands all medications, including dosage, route, action, adverse effects, and need for postoperative evaluation, usually the next day, by the eye surgeon. Review installation technique of eye drops into the conjunctival sac. Teach the patient to avoid over-the-counter medications, particularly those with aspirin. Instruct the patient to report any bleeding, yellow-green drainage, pain, visual losses, nausea, vomiting, tearing, photophobia, or seeing bright flashes of light. Instruct the patient to avoid activities that increase intraocular pressure such as bending at the waist, sleeping on the operative side, straining with bowel movements, lifting more than 15 pounds, sneezing, coughing, or vomiting. Instruct the patient to wear a shield over the operative eye at night to prevent accidental injury to the eye during sleep and to wear glasses during the day to prevent accidental injury to the eye while awake. 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.
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. The most common cataract is age-related (senile cataract). Traumatic cataracts develop 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), or eye inflammation or disease (e.g., glaucoma, retinitis pigmentosa, detached retina, recurrent uveitis). Toxic cataracts result from drug or chemical toxicity. Congenital cataracts are caused by maternal infection (e.g., German measles, mumps, hepatitis) during the first trimester of pregnancy.
Changes in vision go unnoticed for a long time because of the slow progression. Patients frequently complain of problems with reading and night driving. Ask if the patient is color blind, has always worn glasses or contacts, has a history of cataracts, or is under the treatment of an eye doctor or optometrist. Generally, patients with cataracts report decreasing visual acuity with painless, increasingly blurred vision; visual distortion such as glare, dazzling effects, or dimness; or decrease in color perception and discoloration brought about by changes in lens color to yellow, amber, and finally to brown. The presence of other risk factors, such as trauma, radiation exposure, metabolic disorders, eye infection, and medication history, is important. Ascertain if the patient’s mother contracted German measles, mumps, or hepatitis during pregnancy.
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 cataractt 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.
Because the loss of vision is usually gradual, the patient may deny visual dysfunction until it affects the actions of daily life, reading, or driving. Anxiety and fear of losing one’s eyesight are common emotional responses. Social isolation may also occur because visual difficulties impede easy movement away from the home and because of possible embarrassment caused by impaired vision.
Nursing care plan primary nursing diagnosis: Sensory and perceptual alterations (visual) related to decreased visual acuity.
Nursing care plan intervention and treatment
There is no known medical treatment that cures, prevents, or reduces cataract formation. Surgical removal of the opacified lens is the only cure for cataracts. The lens can be removed when the visual deficit is 20/40. If cataract 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.
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.
If nursing care is provided in the patient’s home, structure the environment with conducive lighting and reduce fall hazards. Suggest magnifying glasses and large-print books. Explain that sunglasses and soft lighting can reduce glare. Assist the patient with the actions of daily living as needed to remedy any self-care deficit. Encourage the patient to verbalize or keep a log on his or her fears and anxiety about visual loss or impending surgery. Help plan events to solve the problems with social isolation.
Nursing care plan discharge and home health care guidelines
Be sure the patient understands all medications, including dosage, route, action, adverse effects, and need for postoperative evaluation, usually the next day, by the eye surgeon. Review installation technique of eye drops into the conjunctival sac. Teach the patient to avoid over-the-counter medications, particularly those with aspirin. Instruct the patient to report any bleeding, yellow-green drainage, pain, visual losses, nausea, vomiting, tearing, photophobia, or seeing bright flashes of light. Instruct the patient to avoid activities that increase intraocular pressure such as bending at the waist, sleeping on the operative side, straining with bowel movements, lifting more than 15 pounds, sneezing, coughing, or vomiting. Instruct the patient to wear a shield over the operative eye at night to prevent accidental injury to the eye during sleep and to wear glasses during the day to prevent accidental injury to the eye while awake. 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.
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Nursing Care Plan
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