PATHOPHYSIOLOGY OF CATARACT:

PRECIPITATING
PREDISPOSING FACTORS
FACTORS Exposure to UV rays of sun
Age: 83 years old Lifestyle (likes to read books/
Gender: male magazines and always
Hereditary sleeps late)
Normal aging process

Cells in the lens degenerate

Cellular debris escapes

through degenerated lens

Structures of lens proteins

are altered

Clumping and aggregation

of Lens Protein

Accumulation of yellowish to brown Clouding of the

pigment of lens protein lens

Blockage of some light from Progressive reduced

reaching retina vision
Clouding/ Blurring
of vision
Cloudy area in lens may get Glare vision
larger over time Light sensitivity

Possible complications:
Blindness, Glaucoma,
Increase ICP
 Nursing Care Plan

Problem no.1: Disturbed visual sensory perception related to altered sensory reception of the eye
Date of assessment: September 30, 2010
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Disturbed visual After 8 hours of The nurse shall: After 8 hours of
“Nagbblurred at sensory nursing 1. Asses the sensory awareness To assess causative or contributing nursing
medyo cloudy yung perception intervention the factors. intervention the
paningin ko” as related to patient will regain patient was able
verbalized by the altered sensory normal visual 2. Inquire about patient or Any history of diabetes, hypertension, to regain normal
patient. reception of the functioning. family history of systemic or atherosclerosis and thyroid disease is visual
eye CNS disease possible etiologies for visual loss. functioning.
Objectives:
• (+)blurred 3. Identify self to the patient and To reduce patient’s anxiety.
vision acknowledge visual impairment
• Wears
eyeglasses 4. Asses the vital signs, To monitor patient’s condition prior to
• Presbyopic especially blood pressure surgery
• Altered sense of
balance 5. Assist patient in gowning, To ensure safety.
• Diagnosed with capping, shoe covering and in
Cataract ambulation.
• For Cataract
6. Provide adequate lightning. To relax eyes and decrease discomfort.
extraction via
Phacoemulsifi-
7. Take medical and surgical These may affect the eye of the patient
cation with
history, medications taken on or the surgery.
Intraocular Lens
that day and known allergies.
Implantation on
Right Eye
8. Instill Tropicamide as To maintain the dilation of the pupils
ordered by the doctor. prior to surgery.

9. Assist patient in ambulation To ensure safety.

and endorse to OR for surgery.

10. After surgery, transparent To protect the eyes from further

eye shield is applied. infection or from injury.
11. Involve significant others in Family need information to plan
patient’s care and in giving strategies in patient’s coping
instructions and necessary mechanism.
precautions.

12. Demonstrate proper To prevent risk for infection

administration of eye drops.

13. Inform the importance of To monitor patient’s condition.

drug compliance and follow-up
check-ups.
Problem no.2: Mild anxiety related to intrusive surgical procedure
Date of Assessment: September 30, 2010
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Anxiety related After 1 hour of The nurse shall: After 1 hour of
“Syempre kahit to intrusive nursing 1. Assess patient’s level of Mild anxiety enhances patient’s nursing
naman sabihin niya surgical intervention the anxiety. awareness and ability to identify and intervention, the
na hindi siya procedure patient will have solve problems. the client and also
kinakabahan eh reduced his his watcher was
nakakaramdam anxiety. 2. Assess patient’s coping To help determine the effectiveness of able to have
parin ng kaunting mechanism. coping strategies used. reduced level of
kaba yan sa loob anxiety, with
niya dahil hindi 3. Acknowledge awareness of Acknowledgement of feelings validates verbalizations of
niya rin alam ang patient’s anxiety. and communicates acceptance. “salamat ah.
mangyayari sa Ngayon alam na
kanya sa loob ng 4. Reassure that he is safe. Presence of a trusted person assures namin kung ano
OR pati ako rin patient of her security and safety. ang mangyayari sa
naman eh loob ng OR, hindi
kinakabahan para sa 5. Maintain a calm and tolerant The patient’s feeling of stability na dapat kami
father ko” as manner while interacting with increases in a calm and nonthreatening masyado magalala”
verbalized by the patient. atmosphere.
watcher of the
patient. 6. Orient patient to the Orientation and awareness of the
environment as needed. surrounding promotes comfort and a
Objectives: decrease in anxiety.
• Vital signs:
BP =110/80 mmHg 7. Maintain a quiet and calm Anxiety may escalate with noise.
PR=88bpm environment.
RR=20cpm
• Worried looking 8. Encourage relaxation To enhance patient sense of personal
• Dry mouth techniques such as: deep mastery and confidence.
• Irritable breathing exercises, reassuring
• With cold hands self-statements.
• For anterior
9. Inform the patient what will For the patient to know what to expect
decompression
happen inside the operating inside.
debridement
room.
fusion.
Problem no.3: Risk for infection related to decreased immunity due to invasive procedure and environmental exposure
Date of assessment: September 30, 2010
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Objective: Risk for After 1 hour of The nurse shall: After 1 hour of
• s/p Cataract infection related nursing 1. Note for risk factors for To assess causative factors nursing
extraction via to decreased intervention the occurrence of infection. intervention the
Phacoemulsifi- immunity due client will client was able to
cation with to invasive verbalize 2. Perform proper medical To eliminate existence of verbalize
Intraocular lens procedure and understanding of hand washing before in microorganisms and to reduce the understanding of
implant on right environmental the risk of contact with the patient. existing risk factors the risk of
eye exposure infection and infection and
• Small incision on understanding of 3. Explain to patient the need For patient’s understanding of the risk understanding of
the right eye the post-operative to protect eyes from any risk factors and to be safety conscious the post-operative
health teachings to of infection health teachings
prevent the risk. to prevent the
4. Place a transparent eye To prevent pressure and protect from risk.
shield on right eye. arise of infection

5. Instruct patient not to wash To reduce chance of exposure to

the face and bathing is only common mode of transmission of
from neck to below. Also to infection
avoid direct water in the
newly operated eye.

6. Demonstrate proper To prevent from further complication.

instillation of eye drops.

7. Emphasize hand washing. To reduce the existing microorganism

8. Emphasize drug To determine effectiveness of

compliance as ordered by the
doctor.
9. Involve significant other in
post-operative instructions to
prevent infection
therapeutic regimen.
Family needs information to plan
strategies in patient’s coping
mechanism.
Drug Study
NAME
CLASSIFIC ACTION, INDICATION and SIDE NURSING
OF ATION CONTRAINDICATION EFFECTS RESPONSIBILITIES
DRUG
Action:
Generic Nonsteroid Nepafenac penetrates the cornea and is The most  Do not wear
Name: al anti- converted by ocular tissue hydrolases to common side contact lenses while
Nepafena inflammat amfenac. Amfenac inhibits the action of effects include using nevanac
c ory prostaglandin H synthase (cyclooxygenase), decreased visual suspension.
ophthalm drugs (NS an enzyme required to produce prostaglandin acuity, a feeling  Patients
ic AIDs) which causes pain and swelling in the eye. that something should not touch the
suspensio is in the eye, bottle tip to any
n Indication: increased eye surface to avoid the
(Nevanac Nevanac is used to reduce pain and swelling pressure or a risk of contamination.
) after cataract surgery. sticky sensation,  This product
as well as other should not be taken by
Route: Contraindication: effects. patients with a
Eye drop Contraindicated to those allergic to sensitivity or allergy
nepafenac or to any of the ingredients of the to its ingredients.
medication and those that are allergic or  If you
sensitive to other NSAIDs (e.g., naproxen, experience any of the
acetylsalicylic acid, diclofenac). adverse effects
contact your doctor.
Action:
Generic Anti- Bactericidal. It inhibits DNA gyrase and This drug may  Avoid
Name: bacterial topoisomerase IV. cause excessive placing Vigamox’s
Moxiflox tearing, further dropper directly into
acin Indication: incidents of the eye.
(Vigamo This drug is for bacterial conjunctivitis. conjunctivitis,  Inform
x) hemorrhage patient of the possible
Contraindication: beneath the side effects of the
Contraindicated with hypersensitivity to conjunctiva, dry drug.
quinolones. eyes, itchiness,  Advice
and patient to drink plenty
Route: inflammation of of fluids.
Eye drop the cornea  Instruct
“keratitis”. patient to avoid
hazardous activities.
 Advice not
to use contact lenses
during therapy.
 Instruct to
continuously instill
the drug prescribe by
the doctor.
Action:
Generic Anti- It inhibits prostaglandin synthesis and also the This drug may  Inform the patient
Name: inflammat migration of leucocytes and macrophages to cause blurred of the possible side
Prednisol ory the site of inflammation as well as inhibits vision and effects of the drug.
one phagocytosis and lysosomal enzyme release. temporary  Advice not to rub
Acetate burning or the eyes after
( Pred Indication: stinging of the instillation (through
Forte) This drug is used as an immune-suppressant affected eye. the use of
agent. It is used in some inflammatory eye transparent eye
disorder. shield)
 Instruct the patient
Route: Contraindication: about drug
Eye drop Contraindicated in patient with diseases of the compliance and
cornea and conjunctiva, ocular tuberculosis, follow-up check-up
and fungal disease of the eye. on the next day.
 Inform the patient
that she can keep
her eyes close to
reduce discomfort.
 Instillation of the
drug is during
waking hours no
III. DISCHARGE PLANS

Health Teaching

HEALTH TEACHING GUIDE

TOPIC: Post-operative Instructions and Medication after Cataract surgery.

TIME ALLOTMENT: 10-15 minutes

Methodologies/
Objectives Content Evaluation
Strategies

1.)At the end of 15  Explain the action of the Discussion The client was
minutes of health medication such as: able to
teaching, the a. Vigamox enumerate
patient or the b. Pred Forte eye drops basic
companion will be c. Nevanac eye drops information
able to enumerate about the
and understand the  Explain the following medication
basic information which accompanies each including the
about her drug intake: advantages of
medication a. Contraindication her treatment
including the b. Side Effects and drug
advantages of compliance.
continuing her  Explain when and how will
medications as it be taken (e.g. before or
well as her after meals, twice a day,
compliance to three times a day, etc.
treatment.
 Discuss the possible or
allowed activities for the
patient and necessary
precautions.

 Explain the benefits of

attending her regular
check-ups which includes
the evaluation of the doctor
about the status of her
condition.