Primary Nursing Diagnosis

Sensory and perceptual alterations (visual) related to decreased visual acuity

OUTCOMES. Body image; Safety behavior: Personal; Safety behavior: Fall prevention; Safety behavior: Home physical environment; Anxiety control; Neurological status; Rest; Sleep

INTERVENTIONS. Communication enhancement: Visual deficit; Activity therapy; Cognitive stimulation; Environmental management; Fall prevention; Surveillance: Safety

U PLANNING AND IMPLEMENTATION Collaborative

SURGICAL. 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 cataracts 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. 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.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Acetazolamide

250 mg PO 1-4 times a day

Carbonic anhydrase inhibitor

Reduces intraocular pressure by inhibiting formation of hydrogen and bicarbonate ions

Phenylephrine

Topical ophthalmic use, 1-2 drops of 0.125% solution every 3-4 hr

Sympathomimetic

Causes abnormal dilation of the pupil, constriction of conjunctival arteries

Other Medications: Postoperatively, medications are prescribed to reduce Infection (gentamlcin or neomycin) and to reduce inflammation (dexamethasone), taking the form of eye drops. Acetaminophen is prescribed for mild discomfort; tropicamide is prescribed to induce ciliary paralysis.

Independent

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.

POSTOPERATIVE HOSPITAL CARE. Postoperative care includes covering the affected eye with an 8- to 24-hour patch and protective shield and positioning the patient supine or on the unoperated side. Apply cool compresses to reduce itching. Monitor and report any drainage, pain, or vital sign alteration. Teach the patient how to administer eye drops correctly, and caution the patient to notify the physician immediately upon experiencing eye pain. During recovery, teach the patient how to adjust home environments and daily activities to promote safety.

Anxiety and Panic Attacks

Anxiety and Panic Attacks

Suffering from Anxiety or Panic Attacks? Discover The Secrets to Stop Attacks in Their Tracks! Your heart is racing so fast and you don’t know why, at least not at first. Then your chest tightens and you feel like you are having a heart attack. All of a sudden, you start sweating and getting jittery.

Get My Free Ebook


Post a comment