( Relates to Chapter 22, “Nursing Management: Visual and Auditory Problems,” in the textbook) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

2 Opacity within crystalline lens Leading cause of blindness Most common surgical procedure for those aged over 65 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

3

4 Influencing factors  Age  Blunt trauma  Congenital factors Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

5 Influencing factors  Radiation/UV light exposure  Long-term corticosteroid use  Ocular inflammation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

6 Senile cataract  Most common type  Altered metabolic processes cause Accumulation of water Altered lens fiber structure Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

7 Decrease in vision Abnormal color perception Glaring of vision Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

8 History and physical examination Visual acuity measurement Ophthalmoscopy Slit lamp microscope Glare testing Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

9 Nonsurgical therapy  No nonsurgical “cure”  Visual aids (palliative) Changing eyewear prescription Reading glasses Magnifiers Increased lighting Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

10 Preoperative phase  History and physical assessment  Antibiotic eyedrops  Dilating eyedrops (Table 22-5 in book) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

11 Intraoperative phase  Corneoscleral incision  Cataract extracted and sutured  Cortex irrigated and aspirated  Corticosteroid ointment applied with protective shield Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

12 Implementation of Intraocular Lens Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Intraocular lens implant after cataract surgery.

13 Postoperative phase  Outpatient procedure unless complications occur  Antibiotic and corticosteroid eyedrops  Limiting activities  Follow-up visits Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

14 Visual acuity Psychosocial impact of visual disability Level of knowledge of disease Comfort and ability to comply with postop treatment Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

15 Self-care deficits Anxiety Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

16 Preoperative goals  Make informed decisions regarding therapeutic options.  Experience minimal anxiety. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

17 Postoperative goals  Understand and comply with postoperative therapy.  Maintain level of comfort.  Remain free of infection and other complications. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

18 Health promotion  Wear sunglasses.  Avoid unnecessary radiation.  Adequate antioxidant vitamins  Ensure good nutrition. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

19 Acute intervention  Educate about disease process and treatment options.  Administer medication.  Inform those with patch that they will not have depth perception.  Ensure little to no pain.  Teach signs and symptoms of infection. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

20 Ambulatory and home care  Activity restrictions  Medications  Follow-up visits  Signs and symptoms of possible complications Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

21 Ambulatory and home care  Educate on postoperative visual acuity.  Instruct family to modify activities and environment. Remove area rugs. Prepare frozen meals. Provide audio books. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

22 Expected outcomes  Improved vision  Ability to care for self  Minimal to no pain  Optimistic expectations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

23

24 82-year-old woman is escorted by her daughter into preoperative area for removal of cataract OD. Vision is equally impaired OU. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

25 Patient is scheduled in a few weeks for cataract removal in OS. Patient lives in assisted living and will return there postop. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

26 1.Daughter asks you what can be done to prevent cataracts. What should you tell her? 2.What should you tell the patient and daughter to expect postoperatively? Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

27 3.If the patient is visited only once a day at her home, what may be of concern? 4.What nursing management is crucial during the postoperative period? Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.