Cataract: Medical and Surgical Management, Nursing interventions by nuresnote

 CATARACT

A cataract is a lens opacity or cloudiness. Cataract can develop in one or both eyes at any age. Cigarette smoking, long-term use of corticosteroids, especially at high doses; sunlight and ionizing radiation; diabetes, obesity, and eye injuries can increase the risk og cataractcs. The three most common types of senile ( age-related ) cataracts are defined by their location in the lens: nuclear, cortical, and posterior subcapsular. Visual impairment depends on the size, density, and location in the lens. More than one type can be present in one eye. 

Clinical Manifestation 

• Painless, blurry vision.
• Perception that surrounding are dimmer (as if glasses need cleaning ).
• Light scattering ; reduced contrast sensitivity, sensitivity to glare, and reduced visual acuity. 
• Other effects include myopic shift (return of ability to do close work [e.g. reading fine print] without eyeglasses ) ,astigmatism, monocular diplopia ( double vision), color shift ( the aging lens becomes progressively more absorbent at the blue end of the spectrum ), brunescens (color values shift to yellow-brown), and reduced light transmission. 

Assessment and diagnostic methods

• Degree of visual acuity is directly proportionate to density of the cataract.
• Snellen visual acuity test.
• Ophthalmoscopy.
• Slit-lamp biomicroscopic examination 

Medical management 

No nonsurgical ( medications, eyedrops, eyeglasses ) treatment cures cataracts or prevents age-related cataracts. Studies have found no benefit from antioxidant supplements, vitamin C and E, beta-carotene, and selenium. Glasses or contact, bifocal, or magnifying lenses may improve vision. Mydriatics can be used short term,  but glare is increased. 

Surgical Management 

In general, if reduced vision from cataract does not interfere with normal activities, surgery may not be needed. In deciding when cataract surgery is to be performed, the patient's functional and visual status should be a primary consideration. Surgical options include phacoemulsification (method of extracapsular cataract surgery ) and lens replacement (aphakic eyeglasses, contact lenses, and intraocular lens implants ). Cataracts are removed under local anesthesia on an outpatient basis. When both eyes have cataracts, one eye is treated first, with at least several weeks, preferably months, separating the two procedures. 

Nursing Management 

• Withhold any anticoagulants the patient is receiving, if medically appropriate. In some cases, anticoagulant therapy may continue. 
• Administer dilating drops every 10 minutes for four doses at least 1 hour before surgery. Antibiotic, corticosteroid, and anti-inflammatory drops may be administered prophylactically to prevent postoperative infection and inflammation. 
• Provide patient verbal and written instructions about how to protect the eye, administer medications, recognize signs of complications, and obtain emergency care.
• Explains that there should be minimal discomfort after surgery, and instruct the patient to take a mild analgesic agent, such ad acetaminophen, as needed. 
• Antibiotic, anti-inflammatory, and corticosteroid eye drops or ointments are prescribed postoperatively.