Lippincott Certification Review Medical-Surgical Nursing

312

Chapter 18

●● Signs and symptoms ●● Gradual painless blurring eventually leads to poor reading vision, reduced vision at night and in bright sunlight, and vision loss. ●● Other effects may include halos around lights, milky pupils, and unpleasant glares. ●● Cataracts naturally progress over time with no chance of recovery outside of surgical intervention. ●● Diagnosis and treatment ●● Indirect ophthalmoscopy or slit-lamp examination confirms the diagnosis. ●● Cataracts can be surgically treated by extracapsular extraction, which uses a small incision to remove the anterior capsule and its contents; intracapsular extraction, which removes the entire lens in the capsule; or phacoemulsification, which uses ultrasonic vibration to fragment the lens. ●● In the United States, small incision phacoemulsification with foldable intraocular lens implantation is the standard surgery for cataracts. ●● Corrective lenses may be prescribed to improve vision. ●● A plastic intraocular lens implant may be inserted in the eye as part of the surgical procedure. ●● Cataract glasses (glasses with magnifying lenses) or contact lenses may be prescribed 6 to 8 weeks after surgery. ●● Preoperative nursing interventions ●● Explain the importance of adherence in a preadmission interview. ●● Make sure that someone can drive the patient to and from the day surgery center. ●● Tell the patient to tilt their head backward when shampooing to prevent jarring the eye and increasing IOP. ●● Administer a preoperative stool softener to prevent straining during defecation, which increases IOP. ●● Explain preoperative and postoperative care to decrease the patient’s anxiety. ●● Answer questions and encourage the patient to discuss concerns. ●● Postoperative nursing interventions ●● Review postoperative instructions to improve adherence and prevent complications; the patient may have difficulty reading instructions because of impaired vision. ●● Tell the patient not to bend, strain, lift, cough, sneeze, or rub the eye postoperatively; these actions can increase IOP, which can lead to complications, such as bleeding, vitreous herniation, vision loss, pain, and wound dehiscence; rubbing also increases the chance of infection. ●● Tell the patient not to make quick movements or read, which could irritate the patched eye or dislodge an implanted lens. ●● Teach the patient or family member how to administer eye medications properly; tell the patient to avoid using OTC eyedrops. ●● Teach the patient how to clean the eye to prevent infection. ●● Have the patient wear an eye shield and patch to protect the eye from injury; tell them to keep the eye patch dry and to wear an eye shield while sleeping.

●● Tell the patient to call the practitioner if any of these signs or symptoms occur: eye pain that is increasing or that isn’t relieved with analgesics, yellow or green discharge, temperature above 100°F (37.8°C), blurred vision, a significant reduction in vision, progressive redness, periocular swelling, nausea and vomiting, and seeing halos around lights. ●● Explain postoperative activity restrictions. ●● The patient may walk, climb stairs, watch television, and perform ADLs but should avoid engaging in strenuous physical activity and lifting more than 10 lb (4.5 kg). ●● The patient may bathe or shower but should avoid getting water on the eye patch by tilting their head back when shampooing. ●● The patient should avoid bending from the waist and hanging the head forward; a long-handled grabber may be used to pick up objects. ●● Educate about smoking cessation. ●● Make sure the patient is cared for by a family member or friend after surgery. ●● Advise the patient to refrain from sexual activity until they receive their practitioner’s approval. Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.