By: Ashley Medrano, Theresa Polly, Ashley Alvarado, Ruben Olmsted Cataracts By: Ashley Medrano, Theresa Polly, Ashley Alvarado, Ruben Olmsted

What are Cataracts? Cataracts are cloudy areas in the lens of the eye that can cause changes in vision.

The 3 Most Common Type of Cataracts Nuclear – tends to have a substantial genetic component that causes a central opacity in the lends. It is associated with myopia (i.e. nearsightedness), which worsens when the cataract progresses. Cortical – involves the anterior, posterior, or equatorial cortex of the lens. Cortical cataracts progress at a high variable rate. Vision is worse in very bright light. Posterior Subcapsular – occurs in front of the posterior capsule. Near vision id diminished, and the eye is increasingly sensitive to glare from bright lights.

Diagnosis of Cataracts – How are Cataracts Diagnosed? Visual Acuity Test: A visual acuity test uses an eye chart to measure how well you can read a series of letters (e.g. Snellen Chart.) Your eyes are tested one at a time, while the other eye is covered. Retinal Examination: The eye doctor puts dilating drops in your eyes to open your pupils wide. Making it easier to examine the back of your eyes (retina). Slit-lamp Examination: A slit lamp allows your eye doctor to see the structures at the front of your eye under magnification. The microscope is called a slit lamp because it uses an intense line of light, a slit, to illuminate your cornea, iris, lens, and the space between your iris and cornea. The slit allows your doctor to view these structures in small sections, which makes it easier to detect any signs of cataracts or tiny abnormalities. Ophthalmoscopy: A test that allows a health professional to see inside the fundus of the eye and other structures

Who is at Risk? Increasing age Diabetes Drinking excessive amounts of alcohol Excessive exposure to sunlight Exposure to ionizing radiation, such as that used in X-rays and cancer radiation therapy Family history of cataracts High blood pressure Obesity Previous eye injury or inflammation Previous eye surgery Prolonged use of corticosteroid medications Smoking

Clinical Signs & Symptoms Clouded, blurred or dim vision. Increasing difficulty with vision at night. Sensitivity to light and glare. Seeing "halos" around lights. Frequent changes in eyeglass or contact lens prescription. Fading or yellowing of colors. Double vision in a single eye.

Nonsurgical Treatments Eye protection – wearing sunglasses outdoors to protect eyes. New Research: researchers from the University of California, San Diego have discovered eye drops containing lanosterol can improve vision by dissolving the clumped proteins that form cataracts.

Surgical Treatments Phacoemulsification: a portion of the anterior capsule is removed, allowing extraction of the lens nucleus and cortex while the posterior capsule and zonular support are left intact. An ultrasonic device is used to liquefy the nucleus and cortex, which are then suctioned through a tube. Lens Replacement: After removal of the crystalline lens. The lens which focuses light on the retina must be replaced for the patient to see clearly. These are the 3 types of lens replacement options: aphakic eyeglasses, contact lenses, and IOL implants.

Pre-Operative Care Patients should Wash hair before surgery for hygiene. It won’t need washing the first day or two postoperatively. Educate patient to not rub their eyes, do not wear makeup around eyes Educate patient food or milk 6 hours prior to surgery Three days before surgery patient should Begin using your pre-op eye drops four times a day in your operative eye, at mealtimes and at bedtime. Use your eye-drops on the day of surgery as well, before and after. (If you are INSULIN-DEPENDENT your surgery will be scheduled early. DO NOT TAKE YOUR MORNING INSULIN; instead, bring your insulin to surgery for administration after surgery)

Postoperative Care Educate patient regarding eye protection, recognition of complications, activities to avoid, and obtaining emergency care. Educate the patient administration of medications. Such as mild analgesic agents, acetaminophen, antibiotic, anti-inflammatory, and corticosteroid eye drops or ointments prescribed. Inform that there should be minimal discomfort after surgery.

Postoperative Care Continued.. Eye is unpatched, discharge usually occurs within 1 hour Dark glasses required Mild itching normal Pain indicates complications Reduce IOP Prevent infection Assess for bleeding

Prognosis *Cloudy vision *Foggy vision *Vision Loss Cataract is a clouding of the eye's lens It gradually occurs and isn't noticeable until you have trouble driving at night or difficulty reading and it never goes away on its own. Cataract surgery - a standard procedure that cataract is very successfully removed. Cataract stops progressing on it own and is never reversible. Drugs and illness are promoting factors for cataracts .

Clinical Signs & Symptoms of the Potential Post Op Complications Potential Early Postoperative Complications Complication Effects Acute bacterial endophthalmitis — the most common causative organisms are Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas & Proteus species visual loss, pain, lid edema, hypopyon, corneal haze, and chemosis Toxic anterior segment syndrome —noninfectious inflammation that is a complication of anterior chamber surgery; caused by a toxic agent such as an agent used to sterilize surgical instruments Corneal edema occurs >24 hours after surgery; symptoms include reduced visual acuity and pain.

Clinical Signs & Symptoms of the Potential Post Op Complications Potential Late Postoperative Complications: Complication Effects Suture related problems Toxic reactions or mechanical injury from broken or loose sutures. Malposition of the IOL Results in astigmatism, sensitivity to glare, or appearance of halos. Chronic Endophthalmitis Persistent, low –grade inflammation and granuloma. Opacification of the posterior capsule – the most common late complication of extracapsular cataract extraction. Visual acuity is diminished

Actual Nursing Diagnosis Disturbed sensory perception r/t lens protein denaturation AMB clouded, blurred or dim vision secondary to cataracts. Goal: Improving visual acuity within the limits of individual situations, recognize sensory disturbances and compensate for changes. Interventions: Determine visual acuity, note whether one or two eyes involved. Orient clients to the environment Observation signs of disorientation. Approach from the side that was operated on, talk to touch. Remind clients use of cataract glasses whose purpose enlarge approximately 25 percent, loss of peripheral vision and blind spot may exist. Put the items required / position call bell within reach.

Risk Nursing Diagnosis Risk for injury related to blurred vision Goal: Prevention of injury. Interventions: Help the patient when able to do until postoperative ambulation and achieve stable vision and adequate coping skills, using techniques of vision guidance. Do not put pressure on the affected eye trauma. Use proper procedures when providing eye drugs. Discuss the need for the use of metal shields or goggles when instructed

Cultural Overtones African Americans experience impaired vision from both cataracts and glaucoma at twice the rate of Caucasian Americans, primarily due to lack of treatment. In 2010, white Americans age 40 and older had the highest prevalence rate of cataract (18 percent) followed by black Americans (13 percent). Hispanic Americans had the lowest rates of cataract (12 percent).

Culture Overtones

References Cohen, Paula. "Eye Drops Hold Promise for Reversing Cataracts." CBSNews. CBS Interactive, 28 July 2015. Web. 09 Oct. 2015. Cataracts." - Mayo Clinic. N.p., 5 June 2012. Web. 06 Oct. 2015. Cataracts-Medications." WebMD. WebMD, 9 Sept. 2014. Web. 6 Oct. 2015. Cataracts." Treatments and Drugs. N.p., 30 July 2013. Web. 09 Oct. 2015. Nursing Care Plan." : 4 Cataract Nursing Diagnosis and Interventions. N.p., 14 Mar. 2012. Web. 09 Oct. 2015. NANDA Nursing." : Nursing Care Plan for Cataract. N.p., 23 Dec. 2014. Web. 09 Oct. 2015. NCP for Cataracts - Disturbed Sensory Perception : Visual." Nursing Care Plan. N.p., 15 Oct. 2014. Web. 07 Oct. 2015.