NIMS NURSING COLLEGE, JAIPUR ASSIGNMENT SUBJECT: - MEDICAL SURGICAL NURSING -2 DATE:- 20/9/2020 TOPIC: - CATARACTS SUBMITTED TO: - SUBMITTED BY: - MR. SURENDRA DADHEECH MR. Vikas Kumar ASSISTANT PROFESSOR BSC.NURSING 3rd YEAR NIMS NURSING COLLEGE NIMS-NURSING COLLEGE JAIPUR RAJASTHAN. JAIPUR RAJASTHAN. Cataracts INTRODUCTION It is a clouding or opaqueness of the crystalline lens which leads gradual painless blurring and eventual loss of vision. A cause of blindness and is conventionally treated with surgery. Vision loss occurs because opacification of the lens obstructs light from passing and being focused on the retina. It is 3rd leading cause of preventable blindness. Cataract accounts for over 47% of blindness worldwide, causing blindness in about 17.3 million people in 1990. Surgery for cataract in people with glaucoma may affect glaucoma control. Cataract is the leading cause of reversible blindness and visual impairment globally. Blindness from cataract is more common in populations with low socioeconomic status and in developing countries than in developed countries. Cataract is the leading cause of reversible blindness and visual impairment globally. Blindness from cataract is more common in populations with low socioeconomic status and in developing countries than in developed countries. The only treatment for cataract is surgery. Phacoemulsification is the gold standard for cataract surgery in the developed world, whereas manual small incision cataract surgery is used frequently in developing countries. In general, the outcomes of surgery are good and complications, such as endophthalmitis, often can be prevented or have good outcomes if properly managed. DEFINITION The term cataract is derived from the Greek word cataracts, which describes rapidly running water or falling water. A cataract is a clouding or capacity that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to capacity and obstructing the passage of light. CLASSIFICATION BASED ON:MORPHOLOGY AGE OF ONSET MATURITYAGE OF ONSET: 1. CONGENITAL 2. INFANTILE 3. JUVINILE 4. PRE-SENILE 5. SENILE Morphological: 1.Capsular cataract 2.Sub capsular cataract 3.Cortical cataract 4.Supra nuclear cataract 5.Nuclear cataract 6.Polar cataract MATURITY: 1.IMMATURE CATARCT 2.MATURE CATARACT 3.HYPERMATURE CATARACT Causes of cataract: 1.Old age (commonest)>65 Year. 2.Ocular & systemic diseases – DM – Uveitis – Previous ocular surge. 3.Systemic medication – Steroids – Phenothiazines. 4.Trauma & intraocular foreign bodies 5.Ionizing radiation – X-ray – UV 6.Congenital – Part of a syndrome – Abnormal 7.galactose metabolism Hypoglycaemias. 8.Inherited abnormality – Myotonic dystrophy – 9.Marfan’s syndrome – Rubella – High myopia. Any physical or chemical cause ↓ Disturbs the intracellular and extracellular equilibrium of water and electrolytes ↓ Deranges the colloid system in lens fibres ↓ Aberrant fibres are formed from germinal epithelium of lens ↓ Epithelial cell necrosis ↓ Focal opacification of lens epithelium (glaucomflecken) ↓ Opacification of lens. Signs and symptoms: Painless, blurry vision Reduced visual acuity Myopic shift – return of ability to read without glasses. Astigmatism - optical defect in which vision is blurred due to the inability of the optics of the eye to focus a point object into a sharp focused image on the retina. Visible opaqueness. Diplopia Abnormal colour perception, glare (due to light scatter caused by lens opacities and significantly worse at night and in bright light when the pupil dilates). Brunescence – colour shift from yellow to brown. Reduced light transmission. Colour of pupil will be yellowish, grey or white, Develop in both eyes. Diagnosis: Visual acuity measurements. Snellen visual acuity test. Ophthalmoscopy. Slit lamp microscopic examination. Blood test. Visual field perimetry. A – scan ultrasound. Prevention: Avoid the risk factors – UV rays, x rays, smoking Wear sunglasses Regular intake of antioxidants (vitamins A, C AND E) would protect against risks. Prevent accidents. Treat underlying disorders properly. MANAGEMENT: Non-surgical treatment will not cure cataract. Surgery is performed as outpatient basis usually takes less than 1 hour and discharged in 30 minutes. Topical and intra ocular anaesthesia – 1% lidocaine gel is used. Patient can communicate and cooperate during surgery IV moderate sedation – to minimize anxiety. When both eyes have cataracts – one eye is treated first, after several weeks the other cataracts is been managed. This will help one eye to heal properly and the doctor can check the surgical procedure is effective or not. The doctor can also check the presence of any complications due to surgery. 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 as acetaminophen, as needed. Antibiotic, anti-inflammatory, and corticosteroid eye drops or ointments are prescribed postoperatively.
