A cataract is a cloudiness in the lens without pain gradually, eventually blurred vision can not receive light. (Barbara)
Etiology
- Aging, senile cataract usually encountered.
- Trauma occurs as blunt / sharp exposure to X-rays or radioactive objects.
- Eye diseases such as uveitis.
- Systemic diseases such as diabetes.
- Congenital defect.
Decreased visual acuity depends on:
- There was no sign of inflammation (hyperemia none)
- Oblique illumination looks turbidity grayish or white with a black shadow.
- Examination with the ophthalmoscope appear black on orange base is called the fundus reflex.
- At a more advanced cataract, thus increasing turbidity shadow iris and fundus reflexes disappear into a black (negative).
Pre Operative Assessment of Cataract
Subjective : vision complaints
- Blurred in total.
- Just look good in dim places.
- Can only see the light stimulus alone.
- Double / compound in one eye.
An understanding of cataract surgery include :
- The nature of the procedure.
- Risks and benefits.
- Anesthetic drugs.
- Option for visual rehabilitation after surgery, such as intraocular lens implants, contact lenses and cataract glasses.
Objective :
- There were no signs of inflammation except in complicated cataract that intra ocular disease is still active .
- On irradiation examination lens opacities appear gray or white.
- In ophthalmoscope examination , at a certain distance obtained turbidity is black with a red background .
- On examination of refraction increases . In patients who had been suffering from presbyopia, cataracts later , at an early stage can be read without the use of reading glasses .
- Observation of the signs of glaucoma as a complication of cataract , glaucoma is the most common such as the presence of pain because of increased IOP , visual field abnormalities .
Nursing Diagnosis for Cataract
1. Disturbed Sensory Perception (visual) related to a decrease in visual acuity, double vision.
Goal: sensory perception disorder is resolved.
Outcomes:
- With limited vision the client is able to see the environment as much as possible.
- Know the changes are positive and negative stimuli.
- Identify environmental habits.
Intervention
- Orient the patient's activities on the environment.
- Distinguish between the ability of the visual field of both eyes.
- Observation of signs of disorientation to remain at the patient's side.
- Encourage the client to perform simple activities such as watching TV, radio, etc.
- Instruct the patient to use sunglasses cataracts, prevent peripheral visual field and note the occurrence of blind spots.
- Position open the doors must be closed, minimize obstacles.
Rational:
- Introducing the patient about the environment and activities so as to leave the visual stimulus.
- Determining the ability of the visual field of each eye.
- Reducing patient fear and increase stimulus.
- Increasing sensory input, and maintain a sense of normalcy, without increasing stress.
- Lowering of peripheral vision and movement.
Nursing Diagnosis for Cataract
2. Anxiety related to surgery that will be undertaken and the possibility of failure to obtain a sight again.
Goal: overcome anxiety
Outcomes:
- Expressed concern and fears about the surgery that will be undertaken.
- Expressed understanding of routine actions and treatment perioperatively.
- Create an environment that is calm and relaxed, give encouragement to verbalize and listened attentively.
- Reassure clients that anxiety has a normal response and is estimated to occur in cataract surgery to be undertaken.
- Show misconceptions expressed clients, provide accurate information.
- Present the information using methods and instructional media.
- Explain to the client the required premedication activity.
- Discuss nursing actions preoperative expected.
- Provide information about the activities of the sights and sounds associated with the intra-operative period.
- Help identify the source of anxiety.
- Enhance client confidence.
- Improving learning process and have a source of information written referral after discharge.
- Increased knowledge will add cooperative clients and reduce anxiety.
- Explaining the choice of allowing the client to make decisions correctly.
