Hebrews 11:1

Now faith is the assurance of

things hoped for, the evidence
of things not seen.

CATARACT IMPLEMENTATION
1. Provide a safe environment for the client. Orient the
 The crystalline lens becomes opaque
client to his surroundings to reduce the risk of injury.
 With age, lens fibers become more densely packed,
2. Modify the environment, to help the client meet self-
making the lens less transparent
care needs by placing items on the unaffected side,
 One of the leading cause of preventable blindness
prevent pressure rise o the affected side.
 Usually starts unilateral but often times both lenses are
3. caution the client not to rub the eyes
affected in time
4. No bending, straining at stool, coughing , sneezing
5. Provide sensory stimulation (large prints or tapes) to
Possible causes:
help compensate for vision loss.
1. Aging
2. Anterior uvietis
GLAUCOMA:
3. Blunt or penetrating trauma
 The client experiences visual field loss due to the
4. Congenital
damage to the optic nerve resulting from
5. Diabetes mellitus
increased intraocular pressure
6. Hypoparathyroid
 Can lead to blindness if left untreated
7. Long-term steroid treatment
 Two types open angle and closed angle
8. Radiation exposure
 Open angle glaucoma: there is overproductions of
9. UV light exposure
aqueous humor angles are open.
 Closed-angle the flow of aqueous humor is
Assessment findings
obstructed because of the narrow angle
1. Glare
2. Distorted images
Causes:
3. Gradual dimmed or blurred vision
1. DM
4. Nyctalopia (poor vision at night)
2. Family history of glaucoma
5. ROR (red-orange-reflex lost ) as cataract matures
3. Long-term steroid treatment
6. Yellow, gray, or white pupil.
4. Previous eye trauma or surgery
5. Race (blacks have a higher incidence)
Diagnostic tools
6. Uvietis
1. Slit lamp biomicroscopy
2. ophtlalmoscope
Assessment:
3. A scan ophthalmic ultrasound
Chronic open angle glaucoma:
 Initially asymptomatic
Nursing Diagnoses
 Atrophy and cupping of the optic nerve head
1. Disturbed sensory perception (visual)
 Increased intraocular pressure
2. Impaired physical mobility
 Narrowed field of vision (tunnel)
3. Risk for injury
 Possible asymmetric involvement
Treatment
Acute angle-closure glaucoma
1. ECCE w/ PCIOL – extra capsular cataract extraction with
 Acute ocular pain(severe)
post chamber intraocular lens
 Headache (severe, frontal)
2. Phacoemusification
 Blurred vision
 Dilated pupil
Planning and Goal
 Halo vision
1. The client will have a safe post operative course
 Increased intraocular pressure
2. The client will take steps to prevent infection and
 Nausea and vomiting
reduce intraocular pressure

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/7350740 - 1 -

Diagnostic evaluation:
1. Gonioscopy
2. Ophthalmoscopy Possible causes:
3. Perimetry 1. Aging
4. tonometry 2. Diabetic neovascularization
3. Familial tendency
Nursing Diagnoses 4. Hemorrhage
1. Acute pain 5. Inflammatory process
2. Anxiety 6. Myopia
3. Disturbed sensory perception (visual) 7. Trauma
4. Risk for injury 8. Tumor

Treatment Assessment finding

1. Chronic open-angle glaucoma
2. Reduction of intraocular pressure
3. Trabeculoplasty
Acute angle closure glaucoma
1. Lower down IOP (emergency)
2. Laser iridectomy , surgical iridectomy if pressure
doesn’t decrease with drug therapy.
Chronic open-angle glaucoma
1. Alpha-adrenergic agonist: (alphagan)
2. Beta-adrenergic antagonist : timolol (timoptic)
Acute-angle closure glaucoma
Cholinergic: pilocarpine
Planning and Goals
 The clients vision will improve ad pain will
disappear
 The client will be able to perform postoperative
self-care
 The client will take steps to prevent infection and
reduce IOP
Implementation:
1. Explain the disease process or surgical procedure to
reduce anxiety
2. Assess eye pain and administer medications as
prescribed
3. Provide a safe environment
4. Modify the environment to meet the client’s self-care
needs
5. In acute episodes limit activities that increased IOP
6. Report eye pain not relieved by analgesic that is
accompanied by nausea and vomiting and decrease
vision
7. Encourage the client to express feelings about changes
in his body image to aid acceptance of visual loss.
RETINAL DETACHMENT:
 Separation of the retina from the choroids(the
middle vascular layer of the eye between the
retina and the sclera)
 Occurs when a hole or tear in the retina develops
and the vitreous seeps between the retina and the
choroids, if left untreated retinal detachment can
lead to vision loss.
1. Blurred vision worsening as the detachment increases
2. Painless change in vision
3. Photopsia ( recurrent flashes of light)
4. With progression of detachment, painless vision loss
that maybe described as veil, curtain, or cobweb that
eliminates part of the visual field.
Diagnostic evaluation:
1. Indirect ophthalmoscopy shows retinal tear or
detachment.
2. Slit lamp examination reveals retinal tear or
detachment
3. Ultrasound shows retinal tear or detachment in the
presence of a cataract.
Nursing Diagnoses:
1. Disturbed sensory perception (visual)
2. Risk for injury
3. Anxiety
Treatment
1. Complete bed rest and restriction of eye movement to
prevent further detachment
2. Cryoprexy, if there’s a hole in the peripheral retina
3. Laser therapy, if there’s a hole in the posterior portion
of the retina
4. Scleral buckling to reattach the retina
Planning and goals
 The client will remain free from injury
 The client will understand the treatment options
 The client will be free from permanent visual
impairment
Implementation:
1. Assess the visual status and functional vision in the
unaffected eye to determine self-care needs.
2. Prepare the client for surgery by explaining possible
surgical interventions technique to alleviate some of
the client’s anxiety.
3. Postoperatively instruct the client to lie o his back or on
his unoperated side to reduce intraocular pressure on
the affected side.
4. Discourage straining during defecation, bending down,
and had coughing, sneezing or vomiting to avoid
activities that increase intraocular pressure.
5. Provide assistance with activities of daily living to

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/7350740 - 2 -

 minimize frustration and strain.
6. Assist with ambulation, as needed, to help the client
remain independent.
7. Approach the patient from the unaffected side to avoid Implementation:
startling him 1. Advise the client against reading and exposure to
8. Orient the client to his environment to reduce the risk glaring lights to reduce dizziness
of injury. 2. Keep the side rails of the client’s bed up to prevent falls
3. Instruct the client to avoid sudden position changes
MENIERE’S DISEASE and task that vertigo makes hazardous because an
 Is a dysfunction in the labyrinth that produces attack can begin quite rapidly.
vertigo, sensorineural hearing loss, and tinnitus 4. If the client is vomiting record fluid intake and output
 It affects adults and characteristics of vomitus to prevent dehydration.
 Men more common than women
 Age 30-60

Assessment findings
1. Severe vertigo
2. Tinnitus
3. Feeling of fullness or blockage in the ear
4. Severe nausea
5. Vomiting
6. Sweating
7. Giddiness
8. Nystagmus
9. Sensorieural hearing loss

Diagnostic evaluation:
1. Audiometric studies indicate a sensorineural hearing
loss and loss of discrimination and recruitment.

Nursing diagnoses:
1. Disturbed sensory perception (auditory)
2. Powerlessness
3. Risk for injury

Treatment
1. Restrict sodium intake to less than 2 gms per day
2. Surgery to destroy the affected labyrinth permanently
relieves symptoms but at the expense of irreversible
hearing loss.

Drug therapy options:

1. Anticholinergic: atropine
2. Cardiac stimulant: epinephrine
3. Diuretic
4. Antihistamine: diphendyramine
5. Antihistamine: meclezine
6. sedative

Planning and goal

 The client will regain hearing or develop alternate
means of communication
 The client will use available support systems to
develop coping abilities to deal with the disorder
 The client will remain free from injury.

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/7350740 - 3 -