JMJ MARIST BROTHERS

Notre Dame of Dadiangas University

Marist Avenue, General Santos City
College of Health Sciences
________________________________________________________________________

A CASE STUDY ON CATARACT

In Partial Fulfillment of the Requirements In

Related Learning Experience 112 For The
Degree In Bachelor of Science In Nursing

________________________________________________________________________

Submitted to:

Mr. Aaron Carlo C. Decendario, PhD, MIC, RN

Presented by:

Aira Shane C. Marges, SN

Teza Marygrace L. Maribao, SN
Keiko Lorenz P. Mercado, SN

September 2022
 Cataract ii

ACKNOWLEDGEMENT

As the journey to becoming a nurse continues, there are several challenges that student

nurses continuously face as they persevere through their chosen career path. Having said that, the

case study would not have been made possible without the constant assistance, support, and

encouragement of several individuals. The student nurses would like to take this opportunity to

express their warmest and sincerest gratitude to the following people who assisted them in the

process of completing the case study:

To their Clinical Instructor in RLE 112, Dr. Aaron Carlo C. Decendario, RN, MIC, for

being an excellent mentor and for his dedication, advice, guidance, support, and encouragement

throughout the entirety of the case study completion process;

To the Dean of the College Health Sciences, Dr. Rue Flora P. Ruiz, RN, PhD, for

providing the students the opportunity to develop and learn as student nurses;

To their classmates and fellow student nurses, who, despite the challenges encountered

in this particular subject, have shown compassion, family spirit, and moral support;

To their friends, who gave them continuous comfort and support during the entire

process of the case study;

To their family, who provided them with ongoing support, love, encouragement, and

care; and

Above all, to the Almighty God, who, despite all the difficulties and setbacks, gave them

the motivation and strength to carry out the case study.

 Cataract iii

TABLE OF CONTENTS

Page

Title Page i

Acknowledgement ii

Table of Contents iii

Chapter

I Introduction 1

II Objectives 6

III Case Scenario 7

Patient’s Database 10

Name of Patient (Alias) 10

Address 10

Religion 10

Age 10

Civil Status 10

Nationality 10

Date and Time of Admission 10

Attending Physician 10

IV Patient’s Health History 11

Chief Complaint/s 11

History of Present Illness 11

History of Past Illness 12

Family Health History 12

 Cataract iv

Admitting Diagnosis 13

V Health Assessment 14

Digestive System/Metabolic 14

Respiratory System 14

Cardiovascular/Circulatory System 14

Integumentary System 14

Musculoskeletal System 14

Cognitive and Perceptual/Neurologic System 14

VI Anatomy and Physiology 15

VII Pathophysiology 18

VIII Medical and Nursing Management 26

Laboratory Findings 26

Medical Management 29

Nursing Management 41

Prognosis 44

IX Gordon’s Functional Health Pattern 46

Problem List 49

Prioritization of Problems 50

Nursing Care Plan 52

Prognosis 70

Health Teachings 72

References 75

Curriculum Vitae 82
 Cataract 1

CHAPTER I

Introduction

According to Mayo Clinic (2021), The normally clear lens of the eye becomes clouded

due to a cataract. Cataract sufferers may compare looking through cloudy lenses to looking

through a frosty or fogged-up window. It can be more challenging to read, drive a car especially

at night, or see the expression on a friend's face when one's vision is clouded by cataracts. Most

cataracts grow slowly and don't initially impair your vision. However, cataracts will eventually

obstruct your vision over time. Stronger lighting and eyeglasses can initially help you manage

cataracts. However, if your normal activities are hampered by your poor vision, cataract surgery

may be necessary. The good news is that cataract surgery is typically a risk-free, successful

procedure (Boyd, 2018). When the natural lens of your eye develops a cataract, it is cloudy. Your

lens's proteins deteriorate, making objects appear hazy, less colorful, or blurry. Your lens has

become cloudy if you have a cataract, just like the bottom lens in the illustration. It's similar to

looking through a dirty or foggy car windshield. A cataract causes things to appear fuzzy, hazy,

or less colorful.

The lens of the eye becomes clouded in cataracts. It is caused by a protein build-up on the

eyes' lens and results from the natural aging process. The most typical kind of cataract is called a

nuclear sclerosis cataract. The eye's nucleus is where it starts or the central zone). Nuclear

sclerotic cataract develops gradually over time, frequently. The eye's nucleus gradually becomes

harder and more yellowish at first, and as it progresses, other layers of the eye also become

affected. Next, cortical cataracts begin in the opposite direction from nuclear sclerotic cataracts.

You are more likely to get this kind of cataract if you have diabetes. It begins with the eye's

outermost layer. As it goes along, spokes are formed that connect the lens's exterior to the
 Cataract 2

nucleus. Blurred vision, glare issues, and changes in contrast and depth perception are all signs

of this cataract. If you have diabetes or extremely nearsightedness, you are more likely to

develop posterior subcapsular cataracts. The risk is also higher for people who use steroids,

whether recreationally or for medical purposes. The first symptoms of posterior subcapsular

cataracts are changes in your night vision. With this cataract, you might also experience more

difficulty reading. This cataract typically develops over a few months rather than many years

(Drs. Campbell Cunningham Taylor & Haun, 2019). Third, a posterior subcapsular cataract

begins as a small, opaque area near the back of the lens, directly in the path of light. A posterior

subcapsular cataract frequently impairs reading vision, reduces vision in bright light, and causes

glare or halos around lights at night. These types of cataracts progress more quickly than others.

Finally, some people are born with cataracts, while others develop them as children. These

cataracts could be hereditary or caused by an intrauterine infection or trauma. Congenital

cataracts are the last type of cataract (Mayo Clinic, 2017).

According to the National Eye Institute (2019), the proteins in your eye's lens naturally

begin to deteriorate after the age of 40. These normal changes are what cause the majority of

cataracts. Although doctors and researchers are unsure of the precise cause of some people's

cataracts, they are aware that certain factors can hasten the development of cataracts. In addition

to these risk factors, some medical conditions and treatments, such as diabetes, a serious eye

injury, eye surgery to treat glaucoma or another eye condition, long-term use of steroid

medications to treat conditions like arthritis or allergies, and receiving radiation therapy for

cancer or other diseases, can also increase the likelihood of developing cataracts.

Aging, diabetes (diabetes can cause cataracts to form earlier), family history of cataracts

at a young age, years of excessive sun and UV ray exposure, smoking, obesity, high blood
 Cataract 3

pressure, past eye injury or inflammation, previous eye surgery, and steroid medication use are

some factors that can increase the risk of developing a cataract (Stanford Medicine, 2016).

The symptoms of cataract development can include a number of different ones, but in the

early stages they may be irregular, barely bothersome, or mistaken for another condition, like a

refractive error. The majority of cataracts grow slowly, so you may become accustomed to the

symptoms as they progress. The most common cataract symptoms include hazy or blurry vision,

spots of fuzzy vision, dimness necessitating more light for tasks, reduced color intensity or

yellowing of colors, increased sensitivity to light, glares or halos around lights, changes in your

refractive error, and double vision in one eye (NVision, 2021).

The National Eye Institute states that a cataract can impair vision in two different ways.

The lens of the eye's protein starts to thicken. The amount of light that passes through the lens

and into the optic nerve is affected as the protein clump grows over time, blurring both far and

near vision. The lens eventually turning yellow or brown is the second way a cataract impairs

both near and far vision. Over time, as the color becomes darker, it becomes more challenging to

read and perform other tasks. As the lens changes, you might notice that everything appears

"browner." Although the discoloration reduces both near and far vision, it has no effect on the

sharpness of an image (Southwestern Eye Center, 2018)

The statistics on cataracts around the world reveal an intriguing tale about the availability

of basic medical procedures. The World Health Organization (WHO) estimates that cataracts are

to blame for 51% of all cases of blindness worldwide. That is roughly 20 million cataract-related

blind people. Millions of people simply do not have access to these types of common surgeries,

despite the fact that cataract surgery is common and effective in the United States and much of

the developed world. In addition to the aforementioned, the AAO predicts that between 5 and
 Cataract 4

20% of all cases of blindness worldwide may be caused by congenital cataracts. Cataracts

typically begin to form in a person's golden years and around middle age. The NEI notes that

although cataracts may not affect vision until the 60s, they can begin to develop in people in their

40s and 50s. In Olmsted County, Minnesota, between 2005 and 2011, a Mayo Clinic study of

cataract operations found that 20 percent of patients under the age of 65 underwent the

procedure, while only 1 to 2 percent of patients in their early 40s underwent the procedure

(Tepper, 2018).

332,150 people are estimated to be bilaterally blind in the Philippines as of 2017, with

cataract accounting for approximately 109,609 of those cases, or 33% (Department of Health,

2017). Although the prevalence of blindness has steadily decreased over time in the Philippines,

cataract is still the leading cause of preventable blindness or visual impairment (Guballa, 2019).

In India, women are significantly more likely than men to experience cataract-related

blindness, according to a pooled analysis of the data that was published online in the British

Journal of Ophthalmology. The study did find that surgical treatment for the condition is

significantly less common for women than for men. Globally, 36 million people are blind, and if

no effective preventive measures are taken, that number is projected to increase to over 114

million by 2050. They included 22 studies in their review and combined the data from 12 of

them. The average age of study participants ranged from 61 to 70. Women were more likely than

men to become blind or develop cataracts, with about 4% of men becoming blind compared to

almost 6% of women. In addition, women had a 79% higher risk of cataract blindness and a 35%

higher risk of being blind than men. Despite this, women had a 27% lower rate of cataract

surgery than men. The analysis of pooled data revealed that women represented about one-third

of the prevalence of blindness (35%) and cataract blindness (33 percent) (BMJ, 2019).
 Cataract 5

The National Eye Institute (NEI) estimates that 24.4 million Americans aged 40 or older

are affected by cataracts. Additionally, about 50% of Americans who are 75 years old and older

have cataracts. Regarding cataracts and age, the NEI provides the following breakdown of the

prevalence of cataracts for various age groups: ages 40-49 (2.51%), 50-54 - (5.22%), 55-59

(9.14%), 60-64 (15.45%), 65-69 (24.73%), 70-74 (36.49%), Age 75-79 (49.49%), and age 80+

(68.3%) (Gross, 2018).

 Cataract 6

CHAPTER II

Objectives

The specific and general objectives of the case study on cataract are discussed in this

chapter.

General Objectives

The study aims to outline the anatomy, physiology, pathophysiology, etiology, and

complications based on manifestations, responses, and the medical and nursing management of a

client with cataract disease as well as how to prioritize diseases, impart health knowledge, and

administer treatments

Specific Objectives

Specifically, the case study aims to achieve the following objectives:

1. Define what is cataract.

2. Discuss the causes of cataract.

3. Discover the signs and symptoms of cataract.

4. Identify the risk factors for cataract.

5. Explore the anatomy and physiology of the Nervous System.

6. Describe the pathophysiology of cataract.

7. Discuss the medical and nursing management for cataract.

8. Apply understanding of cataract on the case of the patient.

9. Formulate interventions and medications for cataract.

10. Demonstrate interventions and health teaching.

 Cataract 7

CHAPTER III

Case Scenario

Teresita, age 57 and a married Filipino, was admitted to the hospital due blurring vision.

She is a Roman Catholic and lives in General Santos City. Upon admission, the patient revealed

that she has been wearing eyeglasses since she was 16 years old to correct her myopia and

astigmatism. In the year 2017, the patient reported that she had been experiencing blurry vision

and headaches for about 3 months. Thinking that she needed to get her eyeglasses checked, the

patient went to her eye center. Upon examination, the optometrist stated that she was having

difficulty finding the correct eye grade of the patient and was advised to go to an

ophthalmologist. However, the patient just wanted to get her eyeglasses changed because she

hoped that this would make her vision clearer since blurry vision and headache were her

indications in the past that she needed to change her eyeglasses. Hence, she did not think much

about her situation.

After two years, in the year 2019, the patient was still experiencing the same symptoms.

As a result, the patient decided to go to another eye center to get her eyes checked. At the eye

center, the optometrist said that they will not change the eyeglasses of the patient unless the

patient will have a prescribed eye grade coming from an ophthalmologist. In December of the

same year, the patient finally decided to go to an ophthalmologist, Dr. Villanueva. The patient

was checked and it was found out that the patient had cataracts on both eyes and was advised for

an operation after 6 months. The physician also prescribed Pirenoxine, an eye drop, to the patient

to be instilled 3x a day and 1 drop per instillation. Despite the physician’s advice to have a

surgical operation on June 2020, the patient decided not to go through with the procedure due to

fear. Instead, the patient decided to use other herbal eye drops with the hope of being treated
 Cataract 8

without getting surgery. “It took me a long time to have my surgery because I was afraid that it

will not be successful and I will become blind. I didn’t thought that it will worsen because I

thought that the herbal medicines that I took was enough to cure my cataracts”, the patient

reported.

In 2021, the patient continued to experience deteriorating vision. Hence, she decided to

seek a second opinion from another ophthalmologist, Dr. Atendido. During her check-up, she

was diagnosed with a senile mature cataract on both eyes and was advised for an immediate

operation. The physician prescribed a food supplement, Eye-Vites Max, to be taken once a day

until the operation. The patient still decided to delay her operation due to fear.

This year, the patient reported that her blurry eyesight has already interfered with her

daily living. She cannot read and write without assistance. She also cannot cross the road alone

because she cannot clearly see the moving vehicles. In general, she reported feeling isolated and

having less independence because of her eye condition. As a result, she decided to have the

surgery and admitted herself to the hospital.

The patient was admitted on September 12, 2022, at 8:30 AM with her physician, Dr.

Atendido. The patient reported that her mother also had a senile cataract but was untreated. All

of her family members also wore eyeglasses due to myopia and astigmatism. The patient and her

family also have a history of hypertension. Patient was constantly exposed to the sunlight due to

her occupation. She has been taking her maintenance for hypertension, Losartan, twice a day.

The patient has no history of smoking, alcohol use, and allergies. The patient also denies any

recent illness aside from her blurring vision.

 Cataract 9

The patient was accompanied by her sister. “My family is very supportive with my

surgery. They were the ones who really encouraged me to have this surgery”, as stated by the

patient.

A physical exam was performed on the patient which revealed to be normal. The

patient’s height was 5’0 and weighed 120 lbs. BMI of the patient was 24.4. When asked about

her food intake, the patient answered, “I am conscious of the food that I eat because I have

hypertension. I mostly eat vegetables and fish and I seldom eat meats. The patient also reported

stretching every day, “I stretch every morning right after I wake up and every Sunday, I walk and

jog with my husband and daughter”.

The visual acuity of the patient has declined bilaterally. The visual acuity of the patient

was as follows: OD was 20/70 and OS was 20/50. The patient had normal appearing orbital

structures on both sides. No nystagmus was noted. Upon optical examination, the lens was dark

brown with an iris shadow. No fundal view due to dark opacity in the center against a red glow.

No fourth Purkinje image.

The patient was awake and interactive. She responded appropriately to questions and

provided information accurately. The patient, however, stated her fears about the result of the

procedure. The blood pressure of the patient was taken and the results were 150/90 mmHg. “I’m

scared of the possible outcome of the surgery because I might go blind instead of being cured”,

the patient reported.

Before the surgery, the patient underwent a biometry test. An RT-PCR test was also

administered which tested negative. CBC was performed and the results were normal. A chest x-

ray also revealed normal lungs. The patient was put under local anesthesia through IV. The

surgery started at 11:38 AM and ended at 12:08 PM. The surgeon noted stab incisions,
 Cataract 10

capsulorrhexis, phacoemulsification done, and intraocular lenses were inserted. Medications

prescribed were Vigamox eye drops, Pred Forte eye drops, NaCl eye drops, Ciprofloxacin,

Acetazalamide, and Kalium Durules.

Post-operatively, the patient reported clearer vision but with halos when looking at lights,

pain and discomfort in the eyes, and having a “heavy” feeling in the eyes. Patient gave a pain

rating of 6/10. Patient was grimacing.

Patient’s Database

a. Name of Patient: Teresita

b. Address: General Santos City

c. Religion: Roman Catholic

d. Age: 57 years old

e. Civil Status: Married

f. Nationality: Filipino

g. Date and Time of Admission: September 12, 2022, 8:30 AM

h. Attending Physician: Dr. Atendido

 Cataract 11

CHAPTER IV

Patient’s Health History

a. Chief Complaint/s

Post-operatively, the patient reported clearer vision but with halos when looking

at lights, pain and discomfort in the eyes, and having a “heavy” feeling in the eyes.

b. History of Present Illness

The patient has been wearing eyeglasses since she was 16 years old to correct her

myopia and astigmatism. In the year 2017, the patient reported that she had been

experiencing blurry vision and headaches for about 3 months. Thinking that she needed

to get her eyeglasses checked, the patient went to her eye center. Upon examination, the

optometrist stated that she was having difficulty finding the correct eye grade of the

patient and was advised to go to an ophthalmologist. However, the patient just wanted to

get her eyeglasses changed because she hoped that this would make her vision clearer

since blurry vision and headache were her indications in the past that she needed to

change her eyeglasses. Hence, she did not think much about her situation.

After two years, in the year 2019, the patient was still experiencing the same

symptoms. As a result, the patient decided to go to another eye center to get her eyes

checked. At the eye center, the optometrist said that they will not change the eyeglasses

of the patient unless the patient will have a prescribed eye grade coming from an

ophthalmologist. In December of the same year, the patient finally decided to go to an

ophthalmologist, Dr. Villanueva. The patient was checked and it was found out that the

patient had cataracts on both eyes and was advised for an operation after 6 months.

Despite the physician’s advice to have a surgical operation on June 2020, the patient
 Cataract 12

decided not to go through with the procedure due to fear. Instead, the patient decided to

use other herbal eye drops with the hope of being treated without getting surgery. “It took

me a long time to have my surgery because I was afraid that it will not be successful and

I will become blind. I didn’t thought that it will worsen because I thought that the herbal

medicines that I took was enough to cure my cataracts”, the patient reported.

In 2021, the patient continued to experience deteriorating vision. Hence, she

decided to seek a second opinion from another ophthalmologist, Dr. Atendido. During

her check-up, she was diagnosed with a senile mature cataract on both eyes and was

advised for an immediate operation. . The patient still decided to delay her operation due

to fear.

This year, the patient reported that her blurry eyesight has already interfered with

her daily living. She cannot read and write without assistance. She also cannot cross the

road alone because she cannot clearly see the moving vehicles. In general, she reported

feeling isolated and having less independence because of her eye condition. As a result,

she decided to have the surgery and admitted herself to the hospital.

c. History of Past Illness

The patient has been taking her maintenance for hypertension, Losartan, twice a

day. The patient has no history of smoking, alcohol use, and allergies. The patient also

denies any recent illness aside from her blurring vision.

d. Family Health History

The patient reported that her mother also had a senile cataract but was untreated.

All of her family members also wore eyeglasses due to myopia and astigmatism. The

patient and her family also have a history of hypertension.

 Cataract 13

e. Admitting Diagnosis

The patient was checked and it was found out that the patient had cataracts on

both eyes. A physical exam was performed on the patient. The visual acuity of the patient

has declined bilaterally. The visual acuity of the patient was as follows: OD was 20/70

and OS was 20/50. The patient had normal appearing orbital structures on both sides. No

nystagmus was noted. Upon optical examination, the lens was dark brown with an iris

shadow. No fundal view due to dark opacity in the center against a red glow. No fourth

Purkinje image. The patient was awake and interactive. She responded appropriately to

questions and provided information accurately. The patient, however, stated her fears

about the procedure. The blood pressure of the patient was taken and the results were

150/90 mmHg. Before the surgery, the patient underwent a biometry test. An RT-PCR

test was also administered which tested negative. CBC was performed and the results

were normal. A chest x-ray also revealed normal lungs. The patient was put under local

anesthesia through IV. The surgery started at 11:38 AM and ended at 12:08 PM. The

surgeon noted stab incisions, capsulorrhexis, phacoemulsification done, and intraocular

lenses were inserted. Medications prescribed were Vigamox eye drops, Pred Forte eye

drops, NaCl eye drops, ciprofloxacin, acetazalamide, and Kalium Durules. Post-

operatively, the patient reported clearer vision but with halos when looking at lights,

discomfort in the eyes, and having a “heavy” feeling in the eyes. Patient gave a pain

rating of 6/10. Patient was grimacing.

The patient was diagnosed with senile mature cataract.

 Cataract 14

CHAPTER V

Health Assessment

a. Digestive System/Metabolic

The patient’s height and weight were taken. The patient’s height was 5’0 and

weighed 120 lbs. BMI of the patient was 24.4.

b. Respiratory System

The patient had a chest x-ray and was revealed to be normal. An RT-PCR test was

also performed which tested negative.

c. Cardiovascular/Circulatory System

CBC was performed and was revealed to be normal. The blood pressure of the

patient was taken and the results were 150/90 mmHg.

d. Integumentary System

There were no assessment methods employed to assess the integumentary system

of the patient.

e. Musculoskeletal System

A physical exam was performed on the patient which revealed to be normal.

f. Cognitive and Perceptual/Neurologic System

The visual acuity of the patient has declined bilaterally. The visual acuity of the

patient was as follows: OD was 20/70 and OS was 20/50. The patient had normal appearing

orbital structures on both sides. No nystagmus was noted. Upon optical examination, the

lens was dark brown with an iris shadow. No fundal view due to dark opacity in the center

against a red glow. No fourth Purkinje image.

 Cataract 15

CHAPTER VI

Anatomy and Physiology of the Eye

The human eye is an organ that senses light

and transmits signals to the brain via the optic nerve.

The eye, which may be among the body's most

intricate organs, is made up of numerous

components, each of which is necessary for vision.

(Anatomy of the Eye, 2022) When light reflects off

an object, it enters the eye if the object is in your

field of vision. The surface of the eye's thin tear film

is the first thing it touches. The cornea, the front

window of your eye, is behind this. The light is

focused by this transparent layer. The aqueous

humor, which is liquid, is on the opposite side. It moves throughout your eye's anterior segment

and maintains steady pressure there. Light enters the pupil after passing through the aqueous

humor. The iris, the colored portion of your eye, has a central round opening like this. To

regulate how much light enters farther back, it changes size. (WebMd, 2021) For light focusing,

the lens functions exactly like a camera. Depending on whether the light is reflected off of

something close by or far away, it changes shape. Now the center of the eye is penetrated by this

light. It is moistened by the vitreous, a transparent jelly. The retina, which lines the back of your

eye, is where it will eventually end up. It is comparable to a movie theater screen or a camera's

film. Photoreceptors are cells that are exposed to the focused light.
 Cataract 16

The visual parts of the eye are significantly more intricate in both structure and purpose.

The cornea, iris, and pupil make up the clear portion of the eye. The sclera, which encloses the

remaining portion of the eyeball, is the opaque white portion of the eye. The optic nerve is sheathed

by the sclera. The limbus, which has numerous

eye blood vessels, is where the cornea and sclera

converge. The pupil and iris are the parts of the

eye that are most easily seen. The colored portion

of the eye, the iris, is made up of tissue that lies

beneath the cornea. The color of the eye, which

is predetermined by genetics, also functions to

block out unwanted light.(Sebastian,E., 2010)

According to Sebastian, E. (2010), the cornea and the lens proper are two excellent lenses

that are part of the human eye, which develops directly from the brain. The embryonic skin

covering the eye becomes our cornea as humans develop in the womb. This type of skin lacks the

hair, glands, and blood vessels that are typically found in most other skin types in order to be

completely clear. It has a large number of nerves, making it extremely touch sensitive.

The optic nerve (CN II), a sensory nerve, travels through the back of the eyeball and into

the brain before continuing into the optic chiasm. The right side of the brain receives visual

information from the left side of our visual space (that is, the right side of both right and left

eyes),while the left side of the brain receives information from the right side of our visual space

when you visualize the world. When the input reaches the optic chiasm, it crosses from one side

to the other. Information is transmitted from the chiasm, an X-shaped structure where fibers from

the optic nerves cross, to the visual cortex (the occipital lobe). (The Anatomy of Vision, 2019)
 Cataract 17

Visual image formation is a complicated process that involves several crucial steps. Every

single one of these steps is crucial to the process; if any one does not work properly, vision will

not be clear. The level of abnormal function

determines how blurry one's vision is. Light

has to be focused on the retina in order to see

normally. Like the cornea and lens, glasses

and contact lenses refract light in a particular

way. The moment an object is viewed, the

process of producing vision starts. That

object has a distinctive way of absorbing and

reflecting light. When light from the object is reflected, it returns to your eye and enters through

the cornea. To help focus the light, the cornea bends these light rays in the direction of one another.

The retina is located at the back of the eye, where the light eventually reaches.

Light is focused on the macula to create your central vision, which enables you to see

fine details. In this instance, vision is unimpeded by glasses or contact lenses. (How Vision

Works, 2017)
 Cataract 18

CHAPTER VII

Pathophysiology
Predisposing Factors: Precipitating Factors:
Aging Aging
Diabetes Eye injury
Excessive UV exposure Congenital cataract
Smoking Associated ocular conditions
Obesity Past eye surgery (Vitrectomy)
Hypertension Systemic diseases and syndromes
Previous eye injury or inflammation Long-term use of steroid medications
Previous eye surgery Overexposure to UV radiation
Prolonged use of steroid medications Frequent X-rays or radiation treatments to
Drinking excessive amounts of alcohol the head
Family history of cataract Family history

Degenerative process denature and Barriers develop preventing glutathione and

coagulate lens protein in lens fiber other protective antioxidants from reaching
the nucleus in the lens

Oxidative stress

Production of peroxides and free radicals

Breakdown and aggregation of protein

Damage to cell components

Disturbances Fibrous Cortical Deposition of

occurring at any metaplasia of hydration certain
level of lens lens epithelium between lens pigments i.e.,
growth fibers urochrome

Opacity of lens

Loss of transparency

Cataract formation
 Cataract 19

Congenital Subcapsular Cortical Nuclear

cataract cataract cataract cataract

Signs and Symptoms:

Clouded, blurred or dim vision
Increasing difficulty with vision at night
Sensitivity to light and glare
Need for brighter light for reading and other
activities
Seeing “halos” around lights
Frequent changes in eyeglasses or contact
lens prescription
Fading or yellowing colors
Double vision in a single eye

Figure 1. Book-based Pathophysiology of Cataract

 Cataract 20

Textual Discussion of the Disease Process (Book-based)

A cataract is a cloudiness or opacity of the lens. This condition had already caused visual

impairment in 18 million people worldwide (Grossman & Porth, 2014). In the United States,

more than half of all Americans have cataracts by the age of 80. Worldwide, cataracts are the

leading cause of blindness (Prevent Blindness America, 2012). Cataracts can form in either or

both eyes at any age (Grossman & Porth, 2014).

Cataracts are caused by a number of factors, including aging, diabetes, excessive UV

exposure, smoking, obesity, hypertension, prior eye injury or inflammation, previous eye

surgery, prolonged use of steroid medications, excessive alcohol consumption, and a family

history of cataract. Among these factors, the most common predisposing factor for cataract is

aging (Mayo Clinic, 2017; Stanford Medicine, 2016). According to the Mayo Clinic (2017),

most cataracts develop when the tissue that makes up the eye's lens changes due to aging or

injury. Proteins and fibers in the lens begin to degrade, resulting in hazy or cloudy vision. Some

inherited genetic disorders that cause other health issues can increase your chances of developing

cataracts. Other eye conditions, previous eye surgery, or medical conditions such as diabetes can

also cause cataracts. Long-term use of steroid medications can also result in cataract formation.

Other factors that can contribute to cataract formation include associated ocular conditions such

as myopia, retinal detachment, and retinitis pigmentosa; system diseases and syndromes such as

diabetes, renal disorders, musculoskeletal disorders, down syndrome, and lipid metabolism

disorders; physical factors such as UV radiation in sunlight and x-ray; and having a family

history of cataract (Hinkle & Cheever, 2018).

The lens is made up of specialized proteins known as crystallins, the optical properties of

which are determined by the precise arrangement of their three-dimensional structure and
 Cataract 21

hydration. The lens cytoskeleton provides the specific shape of the lens cells, particularly the

fibre cells of the nucleus, while membrane protein channels maintain osmotic and ionic balance

across the lens. Protein-bound sulfhydryl (SH)-groups of the crystallins are protected against

oxidation and cross-linking by high concentrations of reduced glutathione -'mother of all

antioxidants'. The cortex is the superficial part of the lens matter, containing the younger fibers,

and the nucleus is the deeper part, containing the older fibers. Many degenerative processes,

through various mechanisms, denature and coagulate lens proteins found in lens fibers. As the

eye ages, barriers form that prevent glutathione and other protective antioxidants from reaching

the nucleus in the lens, making it vulnerable to oxidation. Oxidative stress occurs when there is

an imbalance between the systemic manifestation of reactive oxygen species and the ability of a

biological system to readily detoxify the reactive intermediates or repair the resulting damage.

Disruptions in the normal redox state of cells can cause toxic effects by producing peroxides and

free radicals, which damage all cell components, including proteins, lipids, and DNA. The

following mechanisms are involved: disturbances occurring at any level of lens growth

(congenital cataract); fibrous metaplasia of lens epithelium (subcapsular cataract); cortical

hydration between lens fibers (cortical cataract); and deposition of certain pigments, i.e.,

urochrome (nuclear cataract). All of these processes eventually result in an opaque lens behind

the pupil, resulting in loss of transparency and, eventually, cataract formation (Nartey, 2017;

Nizami & Gulani, 2022).

Cataract symptoms include clouded, blurred, or dim vision; increasing difficulty with

night vision; sensitivity to light and glare; a need for brighter light for reading and other

activities; seeing "halos" around lights; frequent changes in eyeglass or contact lens prescription;

color fading or yellowing; and double vision in a single eye. At first, the cloudiness in your
 Cataract 22

vision caused by a cataract may only affect a small portion of the eye's lens, and you may be

completely unaware of any vision loss. As the cataract grows in size, it clouds more of your lens

and distorts the light that passes through it. This could result in more noticeable symptoms

(Mayo Clinic, 2017).

 Cataract 23

Predisposing factors: Precipitating factors:

Aging Aging
Excessive UV exposure Associated ocular conditions (Myopia)
Hypertension Overexposure to UV radiation
Family history of cataract Family history

Disturbance of inorganic ions

Combination with the lens protein Attracted through the capsule, changing its
permeability

Colloidal fluid production

Diffuse along Production of ill-defined Distend the sutures or

interfibrillar spaces to cortical haze interlamellar spaces
reach the capsule

Excessive sclerosis and dehydration of the

nuclear and cortical lens

Blood vessels of the eyes are affected Tissues of the semi-permeable ciliary
epithelial membrane are affected

Senile mature cataract

Signs and symptoms:

Blurred vision
Frequent changes in eyeglasses
Need for brighter light for reading and other
activities

Figure 2. Actual pathophysiology of Cataract

 Cataract 24

Textual Discussion of the Disease Process (Actual)

A cataract occurs when the normally clear lens in your eye becomes foggy. Light passes

through a clear lens to reach your eye. The lens is located behind your iris (colored part of your

eye). The lens concentrates light so that your brain and eye can work together to create a picture.

When a cataract obscures the lens, your eye is unable to focus light in the same way. This causes

blurred vision or other types of vision loss (trouble seeing). The location and size of the cataract

affect your vision (Cleveland Clinic, 2018).

Aging, excessive UV exposure, hypertension, and a family history of cataract are all risk

factors that increase the patient's chances of developing cataract. Aging causes the accumulation

of a yellow-brown pigment due to lens protein breakdown, clumping or aggregation of lens

protein, which causes light scattering, decreased oxygen uptake, decreases in vitamin C, protein,

and glutathione levels, increases in sodium and calcium, and loss of lens transparency. Toxic

factor include exposure to ionizing radiation. This includes the UV radiation from the sunlight

(Hinkle & Cheever, 2018). The patient has been exposed to excessive sunlight for an extended

period of time due to her occupation. The patient also have a history with hypertension and is

currently taking medications for it. The mother of the patient also have senile cataract.

The characteristics of senile cortical cataract are caused by colloidal fluid that has been

extruded from its combination with the lens protein or has been attracted through a capsule that

has changed in permeability. This fluid may produce an ill-defined cortical haze in the early

stages, or it may diffuse along interfibrillar spaces to reach the capsule, where it collects in the

form of vacuoles or globules, or it may distend the sutures or interlamellar spaces to form the

familiar water-split sutures or separated lamellae. Senile nuclear cataract is caused by excessive

sclerosis and dehydration of the nuclear lens material and, later, the cortical lens material. The
 Cataract 25

study of cataract formation in tetany led to the conclusion that an inorganic ion disturbance

occurs, which is sufficient to affect the transparency of the labile colloidal solution of the lens

protein. Diabetic cataracts have characteristics similar to the senile cortical form. The hypothesis

is expressed that the various phenomena observed in the mechanism of senile cataract are those

of permeability disturbances. The blood vessels and tissues of the semi-permeable ciliary

epithelial membrane, the lens capsule, the lens fibers, and the interfibrillar diffusion spaces are

all affected in the eye. The cause of these permeability changes could be chemical, physical, or

dependent on metabolic changes in the overall system (Kirby, 2013). T

he signs and symptoms that the patient experiences was blurred vision, frequent changes

in eyeglasses, and the need for brighter light for reading and other activities. Cataracts are

characterized by painless, blurry vision. The person notices that their surroundings are becoming

darker, as if their glasses need to be cleaned. Light scattering is common, and the person has

decreased contrast sensitivity, glare sensitivity, and visual acuity. Other effects include myopic

shift (return of ability to do close work [e.g., reading fine print] without eyeglasses), astigmatism

(refractive error caused by an irregularity in the curvature of the cornea), monocular diplopia

(double vision), and color changes as the lens turns browner (Cash & Glass, 2016; Eliopoulos,

2018).
 Cataract 26

CHAPTER VIII

Medical and Nursing Management

A visually significant cataract is currently managed by surgically removing the disabled

lens and replacing it with an intraocular lens. Cataract surgery is recommended when a patient's

vision loss is severe enough that they are willing to accept the risks of surgery. Cataract surgery

is not recommended for the prevention of cataracts. The outcome of cataract surgery is not

affected by preoperative visual acuity. Despite advances in surgical technology and procedures

over the last decade, good surgical outcomes still require thorough preoperative evaluation,

precise intraocular lens power assessment, and appropriate intraoperative and postoperative

management. For 1-4 weeks after surgery, topical steroids, antibiotics, or nonsteroidal anti-

inflammatory drugs are used (Alshamrani, 2018). As a preventive measure, many

ophthalmologists recommend UV-coated eyeglasses or sunglasses. Diabetes can be delayed by

reducing risk factors such as alcohol, tobacco, and corticosteroids, as well as controlling blood

glucose levels. A diet rich in vitamin C, vitamin A, and carotenoids (found in vegetables like

spinach and kale) may help prevent cataracts (Khazaeni, 2022).

a. Laboratory Findings

Reduced visual acuity is proportional to cataract density. To determine the degree

of cataract formation, the Snellen visual acuity test, ophthalmoscopy, and slit-lamp

biomicroscopic examination are used. The degree of opacity of the lens does not always

correspond to the patient's functional status. Despite clinically significant cataracts, some

patients can engage in normal activities. Others with less lens opacification experience a
 Cataract 27

disproportionate decrease in visual acuity; thus, visual acuity is an imprecise measure of

visual impairment (Hinkle & Cheever, 2018).

Several tests, such as a simple visual acuity test or pupil dilation, are used by eye

care specialists to diagnose eye cataracts. To make this diagnosis, your optometrist or

ophthalmologist will most likely need to run a battery of tests. Your doctor will review

your medical history and symptoms, as well as perform an eye examination, to determine

whether you have a cataract.

The doctor will have you read letters of varying sizes from a chart. Your eyes will

be tested both individually and collectively. This aids in determining the accuracy of your

eyesight at various distances. The test results are expressed as a ratio, such as 20/20 or

20/40. Normal vision is defined as 20/20. A 20/20 vision ratio means you can see an

object 20 feet away as clearly as anyone else with normal vision. You can see an object

20 feet away as clearly as someone with normal vision can see an object 40 feet away if

you have 20/40 vision. A visual acuity test is a quick, painless way to evaluate your

vision. More tests, however, will be required to determine whether cataracts are the cause

of your vision problems.

Testing for contrast sensitivity is similar to testing for visual acuity. The purpose

of this test is to determine how easily you can distinguish an object from its surroundings.

If you have trouble identifying an object against a low-contrast background, you have

poor contrast sensitivity. Image contrast can be reduced by cataracts. This is due to the

cataract's ability to scatter light and cause glare.

A slit lamp allows your eye doctor to magnify the structures at the front of your

eye. The microscope is known as a slit lamp because it illuminates your cornea, iris, lens,
 Cataract 28

and the space between your iris and cornea with an intense line of light called a slit. The

slit allows your doctor to examine these structures in small sections, making it easier to

detect any small abnormalities.

Pupil dilation is a common test for detecting cataracts. The pupil of your eye

expands when it is dilated. This allows your healthcare provider to see your entire lens. A

clear view of the entire lens allows your healthcare provider to determine whether a

cataract is affecting your vision.

One of the laboratory tests used to detect cataract is a retinal exam. Your eye

doctor will place drops in your eyes to widen your pupils in preparation for a retinal exam

(dilate). This makes inspecting the back of your eyes easier (retina). Your eye doctor can

examine your lens for signs of a cataract using a slit lamp or a special device called an

ophthalmoscope. Applanation tonometry is a test that measures the fluid pressure in your

eye. There are numerous devices available to accomplish this.

A potential acuity test determines how well the eye would see if the cataract were

removed. It is usually performed prior to cataract surgery to ensure that the procedure

will improve your vision. During this test, a potential acuity meter (PAM) uses a laser to

project an eye chart onto the eye. The projection avoids the cataract. The patient reads the

chart like any other eye chart on the wall. If the best measurement is 20/40, the eye will

have at least that level of vision after surgery. When a patient has another eye disease in

addition to a cataract, this test becomes even more important (Bedinghaus, 2022; Mayo

Clinic, 2017).
 Cataract 29

b. Medical Management

There is no nonsurgical treatment that cures or prevents age-related cataracts (e.g.,

medications, eye drops, eyeglasses). The best medical care is prevention. Patients should

be educated by primary care providers about risk reduction strategies such as smoking

cessation, weight loss, optimal blood sugar control for diabetic patients, and wearing

sunglasses outside to prevent early cataract formation (Cash & Glass, 2016).

In general, if the reduced vision caused by a cataract does not interfere with daily

activities, surgery may not be required. When deciding whether or not to have cataract

surgery, the patient's functional and visual status should be prioritized when performing

any procedure (Eliopoulos, 2018). Cataract surgery is common, with over 1 million such

procedures performed in the United States each year (Prevent Blindness America, 2012).

Outpatient surgery is usually performed in less than an hour, with the patient being

discharged in 30 minutes or less. Although complications from cataract surgery are rare,

they can have serious consequences for vision.

Injection-free topical and intraocular anesthesia, such as 1% lidocaine gel applied

to the eye's surface, avoids the risks of regional (retrobulbar and peribulbar) anesthesia,

such as ocular perforation, retrobulbar hemorrhage, optic injuries, diplopia, and ptosis,

and is ideal for patients on anticoagulants. Patients can also communicate and cooperate

during surgery. To reduce anxiety and discomfort, IV moderate sedation may be used.

When both eyes have cataracts, one eye is treated first, followed by the other over

a period of at least several weeks, preferably months. Because cataract surgery is

performed to improve visual functioning, the delay for the other eye allows the patient

and surgeon to assess whether the results of the first surgery are sufficient to avoid the
 Cataract 30

need for a second procedure. The delay also allows the first eye to recover; if

complications arise, the surgeon may decide to perform the second procedure differently.

Phacoemulsification

A portion of the anterior capsule is removed in this method of extracapsular

cataract surgery, allowing extraction of the lens nucleus and cortex while leaving the

posterior capsule and zonular support intact. The nucleus and cortex are liquefied with an

ultrasonic device before being suctioned out through a tube. The posterior chamber IOL

requires a safe anchor, which is provided by an intact zonular-capsular diaphragm. The

pupil is dilated to at least 7 mm (Peng, Fong, Phaik, et al., 2012). A viscoelastic

substance (clear gel) is injected into the space between the cornea and the lens after the

surgeon makes a small incision on the upper edge of the cornea. This keeps the space

from collapsing and makes insertion of the IOL easier. Because the incision is smaller

than in manual extracapsular cataract extraction, the wound heals faster, and there is early

refractive error stabilization and less astigmatism.

Lens Replacement

The patient is referred to as aphakic after the crystalline lens is removed (i.e.,

without lens). For the patient to see clearly, the lens that focuses light on the retina must

be replaced. Aphakic eyeglasses, contact lenses, and IOL implants are the three lens

replacement options.

Aphakic glasses, despite their effectiveness, are rarely used. Objects are

magnified by 25%, giving the impression that they are closer than they actually are.
 Cataract 31

Distortion is caused by the magnification. Peripheral vision is also limited, and binocular

vision (the ability of both eyes to focus on the same object and fuse the two images into

one) is impossible if one eye is aphakic (without a natural lens).

Contact lenses provide patients with nearly normal vision; however, because

contact lenses must be removed on a regular basis, the patient also requires a pair of

aphakic glasses. Patients who have difficulty inserting, removing, or cleaning their

contact lenses should avoid wearing them. Frequent handling and poor sanitation raise

the risk of infection.

The most common method of lens replacement is the insertion of IOLs during

cataract surgery (Eliopoulos, 2018). The surgeon inserts an IOL after cataract extraction,

also known as phacoemulsification. Cataract extraction and posterior chamber IOLs have

a low incidence of complications (e.g., eye infection, loss of vitreous humor, and implant

slipping) (Eliopoulos, 2018). In patients with recurrent uveitis, proliferative diabetic

retinopathy, neovascular glaucoma, or rubeosis iridis, IOL implantation is not

recommended.
 Cataract 32

Drug Study

The possible medications for cataract are shown in the tables below.

1. Pirenoxine

Brand Name Kary Uni

Generic Name Pirenoxine sodium
Date Ordered 2019
Rationale for the Given for the possible treatment of cataract
Drug Order
Classification Anti-cataract
Actual Dose/ Instill 1 drop a time, 3 times daily
Frequency/ Route
Indication Incipient senile cataract
Its pH is between 3.4 and 4.0 and the osmolar ratio is between 0.9 and
Mechanism of
1.2. Immediately after topical application, the pH of this preparation
Action
becomes equivalent to that of the lacrimal fluid, the suspended
pirenoxine particles being dissolved in the lacrimal fluid.
Contraindication Pirenoxine is contraindicated in conditions like uterine hyperactivity
and placenta previa.
Keratitis superficialis diffusa, conjunctival hyperaemia, and
Side Effects conjunctivitis, eye irritation, itching of eye, blurred vision, eye
discharge, lacrimation, eye pain, abnormal sensation in eye, and foreign
body sensation in eyes
Blepharitis, contact dermatitis, and other symptoms of hypersensitivity
Adverse Reactions may occur. When such symptoms occur, discontinue the use.
Diffuse superficial keratitis, conjunctival injection, irritation, itching,
etc. may occur. When such symptoms occur, discontinue the use.
- Use only by instillation, store the ophthalmic solution, once
prepared, protects from heat, light and moisture and use within 20
days.
- Avoid contact of the tip of dropper with eye when instilling. This
drug changes color in the presence of metallic ion.
Nursing - Route of administration: Ophthalmic use only.
Considerations/ - The tip of the eyedropper must not come into contact with the eyes
Responsibilities at the time of application.
- This product is discolored after contamination with metal ions.
- Since particles in the suspension may not disperse depending on
storage conditions even after well shaking, store the product in an
upright position.
Table 1. Pirenoxine
 Cataract 33

2. Sodium chloride hypertonic (ophthalmic)

Brand Name Hypersalt

Generic Name Sodium chloride hypertonic (ophthalmic)
Date Ordered 9/21/2022
Rationale for the To reduce swelling of the cornea after surgery
Drug Order
Classification Ophthalmologicals
Actual Dose/ Instill 1 drop in the affected eye(s) every 3 hours from 6 AM until 9 PM
Frequency/ Route
Indication Used for relief of corneal edema
Mechanism of Reduces corneal edema and associated symptoms by osmotic pressure
Action control; draws excess fluid from cornea into tears

Contraindication Hypersensitivity to product or components

Side Effects Mild burning or irritation in your eyes

Adverse Reactions Eye pain, severe or ongoing eye redness or irritation, vision changes, or
worsening of your eye condition
- Position the patient comfortably, either sitting or lying down (semi-
prone or recumbent) with the head supported
- Wash hands before and after instilling eye drops to prevent cross
infection and to remove drug residue from the hands
- Some local policies require that non-sterile gloves are used when
instilling eye drops or ointment and that an aseptic non-touch
technique is used for first postoperative dressing and application of
eye drops
- Cleaning the eye may be required, for example when there are crusty
or purulent deposits on the eyelids. Clean the lids with non-woven
or cotton swabs dipped in cooled boiled water or sterile saline
solution (cotton wool is contraindicated when there are sutures on
Nursing
the skin)
Considerations/
- Establish that you have the correct eye drops and that they have not
Responsibilities
expired
- Gently agitate the bottle before use to make sure the drug is properly
mixed
- Warn the patient the drops will sting transiently when administered
- Instill the eye drop into the space (fornix) created by gently pulling
down the lower lid
- Ask the patient to look up – this helps to ensure the eye drop does
not land directly onto the sensitive cornea
- Once the eye drop is instilled, release the eyelid, using a tissue or
swab to dab any excess from the cheek
- Avoid holding the tissue too close to the eye, to prevent the drug
wicking away from the eye
 Cataract 34

- Where multiple drops and/or ointment are prescribed for one or both
eyes, the order of administration is important to ensure maximum
therapeutic effect of each
- Only one drop of each drug is required; more than this will create
overflow onto the cheek. Ideally, five minutes should elapse
between administration of a different eye drop to achieve maximum
therapeutic effect
Table 2. Sodium chloride hypertonic (ophthalmic)

3. Moxifloxacin ophthalmic

Brand Name Vigamox

Generic Name Moxifloxacin ophthalmic
Date Ordered 9/12/22
Rationale for the To prevent bacterial infection in the eyes after surgery
Drug Order
Classification Quinolones
Actual Dose/ Instill one drop in the affected eyes 3 times a day from 6 AM to 9 PM
Frequency/ Route
Indicated for the treatment of bacterial conjunctivitis, blepharitis,
dacryocystitis, hordeolum, tarsadenitis, keratitis (including corneal
Indication
ulcer) caused by susceptible strains, as well as preoperative and
postoperative prophylaxis
Mechanism of Inhibits the DNA gyrase and topoisomerase IV required for bacterial
Action DNA replication, repair, and recombination

Contraindication Hypersensitivity to the active substance, to other quinolones or to any

of the excipients
Dry eyes or watery eyes; eye pain or discomfort; blurred vision; mild
Side Effects
itching, redness, or other irritation; or fever, cough, sore throat or runny
nose
severe burning, stinging, or irritation after using Vigamox eye drops; or
Adverse Reactions
eye swelling, redness, severe discomfort, crusting or drainage (may be
signs of infection)
 Cataract 35

- Wash your hands with soap and water before and after using this
medicine.
- Tilt the head back and pressing your finger gently on the skin just
beneath the lower eyelid, pull the lower eyelid away from the eye to
make a space. Drop the medicine into this space.
- Let go of the eyelid and gently close the eyes. Do not blink. Keep
Nursing
the eyes and apply pressure to the inner corner of the eye with your
Considerations/
finger for 1 or 2 minutes to allow the medicine to be absorbed by
Responsibilities
the eye.
- If you think you did not get the drop of medicine into your eye
properly, repeat the directions with another drop.
- To keep the medicine as germ free as possible, do not touch the
applicator tip to any surface (including the eye). Also, keep the
container tightly closed.
Table 3. Moxifloxacin ophthalmic

4. Prednisolone acetate

Brand Name Pred forte

Generic Name Prednisolone acetate ophthalmic suspension
Date Ordered 9/12/22
Rationale for the For postoperative anti-inflammatory for cataract surgery patients
Drug Order
Classification Corticosteroids
Actual Dose/ Instill 1 drop to the conjunctival sac every 3 hours from 6 AM to 9 PM
Frequency/ Route
Indicated for the treatment of steroid-responsive inflammation of the
Indication palpebral and bulbar conjunctiva, cornea, and anterior segment of the
globe
Mechanism of Glucocorticoids inhibit the edema, fibrin deposition, capillary dilation,
Action and phagocytic migration of the acute inflammatory response, as well
as capillary proliferation, deposition of collagen, and scar formation.
Contraindicated in individuals with known or suspected
hypersensitivity to any of the ingredients of this preparation and to other
corticosteroids.
Contraindication Contraindicated in acute untreated purulent ocular infections, in most
viral diseases of the cornea and conjunctiva including epithelial herpes
simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also
in mycobacterial infection of the eye and fungal diseases of ocular
structures.
Stinging/burning/itching/irritation of the eyes for 1 to 2 minutes when
Side Effects you apply this medication, temporary cloudy vision, increased
sensitivity to light, visual disturbance (blurry vision), feeling like
something is in your eye, and
 Cataract 36

allergic reactions
Pain behind your eyes, sudden vision changes, severe headache, sudden
Adverse Reactions eye irritation, blurred vision, tunnel vision, eye pain, seeing halos
around lights, or signs of new eye infection (such as swelling, draining,
or crusting of your eyes
- Wash your hands first with soap and water.
- Shake the bottle well before each use.
- Tilt your head back and, pressing your finger gently on the skin just
beneath the lower eyelid, pull the lower eyelid away from the eye to
make a space. Drop the medicine into this space.
- Let go of the eyelid and gently close your eye. Do not blink. Keep
the eye closed and apply pressure to the inner corner of your eye
Nursing with your finger for 1 or 2 minutes to allow the medicine to be
Considerations/ absorbed by the eye.
Responsibilities - If you think you did not get the drop of medicine into your eye
properly, use another drop.
- To keep the medicine as germ-free as possible, do not touch the
applicator tip to any surface (including the eye). Keep the bottle
tightly closed and upright when you are not using it.
- If you are wearing contact lenses, remove them before putting the
drops in your eyes. Wait at least 15 minutes after using this medicine
before putting your contact lenses back in.
Table 4. Prednisolone acetate

5. Ciprofloxacin

Brand Name Ciclodin

Generic Name Ciprofloxacin
Date Ordered 9/12/2022
Rationale for the To prevent endophthalmitis after surgery
Drug Order
Classification Fluoroquinoloes
Actual Dose/ 500 mg/capsule 1 tab every 6 PM
Frequency/ Route
Ciprofloxacin is used to treat or prevent certain infections caused by
bacteria such as pneumonia; gonorrhea (a sexually transmitted disease);
typhoid fever (a serious infection that is common in developing
countries); infectious diarrhea (infections that cause severe diarrhea);
and infections of the skin, bone, joint, abdomen (stomach area), and
Indication
prostate (male reproductive gland), Ciprofloxacin is also used to treat
or prevent plague (a serious infection that may be spread on purpose as
part of a bioterror attack) and inhalation anthrax (a serious infection that
may be spread by anthrax germs in the air on purpose as part of a
bioterror attack). Ciprofloxacin may also be used to treat bronchitis,
 Cataract 37

sinus infections, or urinary tract infections but should not be used for
bronchitis and sinus infections, or certain types of urinary tract
infections if there are other treatment options. Ciprofloxacin extended-
release (long-acting) tablets are used to treat kidney and urinary tract
infections; however, some types of urinary tract infections should only
be treated with ciprofloxacin extended release tablets if no other
treatment options are available.
Mechanism of It inhibits DNA replication by inhibiting bacterial DNA topoisomerase
Action and DNA-gyrase

Contraindicated in persons with a history of hypersensitivity to

ciprofloxacin or any of the quinolones.
Concomitant administration with tizanidine is contraindicated.
Contraindication
An increased incidence of adverse events related to joints and/or
surrounding tissues, have been observed.
Convulsions increased intracranial pressure, and toxic psychosis have
been reported in patients receiving quinolones, including ciprofloxacin.
Side Effects Nausea, abdominal pain, diarrhea, increased aminotransferase levels,
vomiting, headache, increased serum creatinine, rash, restlessness
Adverse Reactions Arthralgia, pseudomembranous colitis, erythema nodosum, Stevens-
Johnson syndrome, reversible haematological disorders
- History: Allergy to ciprofloxacin, norfloxacin or other quinolones;
renal dysfunction; seizures; lactation
- Physical: Skin color, lesions; T; orientation, reflexes, affect; mucous
membranes, bowel sounds; LFTs, renal function tests
- Continue therapy for 2 days after signs and symptoms of infection
are gone.
- Ensure that the patient swallows ER tablets whole; do not cut, crush,
or chew.
- Ensure that patient is well hydrated.
Nursing - Give antacids at least 2 hr after dosing.
Considerations/ - Monitor clinical response; if no improvement is seen or a relapse
Responsibilities occurs, repeat culture and sensitivity.
- Encourage patient to complete full course of therapy.
- If an antacid is needed, take it at least 2 hours before or after dose.
- Drink plenty of fluids while you are taking this drug.
- You may experience these side effects: Nausea, vomiting,
abdominal pain (eat frequent small meals); diarrhea or constipation;
drowsiness, blurring of vision, dizziness (observe caution if driving
or using dangerous equipment).
- Report rash, visual changes, severe GI problems, weakness,
tremors.
Table 5. Ciprofloxacin
 Cataract 38

6. Acetazolamide

Brand Name Cetamid

Generic Name Acetazolamide
Date Ordered 9/12/2022
Rationale for the To reduce intraocular pressure elevation after cataract surgery
Drug Order
Classification Carbonic anhydrase inhibitors
Actual Dose/ 200 mg/tab 1 tab every 6 PM
Frequency/ Route
Acetazolamide is used to prevent and reduce the symptoms of altitude
sickness. This medication can decrease headache, tiredness, nausea,
dizziness, and shortness of breath that can occur when you climb
quickly to high altitudes (generally above 10,000 feet/3,048 meters).
Indication This medication is also used with other medications to treat high
pressure inside the eye due to certain types of glaucoma. It is also used
to decrease a buildup of body fluids (edema) caused by heart failure or
certain medications. It has also been used with other medications to treat
certain types of seizures (petit mal and unlocalized seizures).
Acetazolamide works by blocking the action of an enzyme called
Mechanism of
carbonic anhydrase. Blocking this enzyme reduces the amount of fluid
Action
(called aqueous humour) that you make in the front part of your eye,
and this helps to lower the pressure within your eye.
Contraindicated for patients with hypokalemia, hyponatremia,
hyperchloremic acidosis, hypersensitivity to acetazolamide or sulfa,
Contraindication liver disease, severe renal disease or dysfunction, long term use in
noncongestive angle-closure glaucoma, cirrhosis, and long-term
administration in patients with chronic, noncongestive angle-closure
glaucoma
Dizziness, lightheadedness, increased urination, blurred vision, dry
Side Effects
mouth, drowsiness, loss of appetite, nausea, vomiting, diarrhea, and
changes in taste
Tingling of the hands/feet, hearing loss, ringing in the ears, unusual
tiredness, easy bleeding/bruising, fast/irregular heartbeat, muscle
cramps/pain, new or worsening eye pain, decrease in vision,
mental/mood changes (such as confusion, difficulty concentrating),
Adverse Reactions
signs of liver disease (such as nausea/vomiting that doesn't stop,
stomach/abdominal pain, yellowing eyes/skin, dark urine), signs of
kidney problems (such as painful urination, pink/bloody urine, change
in the amount of urine), signs of infection (such as sore throat that
doesn't go away, fever, chills)
 Cataract 39

- Establish baseline weight before initial therapy and weigh daily

thereafter when used to treat edema.
- Monitor for S&S of: mild to severe metabolic acidosis; potassium
loss which is greatest early in therapy (see hypokalemia in Appendix
F).
- Monitor I&O especially when used with other diuretics.
- Lab tests: Blood pH, blood gases, urinalysis, CBC, and serum
electrolytes (initially and periodically during prolonged therapy or
Nursing concomitant therapy with other diuretics or digitalis).
Considerations/ - Maintain adequate fluid intake (1.5–2.5 L/24 h; 1 liter is
Responsibilities approximately equal to 1 quart) to reduce risk of kidney stones.
- Report any of the following: numbness, tingling, burning,
drowsiness, and visual problems, sore throat or mouth, unusual
bleeding, fever, skin or renal problems.
- Eat potassium-rich diet and take potassium supplement when taking
this drug in high doses or for prolonged periods.
- Do not breast feed while taking this drug without consulting
physician.

Table 6. Acetazolamide

7. Potassium chloride

Brand Name Kalium Durules

Generic Name Potassium chloride
Date Ordered 9/12/2022
Rationale for the To prevent hypokalemia after cataract surgery
Drug Order
Classification Electrolytes
Actual Dose/ 750 mg/tab 1 tab every 6 PM
Frequency/ Route
Hypokalemia. Prophylaxis during treatment with saluretic diuretics,
Indication
especially in combination with digitalis.
Mechanism of Supplemental potassium in the form of high potassium food or
Action potassium chloride may be able to restore normal potassium levels

Hypersensitivity. Renal insufficiency, hyperkalemia, untreated

Contraindication
Addison’s disease, stricture of the esophagus and/or obstructive
changes in the alimentary tract.
Side Effects Hyperkalemia; abdominal pain, diarrhea, nausea

Adverse Reactions Upper and lower gastrointestinal conditions including obstruction,

bleeding, ulceration, and perforation
 Cataract 40

- Monitor I&O ratio and pattern in patients receiving the parenteral

drug. If oliguria occurs, stop infusion promptly and notify physician.
- Lab test: Frequent serum electrolytes are warranted.
- Monitor for and report signs of GI ulceration (esophageal or
epigastric pain or hematemesis).
- Monitor patients receiving parenteral potassium closely with
cardiac monitor. Irregular heartbeat is usually the earliest clinical
indication of hyperkalemia.
- Be alert for potassium intoxication (hyperkalemia, see S&S,
Appendix F); may result from any therapeutic dosage, and the
patient may be asymptomatic.
- The risk of hyperkalemia with potassium supplement increases (1)
in older adults because of decremental changes in kidney function
associated with aging, (2) when dietary intake of potassium
suddenly increases, and (3) when kidney function is significantly
compromised.
- Do not be alarmed when the tablet carcass appears in your stool. The
Nursing sustained release tablet (e.g., Slow-K) utilizes a wax matrix as
Considerations/ carrier for KCl crystals that passes through the digestive system.
Responsibilities - Learn about sources of potassium with special reference to foods
and OTC drugs.
- Avoid licorice; large amounts can cause both hypokalemia and
sodium retention.
- Do not use any salt substitute unless it is specifically ordered by the
physician. These contain a substantial amount of potassium and
electrolytes other than sodium.
- Do not self-prescribe laxatives. Chronic laxative use has been
associated with diarrhea–induced potassium loss.
- Notify physician of persistent vomiting because losses of potassium
can occur.
- Report continuing signs of potassium deficit to physician:
Weakness, fatigue, polyuria, polydipsia.
- Advise dentist or new physician that a potassium drug has been
prescribed as long-term maintenance therapy.
- Do not open foil-wrapped powders and tablets before use.
- Do not breast feed while taking this drug without consulting
physician.
Table 7. Potassium chloride
 Cataract 41

c. Nursing Management

Nursing Management Rationale

1. Only if indicated by the patient's medical Cataract patients receive the same

history is the standard battery of preoperative care as other ambulatory

preoperative tests (e.g., complete blood surgical patients undergoing eye surgery.

count, electrocardiogram, and urinalysis)

commonly performed for most surgeries

prescribed.

2. The nurse should inquire about patients' Alpha-antagonists (particularly tamsulosin

use of alpha-antagonists in the past. The [Flomax], which is used to treat enlarged

surgical team is then made aware of the prostate) have been linked to intraoperative

possibility of this complication. floppy iris syndrome. Alpha-antagonists can

interfere with pupil dilation during surgery,

causing miosis and iris prolapse as well as

complications. Even if a patient has stopped

taking the medication, intraoperative floppy

iris syndrome can occur.

3. Prior to surgery, dilating drops are This is to provide preoperative care.

administered.

4. Ambulatory surgery nurses begin patient To provide health education.

education about eye medications

(antibiotic, corticosteroid, and anti-

inflammatory drops) that must be self-

 Cataract 42

administered to prevent postoperative

infection and inflammation.

5. Before discharge, the patient receives This is to provide postoperative care.

verbal and written instruction on eye

protection, medication administration,

recognizing complications, avoiding

activities, and obtaining emergency care.

6. To avoid injury, an eye shield is usually

worn at night for the first week.

7. The nurse also informs the patient that

there should be minimal discomfort

following surgery and advises him or her

to take a mild analgesic, such as

acetaminophen, as needed.

8. Following surgery, antibiotic, anti-

inflammatory, and corticosteroid eye

drops or ointments are prescribed.

9. Patients who are prescribed anti-

inflammatory or corticosteroid eye drops

are monitored for potential IOP

increases.

10. For the first 24 hours after surgery, the To avoid accidental eye rubbing or poking.

patient wears a protective eye patch,

 Cataract 43

followed by eyeglasses during the day

and an eye shield at night.

11. If an eye shield is recommended, the To educate about self-care postoperatively.

nurse educates the patient and family on

how to apply and care for it.

12. Because the eye is light sensitive,

sunglasses should be worn while

outdoors during the day.

13. For a few days, expect some morning

discharge, redness, and a scratchy

feeling.

14. To remove minor morning eye discharge,

use a clean, damp washcloth.

15. Because cataract surgery increases the

risk of retinal detachment, the patient

must be aware that any new floaters

(dots) in vision, flashing lights, decrease

in vision, pain, or increase in redness

must be reported to the surgeon.

16. If an eye patch is worn, it is removed This is to promote continuing and

following the first follow-up transitional care.

appointment, which should take place

within 48 hours of surgery.

 Cataract 44

17. Nurses should educate patients on the

importance of keeping their follow-up

appointments because visual status

monitoring and prompt intervention of

postoperative complications improve

visual outcome.

18. When the final corrective prescription is

completed, vision is stabilized when the

eye is completely healed, which usually

takes 6 to 12 weeks.

19. Any remaining refractive errors may

necessitate visual correction.

20. Patients who opt for multifocal

intraocular lenses should be aware that

they may experience increased night

glare and contrast sensitivity.

Table 8. Nursing Management

d. Prognosis

Prognosis of cataract depends upon multiple factors such as the degree of visual

impairment, type of cataract, timing of intervention, mode of intervention, quality of life,

unilateral or bilateral involvement of the eye, and presence of another systemic disease.

In most cases, surgery effectively restores vision. The presence of another systemic
 Cataract 45

disease, the time of intervention, and the mode of surgery can all play a role in the visual

outcome. According to recent studies, the prognosis after surgery is excellent in the vast

majority of cases (70 to 80%). Most patients achieve excellent results after surgery if they

strictly adhere to their ophthalmologist's postoperative instructions and medication

regimens. A routine eye examination is advisable, which will detect any cataract

development in the other eye. After surgical cataract removal, many patients with

monofocal IOLs may require refractive glasses to achieve their best visual acuity.

Gradual opacification of the posterior capsule can occur in a large number of patients,

impairing vision (secondary cataract) (Nizami & Gulani, 2022).

 Cataract 46

CHAPTER IX

Gordon’s Functional Health Pattern

Functional Health Cue Cluster Inference Diagnostic Priority Rationale

Pattern Statement
1. Health S – “It took me a long Ineffective health Ineffective health Low 1 This is given a
Perception & time to have my surgery maintenance maintenance r/t “Low 1” priority
Management because I was afraid ineffective coping because the patient
that it will not be strategies a.m.b. already sought
successful and I will inability to take medical assistance
become blind. I didn’t responsibility for and has already
thought that it will meeting basic decided to undergo
worsen because I health practices the surgery.
thought that the herbal
medicines that I took
was enough to cure my
cataracts”, as stated by
the patient.

O – The patient delayed

her surgery for three
years.
2. Nutrition / S – “I am conscious of Not a problem Not a problem Not a problem Patient maintains a
Metabolism the food that I eat healthy diet and has
because I have a normal BMI
hypertension. I mostly based on her weight
eat vegetables and fish and height.
and I seldom eat
meats”, as verbalized
by the patient.
 Cataract 47

O – Patient’s height
was 5’0 and weighed
120 lbs. BMI of the
patient was 24.4.
3. Elimination N/A N/A N/A N/A N/A
Pattern

4. Activity / S – “I stretch every N/A N/A N/A Patient is engaged

Exercise morning right after I in physical
wake up and every activities and
Sunday, I walk and jog exercise through
with my husband and stretching, jogging,
daughter”, the patient and walking.
reported.
5. Sleep / Rest N/A N/A N/A N/A N/A

6. Cognitive / S – Patient reported
Perceptual clearer vision but with
halos when looking at
lights, discomfort and
pain in the eyes, and
having a ”heavy”
feeling in the eyes.
Patient gave a pain
rating of 6/10.
Acute pain Acute pain High 1
secondary to senile
mature cataract r/t
operative
procedure a.m.b.
self-report of pain
intensity and facial
expression of pain
This diagnosis is
given the highest
priority since the
patient will not be
able to perform
other ADLs when
she is in pain.

O – Patient was awake Risk for infection Risk for infection High 3 This diagnosis is
and interactive. secondary to senile given the third
Responded mature cataract r/t highest priority
appropriately to because it is vital
 Cataract 48

questions and provided to trauma to the that infection must

information accurately. post-operative site be avoided post-
Surgeon performed operatively to
capsulorrhexis and prevent
phacoemulsification. complications that
Stab incisions were might further
noted and intraocular compromise the
lenses were inserted. health of the
Patient was grimacing. patient.
7. Self – Perception N/A N/A N/A N/A N/A
/ Self - Concept

8. Role / S – “My family is very Not a problem Not a problem Not a problem Patient maintains a
Relationship supportive with my good relationship
surgery. They were the with significant
ones who really others and the
encouraged me to have family shows
this surgery”, as stated support to the
by the patient. patient during the
procedure.
O – Patient was
accompanied by her
sister during the
surgery.
9. Sexuality / N/A N/A N/A N/A N/A
Reproductive

10. Coping – Stress S – “I’m scared of the Anxiety Anxiety secondary High 2 This is given a
Tolerance possible outcome of the to cataract surgery “High 2” priority
surgery because I might r/t threat to current because anxiety can
go blind instead of status a.m.b. worry cause further
 Cataract 49

being cured”, the about change in distress of the

patient reported. life event, fear, patient and can
increase in affect the coping
O – Increased in wariness, and mechanism of the
wariness from the increase in blood patient related to
patient. BP: 150/90 pressure the procedure.
mmHg.
11. Value Belief N/A N/A N/A N/A N/A

Table 9. Gordon’s Functional Health Pattern

Problem List

Problem Date Identified Time

1. Ineffective health maintenance r/t September 12, 2022 9:00 AM

ineffective coping strategies a.m.b.

inability to take responsibility for

meeting basic health practices

2. Anxiety secondary to cataract surgery September 12, 2022 9:00 AM

r/t threat to current status a.m.b. worry

about change in life event, fear,

 Cataract 50

increase in wariness, and increase in

blood pressure

3. Acute pain secondary to senile mature September 12, 2022 1:30 PM

cataract r/t operative procedure a.m.b.

self-report of pain intensity and facial

expression of pain

4. Risk for infection secondary to senile September 12, 2022 1:30 PM

mature cataract r/t to trauma to the

post-operative site

Table 10. Nursing Diagnosis Problem List

Prioritization of Problems

Nursing Diagnosis Prioritization Rationale

Acute pain secondary to senile mature High 1 This diagnosis is given the highest priority

cataract r/t operative procedure a.m.b. self- since the patient will not be able to perform

other ADLs when she is in pain.

 Cataract 51

report of pain intensity and facial

expression of pain

Anxiety secondary to cataract surgery r/t High 2 This is given a “High 2” priority because

threat to current status a.m.b. worry about anxiety can cause further distress of the

change in life event, fear, increase in patient and can affect the coping

wariness, and increase in blood pressure mechanism of the patient related to the

procedure.

Risk for infection secondary to senile High 3 This diagnosis is given the third highest

mature cataract r/t to trauma to the post- priority because it is vital that infection

operative site must be avoided post-operatively to

prevent complications that might further

compromise the health of the patient.

Ineffective health maintenance r/t Low 1 This is given a “Low 1” priority because

ineffective coping strategies a.m.b. the patient already sought medical

inability to take responsibility for meeting assistance and has already decided to

basic health practices undergo the surgery.

Table 11. Prioritization

 Cataract 52

Nursing Care Plan

ASSESSMENT HEALTH NURSING DESIRED INTERVENTION RATIONALE EVALUATION

PATTERN DIAGNOSIS OUTCOME
Subjective Cues: Cognitive/ Note: Use P- General: Independent: - The patient Upon discharge,
Patient reported Perceptual E-S format Patient will - Do a thorough who is patient reported
clearer vision but Acute pain report that assessment of the experiencing a pain rating of
with halos when secondary to pain is patient’s pain. pain is the 2/10.
looking at lights, senile mature relieved or Ensure to include best source
discomfort and pain cataract r/t controlled the location, for
in the eyes, and operative with a rating characteristics, information
having a ”heavy” procedure scale of duration, frequency, with regards
feeling in the eyes. a.m.b. self- 2/10. onset, quality, to their pain.
Patient gave a pain report of pain severity, and The PQRST
rating of 6/10. intensity and Specific: mitigating factors method is a Patient was able
facial Patient will (the PQRST of useful to maintain
expression of follow pain). mnemonic in prescribed
pain prescribed the complete pharmacological
Objective Cues: Background pharmacolo- assessment of regimen and
Patient was awake Knowledge gical the patient’s drink all
and interactive. Unpleasant regimen. pain. prescribed
Responded sensory and - Evaluate the - Some medicines.
appropriately to emotional patient’s ability or patients are
 Cataract 53

questions and experience Patient will willingness to look hesitant to try Patient was able
provided associated verbalize at different methods new or to verbalize
information with actual or nonpharma- for pain control. unfamiliar examples of
accurately. Surgeon potential cological methods for nonpharmacolo-
performed tissue methods that pain, such as gical activities
capsulorrhexis and damage, or provide nonpharma- to manage pain.
phacoemulsification. described in relief. cological
Stab incisions were terms of such methods, and
noted and damage; Patient will would be Patient was able
intraocular lenses sudden or demonstrate comfortable to perform
were inserted. slow onset of use of using usual relaxation and
Patient was any intensity relaxation methods. diversional
grimacing. from mild to skills and - Provide - To manage activities to
severe and diversional nonpharmacological pain. relieve pain.
with a activities to pain management
duration of relieve pain. such as promoting a
less than 3 quiet environment,
months. use of relaxation
exercises like deep
breathing exercises
and listening to
relaxing music.
 Cataract 54

- Render methods as - It is crucial

early as possible and
before the pain preferable in
becomes severe. providing the
patient with
an analgesic
before the
start of a
painful
stimulus or
before it
develops
severely.
- Ensure that the - Patients who
patient’s room just had eye
lighting is adjusted surgery are
to the lowest and more
safest possible. sensitive to
light due to
the
manipulation
done to the
 Cataract 55

involved
area.
Reducing
unnecessary
lighting will
help in
providing
comfort and
promoting
the rest that
the patient
needs in
order to
recover fully
from the
operation.
- Encourage the - Dark colored
patient to use sunglasses
sunglasses, may help the
especially in the patient
presence of strong protect their
lighting. sight from
 Cataract 56

unnecessary
lighting to an
already
sensitive
eyesight post-
procedure.
- Render nursing - Oral forms of
tasks at the peak analgesics
effect of analgesics. take peak by
60 minutes
and IV forms
in 20
minutes.
Considering
these will
promote for
patient
comfort and
conformity
with a
treatment
plan.
 Cataract 57

Dependent:
- Provide - Rendering
pharmacologic timely
treatment for pain pharmaco-
relief and reduction logic pain
of intraocular relief will
pressure as ordered ensure
by the physician. adequate
control and
achievement
of the desired
therapeutic
levels in
order to
maintain
analgesia in
the patient.
Giving
medication
for the
control of
 Cataract 58

intraocular
pressure will
reduce
complications
of
uncontrolled
IOP and
promotion of
wound
healing.
- Utilize cold - Application
compress as request of cold
by the patient and as compress has
ordered by the been
doctor. considered to
be effective
in managing
inflammation
and swelling
in the post-
operative site.
The cold
 Cataract 59

application
also helps in
reducing
edema on the
affected site,
therefore
reducing pain
stimulus and
promoting
patient
comfort.
Table 12. Acute pain Nursing Care Plan

ASSESSMENT HEALTH NURSING DESIRED INTERVENTION RATIONALE EVALUATION

PATTERN DIAGNOSIS OUTCOME
Subjective Coping – Note: Use P- General: Independent: - To avoid the After 1 day, the
Cues: Stress E-S format Patient will - Establish therapeutic contagious patient stated
“I’m scared of Tolerance Anxiety report that relationship, conveying effect or that her anxiety
the possible secondary to anxiety is empathy and transmission level is reduced
outcome of the cataract reduced to a unconditional positive of anxiety. to a manageable
surgery because surgery r/t manageable regard. level.
 Cataract 60

I might go blind threat to level after 1 - Be available to the - Establishes

instead of being current status day. client for listening and rapport,
cured”, the a.m.b. worry talking. promotes
patient reported. about change Specific: expression of The patient
in life event, Patient will feelings, and appeared
fear, increase appear helps client relaxed with a
in wariness, relaxed. look at normal blood
and increase realities of pressure.
in blood Patient will illness they
pressure identify are not ready The patient was
Objective Cues: Background healthy ways to deal with. able to identify
Increased in Knowledge to deal with health ways to
- Validates
wariness from Vague and express - Acknowledge deal and express
reality of
the patient. BP: uneasy anxiety. anxiety/fear. Do not anxiety.
feelings.
150/90 mmHg. feeling of deny or reassure client
False
discomfort or that everything will be
reassurances
dread alright.
may be
accompanied
interpreted as
by an
lack of
autonomic
understanding
response; a
or dishonesty,
feeling of
 Cataract 61

apprehension further
caused by isolating the
anticipation client.
of danger. It - Provide accurate - This helps the
is an alerting information about the client identify
sign that situation. what is reality
warns of based.
impending - Provide comfort - Aids in
danger and measures such as meeting basic
enables the providing a quiet human need,
individual to environment and decreasing
take playing soft music. sense of
measures to isolation, and
deal with that assisting
threat. client to feel
less anxious.

Dependent: - For
- Administer pharmacolo-
medications, as ordered. gical
treatment.
 Cataract 62

Table 13. Anxiety Nursing Care Plan

 Cataract 63

ASSESSMENT HEALTH NURSING DESIRED INTERVENTION RATIONALE EVALUATION

PATTERN DIAGNOSIS OUTCOME
Subjective Cues: Cognitive/ Note: Use P- General: Independent: - That could be Upon discharge,
Patient reported Perceptual E-S format The patient - Observe client for signs of the patient was
clearer vision but Risk for will be free of changes in skin developing free from
with halos when infection purulent color and warmth localized purulent
looking at lights, secondary to drainage or at surgical incision infection. drainage or
discomfort and pain senile mature erythema; be and wounds. erythema;
in the eyes, and cataract r/t to afebrile. - Observe client for - That could afebrile.
having a ”heavy” trauma to the changes in color indicate onset
feeling in the eyes. post- Specific: and/or odor of of infection. Patient stated
Patient gave a pain operative site Patient will sections and understanding of
- Observing and
rating of 6/10. verbalize excretions. individual risk
following
Objective Cues: Background understanding - Ensure that the factors.
strict aseptic
Patient was awake Knowledge of individual patient and
technique
and interactive. Vulnerable to causative or caregivers follow
when
Responded invasion and risk factors. strict aseptic
managing the
appropriately to multiplication technique when
wound
questions and of pathogenic Patient will managing the Patient has
ensures the
provided organisms, identify wound through identified
prevention of
information which may interventions proper hand interventions to
opportunistic
accurately. Surgeon to prevent or hygiene.
 Cataract 64

performed compromise reduce risk of infections that reduce risk of

capsulorrhexis and health. infection. may infection.
phacoemulsification. compromise
Stab incisions were proper wound
noted and healing. It will
intraocular lenses also promote
were inserted. better wound
Patient was healing,
grimacing. therefore
allowing for
early recovery
and
rehabilitation
for
resumption of
previous
levels of
activity.

- As with any
surgical
procedure,
 Cataract 65

there is
always the
- Educate the possibility of
patient and complications
caregivers on post cataract
recognizing and surgery. In the
timely reporting case of the
possible surgical
complications removal of a
such as bleeding, patient’s
increased cataracts, the
intraocular patient and
pressure, or caregivers
infection. made aware
of adverse
events such as
excessive pain
on the site,
will help in
limiting any
debilitating
effects for
 Cataract 66

advancing
complications.
Failure to
recognize
these
problems
would cause
delays in
healing, thus
affecting the
capacity to
return to
normal
function that
would have an
impact on the
overall well-
being of the
patient.
- Ensure that the
- To ensure
patient always
proper wound
elevates the head
 Cataract 67

of the bed to at drainage by

least 30 degrees gravity,
during the healing therefore
process. reducing
edema and
allowing for
better wound
healing. It will
also reduce
any latent
pressure that
may damage
sensitive
structures in
the eye.
- Educate the - These
patient of allowed activities can
or restricted increase the
activities post- IOP in the eye
surgical removal which can
of cataracts. lead to
Examples of these complications
 Cataract 68

are coughing, such as

sneezing, wound
vomiting, trunk dehiscence or
bending, etc. vitreous
prolapse, due
to increasing
tensions in the
sensitive
sutures in the
site.
- Teach the patient - Limiting
to follow bed rest activity can
as prescribed, and help with the
to gradually proper wound
increase activity healing of the
as tolerated. site. Ensuring
that the
patient
receives
adequate rest
will speed up
 Cataract 69

the healing
process.

Dependent:
- Administer - Letting the
prescribed patient apply
medications as the prescribed
ordered following medications
the correct utilizing the
manner. proper method
ensures proper
wound
healing, better
tissue
regeneration,
and
prevention of
complications.
Table 14. Risk for infection Nursing Care Plan
 Cataract 70

Prognosis

Criteria Poor Fair Good Justification

Duration of illness 3 Patient was able to seek healthcare when

symptoms worsened but decided to

prolong the surgery. Hence, the cataract

of the patient took three years before

getting removed.

Onset of illness 1 Patient had no knowledge that the

symptoms experienced were related to

cataracts and thought that it was simply a

problem with increasing eye grade.

Precipitating factors 5 Patient provided a comprehensive history

of past and present illness.

Willingness to take the 5 The patient is willing to take the

medications/compliance prescribed medications and complies

with therapeutic with the therapeutic regimen.

regimen

Age 3 The patient is 57 years old seeking

healthcare due to blurred vision as a

result of senile mature cataract.

Environment 3 The patient is constantly exposed to the

UV radiation of sunlight in her

workplace.
 Cataract 71

Family support 5 The family of the patient is very

supportive and assists the patient in his

recovery.

TOTAL 1 9 15 Criteria

Poor = 1, Fair = 3, Good 5

Σ (Frequency x Score)/7
Poor – (1x1=1)
Fair – (3x3=9)
Good – (3x5=15)
Total: 25/7=3.57

Scale of interpretation
Poor = 0-1.5
Fair = 1.7-3.3
Good = 3.4-5
IMPLICATION 3.57 Good

Table 15. Prognosis

 Cataract 72

Health Teachings

Health education, also known as health teaching, is any combination of learning

experiences aimed at assisting patients who are ill and improving their health by increasing their

knowledge or influencing their attitudes toward health.

1. Acute pain secondary to senile mature cataract r/t operative procedure a.m.b.

self-report of pain intensity and facial expression of pain

Health teachings Rationale

Encourage adequate rest periods. To prevent fatigue that can impair

ability to manage or cope with pain.

Review nonpharmacological ways to These are the nonpharmacological

lessen pain such as Therapeutic Touch, techniques that the patient can use

biofeedback, self-hypnosis, and during episodes of pain.

relaxation skills.

Provide for an individualized physical Promotes active, rather than passive,

therapy or exercise program that can be role and enhances sense of control.

continued by the client after discharge.

Discuss with SO(s) ways in which they Family members/SOs may provide

can assist client with pain management. assistance to the client.

Identify specific signs/symptoms and Provides opportunity to modify pain

changes in pain characteristics requiring management regimen and allows for

medical follow-up. timely intervention for developing

complications.

Table 16. Health teachings for Acute pain

 Cataract 73

2. Anxiety secondary to cataract surgery r/t threat to current status a.m.b. worry

about change in life event, fear, increase in wariness, and increase in blood

pressure

Health teachings Rationale

Identify actions and activities the client To assist the patient in relieving anxiety.

has previously used to cope successfully

when feeling nervous/anxious.

List helpful resources and people. To provide ongoing/timely support.

Review strategies, such as prayer and This is useful for being prepared

medication. for/dealing with anxiety-provoking

situations.

Table 17. Health teachings for Anxiety

3. Risk for infection secondary to senile mature cataract r/t to trauma to the post-

operative site

Health teachings Rationale

Review individual nutritional needs, To reduce the risk of infection.

appropriate activities, and need for rest.

Instruct the client/SO(s) in techniques to

protect the integrity of the skin, care for

lesions, and prevent spread of infection.

Emphasize the necessity of taking Premature discontinuation of treatment

antibiotics, as directed. when client begins to feel well may

 Cataract 74

result in return of infection and

potentiation of drug-resistant strains.

Discuss the importance of not taking Inappropriate use can lead to

antibiotics or using “leftover” drugs development of drug-resistant strains or

unless specifically instructed by secondary infections.

healthcare provider.

Table 18. Health teachings for Risk for infection

 Cataract 75

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 Cataract 81

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 Cataract 82

CURRICULUM VITAE
 Cataract 83

Personal Background

Name: Aira Shane C. Marges

Birthdate: March 02, 2002

Birthplace: General Santos City

Nationality: Filipino

Civil Status: Single

Gender: Female

Mobile Number: 09051295685

Address: Purok 10-A, Poblacion, Tupi, South Cotabato

Father: Manuel P. Marges

Mother: Darcy C. Marges

Educational Attainment

Senior High School: Tupi National High School (2018 – 2020)

Tupi, South Cotabato

Junior High School: Tupi National High School (2013 – 2018)

Tupi, South Cotabato

Elementary: Tupi Alliance Church Elementary School (2008 – 2013)

Tupi, South Cotabato

College: Notre Dame of Dadiangas University (2020- Present)

Marist Avenue, General Santos City

 Cataract 84

Personal Background

Name: Teza Marygrace L. Maribao

Birthdate: August 08, 2001

Birthplace: MHARS Hospital, Ozamiz City

Nationality: Filipino

Civil Status: Single

Gender: Female

Mobile Number: 09218751134

Address: Block 13 Lot 1 Phase 1, Doña Soledad Subdivision

Father: Zacarias C. Maribao Jr.

Mother: Tessie L. Maribao

Educational Attainment

Senior High School: Notre Dame of Dadiangas University (2018 – 2020)

Marist Avenue, General Santos City

Junior High School: Notre Dame of Dadiangas University-IBED (2014 – 2018)

Espina, General Santos City

Elementary: Seventh-Day Adventist Elementary School (2008 – 2014)

Atis St., General Santos City

College: Notre Dame of Dadiangas University (2020- Present)

Marist Avenue, General Santos City

 Cataract 85

Personal Background

Name: Keiko Lorenz P. Mercado

Birthdate: September 12, 2001

Birthplace: Tacurong City

Nationality: Filipino

Civil Status: Single

Gender: Female

Mobile Number: 09391218287

Address: Purok 9 1st Block, Gonzales Subdivision, Tacurong City

Father: Renante S. Mercado

Mother: Hilda P. Mercado

Educational Attainment

Senior High School: Notre Dame of Dadiangas University (2018 – 2020)

Marist Avenue, General Santos City

Junior High School: Notre Dame of Tacurong College (2013 – 2018)

Lapu-lapu Street, Tacurong City

Elementary: Tacurong Pilot Elementary School (2008 – 2013)

Alunan Highway, Tacurong City

College: Notre Dame of Dadiangas University (2020- Present)

Marist Avenue, General Santos City