NURSING MANAGEMENT

OF PATIENTS
WITH CATARACT
Submitted To,
Ms. Sebin Bijo
Faculty
L.T. College of Nursing
Submitted by,
Vaghdevi Ankireddi
1st Year MSc Nursing
L.T. College of Nursing

Submitted On,
SUBJECT- Medical Surgical Nursing
TOPIC- Nursing Management of Patient with Cataract
UNIT-
GROUP-
DATE AND TIME –
VENUE- 3rd Year BSc Nursing classroom
METHOD OF TEACHING- Lecture and discussion
TEACHING AIDS – OHP transparency for Definition, Chart for Etiology, Flash Cards for Types, Flow Chart for Pathophysiology,
PPT for Clinical Manifestations, Diagnostic Tests, Medical and Surgical Management, Pamphlet for Nursing Management.
KNOWLEDGE ASSUMED – The students have little knowledge regarding the condition.
 AIMS AND OBJECTIVES
Aim:
At the end of the lecture, the student will be able to understand Nursing Management of Patient with Cataract, and provide
comprehensive nursing care to those patients.

Specific Objectives:
At the end of the class, the student will be able to –
1. Define Cataract.
2. Enumerate the Incidence, Risk factors and Etiology (Causes) of Cataract.
3. Explain in brief the various types of Cataract.
4. Describe the pathophysiological process of Cataract.
5. Enlist the Signs and Symptoms of Cataract.
6. Determine the various diagnostic evaluation tests for Cataract.
7. Discuss the Medical Management of Cataract.
8. Give a brief regarding the surgical management of Cataract.
9. Review the Nursing Management for Patients with Cataract.
Sr. CONTRIBUTORY CONTENT TEACHING LEARNING AV AIDS
No. OBJECTIVE ACTIVITY
1. Introduction Good Morning/Afternoon Everyone present here. Today, I The teacher will be showing PowerPoint
am here to teach you all a topic which you would be pictures to the Students. presentation
guessing. Now, I will be showing you two pictures and You Students try to guess the
all have to tell me what are the differences between the two topic and might succeed in
pictures. So, Let’s start with the game. it.

2. The students would A cataract is a clouding of the normally clear lens of the eye. The teacher asks “What do OHP
be able to define (OR) you all understand by transparency
Cataract. A cataract is when your eye's natural lens becomes cloudy, Cataract?”. Students
due to the proteins that your lens break down and cause respond. Teacher appreciates
things to look blurry, hazy or less colorful. and continues with the
(OR) lecture.
A cataract is a cloudy area in the lens of the eye that leads to
a decrease in vision.

3. The students would ETIOLOGY The teacher asks, “Can Charts

be able to list down anyone list down some
the Etiology There are several underlying causes of cataracts. These causes that could lead to
(Causes), and Risk include: cataracts?”. Students
factors of Cataract. respond. Teacher appreciates
A. Aging and continues with the
 Loss of lens transparency lecture.
 Clumping or Aggregation of lens protein.
 Decreased Oxygen intake
 Increased Sodium and Calcium
 Decrease in Vitamin D and Protein levels

B. Associated Ocular Conditions

 Retinitis pigmentosa
 Myopia
 Retinal detachment
  Infection (uveitis)
C. Toxic Factors
 Ionizing radiation
 Aspirin use
 Long term use of Corticosteroids
 Alkaline chemical eye burns
 Cigarette smoking

D. Nutritional Factors
 Reduced intake of antioxidants
 Poor diet
 Obesity

E. Physical Factors
 Dehydration associated with diarrhea
 Use of purgatives in anorexia nervosa
 UV radiation in sunlight and X-ray.
 Use of Hyperbaric Oxygenation
 Blunt trauma
 Foreign Object perforation
 Electric Shock

F. Systemic Diseases
 Down syndrome
 Diabetes
 Musculoskeletal disorders
 Lipid Metabolism disorders

INCIDENCE

i. Cataract develops in approximately 5-15 million

people worldwide every year.
ii. It is one of the leading causes of Blindness in the
 World.
iii. The age-related cataract is the most common.
iv. Some degrees of Cataract formation is expected in
people older than 70 years of age.
v. More than half of all Americans
BUT have had a cataract
or cataract surgery by age 80.

RISK FACTORS

Factors that increase your risk of cataracts include:

a. Increasing age
b. Excessive exposure to sunlight
c. Obesity
d. High blood pressure
e. Previous eye surgery
f. Drinking excessive amounts of alcohol
4. The students would The teacher explains the Flow Chart
be able to explain In a Normal Eye pathophysiology to the class
the and asks one student to
pathophysiological The lens is positioned behind the colored part of the eye review it.
process of Cataract. (iris).

The lens focuses light onto your eye- producing sharp, clear
images onto the retina

Over Time,
Due to any Underlying factors
(Trauma, Aging, Radiation)
 The lenses in the eye become less flexible, less transparent
and thicker

Various proteins and fibers break down and clump together

within the lenses, thus clouding them.

As Cataract continues to develop, the clouding becomes

denser.

The clouding scatters and blocks the light, this preventing a

sharply, defined image from reaching your retina.

Hence, Blurring of vision takes place and Cataract continues.

5. The students would TYPES: The teacher asks, “What can Flash Cards
be able to be the various types of
differentiate There are several types that include: cataract?”. Students respond.
between various Teacher appreciates and
types of Cataract.  Nuclear Cataracts: moves forward with the
1. The type of cataracts affecting the center of lecture.
the lens are called nuclear cataracts.
2. A nuclear cataract may at first cause more
nearsightedness or even a temporary
improvement in your reading vision.
3. But with time, the lens gradually turns more
densely yellow and further clouds your vision.
 Cortical Cataracts:

1. The type of cataracts that affect the edges of

the lens are called cortical cataracts.
2. A cortical cataract begins as whitish, wedge-
 shaped opacities or streaks on the outer edge
of the lens cortex.
3. As it slowly progresses, the streaks extend to
the center and interfere with light passing
through the center of the lens.

 Posterior Sub capsular Cataracts:

1. The type of cataracts that affect the back of

the lens are called posterior sub capsular
cataracts.
2. A posterior sub capsular cataract starts as a
small, opaque area that usually forms near the
back of the lens, right in the path of light.
3. A posterior sub capsular cataract often
interferes with your reading vision, reduces
your vision in bright light, and causes glare or
halos around lights at night.

 Anterior sub capsular Cataracts:

1. This forms just inside the front of your lens

capsule.
2. An injury or swelling in your eye can lead to
one.

 Congenital Cataracts:
1. The type of cataracts that are present at birth
are called congenital cataracts.
2. Some people are born with cataracts or
 develop them during childhood.
3. These cataracts may be genetic, or associated
with an intrauterine infection or trauma.
 Lamellar or Zonular Cataracts:
1. This type typically shows up in younger
children and in both eyes.
2. The genes that cause them are passed from
parent to child.
3. These cataracts form fine white dots in the
middle of the lens and may take on a Y shape.
4. Over time, the whole center of the lens may
turn white.

6. The students would CLINICAL MANIFESTATIONS: The teacher asks, “Could PowerPoint
be able to co-relate you all relate the causes to presentation
the Signs and  Blurred or Distorted vision physiology and types, & tell
Symptoms of  Glare from bright lights me what could be the
Cataract.  Gradual and Painless loss of vision symptoms of cataract?”.
 Previously Dark pupil may appear Milky or White. Students respond. Teacher
 Increasing difficulty with vision at night appreciates and continues
 Seeing “halos” around lights with the class.
 Fading or yellowing of colors
 Double vision in a single eye (Diplopia)
 Need for brighter light for reading and other activities
 Frequent changes in eyeglass or contact lens
prescription
 Astigmatism
 Myopic Shift

7. The students will be There are several diagnostic tests that are used to detect The teacher asks, “How can Flip Card
able to enumerate we diagnose patients
the various Cataract. Some of them include: suffering from cataract?”
diagnostic Students respond Teacher
evaluation tests for appreciates and moves
 History Collection:
Cataract. forward with the lecture.
The doctor reviews the medical history and the
symptoms present in the patient. Questions about
current medications or any other risk factors are also
part of it.
 Visual acuity test:
a. A visual acuity test uses an eye chart to measure
the level of acuity and to determine the
sharpness or clarity of reading and distance
vision
b. The eyes are tested one at a time, while the
other eye is covered, using a chart or a viewing
device with progressively smaller letters.
c. It determines if the patient has 20/20 vision or
if his/her vision shows signs of impairment.
 Contrast Sensitivity Test:
a. Contrast sensitivity testing is similar to visual
acuity testing.
b. The goal of this test is to find out how easy it
is to separate an object from its back-ground.
c. If it’s hard for the person to identify an object
when it’s on a low-contrast background, then
he/she has poor contrast sensitivity.
 Slit-lamp examination:
a. A slit lamp allows to see the structures at the
 front of eye under magnification.
b. The micro-scope uses an intense line of light,
a slit, to illuminate the cornea, iris, lens, and
the space between them.
c. The slit allows the doctor to view these
structures in small sections, which makes it
easier to detect any tiny abnormalities.
 Retinal exam:
a. To prepare for a retina exam, drops are put in
eyes to dilate the pupils.
b. This makes it easier to examine the retina.
c. Using an ophthalmoscope, doctor examines
the lens for signs of a cataract.
 Applanation tonometry:
a. This test measures fluid pressure in your eye.
b. There are multiple different devices available
to do this.
 Potential Acuity Test:
a. A potential acuity test measures how well the
eye would see without the cataract.
b. It is typically done before cataract surgery to
confirm that the procedure will improve your
vision.

8. The students will be MEDICAL MANAGEMENT The teacher asks, “What Charts
able to explain the could be the treatment that
Medical and 1. Cataract treatment is based on the level of visual could be given to the patient
Surgical impairment they cause. with Cataract?”. Students
Management of respond Teacher appreciates
Cataract. 2. If a cataract minimally affects vision, or not at all, no and moves forward with the
treatment may be needed. lecture.

3. Patients may be advised to monitor for increased

visual symptoms and follow a regular check-up
schedule.

4. In some cases, changing the eyeglass prescription

may provide temporary vision improvement.

5. In addition, anti-glare coatings on eyeglass lenses can

help reduce glare for night driving. Increasing the
amount of light used when reading may be beneficial.

6. When a cataract progresses to the point that it affects

a person’s ability to do normal everyday tasks,
surgery may be needed.

7. Oral medications may be given to reduce IOP such as

mydriatric agents.

PREVENTION

 Reducing exposure to sunlight through UV-blocking

lenses.

 Decreasing or stopping smoking.

 Increasing antioxidant vitamin consumption by eating

more leafy green vegetables and taking nutritional
supplements.
  Get regular eye care. Have your eyes dilated once
every two years after age 60.

SURGICAL MANAGEMENT

GENERAL:
I. Surgical removal of the lens is indicated.

II. When a cataract interferes with activities, the patient

is a candidate for surgery.

III. Because cataract often occurs in both eyes, surgery is

recommended when vision in the better eye causes
problems. Surgery is done only on one eye at a time.

IV. Cataract surgery is usually done under regional block

or topical anesthesia, with or without IV anesthesia.
V. IOL implantations are usually implanted at the time
of cataract extraction, replacing thick glasses that may
provide suboptimal refraction.

VI. In a rare case that intraocular lens is not used, the

person will be fitted with appropriate sunglasses or
contact lens to correct refraction after the healing
process.

SURGICAL PROCEDURES:

1. There are Two types of Extraction:

Intracapsular Cataract Extraction:

 The lens as well as the capsule are removed through a small
incision.

Extra capsular Cataract Extraction:

 The lens capsule is incised and the nucleus, cortex &
anterior capsule are extracted.

 The posterior capsule is left in place and is usually the

base on which the IOL is implanted.

 A conservative procedure of choice, simple to

perform and is usually done under local anesthesia.

2.Phacoemulsification is usually used to remove the lens.

a) A hollow needle vibrating at ultrasonic speed is used
to emulsify the lens.

b) Then the emulsified particles are irrigated and

aspirated from the anterior chamber.

3.Cryosurgery is rarely used to remove the lens.

 A pencil-like instrument with a metal tip is super
cooled (-35°C) and then touched on the exposed lens.

 It results in freezing of the lens, so the lens is easily

lifted off.
9. The students will be The Nursing Management for cataract patients comprises of: The teacher asks, “So, Now Pamphlet
able to demonstrate You all tell me, What
the Nursing Care for NURSING ASSESSMENT: Nursing Care would you
Patients with plan for a patient with
Cataract. History Collection: Cataract?”.
 While taking history from the patient with Cataract,
the nurse notes the client’s age and asks about other
 predisposing factors.
 The nurse asks the patient to describe his/her vision.
 This technique helps the nurse to determine the
impact of visual deficits in the client.

Physical Examination:

a) Vision is generally tested using a Snellen Chart and

Brightness acuity testing.
b) The nurse evaluates the client’s acuity under various
lighting conditions, which can help determine the
exact location of the cataract in the lens and the
degree of visual disability.
c) The nurse examines the lens with the direct
ophthalmoscope and describes any observed
densities by size, shape and location.

Psychosocial Assessment:

 Fear of losing one’s eyesight can be overwhelming

and the client may exhibit great anxiety during an
ocular evaluation.
 When questioning the client about the eyesight, the
nurse uses a calm approach and empathizes with the
client’s lens.

NURSING DIAGNOSIS:

1) Impaired Sensory/Perceptual Alterations (Visual)

related to ocular opacity.

2) Self-Care Deficit related to visual impairment.

 3) Deficient Knowledge (cataract causes,
pathophysiology and treatment) related to lack of
information or previous misinformation.

4) Fear related to loss of eyesight, scheduled surgery or

inability to regain eyesight.

5) Impaired Home Maintenance Management related

to age, limited vision or activity restrictions imposed
by surgery.

6) Social Isolation related to reduced visual acuity, fear

of injury or decreased ability to navigate in
community.

7) Risk for Injury related to decreased vision, age or

presence in unfamiliar environment.

PLANNING AND IMPLEMENTATION:

Goals:
a. Improving the vision.
b. Increased ability to care for self.
c. Increased knowledge level.
d. Ability to share fears.
e. Enhanced positive image.
f. Rejuvenated social status.
g. Decreased Risk of Injury.

Interventions:
1. IMPROVING THE VISION.
 Assess the patient’s ability to see and perform
activities.
 Provide sufficient lighting for the patient to carry
out activities.
 Provide lighting that avoids glare on surfaces of
walls, reading materials, and so forth.
 Assist in diagnostic procedures and provide
appropriate information.

2. INCREASED ABILITY OF SELF-CARE.

 Assess the patient’s strength to accomplish ADLs
efficiently and cautiously on a daily basis.
 Determine the specific cause of each deficit.
 Consider the patient’s need for assistive devices.
 Recognize choice for food, personal care items,
and other things.
 Apply regular routines, and allow adequate time
for the patient to complete task.
 Implement measures to promote independence,
but intervene when the patient cannot function.

3. INCREASED KNOWLEDGE LEVEL.

 Assess the knowledge regarding the condition and
it's Treatment.
 Encourage patient to ask doubts about the
treatment approach.
 Clarify all the questions of the patient.
 Use a calm approach to explain anything to the
patient.

4. ABILITY TO SHARE FEARS.

  Open up about your awareness of the patient’s
fear.
 Discuss the situation with the patient and help
differentiate between real and imagined threats to
well-being.
 Be with the patient to promote safety especially
during frightening procedures or treatment.
 Maintain a relaxed and accepting demeanor while
communicating with the patient.

5. ENHANCED POSITIVE SELF-CONCEPT.

 Offer yourself as a nonjudgmental listener.
 Utilize multidisciplinary support for assistance
with social skills.
 Refer to therapy for deeper issues.

6. REJUVENATED SOCIAL STATUS

o Determine the behavior, person, thing, place, or
situation that is causing the feeling of isolation.
o Offer equipment and resources to improve
isolation.
o Recommend adult daycare centers or facilities.

7. DECREASED RISK OF INJURY.

 Assess patient for degree of visual impairment.
 Inform about special devices that can be used.
 Ensure the room environment is safe with
adequate lighting and furniture moved toward the
walls.
 Keep patient’s glasses and call bell within easy
reach.
 Instruct patient and/or family regarding the need
to maintain a safe environment.
Care for a patient with cataract also includes:

1. Providing preoperative care: Use of anticoagulants

is withheld to reduce the risk of retrobulbar
hemorrhage.

2. Providing postoperative care: Before discharge, the

patient receives verbal and written instructions about
how to protect the eye, administer medications,
recognize signs of complications, and obtain
emergency care.

EXPECTED OUTCOMES:

Evaluation of the patient may include:

1. Regained usual level of cognition.

2. Recognized awareness of sensory needs.
3. Free of injury.
4. Identified potential risk factors in the environment.
5. Appeared relaxed and reporting fear is reduced it to a
manageable level.
6. Verbalized feelings of fear.
7. Identified healthy ways to deal with and express fear.

HEALTH EDUCATION:

1. Activities: Activities to be avoided as instructed by

the nurse.
 2. Protective eye patch: To prevent accidental rubbing
or poking of the eye, the patient wears a protective
eye patch for 24 hours after surgery, followed by
eyeglasses worn during the day and a metal shield
worn at night for 1 to 4 weeks.

3. Expected side effects: Slight morning discharge,

sone redness, and a scratchy feeling may be expected
for a few days, and a clean, damp washcloth may be
used to remove slight morning eye discharge.

4. Notify the physician: Because cataract surgery

increases the risk of retinal detachment, the patient
must know to notify the surgeon if new floaters in
vision, flashing lights, decrease in vision, pain, or
increase in redness occurs.

10. Summary Today, In this lecture, we discussed about Cataract- it’s The teacher summarizes the
causes/etiology, patho-physiology, clinical features, topic and confirms with the
diagnostic tests, management – medical, surgical and nursing students by asking some
along with health education and home care management. questions about the same.
Cataracts are the clouding of the lens of your eye, which is
normally clear. Most cataracts develop in people over age 55,
but they occasionally occur in infants and young children or
as a result of trauma or medications. Usually, cataracts
develop in both eyes, but one may be worse than the other.
Cataracts develop slowly over time, causing symptoms such
as blurry vision, halos around light, yellowing of vision. The
Diagnosis is done through a comprehensive eye examination.
Cataract treatment is based on the level of visual impairment
they cause. If a cataract minimally affects vision, or not at all,
no treatment may be needed. When a cataract progresses to
 the point that it affects a person’s ability to do normal
everyday tasks, surgery may be needed.
11. Recapitulation
1. What is the Main Cause of Cataract?
2. What are the Signs and Symptoms of Cataract?
3. What are the various Surgical Procedures that could
be done for patients with Cataract?

12. Assignment Students will be divided into groups and would be asked to
formulate three nursing diagnosis pre-operatively and post-
operatively, based on the given case scenario.
13. Conclusion Today, I would like to express my gratitude to Sebin ma’am
for giving me a chance to present this topic. I would also like
to thank the class for their active participation and utmost
concentration.

BIBLIOGRAPHY:
I. Suzanne.C.Smeltzer, Brenda.G.Bare. Brunner and Suddharth’s Textbook of Medical Surgical Nursing. Seventh Edition.
Lippincott Company Publishers. [pg. no. 1570-1575]
II. Sandra Nettina. Lippincott Manual of Nursing Practice. 11th edition. Wolter Kleiwers Publication. [Pg. No. 442-445]
III. Janice L. Hinkle, Kerry H. Cheever. Medical Surgical Nursing (Volume 2). 13th Edition. Wolters Kluwer Publications. [pg. no.
1854-1861]
IV. Jeanna.C.Schener. Introductory Medical Surgical Nursing. 3rd edition. J.D.Lippincott Publishers [pg no. 1176-1179]