CATARACT
A Case Study Presented to the Faculty of College of Health Sciences Education In
Partial Fulfillment of the Requirements in NCM 121N/L
Code: 9071
Submitted by:
Sheila Mae C. Saclot BSN-4
Submitted to:
Majella Gonzales, RN, MAN
February 2022
DEFINITION
A cataract is a dense, cloudy area that forms in the lens of the eye. A cataract begins
when proteins in the eye form clumps that prevent the lens from sending clear images to the
retina. The retina works by converting the light that comes through the lens into signals. It
sends the signals to the optic nerve, which carries them to the brain. It develops slowly and
eventually interferes with your vision. You might end up with cataracts in both eyes, but they
usually don’t form at the same time. Cataracts are common in older people.
SIGNS AND SYMPTOMS
Signs and symptoms of cataracts include:
✓ 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 eyeglass or contact lens prescription
✓ Fading or yellowing of colors
✓ Double vision in a single eye
At first, the cloudiness in your vision caused by a cataract may affect only a small part of
the eye's lens and you may be unaware of any vision loss. As the cataract grows larger, it
clouds more of your lens and distorts the light passing through the lens. This may lead to
more-noticeable symptoms.
ETIOLOGY (RISK FACTOR)
Factors that increase your risk of cataracts include:
▪ Increasing age
▪ Diabetes
▪ Excessive exposure to sunlight
▪ Smoking
▪ Obesity
▪ High blood pressure
▪ Previous eye injury or inflammation
▪ Previous eye surgery
▪ Prolonged use of corticosteroid medications
▪ Drinking excessive amounts of alcohol
MEDICAL MANAGEMENT
Assessment and Diagnostic Findings
• Snellen visual acuity test. The Snellen visual acuity test measures the degree of visual
acuity in the patient.
• Ophthalmoscopy. Ophthalmoscopy is used to view the extent of cataract.
• Slit lamp biomicroscopic examination. This procedure is used to establish the degree
of cataract formation.
Surgical Management
• Lens replacement. There are three lens replacement options:
• Phacoemulsification. A portion of the anterior capsule is removed, allowing extraction
of the lens nucleus and cortex while the posterior capsule and zonular support are left
intact.
• Aphakic glasses. In aphakic glasses, objects are magnified by 25%, making
them appear closer than they actually are.
• Contact lenses. Contact lenses provide patients with almost normal vision, but
because contact lenses need to be removed occasionally, the patient also needs
a pair pf aphakic glasses.
• IOL implants. The most common IOL is the single focus lens or monofocal
IOL that cannot alter the visual shape; multifocal IOLs reduce the need for
eyeglasses; accommodative IOLS mimic the accommodative response of the
youthful, phakic eye.
• Extracapsular cataract extraction (ECCE). ECCE removes the anterior lens and
cortex, leaving the posterior capsule intact.
• Intracapsular cataract extraction. This procedure removes the entire lens within the
intact capsule.
Pharmacologic Therapy
• Dilating drops. Dilating drops are administered every 10 minutes for four doses at
least 1 hour before surgery.
• Antibiotic drugs. Antibiotic drugs may be administered prophylactically to prevent
postoperative infection and inflammation.
• Intravenous sedation. Sedation may be used to minimize anxiety and discomfort
before surgery.
NURSING MANAGEMENT
▪ If nursing care is provided in the patient’s home, structure the environment with
conducive lighting and reduce fall hazards.
▪ Suggest magnifying glasses and large-print books. Explain that sunglasses and soft
lighting can reduce glare.
▪ Assist the patient with the actions of daily living as needed to remedy any self-care
deficit.
▪ Encourage the patient to verbalize or keep a log on his or her fears and anxiety about
visual loss or impending surgery.
▪ Help plan events to solve the problems with social isolation.
NURSING
ASESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Objective Cues: Disturbed Sensory That within my 3 to 4 1. Establish rapport. 1. To facilitate cooperation Goal Met
Perception related to hours span of my care; and to gain client’s trust.
▪ Sensitivity to light Poor visual acuity patient will; 2. Assess the patient’s ability 2. Provides a baseline for Within my 3 to 4
and glare. to see and perform activities. determination of changes hours span of my care
a. regain optimal affecting the patient’s visual patient was able to
▪ Clouded, blurred or vision possible acuity. will regain optimal
dim vision. 3. Encourage patient to see 3. Can monitor progressive vision, adapt to
b. will adapt to an ophthalmologist at least visual loss or complications. permanent visual
▪ Increasing difficulty permanent visual yearly. Decreases in visual acuity change, and regained
with vision at night. changes. can increase confusion in the usual level of
elderly patient. cognition.
c. regain usual level of 4. Provide sufficient lighting 4. Elderly patients need
cognition for the patient to carry out twice as much light as
activities. younger people.
Reference: 5. Provide lighting that 5. Elderly patient’s eyes are
Vera, M. (2019). avoids glare on surfaces of more sensitive to glare and
Cataract Nursing Care walls, reading materials, and cataracts diffuse and glare so
Plan. Nurse’s pocket so forth. that the patient has more
guide: diagnoses, difficulty with vision.
prioritized interventions, 6. Provide night light for the 6. Patient’s eyes may require
and rationales. patient’s room and ensure longer accommodation time
lighting is adequate for the to changes in lighting levels.
patient’s needs. Provision of adequate
lighting helps to prevent
injury.
7. Prepare patient for cataract 7. Provides knowledge and
surgery as warranted. facilitates compliance with
the regimen.
8. Instruct patient regarding 8. Helps increase the
normal age-related visual patient’s understanding of
changes, cataracts, and visual changes and to make
methods of dealing with informed choices about
visual acuity changes. options as the patient ages,
the lens becomes denser and
has less elasticity thus
accommodation is decreased.
9. Provide large print objects 9. Assists patient to see
and visual aids for teaching. larger print and promotes a
sense of independence.
10. If surgery is planned, 10. Prepares the patient for
instruct patient and/or family what to expect, facilitate
regarding procedure, post- compliance, and provides
procedure care, and the need instruction about potential
for follow-up with the problems to lessen anxiety.
physician.
HEALTH TEACHING
Activity level
✓ Don't drive for 2 days or as instructed by your eye care provider.
✓ Don't drink alcohol for at least 24 hours.
✓ Don't bend at the waist to pick up objects or lift anything heavy for 2 days.
✓ Relax for the first 24 hours after surgery. Watching TV and reading are OK and won’t
harm your eye.
Eye protection
✓ Don't rub or press on your eye.
✓ Sleep on your back or on your nonoperated side for 2 nights.
✓ If instructed, wear a bandage over your eye for 2 days and 2 nights.
✓ If instructed, wear a shield to protect your eye for 2 days and 2 nights.
✓ While you’re healing, your eye health and vision will be watched. Ask your provider how
often you will need to be seen.
✓ After your eyes have fully healed, your eye care provider can evaluate if you need
eyeglasses or contact lenses.
Using eye drops
✓ You may be given special eye drops or ointment. Here is one way to use eye drops:
✓ Tilt your head back.
✓ Pull your bottom eyelid down.
✓ Squeeze 1 drop into your eye. Don't touch your eye with the bottle tip.
✓ Close your eyes for a few seconds.
✓ If you need more than 1 drop, wait at least 5 minutes before adding the next one.
REFERENCES
Delgado, A. (2017). Healthline: Cataract. Retrieved from
https://www.healthline.com/health/cataract#:~:text=A%20cataract%20is%20a%20dens
e,through%20the%20lens%20into%20signals.
Fairview. (2020). Patient Education: Discharge Instructions for Cataract Surgery. Retrieved from
https://www.fairview.org/PatientEducation/Articles/English/d/i/s/c/h/Discharge_Instruc
tions_for_Cataract_Surgery_83388#:~:text=Don't%20drive%20for%202,first%2024%2
0hours%20after%20surgery.
Mayo Clinic. (2022). Cataract Overview. Retrieved from https://www.mayoclinic.org/diseases-
conditions/cataracts/symptomscauses/syc20353790#:~:text=A%20cataract%20is%20a
%20clouding,frosty%20or%20fogged%2Dup%20window.
Vera, M. (2019). Cataract Nursing Care Plan. Nurse’s pocket guide: diagnoses, prioritized
interventions, and rationales. Washington DC: Sage Publications.
