Cataracts Nursing Care Plans Diagnosis and Interventions
Cataracts NCLEX Review and Nursing Care Plans
A cataract is a condition that involves the clouding of the lens leading to reduced or complete loss of vision.
It is characterized by the build up of protein in the lens of the eye. The protein build up in the lens of the eye causes obstruction and changes to vision.
It is gradual in progression; hence it may not be noted straightaway until there are obvious changes in visual abilities.
Cataracts are eye conditions that we might all be familiar with, as it is quite common especially in elderly people.
In America, almost half of the population age 80 and above have cataracts or have had procedures related to cataracts.
Signs and Symptoms of Cataracts
- Clouded, blurred, or dim vision
- Increasing difficulty of vision at night
- Sensitivity to light and glare
- Need for brighter light when doing activities
- “Halos” around light
- Frequent changes in prescription lenses or glasses
- Fading or yellowing of colors
- Double vision in one eye
Types of Cataracts
There are different types of cataracts, which include:
- Nuclear cataracts. Nuclear cataracts usually affect the center of the lens. They cause the lens to turn yellow in color, and eventually brown. This discoloration makes it difficult to distinguish color patterns visually.
- Cortical cataracts. This type of cataracts affects the edge of the lens. Cortical cataracts are characterized by a wedge-shape opacities or streak on the edge of the lens cortex. Over time the streak can extend up to the centre of the lens.
- Posterior subcapsular cataracts. This type of cataracts affects the back of the lens directly at the path of light. Posterior subcapsular cataracts progress faster than the other types of cataracts. They cause reduced reading vision and halo vision.
- Congenital cataracts. A type of cataracts that develops during childhood, congenital cataracts could be genetic or could also be due to an infection or trauma on the fetus during pregnancy.
Causes of Cataracts
The most common causes of cataracts are ageing and injury.
An accident such as a chemical eye splash can injure the eye, which may directly change the composition of the eyes.
Other health problems and condition can also predispose a person to develop cataracts.
History of eye surgery, diabetes, and long-term steroid use can all lead to the formation of cataracts.
Understanding the parts of the eyes and their function will shed light as to how cataracts are formed.
The lens is a part of the eye that captures light and passes it to the retina for it to be interpreted by the brain.
As a person ages, the lens becomes less flexible and less transparent, and much thicker.
Therefore, it is easier for the surrounding tissue to clump together and build up.
The clump then starts blocking a part of the lens until it gets bigger and start blocking a larger part of the retina making the damage more noticeable.
Both eyes can be affected, but not necessarily at the same severity.
There are certain factors that increase the individual’s risk for developing cataracts, such as:
- Certain conditions including diabetes, hypertension, and obesity
- Excessive sunlight exposure
- History of eye injury or surgery
- Long term corticosteroid use
- Excessive intake of alcohol
Diagnosis of Cataracts
In conjunction with history taking and physical examination, the clinician may perform the following tests to diagnose cataracts:
- Visual acuity test – to determine changes and degree of effect the cataracts has on the individual’s vision. It tests how well an individual can read a series of letters in a distance.
- Slit-lamp examination – to assess the outer structure of the patient’s eye. The test requires a scope called slit to magnify the eye structures.
- Retinal exam – involves the administration of an eye drop to dilate the pupil of the eye. This will allow the clinician to see the back of the eye or the retina. A slit lamp or a special device called ophthalmoscope is used to visualize the retina.
Treatment of Cataracts
- Prescription glasses. The aim of treatment for cataracts is to improve vision. Prescription glasses are the first line of treatment. In most cases, problems with vision does not greatly compromise the quality of life, hence, prescription glasses is mostly enough. However, if the quality of life and activities of daily living are greatly affected, then cataract surgery is recommended.
- Surgery. A generally safe procedure, cataract surgery involves the removal of the clouded lens. It is then replaced with an artificial one. Healing usually takes eight weeks. If both eyes are affected, only one eye at a time will be scheduled for surgery. The other one will have to wait once the operated eye has healed. Cataract surgery is commonly done in an outpatient setting. Risks and benefits are discussed by the doctor and the patient
Nursing Diagnosis for Cataracts
Nursing Care Plan for Cataracts 1
Nursing Diagnosis: Disturbed Sensory Perception (Visual) related to cataracts as evidenced by verbal complaint of vision problems such as cloudy and halo vision, light sensitivity, and inability to see properly
Desired Outcome: The patient will regain optimal vision while being able to cope with and accept permanent vision changes.
|Cataract Nursing Interventions||Rationale|
|Assess the vision ability of the patient using an eye chart, slit-lamp exam, and retinal exam.||To establish a baseline assessment of cataracts in terms of vision capacity.|
|Encourage the patient to have regular checkups with an ophthalmologist at least once a year.||To monitor worsening of vision loss and treat accordingly.|
|Encourage the patient to promote sufficient lighting at home.||The patient may not be able to perform activities of daily living as normal if he/she cannot see properly. Sufficient lighting also reduces the risk for injury.|
|Encourage the patient to always wear the prescribed glasses.||Prescription glasses are the first line of treatment. In most cases, problems with vision does not greatly compromise the quality of life, hence, prescription glasses is mostly enough.|
|Prepare the patient for cataract surgery if indicated.||A generally safe procedure, cataract surgery involves the removal of the clouded lens. It is then replaced with an artificial one. Healing usually takes eight weeks.|
|Encourage the patient to add foods containing vitamins C, E, beta-carotene, zinc, and copper in his/her diet in accordance to daily recommended intake.||A study by AREDS shows benefits if foods containing vitamins C, E, beta-carotene, zinc, and copper are introduced to the patient’s diet.|
|Encourage the patient to inform the ophthalmologist if there is any worsening of symptoms.||To monitor if MD is worsening and if there is a need for further investigation and treatment.|
Nursing Care Plan for Cataracts 2
Nursing Diagnosis: Risk for Trauma/Injury related to loss of vision and/or reduced visual acuity
Desired Outcome: The patient will be able to prevent trauma or injury by means doing activities that can be done within the parameters of visual limitation and by modifying environment to adapt to current vision capacity.
|Cataract Nursing Interventions||Rationale|
|Assess the patient’s degree of visual impairment.||To establish a baseline of visual acuity and gain useful information before modifying the patient’s environment.|
|Place the bed in the lowest position. Place the call bell within reach (if there’s any), and keep the visual aides and patient’s phone and other devices within reach.||To prevent or minimize injury of the patient.|
|Promote adequate lighting in the patient’s room.||To promote safety measures and support to the patient in doing ADLs optimally.|
|Ensure that the floor is free of objects that can cause the patient to slip or fall.||To promote safety measures and support to the patient in doing ADLs optimally.|
|Advise the patient to wear sunglasses especially when going outdoors.||To reduce glare and help protect the eyes.|
Nursing Care Plan for Cataracts 3
Nursing Diagnosis: Deficient Knowledge related to new diagnosis of cataracts as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of cataracts and its management.
|Cataract Nursing Interventions||Rationales|
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. blurry vision).||To address the patient’s cognition and mental status towards the new diagnosis of cataracts and to help the patient overcome blocks to learning.|
|Explain what a cataract is, its types, and related signs and symptoms. Avoid using medical jargons and explain in layman’s terms.||To provide information on cataracts and its pathophysiology in the simplest way possible.|
|Educate the patient about safety measures related to cataracts. Create a plan for Activities of Daily Living (ADLs) with the patient and the caregiver, especially including important activities such as driving, operating machinery, swimming, and bathing.||To encourage the patient to live his/her daily life optimally, while ensuring that he/she is safe from injury despite having this condition.|
|Inform the patient the details about the surgery to remove cataracts. Encourage the patient to ask questions.||To ensure that the patient fully understands the purpose and risks of a cataract surgery.|
|Encourage the patient to make lifestyle changes such as:Eat a healthy dietExercise safely Limit caffeine intakeIncrease oral fluid intakeSleep with head elevatedUse prescription glasses for cataracts||To enable to patient to have an optimal quality of life.|
Nursing Care Plan for Cataracts 4
Risk for Ineffective Therapeutic Regimen
Nursing Diagnosis: Risk for Ineffective Therapeutic Regimen secondary to cataract related to unfamiliarity with the treatment plan
Desired Outcome: The patient will be able to develop a sense of necessity in complying to the treatment plan by showing an increased interest in achieving therapeutic goals and accomplishing them within the prescribed period.
|Cataract Nursing Interventions||Rationale|
|Evaluate for circumstances that may hinder the patient in complying with the program.||Helping the patient be aware of the reasons and rationale of the treatment plan for post-cataract surgeries will ensure for compliance and eventual direction of the planned interventions. However, the interventions may be limited for a variety of reasons such as money issues to physical disabilities.|
|Assess the patient’s confidence in their capability to effectively perform the desired behavior within the plan.||In the self-efficacy theory, a person portraying a positive attitude towards accomplishing a goal is correlated with the success of their performance in achieving favorable outcomes.|
|Evaluate the patient’s skill in attaining their desired activity.||The patient’s skill and determination in doing the action will establish the quality and amount of health teaching and care assistance that would be needed to accomplish the desired health goals of a postoperative patient.|
|Evaluate the patient’s skill to understand or appreciate the needed health-related activity.||Impairments (e.g., cognitive issues) are essential to be acknowledged so that alternatives can be facilitated in accordance with the needs of the patient. Options can be started once problems are established and arranged according to the hierarchy of the patient’s needs.|
|Let the patient be involved in planning for their care program and rehabilitation.||Patients who are actively involved in their care will produce higher chances of achieving success in their rehabilitation program. This is especially important for patients with a compromised sense of sight in which they are highly dependent on prior to having an eye cataract. Still, the patient should be made aware that he/she will face challenges in accomplishing simple activities of daily living (ADLs), but these can be better achieved with a tailored ADL care plan.|
|Inform the patient of the positive effects when following the planned care program.||Patients who are briefed and made to recognize the effectiveness of planned treatment have higher chances of getting involved due to their understanding of the advantages. It helps them understand that complying with the tailor-fit program will reduce their risks and promote their well-being which will therefore let them go back to doing their usual activities.|
|Enlighten the patient with the treatment regimen in the vernacular properly. Propose long-acting therapeutics and reduce needless medications.||Easy to understand instructions to patients will promote their better engagement due to the information being made available within their level of understanding. Also, patients are more likely to forego medications if it requires multiple applications.|
|Ensure that the patient’s therapy is tailor-fitted to the patient’s lifestyle and choices.||A tailor-fitted therapeutic regimen will not only promote cooperation but also encourage increased trust in the healthcare team because of the considerations done for the patient. A rigid and generic approach to treatment is usually ineffective, especially for patients who decline lifestyle changes.|
|Refrain from doing needless clinic visits.||The physical task of going to the doctor’s office, the economic losses in order to comply (e.g., loss of a day’s salary), the pessimistic feelings associated with the healthcare team’s inability to fully understand the patient (e.g., intellectual or cultural gap) in addition to long waiting times before being checked can affect patient compliance and therefore promote withdrawal from the therapeutic regimen.|
|Build with the patient a reward system for every accomplished therapeutic goals.||Establishing a reward system such as verbal recognition, economic bonuses, privileges, etc. will allow for better patient mood, increase in self-esteem, and successful compliance with the treatment plan.|
|Cultivate with the patient a system that will gauge their progress in accordance with their treatment goals.||The patient learning to monitor their own progress, in achieving the preset goals of their treatment regimen, is a crucial component for changes in behavior that will determine faster recuperation.|
|Ensure that their significant others are involved with the treatment plan. Also, include the family in the teaching and explanations of the care plan. Allow for them to support and assist in helping the patient comply with the care plan.||The patient’s significant others are important with in promoting assistance in reaching health goals. They also serve as support in improving appropriate behaviors that will promote lifestyle modifications.|
Nursing Care Plan for Cataracts 5
Nursing Diagnosis: Acute Pain secondary to advanced cataract related to trauma in the post-operative site as evidenced by increased intraocular pressure, complaints of pain and tenderness in the area.
Desired Outcome: The patient will be able to reduce pain scores within tolerable limits of 3 or less in the pain scale, with displays of improved well-being as evidenced by normal levels in blood pressure, pulses, respirations, and relaxed body posture.
|Cataract Nursing Interventions||Rationale|
|Do a thorough assessment of the patient’s pain. Ensure to include the location, characteristics, duration, frequency, onset, quality, severity, and mitigating factors regarding pain (the PQRST of pain).||The patient who is experiencing pain is the best source for information with regards to their pain. The PQRST method is a useful mnemonic in the complete assessment of the patient’s pain for it covers the following guide questions: Provoking factors – The what or the factors that affect pain stimulus.Quality – The how or description of the painRegion – The where or the foci of pain.Severity – Inquire about the pain via different methods such as the pain scale of 1-10, etc.Temporal – The how or the onset, duration, and frequency of the pain.|
|Ascertain the patient’s pain perception.||It is prudent to consider and allow the patient to express their pain with their own words, especially on how they view pain and the state in order to comprehend of what the pain stands for the patient. Verifying the patient’s perception is essential in the care process.|
|Evaluate the patient’s ability or willingness to look at different methods for pain control.||Some patients are hesitant to try new or unfamiliar methods for pain control, such as nonpharmacologic methods, and would be comfortable using usual methods (i.e., the use of analgesics). Exploring the combination of both pharmacologic and non-pharmacologic to manage the patient’s pain may be more effective. Explaining other forms of pain control is one of the duties of the nurse in helping their clients address their discomfort.|
|Evaluate the patient’s reaction to pain and management techniques.||It is essential for the nurse to recognize the patient’s response to pain as factually as possible in order to gauge the response and effectiveness of therapies. Incongruencies with patient reactions against their actual behavior or appearance may signify coping by the patient and not the actual resolution of the pain itself.|
|Ensure that ample time and effort is allowed for the patient in reporting their pain experience.||Pain reporting for the patient may become delayed because of the perception that the care staff is too preoccupied with other demands (such as other personnel, patients, etc.). Any interruptions during management will prevent care staff from completely assessing and managing their patient’s pain.|
|Render methods as early as possible before the pain becomes severe.||It is crucial and preferable in providing the patient with an analgesic before the start of a painful stimulus or before it develops severely. This pre-emptive approach will ensure for better patient comfort and compliance with instruction, especially before any caregiver intervention.|
|Provide pharmacologic treatment for pain relief and reduction of intraocular pressure as ordered by the physician.||Rendering timely pharmacologic pain relief will ensure adequate control and achievement of the desired therapeutic levels in order to maintain analgesia in the patient. Giving medication for the control of intraocular pressure will reduce complications of uncontrolled IOP and promotion of wound healing.|
|Utilize cold compress as requested by the patient and as ordered by the doctor.||Application of cold compress has been considered to be effective in managing inflammation and swelling in the post-operative site. The cold application also helps in reducing edema on the affected site, therefore reducing pain stimulus and promoting patient comfort.|
|Ensure that the patient’s room lighting is adjusted to the lowest and safest possible.||Patient’s who just had eye surgery are more sensitive to light due to the manipulation done to the 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 patient to use sunglasses, especially in the presence of strong lighting.||Dark colored sunglasses may help the patient protect their sight from unnecessary lighting to an already sensitive eyesight post-procedure.|
|Render nursing tasks at the peak effect of analgesics.||Oral forms of analgesics take peak by 60 minutes and intravenous forms in 20 minutes. Considering these will promote for patient comfort and conformity with a treatment plan.|
Nursing Care Plan for Cataracts 6
Risk for Infection
Nursing Diagnosis: Risk for infection secondary to cataract related to trauma to the post-operative site
Desired Outcome: The patient will be able to keep the post-operative site free from any infection such as pain, swelling, skin warm to touch, and presence of foul or purulent discharge.
|Cataract Nursing Interventions||Rationale|
|Ensure that the patient and caregivers follow a strict aseptic technique when managing the wound through the following: Proper hand hygiene techniqueCorrect wound cleaning methodAppropriate wound dressing application.||Observing and following strict aseptic technique when managing the wound ensures the prevention of opportunistic infections that may compromise proper wound healing. It will also promote better wound healing, therefore allowing for early recovery and rehabilitation for resumption of previous levels of activity.|
|Educate the patient and caregivers on recognizing and timely reporting of clinical manifestations of possible complications such as bleeding, increased intraocular pressure, or infection.||As with any surgical procedure, there is always the possibility of complications post cataract surgery. In the case of the surgical removal of a patient’s cataracts, the patient and caregivers made aware of adverse events such as excessive pain on the site, will help in limiting any debilitating effects for advancing complications. Failure to recognize these problems would cause delays in healing, thus affecting the capacity to return to normal functioning that would have an impact on the overall well-being of the patient.|
|Ensure that the patient always elevates the head of the bed to at least 30 degrees during the healing process.||Patients who had surgery for the removal of their cataracts would have edema on the surrounding tissues as a side effect of the manipulation of the area. Elevating the head of the bed to at least 30 degrees ensures for proper wound drainage by gravity, therefore 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 patient of allowed or restricted activities post-surgical removal of cataracts. Examples of these are coughing, sneezing, vomiting, trunk bending, etc.||Due to the sensitive nature of the post-operative site, certain activities are limited to an extent or until the wound has healed properly. Activities, such as coughing, stimulate vagal reflux that increases the intraocular pressure (IOP) in the eye. Significant elevations in the IOP can lead to complications post-cataract surgery, such as wound dehiscence or vitreous prolapse, due to increasing tensions in the sensitive sutures in the site.|
|Teach the patient to follow bed rest as prescribed, and to gradually increase activity as tolerated.||Limiting activity can help with the proper wound healing of the site. Ensuring that the patient receives adequate rest and sleep while recuperating will help with the overall and speedy healing of the wound. It will also avoid any further damage that may happen when doing activities of daily living.|
|Administer prescribed medications as ordered following the correct manner.||Letting the patient apply the prescribed medications utilizing the proper method, such as anti-infectives and anti-inflammatories, ensures proper wound healing, better tissue regeneration, and prevention of complications.|
More Nursing Diagnosis for Cataracts
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020).Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022).Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020).Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020).Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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