2 Cataracts Nursing Care Plans

A cataract is the gradually developing opacity of the of the lens or lens capsule of the eye. It is the most common cause of correctable vision, loss. Cataracts commonly occur bilaterally, with each progression independently. The prognosis is generally good and surgery improves vision in 95% of affected people.

Cataracts Symptoms

Cataracts cause the lens to become cloudy.

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Cataracts normally take years to develop, and they tend to appear in older age. The lens gradually becomes cloudy.

Cataracts can make it hard to read or drive a car, especially during the night. Seeing people’s facial expressions can become difficult.

They develop slowly, so most people do not know they have them at first, but as the clouding progresses, the vision gradually gets worse. Long-distance vision is more severely affected at the beginning.

Cataracts often affect both eyes, but rarely equally.

People with cataracts may have the following symptoms:

Blurry, cloudy, or misty vision

Vision may be affected by small spots or dots

The patient sees small patches that blur parts of the field of vision

Vision worsens when lights are dim

Vision is sometimes worse when there is very bright light, or glare

Some people with cataracts also comment that colors appear less clear and faded

Reading becomes difficult and eventually impossible

Glasses need to be changed more frequently

Eventually wearing glasses becomes less effective rarely, the person may see a halo around bright objects, such as car headlights or street lights, or have double vision in one eye

As vision deteriorates, and the glare of oncoming headlights and street lights gets worse, driving becomes dangerous. Drivers with cataracts start to experience eyestrain and find them blinking more frequently as they try to clear their vision.

Cataracts do not usually change the appearance of the eye. Any discomfort such as irritation, aching, itching or redness is more likely caused by another eye disorder.

Cataracts are not hazardous to the health of the person or the eye. If the cataract becomes hyper mature, or completely white, there may be inflammation, headache, and some pain. A hyper mature cataract that causes pain or inflammation needs to be removed.

Causes

Anyone can develop a cataract, because the greatest risk factor is age.

In the U.S., over 40 percent of people aged 75 years or above have some degree of lens clouding. Over half of all Americans aged 80 or greater have their vision significantly impaired by cataracts.

Factors that may increase the chance of developing cataracts include:

  • Age
  • Family history
  • Diabetes
  • Long-term exposure to bright sunlight
  • Previous eye inflammation
  • Previous eye injury

Airline pilots are more likely to develop nuclear cataracts, because of exposure to ionizing radiation.

Treatment

If the impact is mild, surgical treatment may not be needed. During the early stages, stronger glasses and brighter lights may help improve vision.

The following tips may help people who are not ready yet to have surgery:

  • Make sure any glasses have the most accurate prescription possible
  • Use a magnifying glass for reading
  • Get brighter lamps for the house, such as halogen lamps
  • Wear sunglasses to reduce glare on sunny days
  • Avoid driving at night

These are temporary measures, because the cataracts will continue to develop and the eyesight will worsen.

As it becomes harder to carry out everyday tasks, the individual may need surgery. This is usually a safe and effective procedure.

Prevention

To minimize the complications of cataracts, people should have regular eye exams, especially as they get older.

The following tips can reduce the risk of developing cataracts. Some have been proven to work, while others are not confirmed.

Giving up smoking: Smoking raises the risk of a number of eye conditions, and studies have linked it to a 3-fold increase in cataracts. There are also indications that smokers may experience cataract symptoms earlier.

Nutrition: Healthy food reduces the risk of disease, including eye problems. A healthy diet has plenty of fruits, vegetables, whole grains, unrefined carbohydrates, good quality fats, such as avocado, olive oil, and omega oils, and either plant-sourced proteins or lean, animal-sourced proteins.

Lutein and zeaxanthin have been described as “promising” in preventing cataracts.

Obesity and diabetes: Obesity significantly raises the risk of developing type 2 diabetes, a cataract risk factor. Maintaining a healthy weight and keeping diabetes under control will help reduce the risk.

Other factors that can help to protect against cataracts are:

Wearing sunglasses that block UV radiation when in sunlight

Get at least 7 hours of good quality, continuous sleep every night

Research has suggested that pycnogenol, a pine bark extract, may help reduce the risk of cataracts.

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Types

There are different types of cataract. Some of them are not related to age.

Secondary cataract: These can develop after eye surgery for other conditions, such as glaucoma, or as a result of health issues such as diabetes. Steroid use may increase the risk.

Traumatic cataract: An eye injury may trigger a cataract, up to several years later.

Radiation cataract: Some type of radiation exposure can lead to cataract formation.

Congenital cataract: A cataract may be present at birth, often in both eyes. They do not always affect vision, but if they do, surgery may be needed.

Diagnosis

Anybody who experiences vision problems should see a doctor, who then may refer them to an ophthalmologist or optometrist.

An eye examination and some tests can reveal a cataract.

An ophthalmologist specializes in the medical and surgical care of the eye, while an optometrist provides eye care, but not surgery.

The eye specialist will carry out tests.

These may include:

A visual acuity test, to find out how clearly the person can see an object. It involves reading a list of letters from across a room.

A slit-lamp examination uses a microscope to inspect the cornea, the iris, the lens, and the space between the iris and the cornea.

Tonometry measures the pressure inside the eye.

A retinal examination is carried out after using eye drops to dilate the pupils.

Nursing Care Plans

Treatment of cataract consists of surgical extraction of the cataractous lens opacity and intraoperative correction of visual deficits. The current trend is to perform the surgery as a same-day procedure. Nursing care revolves around patient education before and after surgery and providing safety.

Here are two (2) nursing care plans (NCP) and nursing diagnosis for patients with cataracts: 

  1. Disturbed Sensory Perception: Visual
  2. Risk for Injury

Disturbed Sensory Perception: Visual

Nursing Diagnosis

  • Disturbed Sensory Perception

May be related to

  • Cataracts
  • Poor visual acuity
  • Changes in the eyes due to aging

Possibly evidenced by

  • Visual distortions
  • Loss of vision
  • Diminished visual acuity
  • Photophobia
  • Night blindness
  • Myopia
  • Presbyopia
  • Accommodation changes
  • Changes in usual response to stimuli
  • Presence of cataract

Desired Outcomes

  • Patient will regain optimal vision possible and will adapt to permanent visual changes
  • Patient will be able to verbalize understanding of visual loss and diseases of eyes.
  • Patient will be able to regain vision to the maximum possible extent with the surgical procedure.
  • Patient will be able to deal with the potential for permanent visual loss.
  • Patient will maintain a safe environment with no injury noted.
  • Patient will be able to use adaptive devices to compensate for visual loss.
  • Patient will be compliant with instructions given, and will be able to notify physician for emergency symptoms.
Nursing Interventions Rationale
Assess the patient’s ability to see and perform activities. Provides a baseline for determination of changes affecting the patient’s visual acuity.
Encourage patient to see an ophthalmologist at least yearly. Can monitor progressive visual loss or complications. Decreases in visual acuity can increase confusion in the elderly patient.
Provide sufficient lighting for the patient to carry out activities. Elderly patients need twice as much light as younger people.
Provide lighting that avoids glare on surfaces of walls, reading materials, and so forth. Elderly patient’s eyes are more sensitive to glare and cataracts diffuse and glare so that the patient has more difficulty with vision.
Provide night light for the patient’s room and ensure lighting is adequate for the patient’s needs. Patient’s eyes may require longer accommodation time to changes in lighting levels. Provision of adequate lighting helps to prevent injury.
Prepare patient for cataract surgery as warranted. Provides knowledge, and facilitates compliance with the regimen.
Instruct patient regarding normal age-related visual changes, cataracts, and methods of dealing with visual acuity changes. Helps increase the patient’s understanding of visual changes and to make informed choices about options as the patient ages, the lens becomes denser and has less elasticity thus accommodation is decreased.Presbyopia is an age-related change that begins in people who are in their 40s and progresses. Visual acuity changes occur as the eye becomes more hyperopic as a result of neurologic changes in the visual pathways of the brain. The ability to distinguish fine details decreases because of the loss of neurons in the visual pathways in the brain.

Vitreous humor changes related to aging occur and consist of haziness, vertical flashing lights, line spots, or clusters of moving dots. The ability to differentiate colors also decreases with age because the cones that are responsible for color vision decline in sensitivity. In patients over 60, the lens may become yellowed from age, which results in blue objects appearing gray. Visual field decreases by approximately 1-3 inches per decade after 50.

Provide large print objects and visual aids for teaching. Assists patient to see larger print and promotes a sense of independence.
If surgery is planned, instruct patient and/or family regarding procedure, post-procedure care, and the need for follow-up with the physician. Instruct about complications and emergency signs and symptoms (flashing lights with loss of vision, seeing a “veil” falling over visual field, loss of vision in a specific portion of the visual field, etc.) of which to notify the physician. Prepares the patient for what to expect, facilitate compliance, and provides instruction about potential problems to lessen anxiety.

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