This guide is about Cataracts, Diagnosis of Cataracts, Treatment of Cataracts, and 3 Nursing Care Plan and Nursing Diagnosis Examples for Cataracts. It can be used to create educational nursing care plans for Cataracts.
What is a Cataract?
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.
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.
What are the 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
What are the 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.
What Causes 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
How do you Diagnose for 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
What Treatment Options are Available for Patients Suffering from 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
3 Nursing Care Plan and Nursing Diagnosis Examples for Cataracts
What are Some of the Available Care Plans and Diagnoses for Cataracts?
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 (3) nursing care plan (NCP) and nursing diagnosis guides for patients with cataracts:
Nursing Care Plan 1
Disturbed Sensory Perception: Visual
- Disturbed Sensory Perception
May be related to
- Poor visual acuity
- Changes in the eyes due to aging
Possibly evidenced by
- Visual distortions
- Loss of vision
- Diminished visual acuity
- Night blindness
- Accommodation changes
- Changes in usual response to stimuli
- Presence of cataract
- 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.
|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.|
Nursing Care Plan 2
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.
|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 diet, Exercise safely, Limit caffeine intake, Increase oral fluid intake, Sleep with head elevated, Use prescription glasses for cataracts||To enable to patient to have an optimal quality of life.|
Nursing Care Plan 3
Risk for Injury
- Risk for Injury
May be related to
- Decreased vision
- Night blindness
- Patient will be free of injury and will be able to perform activities within parameters of sensory limitation.
- Patient will be able to be free of injury.
- Patient and/or family will be able to modify the environment to ensure patient safety.
|Assess patient for degree of visual impairment.||Increases awareness of the problem, and identifies severity to allow for the establishment of a plan of care.|
|Ensure the room environment is safe with adequate lighting and furniture moved toward the walls. Remove all rugs, and objects that could be potentially hazardous.||Provides a safe environment to reduce the potential for injury.|
|Keep patient’s glasses and call bell within easy reach.||Provides for assistance for the patient and for optimal visual acuity.|
|Instruct patient and/or family regarding the need to maintain a safe environment.||Reduced visual acuity puts the patient at risk for injury.|
|Instruct patient and/or family regarding safe lighting. The patient should wear sunglasses to reduce glare. Advise family to use contrasting bright colors in household furnishings.||These techniques help enhance visual discrimination and reduce the potential for injury.|
|After surgery to extract a cataract:|
|Remind patient to attend checkup the following day after surgery.||Because the patient will be discharged after he recovers from anesthesia post-op. Warn him to avoid activities that increase intraocular pressure.|
|Instruct patient to wear a plastic or metal shield over the eye with perforations; a shield or glasses should be worn for protection during the day.||To protect the eye from accidental injury.|
|Teach the patient how to administer antibiotic ointment or drops; including steroids.||To prevent infection and inflammation.|
|Instruct patient to watch out for development of complications, such as sharp pain in the eye uncontrolled by analgesics, or clouding in the anterior chamber.||This may indicate infection and should be reported immediately.|
Other possible nursing diagnoses:
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.
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.