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ASSIGNMENT ON CATARACT BY VIKAS KUMAR

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NIMS NURSING COLLEGE, JAIPUR
ASSIGNMENT
SUBJECT: - MEDICAL SURGICAL NURSING -2
DATE:-
20/9/2020
TOPIC: - CATARACTS
SUBMITTED TO: -
SUBMITTED BY: -
MR. SURENDRA DADHEECH
MR. Vikas Kumar
ASSISTANT PROFESSOR
BSC.NURSING 3rd YEAR
NIMS NURSING COLLEGE
NIMS-NURSING COLLEGE
JAIPUR RAJASTHAN.
JAIPUR RAJASTHAN.
Cataracts
INTRODUCTION
It is a clouding or opaqueness of the crystalline lens
which leads gradual painless blurring and eventual
loss of vision. A cause of blindness and is
conventionally treated with surgery. Vision loss
occurs because opacification of the lens obstructs
light from passing and being focused on the retina.
It is 3rd leading cause of preventable blindness.
Cataract accounts for over 47% of blindness
worldwide, causing blindness in about 17.3 million
people in 1990. Surgery for cataract in people with
glaucoma may affect glaucoma control. Cataract is
the leading cause of reversible blindness and visual
impairment globally. Blindness from cataract is
more common in populations with low
socioeconomic status and in developing countries
than in developed countries.
Cataract is the leading cause of reversible blindness
and visual impairment globally. Blindness
from cataract is more common in populations with
low socioeconomic status and in developing
countries
than in developed countries. The only treatment for
cataract is surgery. Phacoemulsification is the gold
standard for cataract surgery in the developed
world, whereas manual small incision cataract
surgery is
used frequently in developing countries. In general,
the outcomes of surgery are good and
complications,
such as endophthalmitis, often can be prevented or
have good outcomes if properly managed.
DEFINITION
The term cataract is derived from the Greek word
cataracts, which describes rapidly running water or
falling water.
A cataract is a clouding or capacity that develops in
the crystalline lens of the eye or in its envelope,
varying in degree from slight to capacity and
obstructing the passage of light.
CLASSIFICATION
BASED ON:MORPHOLOGY AGE OF ONSET
MATURITYAGE OF ONSET:
1. CONGENITAL
2. INFANTILE
3. JUVINILE
4. PRE-SENILE
5. SENILE
Morphological:
1.Capsular cataract
2.Sub capsular cataract
3.Cortical cataract
4.Supra nuclear cataract
5.Nuclear cataract
6.Polar cataract
MATURITY:
1.IMMATURE CATARCT
2.MATURE CATARACT
3.HYPERMATURE CATARACT
Causes of cataract:
1.Old age (commonest)>65 Year.
2.Ocular & systemic diseases – DM – Uveitis –
Previous ocular surge.
3.Systemic medication – Steroids – Phenothiazines.
4.Trauma & intraocular foreign bodies
5.Ionizing radiation – X-ray – UV
6.Congenital – Part of a syndrome – Abnormal
7.galactose metabolism Hypoglycaemias.
8.Inherited abnormality – Myotonic dystrophy –
9.Marfan’s syndrome – Rubella – High myopia.
Any physical or chemical cause ↓ Disturbs the
intracellular and extracellular equilibrium of water
and electrolytes ↓ Deranges the colloid system in
lens fibres ↓ Aberrant fibres are formed from
germinal epithelium of lens ↓ Epithelial cell
necrosis ↓ Focal opacification of lens epithelium
(glaucomflecken) ↓ Opacification of lens.
Signs and symptoms:
Painless, blurry vision
Reduced visual acuity
Myopic shift – return of ability to read without
glasses.
Astigmatism - optical defect in which vision is
blurred due to the inability of the optics of the eye
to focus a point object into a sharp focused image
on the retina.
Visible opaqueness.
Diplopia
Abnormal colour perception, glare (due to light
scatter caused by lens opacities and significantly
worse at night and in bright light when the pupil
dilates).
Brunescence – colour shift from yellow to brown.
Reduced light transmission.
Colour of pupil will be yellowish, grey or white,
Develop in both eyes.
Diagnosis:
Visual acuity measurements.
Snellen visual acuity test.
Ophthalmoscopy.
Slit lamp microscopic examination.
Blood test.
Visual field perimetry.
A – scan ultrasound.
Prevention:
Avoid the risk factors – UV rays, x rays, smoking
Wear sunglasses
Regular intake of antioxidants (vitamins A, C AND E)
would protect against risks.
Prevent accidents.
Treat underlying disorders properly.
MANAGEMENT:
Non-surgical treatment will not cure cataract.
Surgery is performed as outpatient basis usually
takes less than 1 hour and discharged in 30 minutes.
Topical and intra ocular anaesthesia – 1% lidocaine
gel is used.
Patient can communicate and cooperate during
surgery
IV moderate sedation – to minimize anxiety.
When both eyes have cataracts – one eye is treated
first, after several weeks the other cataracts is been
managed.
This will help one eye to heal properly and the
doctor can check the surgical procedure is effective
or not.
The doctor can also check the presence of any
complications due to surgery.
NURSING MANAGEMENT:
Withhold any anticoagulants the patient is
receiving, if medically appropriate.
In some cases, anticoagulant therapy may continue.
Administer dilating drops every 10 minutes for four
doses at least 1 hour before surgery. Antibiotic,
corticosteroid, and anti-inflammatory drops may be
administered prophylactically to prevent
postoperative infection and inflammation.
Provide patient verbal and written instructions
about how to protect the eye, administer
medications, recognize signs of complications, and
obtain emergency care.
Explains that there should be minimal discomfort
after surgery, and instruct the patient to take a mild
analgesic agent, such as acetaminophen, as needed.
Antibiotic, anti-inflammatory, and corticosteroid
eye drops or ointments are prescribed
postoperatively.
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