Cataracts

Cataracts Nursing Care Plans and Diagnosis Interventions

Cataracts NCLEX Review Care Plans

Nursing Study Guide on Cataracts

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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:

  • Age
  • Certain conditions including diabetes, hypertension, and obesity
  • Excessive sunlight exposure
  • Smoking
  • 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:

  1. 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.
  2. 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.
  3. 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

  1. 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.
  2. 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 Care Plans for Cataracts

Nursing Care Plan 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.

InterventionRationale
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 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.

InterventionRationale
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 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.

InterventionsRationales
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.

Other possible nursing diagnoses:

  • Depression
  • Deficient Knowledge
  • Powerlessness

Nursing References

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. (2017). 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. (2018). 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

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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