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01.02 Cataracts

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Overview

A cataract is a clouding of the lens in the eye which leads to a decrease in vision and if left untreated can lead to blindness.

Nursing Points

General

  1. A&P
    1. Lens
      1. Transparent and flexible
      2. Bends rays of light entering through pupil so they focus properly on retina
  2. Cataract
    1. Lens that has lost transparency
    2. Lens loses water and increases in density
    3. Distorts image projected onto retina
  3. Causes
    1. Could be present at birth
    2. Age related
      1. Most common
      2. Cataract formation expected in all people older than 70 years
    3. Trauma
    4. Exposure to toxic agents
    5. Complication of other diseases
  4. Diagnosis
    1. Visual acuity testing
      1. Decreased visual acuity
    2. Eye exam
      1. Will see cloudy lens

Assessment

  1. Early findings
    1. Slightly blurred vision
    2. Decreased color perception
  2. Later findings
    1. Blurred vision
    2. Double vision
    3. Difficulty with ADLs
    4. Leads to blindness
  3. Vision loss is gradual
  4. Pupil appears white

Therapeutic Management

  1. Surgery
    1. Only cure
    2. Phacoemulsification
      1. Sound waves break lens into small pieces
      2. Pieces removed by suction
    3. New lens placed
      1. Donor
      2. Synthetic
  2. Care post surgery
    1. Eye drops several times a day for 2-4 weeks
    2. Mild itching and slight swelling is normal
    3. Pain control
    4. Prevent increases in intraocular pressure
  3. Side effects and complications
    1. Significant swelling
    2. Bruising
    3. Infection
    4. Pain
    5. Bleeding or increased discharge
    6. Bloodshot sclera
    7. Decreased vision
    8. Flashes of light or floating shapes

Nursing Concepts

  1. Functional ability
  2. Sensory perception

Patient Education

  1. Prevention
  2. Post surgery education
    1. Activity restrictions
      1. Avoid increases in intraocular pressure
    2. Eye drop administration
    3. Complications
Study Tools

Video Transcript

Hey guys, this lesson is all about cataracts. By the end of this lesson you’ll understand what cataracts are, how they’re formed and treated, and nursing considerations when caring for these patients.

Ok guys, before digging deeper I wanted to quickly review the lens and its function so we have a good foundation to build upon. So looking at this picture right here you can see the lens. In a normal eye, it should be transparent and flexible. It is important because it bends light rays and helps them focus correctly on the retina.

Okay guys, so now that we have the basics down, let’s move on to cataracts. So a cataract is a clouding of the lens in the eye which leads to a decrease in vision and if left untreated, it can lead to blindness. So you can see in this picture right here the lens of the eye is not clear and has this white opacity to it. This is a cataract. Basically a cataract is a lens that has lost transparency, has lost water and increases in density, which then changes and distorts the image projected onto the retina. Cataracts can be present at birth and can also be age related, which is the most common. Cataracts are expected in all people older than 70 years of age because the lens gradually loses water and increases in density due to fiber compaction that is associated with aging. The density occurs as older lens fibers are compressed and new fibers are produced in the outer layers so the lens proteins dry out and can form crystals. So as the density of the lens increases it becomes opaque. They can also be caused by trauma such as in a penetrating eye injury or exposure to chemicals or toxic agents such as radiation exposure. They can also be a complication of other diseases such as in diabetes. Diagnosis is based on visual acuity testing to test the person’s vision using a Snellen chart, and by performing an eye exam, which will show the clouding of the lens.

Let’s look at assessment findings. So initially, patients can report slightly blurred vision and decreased color perception. This is experienced in the patient’s overall vision. These changes can be so slight that they go unnoticed. Patients may think that their glasses or contact lenses are smudged. Vision continues to gradually get worse and leads to blurred vision, double vision, difficulty with ADLs, and can lead to blindness if untreated. Since the loss of vision is gradual, the patient may not realize their vision changes until reading or driving is affected. When assessing the pupil, it will appear white due to the opacity of the cataract.

So as far as treatment goes, surgery is the only cure for cataracts. The procedure commonly performed for cataract removal is called phacoemulsification. During this procedure, sound waves break the lens into small pieces that are then small enough to be removed by suction. Once all of the bad lens is removed, a new lens is placed. So in this picture over here you can see in this top picture they make a slit to be able to access the lens. Once they have access to the lens the sound waves help break up the lens. The pieces are removed and then a new intraocular lens is placed. If you have time, I highly recommend checking out the link in the attachments. It’s just a 5 minute video on phacoemulsification. I think it is such a cool procedure – you won’t regret it!

After surgery patients will have to administer different kinds of eye drops several times a day for 2-4 weeks. Mild itching and slight swelling are common side effects that can occur post surgery. Pain is usually controlled with acetaminophen or acetaminophen with oxycodone. It’s important to prevent increases in intraocular pressure post surgery. Some things to monitor for include significant swelling, bruising, infection, severe pain, bleeding or increased discharge, bloodshot sclera, decreased vision, or flashes of light or floating shapes. These are all abnormal findings that should be reported to the provider right away.

Part of patient education is going to center around prevention of cataracts in the first place. Some education points to hit on with patients include wearing sunglasses when outside to protect the eyes against harmful UV rays and wearing protective eyewear when doing activities that could cause harm to the eye. Post surgery education will cover different activities to avoid to prevent increases in intraocular pressure like avoiding coughing and sneezing and as well as bending from the waist. Education will also include eye drop administration and complications to monitor for such as infection which could present as increased redness to the eye and yellow or green drainage from the eye.

The priority nursing concepts for patients with cataracts include changes in functional ability and sensory perception because the patient has alterations in vision. This directly affects activities of daily living and their ability to see.
To review, cataracts are due to a clouding of the lens in the eye which impacts vision and can cause blindness. One key point is regarding prevention. Although we can’t prevent aging, we can choose to wear sunglasses and protective eyewear to prevent trauma and further harm to the lens. Early findings are pretty vague and include slightly blurred vision and decreased color perception. Late findings are when the disease has progressed quite a bit and the patient experiences things like severely blurred vision, double vision, and even blindness. Surgery is the only treatment available for cataracts. The most common surgery is phacoemulsification which is when the sound waves break up the bad lens and allow a new lens to be placed which improves vision. Patient education is important to try to prevent the progression of cataracts, activity restrictions to prevent increases in intraocular pressure, eye drop administration post surgery, and complications to monitor for.

Alright guys, that’s it for our lesson on cataracts. Make sure to check out the other resources attached to this lesson. Now, go out and be your best self today. And, as always, Happy Nursing!

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