Cataracts: Risk Factors and Symptoms

• Cataracts involve the clouding of the eye's natural lens, leading to impaired vision
• Cataracts typically develop slowly and are common with aging
• Recognizing signs and symptoms and understanding appropriate interventions are crucial for nursing care and NCLEX questions

Risk Factors

• Advanced age is a primary risk factor due to natural lens changes over time
• Diabetes increases risk due to the impact of high blood sugar levels on the lens
• Excessive sun exposure is another risk factor, with UV radiation contributing to cataract development
• Smoking is associated with increased cataract risk because of oxidative stress
• Family history suggests a genetic predisposition
• Previous eye injury or surgery can disrupt lens structure
• Prolonged use of corticosteroids may accelerate cataract formation

Signs and Symptoms

• Cloudy or blurred vision is a common initial symptom
• Colors may appear faded or yellowed as the lens discolors
• Glare sensitivity, especially at night, can affect driving
• Halos around lights may be seen due to light diffraction through the cloudy lens
• Frequent changes in eyeglass or contact lens prescription indicate worsening vision
• Double vision in one eye can occur as the lens changes shape

Diagnosis

• Visual acuity tests using a Snellen chart assess the extent of vision impairment
• A dilated eye exam allows thorough examination of the lens and other eye structures
• Slit-lamp examination provides a magnified view of the lens to detect abnormalities
• Retinal exam assesses overall eye health
• Tonometry measures intraocular pressure to rule out glaucoma

Treatment

• Regular prescription updates can manage early-stage cataracts
• Lifestyle adjustments such as using brighter lights, anti-glare sunglasses, and magnifying glasses can help improve vision
• Cataract surgery is the definitive treatment involving removal of the clouded lens and replacement with an artificial intraocular lens (IOL)
• Surgery is typically recommended when cataracts significantly interfere with daily activities

Pre-operative Nursing Care

• Assess the patient's visual acuity to establish a baseline
• Review the patient's medications, particularly anticoagulants or alpha-blockers, which may affect surgery
• Educate the patient about the surgical procedure, expected outcomes, and potential complications
• Administer pre-operative eye drops as prescribed, which may include antibiotics, anti-inflammatories, or mydriatics
• Ensure the patient understands and signs the informed consent

Post-operative Nursing Care

• Monitor vital signs and assess for any signs of complications
• Administer prescribed eye drops, ensuring the patient knows the correct technique and schedule
• Educate the patient on activity restrictions, such as avoiding heavy lifting or straining
• Provide protective eyewear, especially at night, to prevent accidental injury
• Instruct the patient on recognizing and reporting signs of infection, such as increased redness, pain, or discharge
• Emphasize the importance of follow-up appointments with the ophthalmologist

Potential Complications

• Infection (endophthalmitis) is a serious but rare complication, presenting with pain, redness, and vision loss
• Bleeding (hemorrhage) can occur within the eye
• Increased intraocular pressure (glaucoma) can damage the optic nerve
• Retinal detachment can cause sudden vision loss and requires immediate attention
• Posterior capsule opacification (PCO) is a common long-term complication where the lens capsule becomes cloudy, treated with a laser procedure (YAG capsulotomy)

Patient Education

• Explain the importance of adhering to the medication schedule
• Demonstrate the correct technique for instilling eye drops
• Teach the patient how to protect the eye and recognize signs of complications
• Provide information on activity restrictions and safety precautions
• Emphasize the importance of attending all follow-up appointments

NCLEX-Style Questions: Focus Areas

• Prioritizing interventions based on post-operative assessments
• Recognizing signs of complications and appropriate nursing actions
• Educating patients on medication administration and potential side effects
• Understanding the impact of cataracts on activities of daily living (ADLs) and strategies to improve independence
• Applying knowledge of risk factors and preventive measures

Sample NCLEX Questions

• A client asks when his vision will be normal after cataract surgery. Which is the nurse’s best response? "Your vision will be best about 6 to 8 weeks after the surgery."
• A client who had cataract extraction is being discharged. Which statement indicates to the nurse that the client understands discharge teaching? "I will wear dark glasses when I am outside."
• What should the nurse teach a client after cataract surgery? Avoid activities that might increase intraocular pressure.
• A client is one day post-op cataract surgery. The client says "Oh, nurse, I tried to have a bowel movement but I cannot push." The nurse should tell the client "I will get you some stool softeners".
• After cataract surgery, the nurse should instruct the client to contact the physician immediately if the client experiences which of these signs or symptoms? New floaters in the vision.