Question

CATARACT CASE STUDY-

Scenario
Mr. Mee is a 78-year-old retired artist. He lives alone with his wife; they have eight grown children. After doing a routine eye exam the doctor determines he has cataracts.

Phacoemulsification is a modern cataract surgery method in which the eye's internal lens is emulsified with an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the anterior chamber.
Scenario continues
Mr. Mee is sent home following an uneventful cataract removal and lens implant of the right eye. His wife brings him to the ER two days postop, and Mr. Mee states his eyesight has changed and he feels like he is "looking through a veil, seeing flashing lights and floaters in his right eye". He denies any eye pain. In examining his peripheral vision, you find no peripheral vision present in his right eye. His left eye is normal.

1.   What do you expect is happening to Mr. Mee and why? Are these normal findings following cataract surgery?

2.   What do you expect will be the intervention for Mr. Mee?

Based on the above diagnosis complete all the items below

3.   ASSESSMENT

4.   MEDICAL/SURGICAL MANAGEMENT

5.   PHARMACOLOGIC INTERVENTION

6.   NURSING INTERVENTION

7.   DOCUMENTATION GUIDELINES

8.   DISCHARGE AND HOME HEALTHCARE GUIDELINES

Answer 1

1) It is a medical emergency. Seeing light flashes, floaters and cobwebs are some of the earliest symptoms of retinal detachment post cataract surgery .

2) #. Nursing interventions include :-

- Restrict activity to avoid additional detachment

- Cover the eye with an eye patch

#. Medical intervention :-

Pharmacological therapy and surgery

3) Assessment-History

Sensation of seeing floaters and flashes

Painless vision loss, described as the sensation of looking through a veil, curtain, or cobweb (which may obscure objects in a particular area of the visual field)

Assessment-Physical Findings

Visual field loss

Visual acuity of 20/200 or worse with loss of central vision (if macula is detached)

Elevation of retina, with or without a tear

Diagnostic Test Results-Imaging

Ocular ultrasonography, used to examine the retina if the lens is opaque, shows intraocular and intraorbital pathology; it also commonly detects retinal detachments, which characteristically produc a dense, sheetlike echo on a B-mode scan.

Diagnostic Test Results-Diagnostic Procedures

Direct ophthalmoscopy shows folds or discoloration in the usually transparent retina.

Indirect ophthalmoscopy shows retinal tears.

Fundoscopic examination shows debris in the vitreous and white fibrous ring (called a Weiss ring

4) Medication is given for retinal detachment:-

tobramycin with dextamethasone (antibiotic-steroid combo)

#. Surgicalinterventions can be performed for a retinal detachment :-

scleral buckling

retinal rebinding

1.Scleral buckling

scleral = silicone

an application of a silicone sponge to promote attachment; local or general anesthesia is give stitches or an encircling band is used

2) Retinal rebinding

the application of a:diathermy (high frequency current);cryotherapy (freezing probes), orp photocoagulation(laser beams)to create an inflammatory response