Question

Part A: Critical Thinking Read the following case study and answer the questions

Mr. Bird, age 70, reports that he has difficulty seeing at night and has given up driving. When questioned further, he also states, “I used to be an avid reader, but I guess I’m getting too old to read. The words aren’t very clear.” The nurse checks his eyes and finds that he is sensitive to light, has opacity of both lenses, and has no pain. The nurse informs the health care provider of these findings who plans further testing.

1. What might the nurse suspect is occurring with Mr. Bird?

2. For which diagnostic tests should the nurse prepare Mr. Bird?

3. After the health care provider (HCP) has made a definitive diagnosis of cataracts, the nurse develops a teaching plan. What should the nurse include in the teaching plan?

Answer 1

1. Nurse would suspect a primary diagnosis of Cataract in this case. The following findings from the initial examination are consistent with this diagnosis:

• Painless, blurred vision as the client reports that he is finding it difficult to read
• Sensitivity to light
• Opacity in both lenses
• Advanced age (70 years): Advancing age is a risk factor for the development of cataract.

A definitive diagnosis of Cataract can be made after ordering

2. Diagnostic tests for which the nurse should prepare the client:

• Opthalmoscopy examination to identify the extent of cataract formation
• Slit - lamp biomicroscopic examination to identify the type and magnitude of cataract formation
• Snellen visual acuity test: Visual acuity is decreased due to loss of transparency in lens

3. Points to be included in the teaching plan by the nurse are:

As there are no pharmacological interventions to manage cataract, the nurse should provide following teaching plan for preoperative and post-operative care for cataract.

• The client is encouraged to increase consumption of foods rich in antioxidants like Vitamin C, beta carotene, Vitamin E which slower cataract progression until surgery
• In order to improve vision until surgery, strong bifocal glasses or contact glasses are given temporarily
• As the client is an avid reader, he should be advised to use adequate light while reading
• Mydriatics can be used for short term for pupillary dilation
• Client is advised to wear protective sun glasses/ shades while going out or looking into bright light sources to reduce photosensitivity
• Bright colors should be used for furniture and the objects are well organized to prevent fall due to impaired vision  

• Client should be informed about the surgical options (Intracapsular cataract extraction, Extracapsular surgery, Phacoemulsification, Lens replacement) and as cataract is present in both eyes, surgery will be performed on one eye first and the second surgery shall be performed to the second eye after few months depending on the outcomes of the first surgery
• While preparing for surgery, client is advised to withhold drugs (if he is taking) such as Warfarin, Aspirin, Non steroidal anti-inflammatory drugs to avoid retro bulbar hemorrhage
• Post operative teaching instructions include: wearing protective glasses or shields following surgery, avoid touching the eye, washing hands properly before touching the operated eye, eye discharges should be cleansed with a sterile tissue / wipes, bathing or application of shampoo to hair should be done carefully seeking assistance to avoid their entry into eyes, limiting the physical activity until the advice of health care provider, Heavy objects (> 15 lb) should not be lifted until advised, care should be exercised while walking up or down the stairs, bending for extended periods are avoided