Question

Hello, i would like to know about what do i need to know post surgical nursing intervention and teaching patient.  Cataract,BPH, Glucoma. Thank you.

Answer 1

Cataract :

Cataract is an opacity of lens may cause due to ageing, hereditary,injury.

Postoperative nursing intervention :

- Maintain eye patch and orient the patient to environment after recovery from sedation.

- antibiotic drop may prescribed to prevent infection.

- corticosteroids drop prescribed to decrease inflammatory response.

- after surgery patient may have little or no pain so mild analgesic may be prescribed as per order.

- Turn the patient to back or non operative side to prevent eye pressure.

- elevate the head of bed by 30-45 degree.

- place the patient belongings on non operative side for easy access.

- use side rails for patient safety.

- assist the patient with ambulation to prevent from fall.

Client teaching :

Avoid eye straining, rubbing, rapid movement, sneezing, coughing, bending,. Vomiting, lifting heavy object heavier than 5lb because it may increase intraocular pressure.

- Measure taken to prevent constipation. Provide oral fluids, fibre rich diet.

- wipe excess drainage with sterile wet cotton ball from inner canthus to outer canthus of eye.

- use eyeshield at night.

- eye itching and mild discomfort are normal few day after procedure.

- notify physician if decrease in vision, severe eye pain,. Increase in redness, or increase in discharge.

Glaucoma :

Galucoma occur due to increase in intraocular pressure that may result in inadequate drainage of aqueous humor from the canal of achlemm or overproduction of aqueous humor.

Postoperative nursing intervention :

After trabeculectomy

- orient the patient after surgery.

- assist the patient with ambulation.

- provide emotional support to the patient.

- use side rails to prevent from fall.

- place patient belongings on non operative side.

- administration of antibiotic to prevent from infection and corticosteroids to be administer to decrease inflammation.

- protect the eye from external injury and provide eye shield on operative side.

- maintain hygiene to prevent infection.

Client teaching :

Teach the client about the importance of eye Care.

- provide eye shield at night and to wear glass during daytime to prevent from injury.

- maintain eye hygiene by cleaning from inner canthus to outer canthus with sterile wet cotton balls.

- avoids touching the eye with bare hands.

- avoid excessive straining, bending, vomiting,. Coughing to prevent from intraocular pressure.

- provide fibre diet to prevent from constipation it may increase intra ocular pressure.

- notify physician if patient may experience eye pain, excessive discharge, increase temperature, swelling or bleeding from operative side.

- avoid strenuous activity like running, jumping, swimming.

- wash hands before applying eye drops. Don't not touch the tip of the dropper with fingers and avoid touching the dropper from eye while administering to prevent from infection.

BPH :

Benign prostate hypertrophy is slow enlargement of prostate gland that result in partial or complete obstruction of urethra.

Post operative nursing intervention :

- monitor complication following surgery like hemorrhage, bladder spasm, urinary incontinence, infection.

- monitor vital signs.

- increase fluid to 2400 to 3000 ml/day unless contraindicated.

- ambulate the client as possible and as soon as urine begin to clear in color.

- administer analgesic to reduce pain, antibiotic to prevent infection, antispasmodic to reduce spasm.

- maintain continuous bladder irrigation with sterile bladder irrigation solution to keep the Catheter free from obstruction and keep the urine pink in color.

- allow patient to express his concern this will alleviate anxiety due to loss of sex role, self esteem or quality of sexual interaction with his partner.

Client teaching :

- blood clot are expected after prostate surgery for first 24 to 36 hours. Large amount of bright red blood in urine can indicate hemorrhage.

- avoid activity like sitting, walking, for prolonged period, valsalva maneuver to prevent increase abdominal pressure.

- notify physician if redness, heat, swelling, purulent drainage occur.

- fiber rich diet and stool softener to be provided to prevent from straining.

- avoiding heavy lifting more than 10 lb, driving, intercourse after surgery.