Nursing Process Gerontic with Sensory Organ Disorder
By. Tri Aan Agustiansyah, S.Kep, NS
The eye and the ear play vital roles in maintaining an active and independent lifestyle. Sometimes, change occur process that affects self-care ability. Older adults who develop vision or hearing problems may experience social isolation and diminished self care ability, inceasing their risk for entering a nursing home. Minor adjustments often can enchance the older adults lifestyle and enable them to remain independent in the home environment. This chapter discusses visual and hearing impairments, as well as the senses of taste, smell, and touch.
The eye is the organ of vision. The eye is a spherical organ set within the orbital cavity. Three supportive layers form a protective covering for the eye : sclera, choroid, and retina. The outhermost layer is white covering of the eyeball called the sclera. The sclera is made of tough connective tissue to protect the delicate layer underneath. The cornea is a continuation of the sclera and forms a transparent layer on the front of the eyeball. Light enters through the cornea. The middle layer of the eyeball, the choroid, is filled with a tiny meshwork of blood vessels. The third and innermost layer is the retina. The retina contains the receptors for vision, the reds and the cones.
The light rays bend as they pass through the eye to focus on the retina. This bending of the light rays is called refraction and is accomplished with the help of three structures : aqueous humor, lens, and vitreous humor. The aqueous humor is a watery fluid that fills the anterior cavity of the eye. The lens is an elastic transparent body of cells that functions in accommodation (ie, focusing light rays on the retina). The lens adjusts its shape to focus on objects nearby or faraway. The ciliary body is a thickened area thet connects the choroid (ie, the middle layer) with the iris. The ciliary body contains muscles thet contract to help control the thickness of the lens and to function in accommodation.
The last of the structures thet affects refraction is the vitreous body, a soft, jelly-like substance that fills the cavity behind the lens. The aqueous humor and vitreous body maintain a relatively constant amount of solution within their respective cavities that helps maintain the shape of the eyeball as well as functioning in refraction. From the retina, the nerve impulses travel to the optic nerve, which transmits the impulses to the brain.
The iris is the colored or pigmented part of the eye. The muscular action of the iris causes the circular opening of the eye, the pupil, to contract or dilate. In this way, the size of the pupil is regulated, ang light entering the eye is controlled. Lacrimal duct near the nasal area of the eye drain tears and small particles into the nose. The tears are produced bay the lacrimal glands located on upper outher corner of each eye.
AGE RELATED CHANGES IN THE EYE
Multiple structural changes occur within the eging eye. The cornea, lens, ciliary body, iris, vitreous body, and aqueous humor all undergo changes with age. The cornea has a generalized decrease in sensitivity, causing the older adult to be less awere of injury to the eye. Epithelial cells within the cornea decrease in number. The production of aqueous humor is decreased with age, but it does not greatly affect the balance of intraocular pressure. The thick fluid of the vitreous body becomes thinner, and floaters may appear within the visual field. In addition to becoming larger and more rigid, the lens becomes discolored and opaque, affecting visual acuity and leading to age-related cataracts.
Sebagai penuaan mata, maka akan terjadi akumulasi cairan yang akan mengumpul di tepi luar dari cornea, lingkaran cairan terlihat keabu-abuan di sekeliling iris yang disebut arcus senilis. Tidak ada kumpulan patologi mengenai arcus senilis. Iris sendiri akan kehilangan pigmennya terkait dengan usia, banyak dijumpai pada orang tua dengan mata biru atau iris yang keabu-abuan. Dengan meningkatnya usia, pupil menjadi mengecil. Dari usia 60 tahun, pupil hanya dua pertiga dari ukuran pada dewasa muda. Pengurangan ukuran pupil berkontribusi terhadap kehilangan ketajaman penglihatan.
Proses dari kemampuan bantuan mata memfokuskan dari objek dekat dan objek jarak jauh. Bantuannya seperti menyempurnakan koordinasi dari badan ciliary dan saraf otot iris. Sebagaimana badan ciliary mengkerut, lensa mempertebal, dan serat otot dari iris mengkerut, hasilnya pupil mengecil. Dalam caranya, otot ciliary mengganti ukuran dari lensa. Usia, bagaimanapun penyebabnya otot ciliary menjadi potongan panjang dan menjadi kehilangan elastisitas. Suatu otot menggantikan dengan jaringan connective, menghasilkan kemampuan sebuah pengurangan untuk mengganti bentuk lensa dan focus dengan jelas di atas objek dekat. Lensa menjadi kehilangan elastisitas dan puing selular panjang mengumpul dengan kapsul lensa menghasilkan kehilangan bantuan. Pertukaran ini menghasilkan kondisi yang disebut presbyopia, atau “old sightedness”.
Kehilangan Ketajaman Penglihatan
Ketajaman penglihatan (yakni kemampuan melihat dengan jelas) pengurangan terkait usia. Beberapa factor mendukung kehilangan ketajaman. Pupil mengecil secara progresif, lensa yang berawan dan kekuningan, cairan vitreous menipis, dan kehadiran dari pelampung dalam badan vitreous semuanya mendukung kehilangan ketajaman penglihatan. Batas pengurangan penglihatan, engurangi penglihatan malan dan di mana sensitifitas meningkat pada cahaya yang menyilaukan.
Perubahan dapat dihasilkan pada orang tua yang mempunyai masalah dalam melakukan perjalanan (terutama waktu malam), menarik aktifitas social dan peforma dari aktivitas sehari-hari. Banyak orang tua yang tua pada usia 60 tahun kehilangan ketajaman penglihatan pada suatu titik, dimana kacamata mesti digunakan. Walaupun, kehilanagan penglihatan tidak dapat dielakkan dan beberapa orang tua tidak hilang kemampuan untuk melihat baik dengan meningkatnya usia.
Biasanya banyak gangguan penglihatan orang tua berhubungan dengan kemerosotan macular, catarak, glaucoma, dan diabetic retinopathy.
Usia-Hubungan Kemerosotan Makular.
Age-related macular degeneration (ARMD) seringkali terjadi pada individu dengan usia 50 tahun dan sebab utama kehilangan penglihatan untuk orang tua sampai 65. Pada populasi usia tersebut, insiden penyakit diperkirakan telah meningkat. Lokasi macula tepatnya di retina di belakang lensa, sel kerucut berlokasi pada macula, menyediakan pusat ketajaman penglihatan dan warna mata. Suatu sel dalam macula fungsinya berkurang terkait dengan usia, dan penggantian dari sel akan berkurang, penyebabnya tidak beratuannya damaged di macula, kehilangan dari fungsi hasil dalam kehilangan penglihatan pusat.
Tanda dan Gejala
Tanda dan gejala tampak samar – samar dan pasien mungkin merasakan sensasi sederhana seperti ada yang salah pada penglihatan. Gambaran menyimpang. Objek mungkin kelihatan salah ukuran atau bentuk dan garis lurus kelihatan berombak atau bengkok. Yang mana kehilangan progressif dari pusat penglihatan, peningkatan sensitifitas pada cahaya yang silau, kabur pada penglihatan, dan berkurangnya warna pada penglihatan. Sekeliling penglihatan tidak terpengaruhi. Akhirnya terjadi kehilangan total dari penglihatan pusat. Diagnosis dibuat dari Ophthalmologist yang menentukan ukuran ketajaman penglihatan. Seorang spesialis diagnostic mengetes memberikan fluorescein angiography IV yang digunakan untuk memastikan diagnosis ARMD.
Beberapa kasus dari ARMD dapat diobati dengan laser jika masalah ditemukan di tahap awal. Terapi laser dapat mencegah atau menunda ektensi dari proses kemerosotan hanya dalam keterbatasan angka dari kasus. Yang patut disayangkan, tidak ada pengobatan yang tersedia untuk sebagian besar kasus ARMD.
Managemen keperawatan meliputi pendampingan pasien dengan kehilangan penglihatan, menopang kemempuan self care , dan pasien dan keluarga dengan peningkatan pengetahuan penyakit dan pilihan pengobatan. Sebagian besar kasus, retensi dari sekeliling penglihatan membolehkan pasien untuk relative mandiri, meskipun modifikasi harus tetap dibuat.
Meskipun glaucoma dapat terjadi pada berbagai usia, sebagian besar beresiko adalah orang tua dengan usia 60 tahun. Penglihatan hilang sebagi hasil glaucoma tidak dapat diperbaiki, tetapi dengan pengobatan dan bedah, kehilangan penglihatan lebih lanjut dapat dikendalikan. Glaucoma terjadi sebagai hasil dari peningkatan Intraocular Pressure (IOP)
There are two main types of glaucoma : open-angle glaucoma or cronic glaucoma and closed-angle or acute glaucoma.
Singns and Symptoms
Open-angle or cronic glaucoma is often difficult to detect. The onset is insidious, and the disisae progresses slowly. Symtoms occur bilaterally and include mild aching og the eyes, loss of peripherial vision, halos around lights, and decreased visual acuity. The loss of peripherial vision leads to a tunnel vision effect.
Acute closed-angle glaucoma is unilateral, and symptoms occur suddenly. Symptoms include severe eye pain, seeing halos around lights, redness, and blurred vision. Nausea, vomiting, or bradycardia may accompany the severe pain.
When sings and symtoms ere present, futher diagnoctic tests are necessary. The tonometer is an instrument used to measure pressure in the eye. Applanation tonometry requires the eye to be anesthelized with drops. Using a slit lamp, a plastic prism is pushed lightly against the eye, measuring the IOP. If air tonometry is used, a puff or air is administered on the cornea to obtain a measurement. The ophthalmologist (ie. Physician who specializes in diagnosis and treatment of disorders of the eye) can view the color and appearance of the optic nerve to determine the extent of the glaucoma and identify any damage. Visual field testing may be done manually or using a computer to determine the individual’s field of vision.
When glaucoma is diagnosed early and treatment instituted, blindness is almost always preventable. Problems arise because extensive damage can occur before any symptoms appear. To detect glaucoma early, it is recommended that order adults have an eye examination by an ophthalmologist yearly. There is no cure for glaucoma, but it may be controlled with medication to reduce aqueous humor or surgery to provide a drainage pathway for the aqueous humor.
For acute glaucoma, treatment involves a type of laser surgery to unblock the drainage tubules. When laser surgery is used for open-angle glaucoma, the procedure is called laser trabeculoplasty. During laser trabeculoplasty, the laser is focused on the trebecular meshwork, causing ashrinkage of some of the trebecular meshwork and allowing the fluid to escape and IOP to decrease. Many patients may be able to discontinue some of their antiglaucoma medication after a trabeculoplasty.
A more traditional surgical procedure is the trabeculectomy (ie, surgical removal of a small section of trebecular mesh). After a trabeculectomy, IOP decreases because the aqueous humor is able to drain out of the anterior portion of the eye. Most patient are able to discontinue all of their antiglaucoma medication after this procedure. Regular follow-up examinations are required, even after successful treatment, because chronic glaucoma can develop years later.
Medication such as pilocarpine or timolol maleate can also be used to manage glaucoma. Timolol (Timoptic) is commonly prescribed, and it decreases the rate at which fluid flows into the eye. Timolol, however, can worsen pulmonary symptoms, causing respiratory distress and decreased pulse rate. Betaxolol (Betoptic) is recommended for patients who have asthma or emphysema. Pilocarpine causes miosis (ie, constriction) of the pupil, opening the blocked channels and allowing normal passage of fluid. Other drugs, such as brimonidine (Alphagan), decrease the formation of aqueous humor.
Oral carbonic anhydrase inhibitors such as acetazolamide (Diamox) reduces fluid flow into the eye. Traditionally these drugs are used as a last resort because of poorly tolerated side affects such as frequent uniration, tingling sensation in the fingers and toes, kidney stones and aplastic anemia. Other disturbing side effects are depression, fatigue and lethargy. Dorzolamide (Trusopt) is the first topical carbonic anhydrase inhibitor and is reasonably well tolerated with significantly less side effects than the more traditional oral medication.
Latanoprost (Xalatan) increases the rate at which aqueous humor flows out og the eye. This drugs has the advantage of once-daily dosing. Latanoprost may cause the iris suntan syndrome, which is an increased amount of brown pigment in the eyes of patients with hazel, green-brown, or blue-brown eyes. This change occurs alowly and may not be immediately evident.
When taking eyedrops, it is important for the patient or the caregiver to understand the importance of taking the medication exactly as prescribed by the ophthalmologist. Some medications have a duration of 6 hours and must be taken at regular intervals to assure that the drug’s effectiveness is maintained for the full 24 hours day.
Older patients taking these drugs must be can carefully monitored. Instruction on the correct method of administration of an ophthalmic drug is necessary. It is important to assess the older adult’s ability to instill drops. Arthritis or other musculoskeletal disorder may make instillation difficult. The patient’s mental status is important. Forgetting to instill the drops may result in an attack of acute glaucoma. In most instances, the drug must be continued for life. The individual is instructed to keep the eye closed for 1 to 2 minutes after administration and press lightly against the nasal corner of the eyelids. This closes the duct that drains into the nose and minimizes absorption into the systemic circulation. The physician is notified if eye discomfort or inflammation occurs. Vision may be blurred immediately after instillation of medication but should clear within 15 to 20 minutes. Notify the health care provider if blurred vision persists. If more than one ophthalmic medication is prescribed, wait 15 minutes between each instillation. Periodic eye examinations are necessary to monitor progress.
A cataract is clouding of the eye’s lens that prevents light from focusing properly on the retina. The lens focuses light rays on the retina (ie, innermost layer of the eyeball that transmits visual stimuli to the optic nerve) and produces an image. The lens functions in accommodation, allowing the eye to focus on close and distant objects.
Although cataracts can occur at any age, the highest incidence is found in individuals older than ege 55. Cataract usually develop slowly over a number of years and develop bilaterally, although often at different time. For example, an older adult may develop visual problems as the result of a cataract and may have surgery to correct the problem. In several months to several years, a cataract may develop in the other eye and require surgery.
Signs and Symptoms
The lens contains, among other things, protein molecules and water. With age, changes within the lens cause the protein to bind together and cloud the lens. Over time, the entire lens may become opaque (ie, cloudy), making clear vision almost impossible. The physician may use the phrase “ripening” when referring to the cataract. The cataract is considered ripe when swelling occurs within the lens as a result of water being drawn into the lens. Although a cataract begins small with little visual disturbance, in time, vision is blurres as in looking through a water fall or cloudy glass. In addition to blurred or hazy vision, other symptoms include
- · Increased problems with glare
- · Need for more light to perform tasks such as reading that require good visual acuity
- · Increased nearsightedness
- · Poor vision at night
- · Need for frequent eyeglass prescription changes
- · Double vision.
Initially, glasses or contacts may be used to improve vision. The only effective treatment for a cataract is surgical removal of the lens. Cataract surgery is one of the most common surgeries performed in the United States esch year. Surgery is unnecessary when a cataract is present but is indicated when the cataract is present but is indicated when the cataract interferes with daily activity.
The most effective surgical procedures to treat cataract are phacoemulsification and extracapsular extraction . during the surgery, the lens is removed and replaced with a clear plastic lens (ie, lens implant).
During extracapsular cataract extraction, the surgeon makes an incision at the point where the cornea and sclera meet. The surgeon enters the eye through the incision and opens the front of the capsule and removes the nucleus of the lens. The surgeon then gently suctions the remainder of the lens, leaving the capsule in place. In phacoemulsification, the surgeon breaks up the lens with ultrasound and then suctions these fregments from the eye through a small sncision.
Aphakia is the term used to describe an the eye with no lens. An intraocular lens implant is usually performed during cataract surgery. A clear plastic lens is implanted into the eye in place of the natural lens. This implant functions like the natural functioning eye and is more convenient for the elderly than wearing cataract eye glasses or contact lenses.
Using the Nursing Process to care for an Elderly Adult With a Visual Impairment
Because the aging process leads to a gradual decline in visual acuity. All older adults are assessed for visual impairment. A snellen eye chart may be used to assess visual acuity. The individual stands at a distance of 20 feet, convers one eye, and reads each line of the chart until the print can no longer be distinguished. For a patient who cannot read, the snellen E chart can be used. In this chart, the E appears in four different positions. Individual’s visual is tested by having the person indicate the direction of the orally or by placting the fingers in the direction the E is Pointing. With age, there is decreased ability to focuc on close objects or see small print (ie, presbyopia), reduced capacity to adjest to chages in light and dark (ie, accommodation), and decreased ability to distinguish color
It is important to assess nursing home residents snd those living alone because the impact of visual impairment is far reaching. Visual defects can affect secial interactions, self care ability, self esteem, and rehabilitation potential. A visual problem may affect the resident’s ability to eat, walk, recognize staff, or navigate within the environment.
Obtain a family history of eye disorder (eg, glaucoma, diabetes, vascular disorders).
The nurse also obtains a history of past and current illnesses or diseases. Disorders such as cerebrovascular accident, dementia, or myasthenia gravis (ie, neuromuscular disorder characterized by severe muscular weakness) produce visual disturbances not related to disease of the eye.
Assessing for visual impairment in older adults with dementia, those with a decreased mental status, or those with a communication deficit may be difficult, because they may be unable to understand questions or follow directions necessary to test visual acuity. In these situations, the nurse must be alert for nonverbal clues that indicate possible visual disturbances, such as eating difficulties, difficulty navigating in the environment, bumping into things, or squinting the eyes when trying to see.
Many older adults wear eye glasses or contact lenses. The nurse assesses manual dexteritly to determine whether the individual is able to place the contact lens in the eye. Eyeglasses are checked for scratches and cleanliness. The patient’s ability to function within the environment is assessed. Does a visual problem decrease the ability to eat food, walk safely within the environment, or interact with others ? Can the individual see to read or watch television ? the nurse refers to an ophthalmologist for futher assessment if indicated. The older adult should have an eye examination at least yearly or more often if any visual impairment occurs or any worsening of a previous visual impairments occurs.
The following nursing diagnoses my be used for an older adult with a visual impairment:
- · Impaired Home Maintenance Management related to lack of assistance
- · Self Care Deficit (Specify type) related to visual disturbances
- · Situational Low Self Esteem related to adjusting to vision loss.
- · Social Isolation related to inability to see clearly, move freely in environment, other (Specify).
- · Risk for injury related to impaired vision, unfamiliar surroundings, other (specify)
- · Knowledge Deficit of assistive agencies
- · Deversional Activity Deficit related to difficulty perporming ususl activities (reading) because of diminished vision
Other nursing diagnoses may be appropriate for individual patients.
Planning and Implementation
Planning the care of an older adult with a visual impairment requires careful attention to providing the individual with a safe home environment, promoting self exteem, preventing secial isolation, creating the means to continue pleasurable diversionary activities, and correcting any knowledge deficit.
Impaired Home Maintenance. Older adults living at home who who have poor vision must learn to manage the home environment. Environmental chanes such as low-glare floors, large print signs marking specific rooms, color-coded tape on the dresser drawers, or large numbers on the telephone may allow the older adul more independence in the home or nursing home environment. If glare is a problem, the individual may wear a yellow tinted visor and a pair of sunglasses. Fluorescent lighting increases the glare and ahoulf be avoided.
Sometimes, assistance may be needed because of loss of vision. Planning care with amultidisciplinary team helps to maintain a high quality of care that meets the individual’s needs. The patient may require assistance such as a home health nurse to make periodic visits, homemaker services, Mealson Wheels, or social services. The nurse assists with obtaining any specialized aquipment, such as a cane to recognize objects in the path and makes arrangements for needed services. The family and friends are involved in the care. Shopping, cleaning, banking, and transporting yhe patient are wall ways for the family to assist the older adult with home maintence. Identify community resources and support systems and involve them in the care.
Self-Care Deficit. Problems with self care can arise in older adults with visual problems. The patient’s room or house is kept the same. Objects and furniture are left in the same place. Smaller items such as toilet articles, grooming aids, clothing, shoes, or the urinal are kept in the specific places where the patient is aware of them and where the items are easily accessible. The doors are left wide open or totally closed. A thorough orientation is need to any new environment.
For eating, have the patient use the face of a clock to identify the imege of the location of specific foods on the plate. Twelve o’clock is the top of the plate, and 6 o’clock is the bottom of the plate. The nurse or staff member describes the various food on the plate in relation to the clock face. Food is “pushed” toward the center of the plate with a roll or a piece.of bread.
Another method to help with self care for those with partial site is to use bright colors that provide a sharp contrast to other colors. This makes vision easier. For example, towels that contrast with bathroom walls are easier locate than towels the same or similar color. Hand rails may be painted a color that contrasts with the walls.
The patient may need simple reminders to put glasses on daily. Sometimes, eye glasses can provide enough vision to promote self care. If manual dexterity is a problem, the nurse or caregiver can provide the needed assistance. Glasses are cleaned with diah soap and wiped with a soft cloth
Situational Low Self-Esteem. Self esteem may be affected when the patient is no longer able to participate in activities requiring sight. Encourage expression of feelings and anxietas. The nurse must actively listen and convey confidence in the patient’s coping abilities. Positive feedback is given. It is important to help the patient to develop goals that can be attained to build confidence. The patient is allowed to make decisions about care and have control over the environment. The family and care givers are involved as much as possible. The patient is encouraged to attend a support group. The nurse promotes self care, socialization, and the use of diversionary activities to combat low self esteem.
Social Isolation. When faced with visual impairment, some older adults may withdraw from social activities and isolate themselves from interaction with others. For example, a nursing home resident may refuse to participate in group activities or come to the dining hall to eat and remain alone in the room.
Sighted guides may be assigned to lead a visually impaired person from place to place. The sighted guide may be a nurse assistant, a fellow patient, a family member, a friend, or another member of the health care team. These guides walk from place to place with the visually impaired person to assist her around the home, outside, in the acute care facility, or in the nursing home. If the patient agress to have a guide, the guide offers his elbow or arm. The visually impaired person takes the arm slightly above the albow. During ambulation, the guide remains slightly ahead. While walking, the guide describes the surroundings.
The nurse must actively listen as the patient expresses feelings and emotions. Time spent with the individual shows a genuine interest in the patient’s welfare. It is also important to encourage socialization. In some cases, the nurse must mobilize the individual’s support system. Senior citizen centers, church groups, day care centers, and foster grandparent programs may also be used to increase opportunities for socialization.
Risk for Injury. Older adults are at an increased risk for injury, especially from falls. A visual disturbance places the older adult at an even greater risk for injury. When caring for a person with a visual impairment, it is important to orient them to the physicial environment. The nurse describes where furnishings are located and the location of the closet or the bathroom. Objects are kept in the same place in the environment. The area is kept clean and uncluttered. Environmental hazards, such as throw rugs or spills, must be taken care of as soon as possible. It is important to provide names, addresses, and phone numbers of organization that offer help to the visually impaired. Familt members or caregivers are taught ways to keep the home environment safe.
When assisting with ambulation, walk slowly and stand to the side slightly ahead of the visually impaired person. The patient grasps the nurse’s or caregiver’s elbow when walking. The nurse should not grasp the patient’s elbow and pull the person along or push the individual. By allowing the visually impaired person to hold the elbow or arm, tension and anxiety are reduced, and there is less risk for injury.
The home or physicial surroundings must be well lighted. Visually impaired individuals need three or four times more light than a normally sighted person. The nurse makes sure environment does not produce glares. For example, nonfluorescent lighting produces less glare than other forms of lighting. For those with partial sight, it is important to keep large printed signs to mark rooms and large numbers on phones. The patient is taught how to use a cane for ambulating.
Diversional Activity Deficit. The patient is encouraged to acknowledge his or her feelings and reality of the current situation. Activity option are explored taking into consederation the loss of vision. Modifications or adjustments are made so activities the individual previously enjoyed can still be a source of pleasure. For example, if the patient enjoyed reading, suggest that large print books or megazines be used or that the individual listen to audiotapes of books. Large print books or megazines and taped booksnmay be found in the public library or modestly priced at most book stores. If partial vision remains, keep areas well lighted. It may be necessary to use a 300 watt bulb when reading.
The patient may want to have a magnifying glass available. Magnifiers are one of the most basic and valuable tools for the patient with low vision. Magnifiers come in various forms : hand held, stand, and lighted. Radios, compact discs, and tapes offer the opportunity for diversion and relaxation without the need for a magnifier.
The patient is referred to support groups or self help agencies. For those interested in learning Braille refer to the appropriate agency. Names of individuals who agree to be “telephone buddies” are provided. These individuals can talk to the patient, provide encouragement, and offer an enjoy able alternative during long days.
Assistive Agencies. Numerous agencies are available to assist those with visual disturbances. The patient and family may not be awere of these resource. The nurse can provide a listing of these resources.
Evaluation and Expected Outcomes
Successful treatment can be gauged by the following responses :
- · Assistance is obtained for home care
- · Family becomes involved in home care
- · Patient provides self care within limitations
- · Patient relates feelings of improved self esteem
- · Patient participates in social activities.
- · Patient relates use of safety measures to prevent injury.
- · Patient relates ability to enjoy diversionary activities.
- · Patient expresses increased awareness of assistive agencies.
Patient Teaching After Cataract Surgery :
- · Perform usual activities in moderation. For example, watching television or reading is permitted, but only for short periods.
- · Do not bend over the sink or tub or place the head down below the waist. When washing hair, tilt the head slightly backward.
- · Sleep on the back or side, not the abdomen.
- · Wear sunglasses for protection.
- · Do not rub eyes, squeeze eyelids, or cough.
- · Take a stool softener to avoid satraining during a bowel movement.
- · Follow the physician’s recommendations concerning resuming sexual activity.
- · Do not lift anything heavier that 15 pounds.
- · Take medications as prescribed by the physician.
- · Use sterile cotton or gauze moistened with sterile water or normal saline to clean the eye.
- · When instilling eye drops, tilt the head back, gently pull down the lower conjunctival sac, and instill the correct number of drops.
- · Wear a protective shield at nigh if prescribed by the physician.
- · Immediately report any of the following symtoms : eye pain, redness, swelling, inflammation, discharge from the eye, changes in visual acuity, light flashes, spots in the visual field, or halos around lights.
Assessment of Visual Impairment
- · Visual disturbances (eg, blurred, cloudy, or hazy vision, loss of peripherial vision, halos, tunnel vision, and loss of central vision)
- · Glare or increased sensation to light.
- · Frequent need to change eyeglasses or eyeglass change does not result in improved vision
- · Increased tearing
- · Pain or pressure in the eye (severe pain in the eye is an emergency and requires immediate treatment)
- · Headache
- · Self care ability
- · Poor night vision
- · Problems distinguishing color
- · During eye examination, note any gray or milky white appearance of pupil. The size of pupil and papillary response is documented.