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FAR EASTERN UNIVERSITY

INSTITUTE OF NURSING

CATARACT

(case study)

Submitted By:

Dayot, Mary Joyce J.

Vibar, Justin FayeP.

BSN 401- Group 2/A

Submitted To:

Alma Taragua RN,MAN

Date:

December-11-2013

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I. Biographic Data

Name: PPQ

Address: Las Pinas City

Age: 72 years old

Gender: Female

Religious Affiliation: Roman Catholic

Marital Status: Married

Occupation: None

Chief Complaint: Blurred, cloudy and dry eyes

Provisional Diagnosis: Cataract

Attending Physician: Dr. Briones

II. Nursing History

A.Past Health History

Childhood Illness

The patient said that she had measles and chicken pox when she was a child. The patient said that she is not completely immunized.

Allergies

According to the patient she has allergies to bagoong and when it comes tomedications, she doesnt have allergies.

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Accidents

Ther are no accident happened to the patient.Hospitalizations

The patient said that she had ligation during the 1960s.

Medications used or currently taken

Carbidilol Caltrate (Calcium Supplement) Mydriatic eye drops

Foreign travel

The patient said that she went to US but cant recall the date..

B. History of Present Illness The patient complained of blurred, cloudy and dry eyes last September 13 so she

decided to went to the hospital to have her eyes checked.

C. Family History

Legend:

The patient is the only child in the family. The above genogram shows that hypertension, runs in the family and is

dominant in her mothers side. There is known hereditary disease present in her family such as asthma and diabetes mellitus.

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III. Patterns of FunctioningA.Psychological Health

According to the client, when she experiences any stress, she would notice that she would just sit and

would think deeply, she said that although she would tell what is the problem she still would not fully

give information regarding the real situation. According to her she sometimes would talk about the

problem with some of her immediate family. She also said that she is a loner but strong woman. She

would rather read pocket books during her free times rather than chatting with their neighbors and shestates that she is a strong one because of making her children successful and could think ahead making

things handled with ease.

Interpretation: Normal

Analysis:

Stress is a universal phenomenon. All people experience it, stress could have physical, emotional,

intellectual, social and spiritual consequences. Usually stress affects the whole person. Psychologic

manifestations of stress include anxiety, fear, anger, depression and unconscious ego defense

mechanisms.

Source: Fundamentals of Nursing p.1060

B. Socio-Cultural PatternsThe client was not part of any ethnic groups. The client lives in a quiet area. The patient stated that

their house is well ventilated and well-lighted. They clean their house everyday and they segregate their

garbage. Their source of income is stable because the patients children do all have a stable work in

United State of America and issues about money was not an issue. Every Sunday the patient and her

husband would see to it that they would have to go to church and dine outside. Her relationship with her

family is good because she said that they would see to it that problems would be solve at the end of the

day.

Interpretation: Normal

Analysis:

The financial needs of elders vary considerably. Though most need less money for clothing,

entertainment, and work. Food and medical costs alone are often a financial burden. Adequate financial

resources enable the older person to remain independent. Environment may produce insufficient stimuli

placing the client at risk for sensory deprivation, or excessive stimuli.

Source: Fundamentals of Nursing p.417

Fundamentals of Nursing p985

C. Spiritual PatternsThe patients religion is Roman Catholic. They always practice to pray before each and every meal. They

attend the mass every Sunday. It is also stated that before going to sleep they dont forget to be grateful tothe Almighty Creator.

Interpretation: Normal

Analysis:

Spirituality generally involved relationship with higher entities. Spiritual health or well-being, is

manifested by a feeling of being generally alive, purposeful and fulfilled. According to Pilch, spiritualwellness is a way of living, a lifestyle that views and lives life as purposeful and pleasurable, that seeks

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out life-sustaining and life-enriching options to be chosen freely at every opportunity, and that sinks its

root deeply into spiritual values and or/specific religious beliefs.

Source: Fundamentals of Nursing p1043

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IV. Activities of Daily Living

ADL Before Hospitalization Interpretation and Analysis

1. Nutrition The patient is very fond of eating healthyfoods like dark green leafy vegetables and

fish. She limits herself in eating pork. She

eats at home with her husband. She had a

good appetite.

Interpretation:Normal

Analysis:

The older adult requires the same

basic nutrition as the younger adult

However, fewer calories are needed by

elders because of the lower metabolic

rate and the decrease in physicaactivity.

2. Elimination The patient defecates every other day.Patient reported that her stool is firm,

brown in color and experiences difficulty

in defecating. It is reported that although

the patient had difficulty in defecating,

she doesnt feel uncomfortable when

urinating. She urinates 8-9 times per day

with approximately 150 ml per void. The

color is light yellow and slightly aromatic

Interpretation: Deviation from

Normal

Analysis:

Normal urinary output average

1500 mL/24 hr (60 mL/hr); should be

no less than 30mL/hr; most people

void 5-6 times/day.

Normal bowel movement - the color of

an adults stool is brown and itsconsistency is formed, soft, semi-solid

and moist.

Adults should be advised norma

patterns of bowel elimination vary

considerable. Toileting is

recommended 30 min after meals

especially after breakfast when

gastrocolic reflex is strongest. A

normal pattern maybe every other day;

or others, twice a day.3.

Exercise The patient stated that everytime the sheis at home she would just sit or lay down

on bed, having siesta time. Every morning

she walks for about 1 kilometer in going

to market to buy ingredients in their

everyday meal.

Interpretation: NormalAnalysis:

As age advances, muscle tone and

bone density decreases, joints lose

flexibility, reaction time slows, and

bone mass decreases, particularly in

women who have osteoporosis

4. Hygiene She enumerates her hygiene routines:- Taking a bath once or twice a day;

every morning and sometimes in

evening.

- Handwashing before and after eatingand using the restroom.- Trimming her nails twice a week- Wearing slippers inside the house- Using cologne- Cleaning her dentures every after

eating and cleaning her tongue and

gums.

Interpretation:Normal

Analysis:

Elderly hygiene is an issue that

many caregivers have to deal with

Some elderly parents refuse to take ashower or bathe, change their clothes

brush their teeth or clean their house

all of which result in bad elderly

hygiene. However, for many elders

depending on others to help them with

hygiene is embarrassing.

5. Sleep and Rest She sleeps for about 6-7 hours a day. 6hours in the evening and another 1 hour

Intervention: Normal

Analysis:

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in the afternoon during their siestatime. She usually wakes up at 4 in the

morning and sleeps 9 in the evening. She

added that everytime she wakes up in the

morning, she feels satisfied to the length

of her sleep.

Older adults usually awaken 1.3

hours earlier and go to bed

approximately 1 hour earlier than

younger adults. Elders may show an

increase in disturbed sleep that can

create a negative impact on their

quality of life, mood and alertness.

Although the ability to sleep becomes

more difficult, the need to sleep doesnot decrease with age.

Reference:

Fundamentals of Nursing, 8th Edition, Vol 1 & 2, Kozier & Erb Suzzane C. Smeltzer, Brunners &Suddaraths, 12th Edition

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V.Physical Assessment

Areas to be

assessed

Normal Findings Actual Findings Interpretation

and Analysis

Eyebrows

a. Hairdistribution

and alignment

and movement

Hair is evenly

distributed;

symmetrically

aligned; equal

movement

Hair evenly

distributed

Normal

Eyelashes

a. Evenness ofdistribution

and direction

of curl

Evenly distributed;

curled slightly

outward

Curled slightly

outward and

evenly distributed

Normal

Eyelids

a. Surfacecharacteristics

and the ability

to blink

Skin intact and

involuntary

blinking of both

eyelids

Skin intact and

involuntary

blinking of both

eyelids

Normal

Conjunctiva

a. Bulbarconjunctiva

from lesions,

color, and

texture

b. Palpebral

No lesions and

transparent

capillaries are

evident

No lesions and

transparent

capillaries are

evident

Normal

Normal

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conjunctiva Shiny, smooth and

pink red

Shiny, smooth and

pink red

Sclera

a. Color andclarity

White White Normal

Cornea

a. Clarity andtexture

Transparent,

smooth, shiny

Transparent,

smooth, shiny

Normal

Iris

a. Color andshape

Oval and flat Brown with white,

oval, cloudy andirregular in texture

Abnormal

Pupils

a. Color, shape

b. Test eachpupil for light

and

accommodatio

n

Black in color,

equal in size, round

and smooth

Pupil constrictswhen illuminated

Black in color,

equal in size, round

and smooth

Pupils constrict

Normal

Normal

Lacrimal glands,

Lacrimal sac and

Naso Lacrimal duct

No edema and

tearing

No edema and

tearing

Normal

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Auricles

a. Color,symmetry and

position

b. Palpate

texture, elasticity

and tenderness

Color same as the

facial color;

symmetrical;

auricle aligned

with the outer

canthus of the eye

Mobile, firm and

not tender; the

pinna recoils after

it is folded

Color same to face

and symmetrical

Pinna recoils

Normal

Normal

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VI. Laboratory and Diagnostic Examinations Results

DATE PROCEDURE NORMS RESULTSINTERPRETATION

AND ANALYSIS

September/24/2013 Hematology

Hemoglobin

(11.93-14.30) 13.9G/DLNORMAL

Hemoglobin Level

Hematocrit

(36.81-43.71)41.0%

NORMAL

HEMATOCRIT

LEVEL

RBC Count

(3.8-5.05)4.38 1012/L NORMAL RBC LEVEL

WBC COUNT

(4.19-12.3)5.8 109/L

NORMAL WBC

LEVEL

PLATELET

COUNT(150-450)

Adequate

109/L

NORMAL PLATELET

LEVEL

DATE PROCEDURE NORMS RESULTSINTERPRETATION

AND ANALYSIS

September/24/2013Fasting Blood

Sugar

FBS

(3.64-6.16

mmol/L)

6. 16 G/DL NORMAL FBS

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XI. Discharge Plan

Medications Mefenamic Acid as needed every 6 hours

Exercise Avoid straining during defecation. Gentle exercises are fine.

Treatment Phacoemulsification

Health Teachings Advice the following to patient:

Take a rest. You may read and watch TV. Gentle exercises

are fine too. You can go out, but try to avoid

crowded and dusty places. Wearing sunglasses

when you are outdoors may help to keep your

eyes comfortable and less sensitive to light.

You will be given eye drops for about a monthto prevent infection and reduce inflammation

Follow your doctor's instructions carefully. If

you need to, ask a family member or friend tohelp instill the eye drops. If you were to go out

make sure you have access to hand hygiene

facilities so that you can clean your hands

before you instill your eye drops. Shake the eye

drop bottle before use. Tilt your head back, look

up and pull the lower eyelid down. Instill just

ONE drop into the eye, avoiding contact with

the eye lashes. Wait 5 minutes before instilling

a different eye drop.

For mild pain, you may take mefenamic acid. Ifyou have pain that is not relieved by this

medicine, call your doctor.

When you sleep, please put on the eye shieldgiven to you for at least 1 week to 1 month so

that you dont press on the operated eye.

For the first few days, your vision may beblurred, so be careful to avoid falling over or

hurting your head or eye, especially if the

operated eye is padded and the other eye also

suffers from poor vision.

Out-Patient Department follow-up Our Lady Of Peace Hospital- Eye clinic 7:30 am-December 29,2013- Friday

Diet No restriction on the diet. Any pre-existing dietsshould be continued.

Increase fluid intake.Sexuality/ Spirituality Continue to seek Gods help.

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Anatomy and Physiology of Eyes

The human eye is the organ which gives us the sense of sight, allowing us to observe and learn more

about the surrounding world than we do with any of the other four senses. We use our eyes in almost

every activity we perform, whether reading, working, watching television, writing a letter, driving a car,

and in countless other ways. Most people probably would agree that sight is the sense they value more

than all the rest.

The eye allows us to see and interpret the shapes, colors, and dimensions of objects in the world by

processing the light they reflect or emit. The eye is able to detect bright light or dim light, but it cannot

sense objects when light is absent.

process of vision

Light waves from an object (such as a tree) enter the eye first through the cornea, which is the clear dome

at the front of the eye. It is like a window that allows light to enter the eye. The light then progresses

through the pupil, the circular opening in the center of the colored iris.

Fluctuations in the intensity of incoming light change the size of the eyes pupil. As the light entering theeye becomes brighter, the pupil will constrict (get smaller), due to the pupillary light response. As the

entering light becomes dimmer, the pupil will dilate (get larger).

Initially, the light waves are bent or converged first by the cornea, and then further by the crystalline lens

(located immediately behind the iris and the pupil), to a nodal point (N) located immediately behind the

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back surface of the lens. At that point, the image becomes reversed (turned backwards) and inverted

(turned upside-down).

The light continues through the vitreous humor, the clear gel that makes up about 80% of the eyes

volume, and then, ideally, back to a clear focus on the retina, behind the vitreous. The small central area

of the retina is the macula, which provides the best vision of any location in the retina. If the eye is

considered to be a type of camera (albeit, an extremely complex one), the retina is equivalent to the filminside of the camera, registering the tiny photons of light interacting with it.

Within the layers of the retina, light impulses are changed into electrical signals. Then they are sent

through the optic nerve, along the visual pathway, to the occipital cortex at the posterior (back) of the

brain. Here, the electrical signals are interpreted or seen by the brain as a visual image.

Actually, then, we do not see with our eyes but, rather, with our brains. Our eyes merely are the

beginning of the visual process. Watch an 11-minute film, created in 1941, about the anatomy andphysiology of the eye: How the Eye Functions.

myopia, hyperopia, astigmatism

If the incoming light from a far away object focuses before it gets to the back of the eye, that eyes

refractive error is called myopia (nearsightedness). If incoming light from something far away has notfocused by the time it reaches the back of the eye, that eyes refractive error is hyperopia

(farsightedness).

In the case of astigmatism, one or more surfaces of the cornea or lens (the eye structures which focus

incoming light) are not spherical (shaped like the side of a basketball) but, instead, are cylindrical or toric

(shaped a bit like the side of a football). As a result, there is no distinct point of focus inside the eye but,

rather, a smeared or spread-out focus. Astigmatism is the most common refractive error.

presbyopia (after 40 vision)

After age 40, and most noticeably after age 45, the human eye is affected by presbyopia. This natural

condition results in greater difficulty maintaining a clear focus at a near distance with an eye which sees

clearly far away.

Presbyopia is caused by a lessening of flexibility of the crystalline lens, as well as to a weakening of the

ciliary muscles which control lens focusing. Both are attributable to the aging process.

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An eye can see clearly at a far distance naturally, or it can be made to see clearly artificially, such as with

the aid of eyeglasses or contact lenses, or else following a photorefractive procedure such as LASIK

(laser-assisted in situ keratomileusis). Nevertheless, presbyopia eventually will affect the near focusing

of every human eye.

eye growth

The average newborns eyeball is about 18 millimeters in diameter, from front to back (axial length). In

an infant, the eye grows slightly to a length of approximately 19 millimeters.

The eye continues to grow, gradually, to a length of about 24-25 millimeters, or about 1 inch, in

adulthood. A ping-pong ball is about 1 inch in diameter, which makes the average adult eyeball about

2/3 the size of a ping-pong ball.

The eyeball is set in a protective cone-shaped cavity in the skull called the orbit or socket. This bonyorbit also enlarges as the eye grows.

extraocular muscles

The orbit is surrounded by layers of soft, fatty tissue. These layers protect the eye and enable it to turneasily.

Traversing the fatty tissue are three pairs of extraocular muscles, which regulate the motion of each eye:

the medial & lateral rectus muscles, the superior & inferior rectus muscles, and the superior & inferior

oblique muscles.

eye structures

Several structures compose the human eye. Among the most important anatomical components are the

conjunctiva, cornea, crystalline lens, extraocular muscles, iris, macula, optic nerve, retina, and vitreous

humor.

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Cataract

Cataracts are cloudy areas in the lens inside the eye - which is normally clear. Cataracts can develop in

one or both eyes. If they develop in both eyes, one will be more severely affected than the other. A

normally clear lens allows light to pass through to the back of the eye, so that the patient can see well-

defined images. If a part of the lens becomes opaque light does not pass through easily and the patient's

vision becomes blurry - like looking through cloudy water or a fogged-up window. The more opaque

(cloudier) the lens becomes, the worse the person's vision will be.

According to Medilexicon's medical dictionary, cataract is "Complete or partial opacity of the ocular

lens.". There are two types of cataracts:

Age related cataracts - they appear later in life; the most common form.

Congenital cataracts (childhood cataracts) - these may be present when the baby is born, or shortly after

birth. Cataracts may also be diagnosed in older babies and children - these are sometimes referred to as

developmental, infantile or juvenile cataracts. Researchers from the University Zurich were the first to

identify the chromosomal location and exact molecular defect in the coding region of the gene

responsible for a childhood cataract.

A patient with cataracts will eventually find it hard to read, or drive a car - especially during the night.

Even seeing people's facial expressions becomes difficult. Cataracts are not usually painful. The patient's

long-distance vision is more severely affected at first.

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Cataracts cause more vision problems globally than any other eye condition or disease - especially in

developing countries, where they are much more common among poor people, according to a study

carried out in Kenya, The Philippines, and Bangladesh.

Some studies indicate that cataracts are more common among elderly people further down the

socioeconomic ladder in the USA - prevalence of cataracts causing significant visual problems appears

high among older U.S. Hispanics who also often encounter barriers to access to care (in the USA

"Hispanics" refers to Americans of Latin American origin, not people who originate from Spain).

Both men and women are affected equally.

According to the National Health Service (NHS), UK, approximately one third of people aged 65 or over

have cataracts in one or both eyes.