1. Cataract: developmental or degenerative opacification of the crystalline lens.
    1. Risk factors:
      1. Aging (most common).
      2. Trauma (x-rays, infrared or possibly ultraviolet exposure).
      3. Systemic disease (diabetes).
      4. Congenital defect.
      5. Drug effects (corticosteroids).
    2. Assessment:
      1. Subjective data-vision: blurring, loss of acuity (see best in low-lit conditions); distortion; diplopia; photophobia.
      2. Objective data:
        1. Blindness: unilateral or bilateral (particularly in congenital cataracts).
        2. Loss of red reflex; gray or cloudy white opacity of lens.
    3. Analysis/nursing diagnosis:
      1. Visual sensory/perceptual alterations related to opacity of lens.
      2. Risk for injury related to accidents.
      3. Social isolation related to impaired vision.

  2. Cataract removal: removal of opacified lens because of loss of vision; extracapsular cataract extraction followed by intraocular lens (IOL) insertion is procedure of choice.
    1. Nursing care plan/implementation:
      1. Preoperative:
        1. Goal: prepare for surgery (ambulatory center). Antibiotic drops or ointment, mydriatic eyedrops as ordered; note dilation of pupils; avoid glaring lights; usually done under local anesthetic with sedation.
        2. Goal: health teaching. Postoperative expectations: do not rub, touch, or squeeze eyes shut after surgery; eye patches will be on; assistance will be given for needs; overnight hospitalization not required unless complications occur; mild iritis usually occurs.
      2. Postoperative:
        1. Goal: reduce stress on the sutures and prevent hemorrhage.
          1. Activity: ambulate as ordered, usually soon after surgery; generally discharged few hours after surgery.
          2. Position: flat or low Fowler's; on hack or turn to nonoperative side 3-4 weeks, because turning to operative side increases pressure.
          3. Avoid activities that increase IOP: straining at stool, vomiting, coughing, brushing teeth, brushing hair, shaving, lifting objects over 20 lb, bending, or stooping; wear glasses or shaded lens during day, eyeshield at night.
          4. Provide mouthwash, hair care, personal items within easy reach, “stepin” slippers to avoid bending over.
        2. Goal: promote psychological well-being with elderly, frequent contacts to prevent sensory deprivation.
        3. Goal: health teaching.
          1. If intraocular lens not inserted, prescriptive glasses may be used (cataract glasses); explain about magnification, perceptual distortion, blind areas in peripheral vision; guide through activities with glasses; need to look through central portion of lens and turn head to side when looking to the side to decrease distortion.
          2. Eye care: instillation of eyedrops (mydriatics and carbonic anhydrase inhibitors) to prevent glaucoma and adhesions if IOL not inserted; with IOL, steroid-antibiotic use
          3. Signs/symptoms of infection (redness, pain, edema, drainage); iris prolapse (bulging or pear-shaped pupil); hemorrhage (sharp eye pain, halfmoon of blood).
          4. Avoid: heavy lifting; potential eye trauma.
    2. Evaluation/outcome criteria:
      1. Vision restored.
      2. No complications (severe eye pain, hemorrhage).
      3. Performs self-care activities (instills eyedrops).
      4. Returns for follow-up ophthalmology care-recognizes symptoms requiring immediate attention.