NCLEX Review Guide: Cataracts - Adult Health Visual/Auditory

Understanding Cataracts

• Cataracts are the clouding or opacity of the lens that blocks light transmission to the retina, causing progressive vision loss.
• Most common cause of blindness worldwide, typically affecting adults over 65 years old due to normal aging processes.
• Risk factors include diabetes mellitus, prolonged corticosteroid use, UV radiation exposure, smoking, and eye trauma.

Clinical Manifestations

• Progressive, painless vision loss with decreased visual acuity and contrast sensitivity.
• Complaints of glare sensitivity, especially with bright lights or when driving at night with oncoming headlights.
• Colors appear faded or yellowed, and patients may experience double vision in the affected eye.
• Frequent prescription changes for glasses or contact lenses as vision continues to deteriorate.

Pre-operative Care

1. Assess baseline visual acuity and obtain complete health history including current medications.
2. Educate patient about the surgical procedure and expected outcomes, addressing fears and misconceptions.
3. Discontinue anticoagulants as ordered to reduce bleeding risk during surgery.
4. Administer pre-operative eye drops as prescribed, typically mydriatics to dilate the pupil.

Post-operative Care

• Position patient with head of bed elevated 30-45 degrees and avoid positioning on the operative side to prevent increased intraocular pressure.
• Monitor for signs of complications including severe eye pain, sudden vision loss, nausea/vomiting, or purulent drainage.
• Administer prescribed eye drops including antibiotics and anti-inflammatory medications on strict schedule.
• Teach patient to avoid bending, lifting heavy objects, or straining during bowel movements for several weeks.

Common Pitfalls to Avoid

• Don't confuse cataracts with acute conditions - cataracts develop slowly and are not medical emergencies.
• Remember that post-operative eye pain should be minimal - severe pain indicates complications requiring immediate attention.
• Avoid recommending eye patches for extended periods - modern cataract surgery typically uses protective shields only at night.