A 72-year-old client is scheduled for cataract surgery tomorrow morning. Which preoperative instruction is most important for the nurse to emphasize?

Avoiding bending or lifting post-cataract surgery is critical to prevent increased intraocular pressure, which can lead to complications like bleeding or lens displacement.

Understanding the Priority Preoperative Instruction

The question asks for the most important preoperative instruction to emphasize for a client undergoing cataract surgery. While several instructions are important, the priority is the one that directly prevents a serious postoperative complication. The correct answer is to avoid bending over or lifting heavy objects after surgery.

Why This Is the Most Critical Instruction

Cataract extraction with intraocular lens (IOL) implantation involves creating a small incision in the cornea. Although the incision is often self-sealing, it is vulnerable to sudden increases in intraocular pressure (IOP) during the initial healing phase. Activities such as bending over, lifting heavy objects, straining during a bowel movement, or even sneezing forcefully can cause a rapid spike in IOP. This mechanical stress can disrupt the wound, leading to serious complications like wound dehiscence, hyphema (bleeding in the anterior chamber), or prolapse of the iris. Postoperative instructions to minimize these activities are a cornerstone of preventing such complications, and a cross-sectional survey of eye health workers confirms that activity restriction is a universal component of post-cataract surgery counseling ^[3]. Emphasizing this before surgery prepares the client to actively participate in their own safety immediately upon returning home.

Analysis of Other Options

- Option 1: Take all regular medications as usual on the morning of surgery. This is a dangerous blanket instruction. The nurse must provide individualized guidance. For example, anticoagulants and antiplatelet agents are often held preoperatively to reduce the risk of retrobulbar hemorrhage, while some other medications, like those for blood pressure, may be taken with a sip of water. A non-specific instruction could lead to serious harm and is therefore not the most important universal statement.

- Option 3: Remove contact lenses 24 hours before the procedure. While it is a standard instruction to remove contact lenses well before surgery to allow the cornea to return to its natural shape for accurate biometry (the measurement of the eye for IOL power calculation), this is a preparatory step for surgical precision, not an immediate safety measure to prevent a structural complication. The guideline on preoperative examinations highlights the importance of these assessments for surgical planning, but the priority in postoperative safety education lies elsewhere .

- Option 4: Fast for 8 hours before the surgery as with general anesthesia. Cataract surgery is overwhelmingly performed under local or topical anesthesia with monitored sedation, not general anesthesia. Standard NPO (nothing by mouth) guidelines for such procedures are far less stringent, typically allowing clear liquids up to 2 hours before surgery. An 8-hour fast is unnecessarily aggressive and could lead to dehydration and discomfort, especially in an older adult client. A digital health intervention study for cataract surgery patients focuses on improving adherence to correct preoperative instructions, which would not include such an inappropriate fasting mandate .

Clinical Application and Underlying Rationale

The core of this question is distinguishing between routine preoperative preparation and the critical safety education that prevents direct physical harm. The healing corneal wound is subject to the laws of physics; any Valsalva-like maneuver or gravitational increase in venous pressure to the head can elevate IOP. The immediate postoperative period is when the wound is least stable, and a sudden IOP spike can compromise the structural integrity of the eye. While a predictive nomogram has been developed to assess the risk of IOL rotation postoperatively, this is a long-term refractive concern, not an immediate surgical wound threat . The nurse’s primary focus in preoperative teaching must be on empowering the client with the knowledge to protect the surgical site from the moment they leave the operating room, making the instruction to avoid bending and lifting the highest priority.