Cataract - Calling All Eye Nurses (or anyone who has cared for post-op cataract pt)

Nurses General Nursing

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Can anyone tell me what the norm is these days for cataract post-op care?

Specifically, is it inadvisable to send an older person straight home alone? Even if no general anesthetic is used, I imagine whatever is used as pre-op sedation could make an elderly person weak, maybe dizzy, prone to stumble and fall, especially if the operated eye is patched. Plus, they probably are advised to be NPO for at least 8 hours pre-op, so will already be weak from that.

Is it patched? How is one's vision fresh post-op?

What about bending over, lifting, chewing, washing hair, coughing, sneezing, hard BM's, other straining?

Other issues?

Thanks for any help.

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Is it patched? How is one's vision fresh post-op?

What about bending over, lifting, chewing, washing hair, coughing, sneezing, hard BM's, other straining?

Other issues?

Thanks for any help.

just one eg. - family - yes, she was sent home with an eye patch, and someone had to accompany her there and home

She knew nothing about how to instill the eye drops, and knew nothing about washing her hands (my conclusion - no one bothered to teach her - or - she wasn't listening?)

then she became paranoid, hallucinating, psychotic - it was awful (and I've been told that this happens - probably because of the person's realization that they can't see, they depend on others, feel afraid of any pain during the procedure)

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They can't go home alone because even if a general isn't used, morphine and versed usually are. Yes, the eye is patched. No straining or bending. Can't be alone for at least 24 hours.

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Specializes in ER OB NICU.

In the 1970s, we sandbagged their heads, they were not even to breathe deep, thought was it would increase ocular pressure. Patients were fed by a nurse, and not sent home for 3 days or later. Biggest problem is drops. Difficult to read and adminster own.

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Day surg. nurse here--we D/C pts. to someone responsible. You can't guarantee that person will stay with them, but we do try to reinforce that it's best that someone be with them. They get minimal sedation, but usually the pts. are elderly and have co-morbidities, so there are risks even with minimal anesthesia.

Generally, drops aren't started until the next day after they've seen the doc. They go home with an eye shield. There are a few exceptions to that rule, but I'd say for our pts, 99% of the time, it's no drops til the next day.

Of course, you teach them about avoiding anything that would increase intraocular pressure, e.g. bending, straining, etc. We tell them to wait until the shield is removed to shower or wash hair.

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As far as vision post op, shield usually on until the next day, which is usually your follow up appt. Vision should be clearer, but your focus ability will now be impaied. So if you wore prescription glasses for that eye, they would still be required unless you got the new implants that corrects the prescription(which costs much more and not always covered). As one Dr once told me,"whatever age you are when you have your cataract corrected, you now have a 80 year old eye". Meaning, your focus ability will be impaired for life.

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Need some advice-

My mum went into hospital on Thursday here in the UK. She was sent home on Friday morning when after taking her to OR, found that with local, she could not keep still enough to complete the surgery. The doc and Anethestist then argued over her, as the doc wanted to do the surgery and the anethestist would not put her under a general, because she was aneamic!

Please enlighten me how patients with comorbidities are handled. I am off to the hospital with her for her next appointment.

PS my mum was EXTREMELY anxious throughout her expereince, and I am not sure i am going to be able to get her to undergo this procedure. Although she was so anxious, no one thought about medicating her for the anxiety.

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Can anyone tell me what the norm is these days for cataract post-op care?

Specifically, is it inadvisable to send an older person straight home alone? Even if no general anesthetic is used, I imagine whatever is used as pre-op sedation could make an elderly person weak, maybe dizzy, prone to stumble and fall, especially if the operated eye is patched. Plus, they probably are advised to be NPO for at least 8 hours pre-op, so will already be weak from that.

Is it patched? How is one's vision fresh post-op?

What about bending over, lifting, chewing, washing hair, coughing, sneezing, hard BM's, other straining?

Other issues?

Thanks for any help.

Patients are normally sent home and have someone drive them home. They should not be alone due to having the patch on until their next appt. And they actually get something to drink and eat in the recovery room. They usually get a block to the eye area only and mild sedation while doing the block.

Have not seen a patient NPO after cataract surgery for years. The entire procedure is less than 15 minutes in the OR room and that includes prepping the patient and getting them draped.

They do not even get completely undressed, just shirt or blouse removed and gown on. Most cases are done in out-patient surgery centers, or even suites that the physicians have at their own offices.

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Need some advice-

My mum went into hospital on Thursday here in the UK. She was sent home on Friday morning when after taking her to OR, found that with local, she could not keep still enough to complete the surgery. The doc and Anethestist then argued over her, as the doc wanted to do the surgery and the anethestist would not put her under a general, because she was aneamic!

Please enlighten me how patients with comorbidities are handled. I am off to the hospital with her for her next appointment.

PS my mum was EXTREMELY anxious throughout her expereince, and I am not sure i am going to be able to get her to undergo this procedure. Although she was so anxious, no one thought about medicating her for the anxiety.

This is something that needs to be discussed with her physician. Not something that requires a general anesthesia normally in the first place. But have seen it done, more so for physician request rather than because of issues with the patient. Many medications can now be given to completely relax her, yet not give her a breathing tube down her throat.

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Wow, you guys are smart!

What can you tell me about complications? Besides possible infection, possible falling while still sedated and groggy, pain, what can go wrong? I did read the thread by Tazzi that comes up at the bottom of the page. Scary.

BTW, what do they give for post-op pain?

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Usually nothing more than Tylenol for pain. There's minimal discomfort; most describe it as a feeling of "grit" or "sand" in the eye if anything at all.

The most common complication we see is a "retained suture." Honestly, we really don't get a whole lot of people coming back with post-op complications. They generally do quite well.

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Hope I'm not too late. I have been busy with school/ clinical stuff and this is my first chance to respond. As far as complications (aside from infection/ endophthalmitis) here's a pretty extensive list I came up with: Iritis, CME (cystoid macular edema), increased intraocular pressure, anterior vitreous prolapse, corneal edema, hyphema, retinal detachment, retained lens fragment, "dropped" lens (into posterior chamber -an emergency retina specialist intervention), corneal abrasion, damage to iris -including transillumination, irregular/ surgical pupil, acute glaucoma crisis (from viscoelastic compound "clogging" trebecular mesh work). Other complications could include myopia/hyperopia, failure to achieve target visual acuity.

Pts are usually seen one day, one week and about 5 weeks out. Most of our docs use Pred Forte, Acular and Zymar starting the day after surgery. About a third have pts start the Acular a few days before and the Zymar (an antibiotic) one day before. Two of our docs are trying Xibrom instead of Acular. Wait five minutes between gtts. We typically have pt s use tylenol for pain control.

Pt's are told to keep water out of the eye for two weeks, showers are permitted as long as keep eyes closed when rinsing hair/ face. No strenuous activitivity or heavy lifting for 1-2 weeks. No bending head lower that heart. Of course, no eye rubbing. We give them a clear plastic shield to wear at night/ sleeping. Chewing is O.K. Never had any issues with straining/ BMs, coughs or sneezing.

Visual acuity varies after the surgery, but on average I would say V/A ranges from 20/40-20/100 first day p/o.

Hope this helps!

~Wave

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