During the early postoperative period, the client who has had a cataract extraction complains of nausea and severe eye pain over the operative site. The initial nursing action is to:
1. Call the physician.
2. Reassure the client that this is normal.
3. Turn the client on his or her operative side.
4. Administer the prescribed pain medication and antiemetic.
Eye Cataract – adult
A cataract is a clouding of the lens of the eye.
Causes
The lens of the eye is normally clear. It acts like the lens on a camera, focusing light as it passes to the back of the eye.
Until a person is around age 45, the shape of the lens is able to change. This allows the lens to focus on an object, whether it is close or far away.
As a person ages, proteins in the lens begin to break down. As a result, the lens becomes cloudy. What the eye sees may appear blurry. This condition is known as a cataract.
Factors that may speed cataract formation are:
Diabetes
Eye inflammation
Eye injury
Family history of cataracts
Long-term use of corticosteroids (taken by mouth) or certain other medicines
Radiation exposure
Smoking
Surgery for another eye problem
Too much exposure to ultraviolet light (sunlight)
In many cases, the cause of cataract is unknown.
Cataracts develop slowly and painlessly. Vision in the affected eye slowly gets worse.
Mild clouding of the lens often occurs after age 60. But it may not cause any vision problems.
By age 75, most people have cataracts that affect their vision.
Problems with seeing may include:
Being sensitive to glare
Cloudy, fuzzy, foggy, or filmy vision
Difficulty seeing at night or in dim light
Double vision
Loss of color intensity
Problems seeing shapes against a background or the difference between shades of colors
Seeing halos around lights
Frequent changes in eyeglass prescriptions
Cataracts lead to decreased vision, even in daylight. Most people with cataracts have similar changes in both eyes, though one eye may be worse than the other. Often there are only mild vision changes.
Tacrolimus (Prograf) is prescribed for a client. Which disorder, if noted in the client’s record, would indicate that the medication needs to be administered with caution?
1. Pancreatitis
2. Ulcerative colitis
3. Diabetes insipidus
4. Coronary artery disease
MEDICATIONS FOR PREVENTING ORGAN REJECTION
Tacrolimus (Prograf)
Tacrolimus inhibits calcineurin and thereby prevents T cells from producing interleukin-2, interferon- g, and other cytokines.
Tacrolimus is more effective than cyclosporine, but is more toxic.
Adverse effects are similar to those of cyclosporine and include nephrotoxicity, infection, hypertension, tremor, hirsutism, neurotoxicity, gastrointestinal effects, hyperkalemia, and hyperglycemia.
Tacrolimus should be used cautiously in immunosuppressed clients and those with renal, hepatic, or pancreatic impairment.
Tacrolimus is contraindicated for clients hypersensitive to cyclosporine.
Monitor blood glucose levels and administer prescribed insulin or oral hypoglycemics.
A nurse is providing dietary instructions to a client who has been prescribed cyclosporine (Sandimmune). Which food item would the nurse instruct the client to avoid?
1. Red meats
2. Orange juice
3. Grapefruit juice
4. Green leafy vegetables
MEDICATIONS FOR PREVENTING ORGAN REJECTION
Cyclosporine (Sandimmune, Gengraf, Neoral)
Cyclosporine inhibits calcineurin and acts on T lymphocytes to suppress the production of interleukin-2, interferon-g, and other cytokines.
Cyclosporine may be used to prevent rejection of allogeneic kidney, liver, and heart transplants.
Prednisone may be administered concurrently.
Oral administration of cyclosporine is preferred; intravenous administration is reserved for clients who cannot take the medication orally.
Blood levels of the medication should be measured regularly because of its nephrotoxic effects.
The most common adverse effects are nephrotoxicity, infection, hypertension, tremor, and hirsutism.
Assure the client that hirsutism is reversible; instruct on the use of a depilatory.
Other adverse effects include neurotoxicity, gastrointestinal effects, hyperkalemia, and hyperglycemia.
The risk of infection and lymphomas is increased with the use of cyclosporine.
Cyclosporine is contraindicated in the presence of hypersensitivity, pregnancy and breastfeeding, recent inoculation with live virus vaccines, and recent contact with an active infection such as chickenpox or herpes zoster.
Cyclosporine is embryotoxic, and women of childbearing age should use a mechanical form of contraception and avoid oral contraceptives.
The client should be informed about the possibility of renal damage and liver damage and the need for periodic liver function tests and determination of coagulation factors and blood urea nitrogen, serum creatinine, serum potassium, and blood glucose levels.
The client should be instructed to monitor for early signs of infection and to report these signs immediately.
Available in a pill form; if the client is unable to swallow the pill, instruct the client to dispense the oral liquid medication into a glass container by using a specially calibrated pipette, mix well, and drink immediately; rinse the glass container with diluent and drink it to ensure ingestion of the complete dose; dry the outside of the pipette