CATARACT SURGERY

Definition
A cataract us a lens opacity or cloudiness. Cataracts are responsible for visual
disability in 18 million people worldwide. Cataract surgery is a procedure to remove the lens
of your eye and, in most cases, replace it with an artificial lens. Normally, the lens of your
eye is clear. A cataract causes the lens to become cloudy, which eventually affects your
vision. Cataract surgery is performed by an eye doctor (ophthalmologist) on an outpatient
basis, which means you don't have to stay in the hospital after the surgery. Cataract surgery
is very common and is generally a safe procedure.
Conditions that need this procedure

You might not have any symptoms at first, when cataracts are mild. But as cataracts
grow, they can cause changes in your vision. For example, you may notice that:

 Your vision is cloudy or blurry

 Colors look faded
 You can’t see well at night
 Lamps, sunlight, or headlights seem too bright
 You see a halo around lights
 You see double (this sometimes goes away as the cataract gets bigger)
 You have to change the prescription for your glasses often

These symptoms can be a sign of other eye problems, too. Be sure to talk to your eye
doctor if you have any of these problems. Over time, cataracts can lead to vision loss.

Risk Factors
 Aging
- Accumulation of a yellow-brown pigment due to the breakdown of the lens protein
- Clumping or aggregation of lens protein (which leads to light scattering)
- Decreased oxygen uptake
- Decrease in levels of vitamin C, protein and glutathione (antioxidant)
- Increased in sodium and calcium
- Loss of lens transparency
 Associated ocular conditions
- Infection (e.g. herpes zoster, uveitis)
- Myopia
- Retinal detachment and retinal surgery
- Retinitis pigmentosa
 Toxic Factors
- Alkaline chemical eye burns, poisoning
- Aspirin use
- Calcium, copper, iron, gold, silver and mercury which lead to deposit in the
pupillary area of the lens
- Cigarette smoking
- Corticosteroids, especially at high doses and in long-term use
- Ionizing radiation
 Nutritional Factors
- Obesity
- Poor nutrition
- Reduced levels of antioxidant
 Physical Factors
 - Blunt trauma, perforation of the lens with a sharp object or foreign body, electric
shock
- Dehydration associated with chronic diarrhea, the use of purgatives in anorexia
nervosa and the use of hypertonic oxygenation
- Ultraviolet radiation in sunlight and x-ray
 Systemic Diseases and Syndromes
- Diabetes
- Disorders related to lipid metabolism
- Down syndrome
- Musculoskeletal disorders
- Renal disorders
Complication after the surgery
Potential cataract surgery complications include:

 Posterior capsule opacity (PCO)

 Intraocular lens dislocation

 Eye inflammation

 Light sensitivity

 Photopsia (perceived flashes of light)

 Macular edema (swelling of the central retina)

 Ptosis (droopy eyelid)

 Ocular hypertension (elevated eye pressure)

 Infection

 Inflammation

 Retinal detachment

 Lens fragments

 Fluid build-up in the retina

 Secondary cataract

 Swelling in the cornea

 Bleeding

 Floaters and flashes of lights

Other potential cataract surgery complications are minor and may include:
  Swelling of the cornea or retina.

 Increased pressure in the eye (ocular hypertension).

 Droopy eyelid (ptosis).

Minor complications usually clear up with medications and more healing time. When cataract
surgery complications do occur, most are minor and can be successfully treated medically or
with additional surgery.

Nurse on Duty
Nursing Responsibilities before the procedure (Pre-op)
 Informed consent is a legal document that explains the tests, treatments, or
procedures that you may need. Informed consent means you understand what will be
done and can make decisions about what you want. You give your permission when
you sign the consent form. You can have someone sign this form for you if you are
not able to sign it. You have the right to understand your medical care in words you
know. Before you sign the consent form, understand the risks and benefits of what
will be done. Make sure all your questions are answered.
 An IV is a small tube placed in your vein that is used to give you medicine or liquids.
 Vital signs: Healthcare providers will check your blood pressure, heart rate, breathing
rate, and temperature. They will also ask about your pain. Vital signs give information
about your current health.
 Heart monitor: Sticky pads placed on your skin record your heart's electrical activity.
 Anesthesia:
 Regional anesthesia: Medicine is injected to numb the body area where the
surgery or procedure will be done. You will remain awake during the surgery
or procedure.
 General anesthesia will keep you asleep and free from pain during surgery.
Anesthesia may be given through your IV. You may instead breathe it in
through a mask or a tube placed down your throat. The tube may cause you
to have a sore throat when you wake up.
 Tell the patient what to expect during postoperative assessment and monitoring.
 Teach the patient how to cough, deep breathe, and use an incentive spirometer to
reduce the risk of postprocedure pneumonia.
 Prepare the patient for proposed exercise and progressive ambulation regimens, if
necessary.
 Conduct a preprocedure verification to make sure that all relevant documentation and
related information or equipment is available and correctly identified to the patient’s
identifiers.
 Verify that the laboratory and imaging studies have been completed, as ordered, and
that the results are in the patient’s medical record. Notify the doctor of any
unexpected results.
 Ensure that the patient has had nothing by mouth for 6 to 8 hours before the
procedure, except in emergency situations.
Nursing Responsibilities during the procedure (Intra-op)
 Have X-ray capabilities in the room
 Be prepared to assist the surgeon in applying a cast or splint.
 Check tank levels for power equipment before beginning the procedure.
 Have adequate help to hold up and stabilize arm during prepping and draping
procedure.
 If distal fracture (near wrist), a hand table (side extension table) may be used.
 An incision is made in the skin over the broken bone. Your healthcare provider will
put the broken bone pieces back together. Metal pins, screws, rods, or plates are
screwed into the side of the broken bones to hold them together while they heal.
Your healthcare provider may take some bone from your hip. The bone can be used
to help fix your broken leg.
 X-rays may be taken during surgery to help healthcare providers make sure your
broken bone is straight. The x-rays also tell your healthcare providers if the pins,
plates, and screws are placed correctly. Healthcare providers may put a hinge called
an external fixator on the outside of your broken bone. It will be taken off when your
bones have healed. The incision is closed with stitches. Steri-strips (thin strips of
 tape) may be put over your incision. A brace or cast will be put on your leg to keep
the bones straight while they heal.
Nursing Responsibilities after the procedure (Post-op)
You will be taken to a recovery room until you are fully awake. Healthcare providers will
watch you closely for any problems. When healthcare providers see that you are okay, you
will be taken to your hospital room. Do not get out of bed until your healthcare provider says
it is okay. A healthcare provider will check your bandage and brace or cast after surgery.
 Activity: Exercise your uninjured leg in bed when your healthcare provider says it is
okay. Lift your leg off the bed and draw big circles with your toes. This helps prevent
blood clots. Your healthcare provider will tell you when it is okay to get out of bed.
Call your healthcare provider before you get up for the first time. If you ever feel weak
or dizzy, sit or lie down right away then push your call button.
 Brace or cast: A brace or cast will be put on your broken leg after surgery.
 Take deep breaths and cough 10 times each hour. This will decrease your risk for a
lung infection. Take a deep breath and hold it for as long as you can. Let the air out
and then cough strongly. Deep breaths help open your airway. You may be given an
incentive spirometer to help you take deep breaths. Put the plastic piece in your
mouth and take a slow, deep breath, then let the air out and cough. Repeat these
steps 10 times every hour.
 Drains: Thin rubber tubes may be put into your skin to drain fluid from around your
incision. They will be taken out when the incision stops draining.
 You will be able to drink liquids and eat certain foods once your stomach function
returns after surgery. You may be given ice chips at first. Then you will get liquids
such as water, broth, juice, and clear soft drinks. If your stomach does not become
upset, you may then be given soft foods, such as ice cream and applesauce. Once
you can eat soft foods easily, you may slowly begin to eat solid foods.
Medicines:
 Antibiotics: This medicine helps fight infection caused by bacteria. Antibiotics may be
given by IV, as a shot, or by mouth.
 Antinausea medicine: This medicine may be given to calm your stomach and to help
prevent vomiting.
 Blood thinners: This medicine helps prevent clots from forming in the blood. Blood
thinners may be given before, during, and after a surgery or procedure.
 Pain medicine: Healthcare providers may give you medicine to decrease your pain.
This medicine may be given as a shot, by mouth, or through your IV. Tell healthcare
providers if the pain does not go away or comes back. A special pump may be used
that allows you to push a button and give yourself the medicine through your IV. This
is called patient-controlled analgesia and is set up so you cannot give yourself too
much medicine.
 Bowel movement softeners: This medicine helps soften your bowel movement to
prevent constipation. It will also help prevent straining when you have a bowel
movement.
 Pressure stockings: These are long, tight stockings that put pressure on your legs to
promote blood flow and prevent clots.
 Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to
an air pump. The pump tightens and loosens different areas of the boots to help
prevent blood clots.
PROSTATECTOMY
Definition
A prostatectomy is a surgical procedure for the partial or complete removal of the
prostate and is usually performed to relieve urinary obstruction cause by benign and
malignant diseases. It may be performed to treat prostate cancer or benign prostatic
hyperplasia.
Conditions that need this procedure
Prostatectomy may be indicated for patient having Benign Prostatic Hyperplasia
(BPH) also called prostate gland enlargement, prostatitis. Most often, prostatectomy is done
to treat localized prostate cancer. It may be used alone, or in conjunction with radiation,
chemotherapy and hormone therapy. Radical prostatectomy is surgery to remove the entire
prostate gland and surrounding lymph nodes to treat men with localized prostate cancer
Risk Factor

 Age
- Prostate cancer is rare in men younger than 40, but the chance of having
prostate cancer rises rapidly after age 50. About 6 in 10 cases of prostate cancer
are found in men older than 65.
 Race/ethnicity
- Prostate cancer develops more often in African-American men and in Caribbean
men of African ancestry than in men of other races.
 Geography
- Prostate cancer is most common in North America, northwestern Europe,
Australia, and on Caribbean islands. It is less common in Asia, Africa, Central
America, and South America.
 Family history
 Diet
 Obesity
 Smoking
 Inflammation of the prostate
 Sexually transmitted infections
 Vasectomy
Complication after the surgery
Potential complications may include the following:

 Hemorrhage and shock

 Infection
 Venous thromboembolism (VTE)
 Catheter obstruction
 Complications with catheter removal
 Erectile dysfunction (impotence)
 Narrowing of the urethra or bladder neck.
 Formation of cysts containing lymph (lymphocele)