Madam A, 60-year-old, complain of blurring of vision.

The doctor has

diagnosed her to have cataract and scheduled for extracapsular
1.cataract extraction and had successfully undergone the operation.

a) Define cataract.
A cataract is an opacification (clouding) of the lens of the eye which
interfere with light transmission to retina and ability to perceive images
clearly.

2.Madam A, 60-year-old, complain of blurring of vision. The doctor has

diagnosed her to have cataract and scheduled for extracapsular cataract
extraction and had successfully undergone the operation.

b) State THREE (3) types of cataract.

i. Congenital Cataract (Punctate cataract, Zonular cataract, Coronary
cataract)
ii. Diabetic cataract.
iii. Traumatic cataract.
3. Madam A, 60-year-old, complain of blurring of vision. The doctor has
diagnosed her to have cataract and scheduled for extracapsular cataract
extraction and had successfully undergone the operation.
c) Explain the nursing intervention to prevent post operative complication
of:
i) Potential for increased intraocular pressure related to the surgery.

1. Assess for potential surgical complications such as pain, hemmorhage, flashes of light, and
sensation of curtain being drawn over the eye and cloudy apperanced. Evidence of any of the above
manifestations or unusual complaints by the client should be reported to the physician.

2. Assess dressings of surgery for the presence of bleeding or drainage from the eye, as either
indicate a surgical complication.

3. Maintain the eye patch or eye shield in place. The eye patch or shield helps prevent inadvertent
injury to the operative site.

4. Place the client in a semi-Fowler’s or Fowler’s position, having the client lie on the unaffected side.
These positions reduce intraocular pressure in the affected eye.

5. Assess the client, and medicate or assist to avoid vomiting, coughing, sneezing, or straining as
needed. These activities increase intraocular pressure.

6. Approach the client on the unaffected side. This approach facilitates eye contact and
communication.

7. Administer antibiotic, anti-inflammatory, and other systemic and eye medications as prescribed.
Medications are prescribed postoperatively to prevent infection or inflammation of the operative
site, maintain pupil constriction,and control intraocular pressure.

8. Administer antiemetic medication as needed. It is important to prevent vomiting to maintain

normal intraocular pressures.
4. Madam A, 60-year-old, complain of blurring of vision. The doctor has
diagnosed her to have cataract and scheduled for extracapsular cataract
extraction and had successfully undergone the operation.

c) Explain the nursing intervention to prevent post operative complication

of:

ii) Potential for infection.

1. Monitor and report immediately any signs and symptoms of
complications to the doctor.
I.Vital sign. Elevated temperature may indicated infection.
II.Blood investigation. Increase number of White Blood Count may
indicated infection.
III.Postoperative eye. Assess for sign and symptoms infection such
redness, tenderness, swelling and pus.

2. Maintain strict aseptic technique, perform handwashing or handrub

frequently. It would minimize infection. Always wash hand before
touching or cleaning the postoperative eye.

3. Instruct patient to wear glasses or metal eye shield at all times. A

shield or glasses should be worn for protection during the day to protect
the eye from accidental injury and potential of infection.

4. Instruct patient to cover postoperative eye during bath or shampoo to

prevent infection and seek assistance if indicated.

5. Give medications as prescribed, according to prescribed techniques.

Antibiotic drug helps prevent infection and inflammation
6. Provide high protein diet and high vitamin c supplement to increase
immunity body and prevent infection.

7. Advice and teach the patient how to administer antibiotic ointment or

drops; including steroids to prevent infection and inflammation as
ordered by doctor such as Gutt ciprofloxacin.

5. Mr. J, a 60-year-old pensioner is newly diagnosed with

nasopharyngeal cancer and is treated with radiation therapy.

a) State SEVEN (7) warning signs of cancer.

1. Change in bowel or bladder habits.
2. Unusual bleeding or discharge.
3. Thickening or lump in the breast or elsewhere.
4. A sore that does not heal.
5. Obvious change in a wart or mole.
6. Nagging cough or hoarseness.
7. Indigestion or difficulty in swallowing.
6. Mr. J, a 60-year-old pensioner is newly diagnosed with
nasopharyngeal cancer and is treated with radiation therapy.

c) Discuss the nursing interventions with rationales for the following

nursing diagnosis:

Risk for impaired skin integrity related to radiation therapy.

1.Assess the patient’s skin at treatment site such as rashes, abrasion,
redness and outbrakes. Prior assessment of wound etiology is critical for
proper identification of nursing intervention.
2.Assess surface that patient spends majority of time on such as pillow
and mattress. The friction against the pillow can induce inflammation at
treatment site.
3.Recommend patient to wearing soft, loose cotton clothing to protects
skin from ultraviolet rays and reduces risk of recall reactions.
4.Educate patient not to apply any lotion or ointment at treatment site.
Topical agents might increase the radiation dose to the skin and induce
irritation at treatment site.
5. Instruct patient to turn or reposition frequently to promotes circulation
and prevents undue pressure on skin and tissues.
6.Educate patient not to scratch at treatment site to reduce shearing
forces on the skin.
7.Advice patient to drink water 6 to 8 glass per day. Sufficient hydration
and help maintain skin turgor, moisture, and suppleness which provide
resilience to damage caused by pressure.
8.Educate patient to seek for treatment if the skin condition worsen.
Early treatment can reduce worsen complication.
7. Mr K, 45-year-old complains of severe right ear pain. After physical
examination doctor has diagnosed him with otitis media on the right ear
and need to hospitalize for further treatment.

a) Define otitis media

Inflammation or infection of middle ear caused by various type of
bacteria, depending on patient’s age and type of infection.

8. Mr K, 45-year-old complains of severe right ear pain. After physical

examination doctor has diagnosed him with otitis media on the right ear
and need to hospitalize for further treatment.

b) State the pathogenesis stages in otitis media.

This problem mainly associated with eustacian tube dysfunction.
Otitis media begins as an inflammatory process following a viral upper
respiratory tract infection involving the mucosa of the nose,
nasopharynx, middle ear mucosa, and eustachian tubes.
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella
catarrhalis are the most common organisms.
Bacteria can enter the eustachian tube from contaminated secretions in
the nasopharynx and the middle ear from the tympanic membrane
perforation.
A purulent exudate is usually present in the middle ear, resulting in a
conductive hearing loss.
9. Mr K, 45-year-old complains of severe right ear pain. After physical
examination doctor has diagnosed him with otitis media on the right ear
and need to hospitalize for further treatment.

c) Describe THREE managements for otitis media.

1. Pharmacology:
 Administer analgesic as ordered by doctor such as IV tramal 50mg
TDS, Tablet Paracetamol 1gram QID to relieve pain and reduce
fever.
 Administer Antibiotic such Iv Augmentin 1.2gram TDS to reduce
the infection.
 Administer Antihistamine such as Tablet Loratidine 1 0mg OD
antihistamines may reduce the congestion of mucous membranes
and decrease obstruction of tubes lined by mucous membrane,
such as the Eustachian tube.
 Administer oral Decongestants, used to reduce the mucosal
edema of the auditory tube and improve its patency.

2. Nursing management:
 Rest patient in bed for comfort patient and reduce pain.
 Advice patient to chew gum or suck hard candy when flying to
open the eustachian tube & allow air into the middle ear
 Advice patient to keep ear dry and avoid water gets into the ear
 Assess vital sign and laboratory data. Elevated temperature and
increase number of WBC may indicated infection.
 Provide divertional therapy such reading book and watching
television to avoid distraction and reduce pain.

3. Surgical management :
Myringotomy. An incision is made into the tympanic membrane to relieve
pressure and to drain serous or purulent fluid from the middle ear.
10. Mr K, 45-year-old complains of severe right ear pain. After physical
examination doctor has diagnosed him with otitis media on the right ear
and need to hospitalize for further treatment.

d) Describe nursing intervention for “Pain related to swelling of tympanic

membrane.”
1. Provide rest to patient such as semi fowlers position to reduce pain.
2.Assess and document pain characteristics use pain assessment
tools. Patient’s self-report is the most reliable information about the
chronic pain experience and to evaluate effectiveness of treatment.
3.Observe ear canals for the sign of infection such as inflammation,
swelling redness or ear discharge is possible cause of ear pain to
compare pretreatment symptom and posttreatment outcome.
4. Administer Analgesic as ordered by doctor such as Iv Tramadol
50mg tds /prn to relieve ear pain.
5. Encourage patient to do divertional therapy such as reading book or
watching TV to minimize distraction of pain.
6.Plan care activities and all procedure around periods of greatest
comfort whenever possible. Pain diminishes activity.
7. Perform the procedure such as aural toilet with care and gently to
reduce pain.
8. Provide moral support such as explanation and reassurance and
breathing exercise or relaxation technique.
9. Encourage soft diet. Avoid spicy food nd drink plenty of water.
11.Mr K, 45-year-old complains of severe right ear pain. After physical
examination doctor has diagnosed him with otitis media on the right ear
and need to hospitalize for further treatment.

e) Explain health education to Mr K to prevent from recurrent otitis

media.
Explain to the patient the cause and symptoms of otitis media to provide knowledge and increase
cooperation.

2. Advice patient to take antibiotic, analgesic and other medications as prescribed. Avoid Over
The Counter (OTC) medication.

3. Instruct patient to keep hygiene such as handwashing to prevent contamination.

4. Instruct patient to keep ear dry. Avoid diving and swimming and using ear plug.

5. Teach patient to protect the ear canal with cotton or lamb’s wool while bath or shampoo.

6. Encourage patient to increased fluid intake, good nutrition, and adequate rest. Decreases
susceptibility to infection.

7. Eliminate allergens and airway irritants such as tobacco, smoke, and dust. Passive smoking
contributes to increase the incidence of otitis media.

8. Advice patient avoid over crowded place to prevent infection from others.

9. Limit visitors and avoid exposure to people with existing upper respiratory infections.Other
people can spread infections or colds to a susceptible patient through direct contact, contaminated
objects, or through air currents.

10. Educate patient to monitoring hearing loss. If persistently having hearing loss advise patient
to seek medical treatment immediately.

11. Keep follow-up appointments until the tympanic membrane is normal. Stress patient the
important of TCA.

Change in bowel or bladder habits.

• This could indicate cancer of the bowel, prostate,bladder, or
kidney. Cancer of the bowel causes blockage in the passage, which can
lead to constipation, diarrhea, gas pains, blood in the stool, and rectal
bleeding
2. A sore that does not heal.
• These could indicate mouth or skin cancers. These sores are often
painless, so do not wait until you feel pain before you seek help.
3. Unusual bleeding or discharge.
• For example, unusual vaginal bleeding or discharge may be early
signs of cancer of the uterus, which can often be cured when detected
early. Fortunately the Pap test can find cervical cancer in its earliest and
most curable stage, before there are any signs or symptoms.
4. Thickening or lump in the breast or elsewhere.
• This especially applies to the breast for women and to the testicles
for men.
5. Indigestion or difficulty in swallowing.
• These can be symptoms of cancer of the stomach and esophagus
6. Obvious change in a wart or mole.
• Cancer can develop in almost any area of the skin, especially
those parts that are often exposed. Skin cancer may appear as a dry,
scaly patch; a pimple that persists; an inflamed area with a crusting
center; or as a firm nodule. Malignant melanoma, a relatively uncommon
cancer of the skin, usually occurs as a dark brown or black, small, mole-
like growth. Any mole that becomes larger, bleeds, or becomes an open
sore should be considered suspicious.
7. Nagging cough or hoarseness.
• This may indicate either lung cancer or cancer of the throat, known
as laryngeal cancer