Tanglao, Jeffrey B.

BSN215 Group 60 B
Generic Name/ Trade Name Phenylephrine HCl Ophthalmic Preparation 2.5% Solution Tropicamide Dosage / Frequency 3 Drops every 10 minutes Classification

DRUG STUDY (Drugs used for ECCE)

Indication Contraindications Side effects

Prof. Rosalie R. Villanueva 12 -14-2011

Nursing Responsibilities

Sympathomimetic Amine Ophthalmic Vasoconstrictor or Mydriatic

Decongestant and Vasoconstrictor and for Pupil Dilatation in Uveitis, open angle glaucoma, refraction, ophthalmoscopic examination, diagnostic procedures and before Intraocular Surgery

* Allergies with Phenylephrine * Severe hypertension * Ventricular Tachycardia * narrow angle glaucoma Used Cautiously with: * Thyrotixicosis * DM, HTN * CV Disorders * Prostatic Hypertrophy * Unstable Vasomotor Syndrome * Pregnancy * Lactation

*Headache * Blurred Vision * Photophobia * Difficulty with Night Vision * Rebound Meiosis * Significant BP elevation for Elder, Cardiac patients

~ Assess for the stated Contraindication ~ Assess skin Color, Orientation, reflexes, affect, Peripheral sensation, vision ~Monitor BP, pulse and peripheral perfusion ~ Ensure that the patient is adequately hydrated ~ Do not administer solutions that has turned brown or contained precipitates ~ Administer as follows: 1. Have the patient lie down and tilt the head backward 2. Hold the dropper above the eye and drop the medicine on the lower lid 3. Have the patient maintain the eye open and avoid blinking for 30 seconds 4. Apply gentle pressure on the inner corner of the eye with 1finger for 1minute ~ Do not administer other eye drops for the next 5 seconds ~Instruct the patient to report eye pain, vision changes, floating spots, eye redness, photosensitivity and headache.

Generic Name/ Trade Name

Dosage / Frequency 3 Drops every15 minutes

Classification

Indication

Contraindications

Side effects

Nursing Responsibilities

Diclofenac Sodium
Ophthalmic Drops

Anti-inflammatory NSAIDS ~ inhibit prostaglandin release thus producing anti inflammatory and anti pyretic effects

This drug can also be used as a post operative medication for inflammation after a Cataract Extraction.

~ This drug is contraindicated with patients with known hypersensitivity to Diclofenac, NSAIDS and patients with significant renal impairment. ~ It is also contraindicated with pregnant woman as it can cause teratogenic effects on the fetus.

~ Headache ~ Dizziness ~ Somnolence ~ Insomnia ~Ophthalmic Effects

~ Assess for the stated Contraindication ~ Assess skin Color, Orientation, reflexes, ophthalmologic and audiometric evaluation ~ Administer drug with food

~Arrange for periodic ophthalmic examination for prolonged use.

Tobramycin Sulfate Ophthalmic Drops

3 Drops(OS) every 4 hours

Aminoglycoside Antibiotics

Bactericidal inhibits protein synthesis in susceptible strains of gram negative bacteria; disrupts the bacterias functional cell wall integrity.

Ophthalmic Treatment of Superficial Ocular Infection due to susceptible strain of organisms.

* Allergies with Aminoglycoside * Pregnancy * Lactation Used Cautiously with elderly patients with ~ Diminished hearing ~ decreased renal function ~ dehydration ~ Neuromuscular disorders ~ herpes ~ Mycobacterial infections ~ Fungal Infections

~ Ototoxicity ~ Vestibular Paralysis ~ Disorientation ~ Nystagmus ~ Visual Disturbances ~ Headache ~ Numbness ~ Tingling ~ Palpitations ~ Hypotension/ Hypertension EENT: ~ Localized ocular toxicity ~ Lid itching ~ Conjunctival Irritation

~ Assess for the stated Contraindication ~ Arrange for culture and sensitivity before starting the therapy. ~ Use ophthalmic Tobramycin only when indicated by sensitivity tests ~monitor total serum concentration ~ Ensure that the patient is adequately hydrated

Generic Name/ Trade Name

Dosage / Frequency 3 Drops every15 minutes

Classification

Indication

Contraindications

Side effects

Nursing Responsibilities

Proparacaine Hydrochloride
Ophthalmic Drops

Local Anesthetic / Topical Ophthalmic Anesthetic

Used for suture removal from the cornea, tonometry, gonioscopy, removal of corneal foreign bodies, conjunctival scraping for diagnostic purposes & other short corneal & conjunctival procedures.

~ This drug is contraindicated with patients with known hypersensitivity to any component of the solution. ~This product should never be prescribed for the patient's own use.

~ Transient stinging & burning, ~ conjunctival redness. ~Prolonged use may result in corneal infection ~opacification ~permanent visual loss ~corneal perforation.

~ Assess for the stated Contraindication ~ Assess skin Color, Orientation, reflexes, ophthalmologic and audiometric evaluation ~Arrange for periodic ophthalmic examination for prolonged use. ~ Do not instill repeatedly

Operation Performed: Extra Capsular Cataract Lens Extraction

Extracapsular cataract extraction (ECCE) is a category of eye surgery in which the lens of the eye is removed while the elastic capsule that covers the lens is left partially intact to allow implantation of an intraocular lens (IOL). This approach is contrasted with intracapsular cataract extraction (ICCE), an older procedure in which the surgeon removed the complete lens within its capsule and left the eye aphakic (without a lens). The patient's vision was corrected after intracapsular extraction by extremely thick eyeglasses or by contact lenses.

PRE - OPERATIVE NURSING ACTIONS:

~ Secure consent for the operation ~ Verify patients identity ~ Complete pre-operation checklist, ensure that the patient is prepared for the procedure ~ Secure the patients belongings / personal items ~ Provide patient education about the procedure ~ Pre-medicate with prescribed Mydriatics as necessary ~ Get baseline Vital Signs and monitor for changes

POST - OPERATIVE NURSING ACTIONS:

~Ensure that they have a friend or relative drive them home after the procedure. ~Educate the client about the medicationsusually steroids and antibioticsin the operated eye before the patient leaves the clinic. ~ Inform the client to have their regular eyeglasses checked to see if their lens prescription should be changed. ~ Patients can carry out their normal activities within one to two days of surgery, WITH THE EXCEPTION OF HEAVY LIFTING OR EXTREME BENDING. ~ Patients should wear their protective eyeglasses during the day and tape an eye shield over the operated eye at night. ~ Instruct to wear sunglasses on bright days. ~ Avoid rubbing or bumping the operated eye ~ Instruct patients to use these eye drops exactly as directed. ~ Remind patients recovering from cataract surgery about the next checkups in the first few weeks following ECCE. ~ Administer pain medications as needed. ~ Educate patient on eye drops application and so as for other prescribed medication.