I.

Patients Profile A. Demographic data Name: Mr. Y Age: 85 y/o Sex: Mali Civil Status: married Religion: Roman Catholic Address: Poblacion Centro, Tubao, La Union Date of birth: April 29, 1927 Nationality: Filipino B. Environmental Status Their community is set in a rural environment where peace and order is well maintained by the barangay. The patient said, as he asked by the group to describe the house lamang that sa she lives in May gawa isang sa bungalow at na may ng yari sa concreto ang aming bahay pero sa banding kusina ay gawa kawayan. As he kwarto dalawang lote na bintana. continued, ang sukat

kinatatayuan ng bahay namin ay humigit kumulang seventy-two square meters. The patient is the one who maintains the cleanliness of their house which he does religiously every morning and after breakfast. Instead, They use mosquito with her nets as deterrent for mosquitoes. They dont have their own toilet bathroom. they share husbands parents near their house. As with the water pump, they have it at the back of their house located approximately 10 feet away. According furnace using to him, he as cooks fuel. their They food do in not a clay a

charcoal

have

refrigerator; instead, they buy their food daily from the market. their Her husband is usually far does from the the marketing market because other

location

quite

and

facilities. According to the patient, he is contented with

the security that the barangay officials are providing ion their community and the environment where he is currently residing.

C. Lifestyle The patient usually wakes at around six to seven oclock in the morning. he is also fond of chatting and socializing with neighbors. The patient as he claimed is omnivorous. She likes to drink coffee right after meal. he is also fond of eating salty and sweet foods like, as verbalized, salted peanuts, seafoods, junk foods, noodles, kakanin, and drink pop cola. As verbalized, Hindi ako naninigarilyo at umiinom ng alak. Wala akong bisyo magmula ng bata pa ako. The patient usually sleeps at around 9 oclock in the evening after watching televisio D. Family Health History According to the patient, they have a family history of cataract, hypertension, breast cancer, diabetes mellitus and asthma. E. History of Past Illness F. History of Present Illness The patients symptoms started last 2002. he experienced difficulty of seeing things and blurry visions. At first he ignored it but as he experiences it more often she worried for her health condition. of her Even his The relatives patient noticed that the the

enlargement

neck.

said

palpitations

occur

every

day

and

he

had

difficulty

of

sleeping at night.

II.

Anatomy and Physiology

Orbit - refers to the bony socket of the skull that contains the eyeball or globe, and the surrounding nerves, blood vessels, fat, connective tissue, and muscle. Precorneal tear film - The precorneal tear film is produced by the meibomian glands (outer fat layer), the lacrimal and nictitans

glands (watery layer), and the conjunctiva (inner fat layer). The tear film provides an optically smooth surface to the cornea, helps deliver nutrition to the cornea, and contains vitamins, enzymes, and other substances that affect corneal health. The cornea is one of the most sensitive tissues in the body. Corneal nerves are concentrated in the superficial (outer) cornea, with no nerves present in the Descemet's membrane. The limbus is located at the peripheral edge of the cornea and forms the transition zone between the clear cornea and the white sclera. In most horses, there is an obvious gray line at the limbus where ligaments bridging the iris and cornea are visible. The sclera is connected to the cornea and constitutes the major portion of the outer layer of the eyeball. Pupil--The pupil (hole in the iris) changes in size depending upon environmental light intensity-- it constricts in bright light and dilates in dim light to control the amount of light entering the lens. The lens is a transparent structure located behind the iris and held in place by ligaments. The horse uses the lens to focus on nearby objects. Optic disk--The horse's optic disk (which is also called the optic papilla or optic nerve head)contains ganglion cell nerve fibers and can be seen with the ophthalmoscope. Retina--The retina is the most complex structure of the eye and is the most metabolically active tissue in the body. It converts light energy into chemical energy to generate the electrical signal that is conducted to the brain in order for the horse to see.

III.

Pathophysiology Cataract Senile Main problem: the lens ages, its weight and thickness increases while its accommodative power decreases

Risk factors: Female gender Older than 40 years old heriditary Low iodine intake African-Americans seem to have nearly twice the risk of developing cataracts Over exposure to sunlight Smoking and alcohol use

Diagnostic tests and laboratory results: Visual Acuity: A visual acuity test measures your quality of vision at certain distances. Your doctor will ask you to read letters of various sizes from a chart. Your eyes will be tested individually and together to measure the accuracy of your eyesight at different distances. A visual acuity test is an easy, painless, and quick way to diagnosis cataracts, although more tests will be needed to make sure cataracts are the cause of your vision problems. Contrast Sensitivity: Contrast sensitivity testing is similar to visual glare acuity caused testing by the but places Eye greater doctors emphasis consider on how cataracts can decrease image contrast due to light scattering and cataract. contrast sensitivity testing to be a more realistic measurement of true quality of vision.

Slit Lamp: A slit lamp is a special type of microscope that magnifies your eye so your doctor can examine the lens to determine the presence and severity of a cataract. Your doctor will ask you to place your chin on the chin rest of the slit lamp. A light will then be directed at your eye. By looking through the slit lamp, your doctor can examine the lens to determine the degree to which it is clouded. Pupil Dilation: Pupil dilation is a common test used in

diagnosing cataracts. Clouding of

the lens is

not noticeable

until a cataract reaches an advanced stage. When your eye is dilated, however, the pupil increases in size, offering a view of your entire lens. By thoroughly examining the lens, a doctor can determine whether or not a cataract is affecting your quality of vision.

Signs and Symptoms: decrease in clarity of vision, not fully correctable with glasses loss of contrast sensitivity Haloes may be observed around lights Night vision will be diminished will look grey or white to the observer shadows and color vision are less vivid

Treatment: Surgery (Anterior chamber implants, Posterior chamber implants, Small Incision Cataract Surgery, Intracapsular surgery, Phacaemulsification, Cataract Surgery, Extracapsular surgery)

IV.

Patients Preparation A. Skin preparation The skin around the eye was cleansed with antiseptic solution. B. Drapings Sterile C. Position The patient was placed in a supine position with the head turned to the side. (eyeto be operated is up and the dependent ear is well padded) stabilized ina padded, foam, or gel headrest D. Anesthesia used The thyroid surgery was performed with general anesthesia. The specific type using of general anesthesia tube a using was endotracheal by the Before anesthesia endotracheal inserted sheets or towels were draped above the head, keeping only eye visible.

anesthesiologist

(intubation)

laryngoscope.

intubation, the anesthesiologist put the patient to sleep and prevented muscle spasm. other pre-anesthetic drugs were given through IV before the intubation. After inserting the tube, the anesthesiologist checked the patency and the level of the tube until it was inserted and when its intact the tube was connected to the breathing circuit connected to the anesthesia machine. V. Operative procedure After the patient was anesthetized, the surgeon determined the very small incision line measuring bilaterally from the eye. Then he made about 1/8 inch in the white of the eye near the outer edge of the cornea. A small ultrasonic probe is inserted through this opening and, oscillating at 40,000 cycles per minute, is used to break up (emulsify) the cataract into tiny pieces. The emulsified material is simultaneously suctioned from the eye by the open tip of the same instrument. The hard central core of the cataract (the nucleus) is removed first, followed by

extraction of the softer, peripheral cortical fibers that make up the remainder of the lens. The front (anterior) section of the lens capsule is removed along with the fragments of the natural lens. The back (posterior) portion of the capsule is left in place to hold and maintain the correct position for the implanted intraocular lenses. Next, After removal of the cataract, a prescription intraocular lens, or IOL, is permanently implanted in the lens capsule to replace the natural crystalline lens of the eye that was removed during the surgery. This lens is rolled inside a tiny hollow tube and inserted through the same incision that was used to remove the cataract. The folded lens is pushed out of the tube by a tiny plunger and, as it unfolds, is positioned by the surgeon in the center of the lens capsule. The new lens is held in place by microscopic, spring-like wires that are attached to the implant. Finally, he closed the incision and applied dressing on top. VI. OR instruments used

1. This lens is designed for wide angle viewing of phakic, fluid filled eyes during vitrectomy and helps in visualization of the posterior and peripheral fundus in phakic and aphakic eyes. It is also useful in endolaser of peripheral fundus. 2. These flexible nylon hooks retract the iris with minimal damage to the tissue and provide a fast and simple method for temporary pupil enlargement. 3. This helps in safe back flushing of the incarcerated tissue during passive aspiration of intra ocular fluids. 4. Circular expansion and stabilization of the periphery of the capsular bag Reduced risk of capsular fibrosis Reduced risk of capsular shrinking Safe IOL centration in eyes with zonular dehiscence Stabilized conditions during (phaco emulsification) surgery 5. Helps in stabilizing the nucleus in cases of PC rupture. 6. It helps to insert the endocapsular ring in the capsular bag in a very controlled manner, making it extremely easy to use. 7. Useful for atraumatic brushing of the retinal surface with simultaneous aspiration. Useful for repositioning of retinal folds or breaks. 8. Maintains the position of the capsule during phaco. Supports the fornix as well as the capsulorhexis rim, so that the peripheral capsule isn't attracted towards the phaco tip. Avoids the problem of the capsular tension ring trapping cortex. Prevents zonular stress during nuclear rotation. Makes it possible to perform posterior chamber phaco even with subluxated lenses having minimum zonular support.

UNIVERSITY OF BAGUIO SCHOOL OF NURSING

University of Baguio School of Nursing

OR WRITE-UP: Phacoemulsification

SUBMITTED BY: Marion Dela Vega Rinwa Guiang

-NPA2-

SUBMITTED TO: Ms.