Pre-Operative # Fear and anxiety related to the surgery Post Operative # Risk of Fall due to Impaired Vision #Risk

of Eye Infection related to Surgery #Pain related to surgical wound #Knowledge Deficit related to Eye Care

Objective: Patient express less fear and anxiety Nursing Intervention: 1-Introduce self and ward staff. Establish a therauputic relationship. : So client feel comfortable 2- Orientate patient to ward routine : To make client at ease and gain client confidence 3-Demonstrate a caring and polite attitude : So client feel comfortable and less fear 4- Assess clients knowledge regarding the operation : To facilitate health education 5-Reinforce doctors explanation : Makes client understand better 6-Introduce patient to another patient that had gone the same operation To gain clients confidence 7-Explain all physical preparation and post operative expectations pre operatively 8- encourage family members to visit To give a continous moral support

Objective: Client does not sustain any eye injury

1-Transfer patient with care from trolley to the bed with hand support the head Aggrassive movemoent can cause eye bleeding 2-Place patient in unoperated side (recumbent/lateral) To avoid pressure on the operated eye 3- Ensure patient had eye pad/ Castella shield over the operated eye To protect from injury 4-Advise patient to rest in bed for 24hours To prevent from increase in IOP 5-Teach patient to use call bell To call for assisstance 6-Reorientate patient when fully conscious Help patient to remember the surrounding 7-Place locker on the side of the good eye So client easy to grab things and avoid putting pressure on operated eye 8. Assist patient to ambulated when permitted Prevent from fall

Objective: Patient are at no risk of eye infection

1-Observe condition of eye 24 hours post-op To detect any signs of infection eg redness, tearing, discharge 2-Perform eye dressing QID using aspetic technique To prevent cross infection 3-Instill antibiotics drops- Gutt Chloramphenicol pre and post-op As a prophylaxis 4-Take vital signs QID especially temperature To detect fever that indicate sign of infection 5-Take eye swab for culture and sensitivity if there is eye disharge To detect causative organism and treat appropriately 6-Instill Gutt Dextrosone (Maxidex) as ordered To reduce inflammation 7- Cover operated eye with castella shield To protect from dust 8-Instill antibiotic drops every 15minutes as ordered eg Gutt Gentamycin To treat eye infection

 1- Remind patient to inform nurse immediately for any pain

over the operated eyes For rapid intervention can be taken 2- Assess patients level of pain and document in nursing report So right intervention depends on level of pain can be taken 3- Administer analgesics as ordered by the doctor Eg- Oral Tramal 500mg prn To reduce level of pain 4-Reassess effect of analgesics after half an hour To evaluate the effectiveness of the medication 5-Check patient eye pad/ bandage To detect any bloood stain, discharge 6-Advise patient to rest in bed To decrease level of pain

 Objective: Patient is knowlegable about the eye care 1- Teach patient how to:

a- Prevent eye infection

Wash hand with soap and water, rinse and dry. Clean the eye using cool boiled water, cotton

swabs and clean container Instill eye drops as ordered Not to go over crowded area- Night market, shopping mall

 Wear castella shield day and night for 1 week, at night

for 2-3 weeks Avoid pressure, squeezing and wrinkles eyes, carrying infant Touch eye unnessarily Purposely wink on the operated eye Wipe away tears with hand Bend head agrresively Lie on operated eye Do not eat on the operated side Do not bite hard food Do not cough or sneeze with mouth closed Do not shave his beard (men)

 Wear dark sunglasses outdoors to prevent from

UV rays

d. Prevent strain on the eye

Do not try to reach for objects that are out of

reach Straining during defecation Sneezing/coughing with mouth closed Avoid driving for 1 month Do not reading or watching TV for prolonged time Do not lifting heavy objects >5kg Do no participating on certain sport-Rugby

1- Can wash face but ensure soap doesnt get into the eyes 2-Can shower but face held away from shower head 3- Can reading or watch tv but not for prolong time. Rest eye in between 4. Muslim can pray but cannot bend head below waist level 5. Ladies can makeup but not for 1-2 weeks post-operatively

 Take a well balanced diet with more fluids,

fruit and fiber Regular follow up to evaluate progress Advise patient to seek prompt treatment if any complications arise eg severe eye pain