DEPARTMENT OF INPATIENT Pre - operative Ophthalmic Nursing care.

DEPARTMENT OF INPATIENTDEPARTMENT OF INPATIENT

Pre - operative Ophthalmic Nursing carePre - operative Ophthalmic Nursing care

Preoperative EvaluationPreoperative Evaluation

Once the patient has been admitted in the Once the patient has been admitted in the ward for surgery or treatment, as per the ward for surgery or treatment, as per the instructions in the case sheet, the OA has instructions in the case sheet, the OA has to do the necessary tests and record them to do the necessary tests and record them in the case sheet. in the case sheet.

The following tests are done prior to the The following tests are done prior to the intra ocular /cataract surgery.intra ocular /cataract surgery.

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Routine preoperative testsRoutine preoperative tests

Special situationsSpecial situations

Systemic ConsiderationsSystemic Considerations

Assisting the doctor in examining PatientsAssisting the doctor in examining Patients

Pre operative Counselling.Pre operative Counselling.

Routine preoperative testsRoutine preoperative tests Visual acuityVisual acuity

RefractionRefraction

Intraocular pressure (IOP)Intraocular pressure (IOP)

SyringingSyringing

A - scan, K- reading A - scan, K- reading

Random blood sugar (RBS)Random blood sugar (RBS)

Visual acuityVisual acuity• Vision should be tested with and without Vision should be tested with and without

glasses and with pinhole.glasses and with pinhole.

• In advanced and mature cataract, In advanced and mature cataract, perception and projection of light should perception and projection of light should be tested in four quadrants to rule out be tested in four quadrants to rule out retinal problems.retinal problems.

• Normal Visual acuity is 6/6Normal Visual acuity is 6/6

• Both the eyes should be refracted.Both the eyes should be refracted.

• If the extent of cataract does not correspond If the extent of cataract does not correspond to the visual loss, posterior segment to the visual loss, posterior segment pathology should be ruled out.pathology should be ruled out.

• In such cases the possibility of poor In such cases the possibility of poor prognosis should be explained to the patient prognosis should be explained to the patient before the surgery.before the surgery.

RefractionRefraction

• Usually IOP is tested by Schiotz / non Usually IOP is tested by Schiotz / non contact tonometer in both eyes.contact tonometer in both eyes.

• The IOP must be normal before cataract The IOP must be normal before cataract surgery.surgery.

• If IOP is raised, it is conformed by If IOP is raised, it is conformed by applanation tonometry and glaucoma clinic applanation tonometry and glaucoma clinic opinion is obtainedopinion is obtained

Intraocular pressureIntraocular pressure

SyringingSyringing• Patency of nasolacrimal duct should be tested.Patency of nasolacrimal duct should be tested.

• If the duct is partially free/Not free with clear fluid , hourly If the duct is partially free/Not free with clear fluid , hourly antibiotic drops is started and conjunctival Swab is taken for antibiotic drops is started and conjunctival Swab is taken for culture sensitivity.culture sensitivity.

• The operation is performed only after the culture shows no The operation is performed only after the culture shows no growth.growth.

• If duct is not free, with mucus or purulent discharge, If duct is not free, with mucus or purulent discharge, DCR/DCT has to be done and cataract surgery can be done DCR/DCT has to be done and cataract surgery can be done after one month.after one month.

A – Scan, K-readingA – Scan, K-reading It is essential in case of IOL surgeryIt is essential in case of IOL surgery

It gives the power of Plano convex IOL and +2 is It gives the power of Plano convex IOL and +2 is added to this for biconvex IOL.added to this for biconvex IOL.

In case of scarred cornea and irregular surface In case of scarred cornea and irregular surface of cornea, the K reading will not be possible.of cornea, the K reading will not be possible.

In this case the other eye should be taken into In this case the other eye should be taken into considerationconsideration

Random blood sugar (RBS)Random blood sugar (RBS) RBS test is compulsory for all cataract RBS test is compulsory for all cataract

patients to ensure that they are not patients to ensure that they are not diabetic. diabetic.

Normal RBS value is < 160Mgs.Normal RBS value is < 160Mgs.

If the patient’s Blood sugar is raised, If the patient’s Blood sugar is raised, additional tests like FBS and PPBS are additional tests like FBS and PPBS are done.done.

Special situationSpecial situation

• B – Scan done in cases of mature cataract B – Scan done in cases of mature cataract (With other eye having any fundas pathology like (With other eye having any fundas pathology like diabetic retinopathy ) and traumatic or diabetic retinopathy ) and traumatic or complicated cataract.complicated cataract.

• In one eyed patients, conjunctival culture In one eyed patients, conjunctival culture sensitivity has to be done before surgery.sensitivity has to be done before surgery.

Systemic considerationSystemic consideration• Blood Sugar estimationBlood Sugar estimation

• Blood Pressure RecordingBlood Pressure Recording

• Cardiac EvaluationCardiac Evaluation

• AsthmaAsthma

• Renal failure and renal transplantationRenal failure and renal transplantation

• Allergic conditionsAllergic conditions

Blood Sugar EvaluationBlood Sugar Evaluation

• FBS Normal 70 to 100 MgsFBS Normal 70 to 100 Mgs

• PPBS Normal 80 to 120 MgsPPBS Normal 80 to 120 Mgs

• Diabetes should be well under control. If not controlled, Diabetes should be well under control. If not controlled, physician's opinion must be taken and treatment given physician's opinion must be taken and treatment given according to the advice.according to the advice.

• On the day of operation, oral hypoglycemic agents is On the day of operation, oral hypoglycemic agents is avoided in the morning and only 1/3avoided in the morning and only 1/3rdrd of dose of insulin is of dose of insulin is given to prevent hypoglycemia.given to prevent hypoglycemia.

Blood Pressure recordingBlood Pressure recording

•Normal B.P 120/80 MMHG

•Systolic < 160 mmhg

•Diastolic < 90 mmhg

•If B.P high, physician’s opinion is taken.

• Pupilary dilatation is achieved with plain Pupilary dilatation is achieved with plain tropicamide, or cyclopentolate.tropicamide, or cyclopentolate.

• Phenylephrine and adrenaline should be Phenylephrine and adrenaline should be avoided.avoided.

• Important investigations like blood urea, Important investigations like blood urea, serum creatinine and serum cholesterol serum creatinine and serum cholesterol may be done according to the physician's may be done according to the physician's advice.advice.

CardiacCardiac• Surgery should be performed only after Surgery should be performed only after

six months of the previous attack of MI.six months of the previous attack of MI.

• Phenylephrine and adrenaline should be Phenylephrine and adrenaline should be avoided.avoided.

• Surgery must be done under cardiac Surgery must be done under cardiac monitoring.monitoring.

AsthmaAsthma• In asthmatic patients, chest auscultation should In asthmatic patients, chest auscultation should

be done for the presence of rhonchi.be done for the presence of rhonchi.

• Patients should continue the anti asthmatic Patients should continue the anti asthmatic treatment.treatment.

• An injection of Broncho dilator can be given An injection of Broncho dilator can be given before surgery to make the patient comfortable before surgery to make the patient comfortable on the operation table (if needed).on the operation table (if needed).

• Airway in OTAirway in OT

Renal failure and renal transplantationRenal failure and renal transplantation

• Blood urea and serum creatinine should be doneBlood urea and serum creatinine should be done

• Nephrotoxic drugs likes ( NSAIDS, Diamox) should Nephrotoxic drugs likes ( NSAIDS, Diamox) should be avoided.be avoided.

History of Allergy:History of Allergy: - -

• It is mandatory to get the information from the It is mandatory to get the information from the patient and record it in the case sheet.patient and record it in the case sheet.

• If the patient has any history of medicinal allergy, a If the patient has any history of medicinal allergy, a xylocaine test dose must be given before giving xylocaine test dose must be given before giving local anaesthesia.local anaesthesia.

Assisting the doctor in examining PatientsAssisting the doctor in examining Patients

• In the ward, the ward OA has to give the In the ward, the ward OA has to give the doctors all the details about the patients.doctors all the details about the patients.

• The doctor checks the patient in the slit lamp The doctor checks the patient in the slit lamp and records the findings.and records the findings.

• The OA assists the doctor in all the procedures.The OA assists the doctor in all the procedures.

• The OA has to adhere to the instructions given The OA has to adhere to the instructions given by the doctor.by the doctor.

Pre operative CounsellingPre operative Counselling• Depending on the patient’s emotional state and their Depending on the patient’s emotional state and their

situation Counselling should be given.situation Counselling should be given.

• Knowledge of the patient should be analyzed to know Knowledge of the patient should be analyzed to know whether there is an awareness about the surgery.whether there is an awareness about the surgery.

• The patients should be told about the nature of the disease, The patients should be told about the nature of the disease, the treatment procedure, the surgical method, and the type the treatment procedure, the surgical method, and the type of anesthesia (retro bulbar, facial, topical)of anesthesia (retro bulbar, facial, topical)

• Importance of the surgery, complications and positive Importance of the surgery, complications and positive results should be explained to the patients.results should be explained to the patients.

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• Usual duration of stay, Date and timing of the Usual duration of stay, Date and timing of the surgery and should be informed.surgery and should be informed.

• Duration of the surgery need not be informedDuration of the surgery need not be informed

• The facilities provided by the hospital should be The facilities provided by the hospital should be clearly explained.clearly explained.

• Ask the patients to relax and inform them the Ask the patients to relax and inform them the time they have to be ready for the surgery.time they have to be ready for the surgery.

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• Counsel the patients to have no fear about Counsel the patients to have no fear about the surgery.the surgery.

• Ensure them that the OA will be there to help Ensure them that the OA will be there to help them at any time.them at any time.

• Before the day of surgery the OA has to Before the day of surgery the OA has to clean the periorbital area with iodine.clean the periorbital area with iodine.