Transcript Preoperative Ophthalmic nursing care

DEPARTMENT OF INPATIENT
Pre - operative Ophthalmic Nursing care
Preoperative Evaluation
 Once the patient has been admitted in the
ward for surgery or treatment, as per the
instructions in the case sheet, the OA has
to do the necessary tests and record them
in the case sheet.
 The following tests are done prior to the
intra ocular /cataract surgery.
Cont….
 Routine preoperative tests
 Special situations
 Systemic Considerations
 Assisting the doctor in examining Patients
 Pre operative Counselling.
Routine preoperative tests
 Visual acuity
 Refraction
 Intraocular pressure (IOP)
 Syringing
 A - scan, K- reading
 Random blood sugar (RBS)
Visual acuity
• Vision should be tested with and without
glasses and with pinhole.
• In advanced and mature cataract,
perception and projection of light should
be tested in four quadrants to rule out
retinal problems.
• Normal Visual acuity is 6/6
Refraction
• Both the eyes should be refracted.
• If the extent of cataract does not correspond
to the visual loss, posterior segment
pathology should be ruled out.
• In such cases the possibility of poor
prognosis should be explained to the patient
before the surgery.
Intraocular pressure
• Usually IOP is tested by Schiotz / non
contact tonometer in both eyes.
• The IOP must be normal before cataract
surgery.
• If IOP is raised, it is conformed by
applanation tonometry and glaucoma clinic
opinion is obtained
Syringing
• Patency of nasolacrimal duct should be tested.
• If the duct is partially free/Not free with clear fluid , hourly
antibiotic drops is started and conjunctival Swab is taken
for culture sensitivity.
• The operation is performed only after the culture shows no
growth.
• If duct is not free, with mucus or purulent discharge,
DCR/DCT has to be done and cataract surgery can be
done after one month.
A – Scan, K-reading
 It is essential in case of IOL surgery
 It gives the power of Plano convex IOL and +2 is
added to this for biconvex IOL.
 In case of scarred cornea and irregular surface
of cornea, the K reading will not be possible.
 In this case the other eye should be taken into
consideration
Random blood sugar (RBS)
 RBS test is compulsory for all cataract
patients to ensure that they are not
diabetic.
 Normal RBS value is < 160Mgs.
 If the patient’s Blood sugar is raised,
additional tests like FBS and PPBS are
done.
Special situation
• B – Scan done in cases of mature cataract
(With other eye having any fundas pathology like
diabetic retinopathy ) and traumatic or
complicated cataract.
• In one eyed patients, conjunctival culture
sensitivity has to be done before surgery.
Systemic consideration
• Blood Sugar estimation
• Blood Pressure Recording
• Cardiac Evaluation
• Asthma
• Renal failure and renal transplantation
• Allergic conditions
Blood Sugar Evaluation
• FBS Normal 70 to 100 Mgs
• PPBS Normal 80 to 120 Mgs
• Diabetes should be well under control. If not controlled,
physician's opinion must be taken and treatment given
according to the advice.
• On the day of operation, oral hypoglycemic agents is
avoided in the morning and only 1/3rd of dose of insulin
is given to prevent hypoglycemia.
Blood 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
tropicamide, or cyclopentolate.
• Phenylephrine and adrenaline should be
avoided.
• Important investigations like blood urea,
serum creatinine and serum cholesterol
may be done according to the physician's
advice.
Cardiac
• Surgery should be performed only after
six months of the previous attack of MI.
• Phenylephrine and adrenaline should be
avoided.
• Surgery must be done under cardiac
monitoring.
Asthma
• In asthmatic patients, chest auscultation should
be done for the presence of rhonchi.
• Patients should continue the anti asthmatic
treatment.
• An injection of Broncho dilator can be given
before surgery to make the patient comfortable
on the operation table (if needed).
• Airway in OT
Renal failure and renal transplantation
• Blood urea and serum creatinine should be done
• Nephrotoxic drugs likes ( NSAIDS, Diamox) should
be avoided.
History of Allergy: • It is mandatory to get the information from the
patient and record it in the case sheet.
• If the patient has any history of medicinal allergy, a
xylocaine test dose must be given before giving
local anaesthesia.
Assisting the doctor in examining Patients
• In the ward, the ward OA has to give the
doctors all the details about the patients.
• The doctor checks the patient in the slit lamp
and records the findings.
• The OA assists the doctor in all the procedures.
• The OA has to adhere to the instructions given
by the doctor.
Pre operative Counselling
• Depending on the patient’s emotional state and their
situation Counselling should be given.
• Knowledge of the patient should be analyzed to
know whether there is an awareness about the
surgery.
• The patients should be told about the nature of the
disease, the treatment procedure, the surgical
method, and the type of anesthesia (retro bulbar,
facial, topical)
• Importance of the surgery, complications and
positive results should be explained to the patients.
Cont…
• Usual duration of stay, Date and timing of the
surgery and should be informed.
• Duration of the surgery need not be informed
• The facilities provided by the hospital should be
clearly explained.
• Ask the patients to relax and inform them the
time they have to be ready for the surgery.
Cont…..
• Counsel the patients to have no fear about
the surgery.
• Ensure them that the OA will be there to help
them at any time.
• Before the day of surgery the OA has to
clean the periorbital area with iodine.