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Clinical Ophthalmic Assistants Manual - Chater 12

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Ophthalmic Sub Specialty Nursing Care

Cataract and glaucoma

Postoperative instructions to cataract and glaucoma patients

  • Verify the case sheets and understand the type of surgery performed on the patient. Accordingly, give the medicines and clearly instruct about the usage of the drugs.
  • Give the right medicine to the patient immediately after the patient is brought to the room after surgery.
  • Communicate with the patient and comfort the patient if suffering from pain. Make them feel happy about the surgery.
  • Prepare a sterile dressing tray for postoperative dressing in field setting.
  • Know the details of postoperative care of cataract
  • Know various postoperative complications and be able to institute their management as eye surgeon advises.
  • Fill prescription of drugs and other specific instructions in the discharge slip for doctor's signature.
  • Verify the type of surgery undergone by the patient and accordingly instruct the home care procedures at the time of discharge.
  • Explain the drug administration and confirm the follow-up visit between the ophthalmologist and the patient.
  • Help in getting reimbursement forms duly signed by the institution whenever patients demand.
  • Take measures for preventing postoperative cross infection in the camp.
  • Patient should be instructed to take liquid food and their tablets after the surgery.
  • Before giving the tablets the OA should confirm with the patients whether they have allergy to the medicines. If the patient is allergic to the medicine, the doctor should be informed and get the alternative medicine.
  • Regular food can be taken
  • The patients are instructed not to lie on the side of the operated eye ;for example if the left eye is operated they should not lie on the left side but can lie on the right side. They can be in supine position. They can walk, talk, and do routine work as usual.
  • The patients are instructed to take rest after the surgery and to take the tablets as per the doctor's instruction. The glaucoma patients should continue their regular medicines.
  • After the doctors rounds, the condition of the eye after the surgery will be explained to the patients.
  • Bandaging the eye should be demonstrated and taught to the attendar and the patient.
  • Body wash can be taken from the next postoperative day. Head bath is allowed after 15 days (PHACO patients) and 1 month (IOL patients) . Depending on the type of implant the instruction for bathing could be changed. Eye cleaning can be done without using soap. Cotton ball has to be dipped in warm water, squeeze it and clean the outer area of the eye without pressure. Clean gently. Oil can be applied to the hair, combing can be done as usual.
  • For male patients self-shaving can be done.
  • Patient should avoid being in smoky and dusty places and avoid giving strain by frequently watching TV and reading books.
  • Dark glasses should be used in the daytime for one month.
  • At night time the patient has to wear bandage with shield for 5 days.
  • Eye cleaning and instilling eye drops procedure is taught to the patient.
  • Instilling eye drops procedure: Before instilling the drops the hands should be washed thoroughly, then the lower lid should be everted and two drops are instilled and eye has to be closed.
  • Eye cleaning procedure: Cotton is to be dipped in the warm water and squeezed well. Then the lid margins and surrounding of the eye is to be cleaned with the cotton.
  • Billing procedure, reimbursement procedure and other doubts about charges should be explained.
  • Follow up date is given. Timing can be given according to the patients' convenience.
  • Timing for the discharge should be informed earlier.

Retina

  1. The patient's blood pressure and pulse should be checked after the surgery.
  2. Antibiotic and painkiller tablets will be given to the patients after ½ an hour.
  3. For the first four hours liquid diet will be suggested for the patients.
  4. Medications are given to the patients if there is any complication like vomiting and pain.
  5. If the patients were given SOI / C3F8 / SF6 / AIR then the patients are to lie in the prone position. After 5 hours the ophthalmologist will check the intra ocular pressure in the eye. If the intraocular pressure is high then antigluacoma medicines are to be started.
  6. According to the surgeon's instruction the patients will be positioned after the surgery.

Post operative instructions

1. Medication

  • Patient has to follow the instructions on applying drops as given by the OA at the time of discharge for a period of 30 days.
  • The patient should apply drops after washing their hands thoroughly.
  • In addition to eye medication, patients with diabetes, high B.P. heart disease and asthma should continue their medicines regularly.

2. Instruction concerning eye

  • The patient has to protect the eye with green shade for 40 days and wear the black glass for the day time.
  • Redness, watering of eyes and a little irritation are common and the patient need not worry about it. But if it is unbearable it is best to consult an ophthalmologist.
  • Instruct the patient not to rub the operated eye.

3. Body wash

  • Body wash can be taken from the next postoperative day. Head bath could be taken after one month.

4. Food

  • Regular food can be taken except the hard foodstuffs that are to be avoided.
  • Tobacco chewing, smoking and taking alcoholic drinks are strictly prohibited.

5. Activities

  • Walking, reading, writing, watching T.V. etc. should not be performed.
  • Jumping, swimming, lifting heavy objects, cooking, gardening, yoga, should be avoided during the first month after surgery.
  • Avoid playing games like basket ball, football, cricket and tennis for a certain period of time.
  • Self-shaving is allowed after 2 weeks.

Special instruction

    The patients who were given SOI / C3F8 / SF6 / AIR should lie in the prone position for 15 days.

Cornea

Corneal transplantation and corneal suturing

1. Medication

  • Follow medications as per ophthalmologist's instruction.
  • Close the bottle (antibiotic drops) after use and store it in a cool place.
  • In addition to eye medication, patients with diabetes, high B.P. heart disease and asthma should continue their medicines regularly.

2. Instruction concerning eye

  • Do not rub the operated eye.
  • Any discharge from the eyes should be wiped gently with sterile cotton. The cotton should be placed in boiled warm water for 10 minutes, cooled, squeezed and then be used.
  • Do not lie on the side of the operated eye, because it should not be subjected to pressure or stress.
  • Wear dark glasses during the day and green shade during night for the first 4 weeks.
  • If symptoms like redness, profuse watering, pain and reduced vision occurs in the operated eye, consult an ophthalmologist.

3. Face wash

  • The face should not be washed for seven days. A soft wet towel should be used to wipe the face without rubbing the operated eye.

4. Activities

  • Shaving can be done.
  • Normal activities like walking, reading, writing, watching T.V. etc., can be performed.
  • Jumping, swimming, lifting heavy objects, cooking, gardening, yoga, should be avoided during the first month after surgery.
  • Avoid playing games like basketball, football, cricket and tennis for a year after surgery.

5. Bath

  • After surgery, body bath can be taken daily and head bath after one month.

6. Food

  • No diet restriction except in diabetics.

7. Special instruction

  • If any other health problem arises, consult a physician immediately.

8. Follow up

  • Come for the first follow up after a month and then confirm the second follow up date.
  • Pterygium transplantation, bowman's catery, excision piopsy & pterygium excision

General instructions

  • Do not rub operated eye
  • Cleaning: Any discharge from the eyes should be wiped gently with sterile cotton. (Put the cotton in boiling water for 10 minutes, cool, squeeze and then use it).
  • Do not wash your face for the first 7 days; use a soft wet towel instead to wipe the face.
  • Shaving can be done.
  • After surgery, take body bath daily and head bath after 10 days.
  • Do not lie on the side of the operated eye, because it should not be subjected to pressure or stress.
  • Normal activities like walking, reading, writing, watching T.V. etc., can be performed.
  • Jumping, swimming, lifting heavy objects, cooking, gardening, yoga, should be avoided during the first month after surgery.
  • Avoid playing games like basketball, football, cricket and tennis for a year after surgery.
  • No diet restriction except in diabetics.
  • If any, other health problem arises, consult a physician immediately.

Corneal ulcer

Counselling and instructions

  • The patient is instructed to take only body bath.
  • The OA will give the medicines according to the ophthalmologist's prescription.
  • Cleaning: Any discharge from the eyes should be wiped gently with sterile cotton. (Put the cotton in boiling water for 10 minutes, cool, squeeze and then use it).
  • Drops should be applied after washing the hands.
  • Food: No diet restriction except in diabetics. Diabetic patients should control their sugar level.
  • If any other health problem arises, consult a physician immediately.

Orbit

Post operative instruction and care

Monitoring

  • The patient's blood pressure and pulse should be checked after the surgery.
  • The OA should check for bleeding or edema in the operated eye.

Medication

  • Antibiotic and painkiller tablets are given to the patients half an hour after the surgery

Patient counselling

  • Patients should take normal food except hard foodstuffs.
  • The OA should enquire the patients regarding allergy to any medicines.
  • The patient should be told that the suture will be removed after 5 days.

DCR patients

  • The patients will be fitted with nose pack which will be removed after 24 to 48 hours. The patient should not remove the nose pack.
  • The patient should be instructed to breathe through their mouth as they cannot breathe normally through nose due to nose pack.
  • They should lay on a flat surface and not use pillow
  • They should avoid coughing and sneezing because this may lead to bleeding through the nose. Notify the doctor immediately in case of nasal bleeding.

Evisceration

  • For evisceration patients the OA assists the ophthalmologist in removing the betadine pack.
  • Instructions are given to the patients regarding cleaning the eye and medicine intake.
  • Cleaning: Any discharge from the eyes, should be wiped gently with sterile cotton. (Put the cotton in boiling water for 10 minutes, cool, squeeze and then use it).
  • The patient should not rub the operated eye and wound.
  • Tobacco chewing, smoking and taking alcoholic drinks are strictly prohibited.
  • Self-shaving is allowed after 2 weeks.
  • The patient should continuously wear the green shade for 15 days. Once in two days the green shade should be washed using medicated soap.
  • After 15 days the patient can take head bath.
  • Patient has to consult the ophthalmologist after 30 days.

Paediatric Ophthalmology

Post operative care

  • Receive the patient from the operation theatre
  • Maintain clear airway
  • Maintain proper position
  • Check the vital signs
  • Recognize the immediate complications, both ocular and systemic and inform the ward doctor.
  • Check patient passes urine after surgery
  • Management of acute emergencies like administration of O2
  • Instruction to the parents regarding feeding, possibility of vomiting in cases of GA patients, systemic medication (injections or oral) as advised.
  • Assisting the ward doctor in examination of the children
  • Taking care of application of medications as advised by the ward doctor.
  • Discharge summary with the postoperative instructions according to the case sheet.
  • Follow up date for the next visit
  • Additional care to ensure complete satisfaction of the parents
  • Report any problem to the concerned doctor

Summary

The outcome of the surgery is dependent on the post operative evaluation and treatment. Clear instructions to the patient will give the best outcome. Printed instructions should be given to the patient for reference at home.

Key points to remember

  • OA must make the patient aware of following instructions completely for optimum surgical results.
  • OA will instruct the patients to use medications appropriately.
  • OA must be aware of different instructions to speciality patients and ensure that the correct instructions are given and understood by the patients.
  • Importance of follow up visits is stressed to the patient

Student exercise

Fill in the blanks

  1. Postoperative cataract and glaucoma patients may take bath after ___________ days.
  2. Patient should not carry heavy weight at least for ___________ days.
  3. Before instilling eye drops hands should be ____________.
  4. Postoperative retina patient should have their ____________ and _________ checked after surgery.
  5. Avoid playing games like ________ and _________ after retina surgery.

Answer the following

  1. State the details of postoperative care for cataract patients.
  2. Explain how the patient is to lie in the bed after retina surgery.
  3. Discuss restrictions in the diet after surgery.
  4. Write short notes on:
    • Nose pack
    • Instructions for corneal ulcer patients
    • Paedeatric postoperative care
  5. State the importance of follow up visits for the patients.