Insight (American Society of Ophthalmic Registered Nurses)
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As an ophthalmic nurse, you may wonder why it is so important to assess and manage the pain, or "fifth vital sign" of cataract surgery patients. How much pain could a patient experience as a result of a relatively short procedure? In January 2004, while reviewing the pain levels of 135 outpatient surgery patients undergoing cataract surgery, 21% of the patients reported pain. Twelve percent (12%) experienced mild pain and 9% experienced moderate to severe pain. ⋯ To improve the quality of pain assessment and documentation, and to meet the hospital compliance rate of 85%, an audit was performed on 60 outpatient cataract surgery charts over a one-month period. An initial compliance rate of 83% was established. After staff education and changes to the critical pathway, a re-audit demonstrated an increase to 95% in pain assessment and documentation.
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Decreased visual acuity and loss of visual ability are devastating anesthetic and surgical complications. The incidence is greater in patients with preexisting hypertension, diabetes, sickle cell anemia, renal failure, gastrointestinal ulcer, narrow-angle glaucoma, vascular occlusive disease, cardiac disease, arteriosclerosis, polycythemia vera, and collagen vascular disorders. Precipitating factors for ischemic optic neuropathy include prolonged hypotension, anemia, surgery trauma, gastrointestinal bleeding, hemorrhage, shock, prone position, direct pressure on the globe, and long operative times. ⋯ At-risk patients should receive transfusion once the calculated allowable blood loss has been surpassed Unacceptable hemoglobin and hematocrit values should be corrected preoperatively and levels monitored during the case to avoid intraoperative anemia in at-risk patients. The blood pressure of patients with predisposing diseases should be kept within normal limits. To avoid this devastating complication, it is imperative that anesthesia providers understand contributing factors and prevention strategies.
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Randomized Controlled Trial Comparative Study Clinical Trial
A clinical trial of distraction techniques for pain and anxiety control during cataract surgery.
This research study evaluates the effectiveness of distraction interventions on subject perceptions of discomfort or pain and anxiety during the ocular anesthetic injection prior to cataract surgery. Eighty subjects received either usual care, usual care with massage, usual care with verbal coaching and slow breathing, or usual care with massage and verbal coaching and slow breathing combined as different types of distraction interventions. ⋯ The statistical analyses revealed a significant reduction of discomfort or pain and anxiety when the distraction interventions were implemented during the ocular anesthetic injections. Because the different distraction interventions are effective, inexpensive, and easy to implement, routine use during ocular anesthetic injections, prior to cataract surgery, is recommended.