1

Chapter 1 The Problem and Its Background Introduction Cataract blindness poses one of the greatest public health challenges of the 21st century. Cataract is the

leading cause of blindness worldwide, accounting for nearly half (47.8%) of all cases of blindness. According to the World Health Organization (WHO), an estimated 20 million people worldwide are blind from bilateral cataracts. It is estimated that over 90% of the worlds visually impaired live in developing countries. In these countries, blindness is associated with considerable in large disability economic and and excess social

mortality,

resulting

consequences (www.v2020la.org) A cataract is a clouding of the normally clear lens of your eye. Looking through a cloudy lens is like trying to see through a frosty or fogged-up window. Clouded vision can make it more difficult to read, drive a car especially at night or see the expression on a friends and face. cause

Cataracts

commonly

affect

distance

vision

problems with glare. They generally dont cause irritation or pain. Most cataracts develop slowly and dont disturb

your eyesight early on. But as the clouding progresses, the cataract eventually interferes with your vision. Early on, stronger lighting and eyeglasses can help you deal with vision problems. But if impaired vision jeopardizes your normal lifestyle, you might need surgery. Fortunately,

cataract removal is generally a safe, effective procedure. The word is derived from the Latin word cataracta which means waterfall, probably for the clouding of vision it causes. Cataracts only affect one part of the eye the crystalline lens. Each eye is equipped with a biconvex, transparent lens that plays a very important part in

focusing light rays entering the eye onto the retina. The lens has the capacity to alter shape so that the eye can have both near and distant vision. The important thing here is that the eye lens is

transparent. It has to be, in order to allow light rays to enter the eye. Cataracts cause the eye lens to become

opaque, blocking light entry and leading to loss of vision. (www.healthyway.com)

General Objectives To assess, understand, evaluate, and intervene the major health problems and plan to implement interventions that will improve the clients health status. Specific Objectives This research seeks to provide different information about the disease to be presented and about the client being considered with the following specific objectives: Present the abnormal results of the Physical

Assessment made on the client. Present the different lab results or test done to the client with its interpretation Discuss the normal anatomy and physiology of the Eye Explain the Pathophysiology of Cataract Discuss the drugs prescribed to the client by a Drug study Present an appropriate NCP for the most prioritized problem

CLIENT PROFILE

Name Age Date of birth Address

: Mrs. L : 77years old : March 22, 1935 : Block L, Barangay Marcos Village, Palayan City

Sex Religion Status Nationality

: Female : Roman Catholic : Married : Filipino

Educational Attainment : Elementary Graduate Occupation : None

Assessment Health Perception-Health Management Family History of Illness The client has family history of cataract. Present History of illness The client was diagnosed with cataract when she was 77 years old. Nutritional and Metabolic Pattern Usual Food Intake The client usually eats two cups of rice and vegetable during lunch breakfast, and one one of cup of rice and and fish/meat during during

cup

rice

vegetables/meat

dinner. Food Restrictions The client is restricted to take salty foods. Food Allergies There are no food restrictions Usual Fluid Intake The client is taking 8 or more glasses of water daily.

Elimination Pattern Bladder Habits The client usually voids 5-6 times per day. His urine is yellowish and he has no problem in urination. Bowel Habits The client defecates 1 or 2 times a day. His stool is well formed and he has no problem in defecating. Activity and Exercise Pattern Self Care Ability: 0=Independent 1=Assistive device 2=Assistance from others 3=Assistance from person and equipment 4=dependent/Unable

Table 1. Self Care Ability 0 Eating Bathing Dressing Toileting Bed Mobility Transferring Ambulating Stairs Shopping Cooking Home Maintenance 1 2 3 4 REMARKS The patient can eat independently The patient can bathe independently The patient can dress independently The patient can go to the toilet independently The client can move in bed independently The patient can transfer herself independently The patient can ambulate independently The patient can go up and down to the stair independently The patient can go shopping independently The patient can cook food for her family independently The patient can still able to do the household chores independently

Usual Daily Activity Exercise The client daily activity was cleaning the backyard and their home. Any Limitations of Physical Activities The client was restricted to do strenuous activities.

Cardiovascular The minute. position. Respiratory Pattern The chest is of 20 the cycles client per is symmetrical. with His pulse His of the client is is pulse 90/79 is 80 beats in per

blood

pressure

mmHg

sitting

respiration respiration.

minute

diaphragmatic

Sleep Pattern The client sleeps at nine in the evening and wake up at five in the morning. He has more or less eight hours of sleep every night. Cognitive and Perceptual pattern The client has no problem in cognitive functioning. He can recall past as well as recent events in his life. He is oriented to time, place person and to his condition. Roles and Relationship The client He lives with her husband, dauhter in
and

3 of

grandchildren.

support

the

whole

family

terms

financial needs.

Sexuality and Reproductive The client has no history of any reproductive problem. Vital signs This table shows the vital signs of the client during home visits. Table 2 Vital Signs Date November 26,2012 November 3, 2012 BP (mmHg) 90/70 90/70 Temperature 36.5 36.8 RR 22 21 PR 78 69

Weight and Height As of November 15, the client weight is 50 kilogram and his height is five (5) feet and two (2) inches. Body Mass Index Computation: BMI=_Weight (kg) Height (m) BMI= 50kg__ (1.575m)
2

BMI= 20.161 kg/m2

10

Table 3 BMI Weight Status Categories BMI Below 18.5 18.5-24.9 25-29.9 30 and Above Weight Status Underweight Normal Overweight Obese

Interpretation: upon computation of patient body mass index revealed 20.161 that interpret normal for his height.

Summary Presentation of Clients Assessment The table below shows the physical assessment of the patient from head to toe. Table 4 Head to Toe assessment
Body Parts Skull Normal findings Generally round within the prominence in the frontal or occipital area No tenderness noted upon palpation Scalp Can be moist or oily No scars noted Free from lice, nits and dandruff No tenderness nor masses on palpation Hair Can be black or brown Eventually distributed, covers Actual findings Skull is generally round within the prominence No tenderness noted upon palpation. Scalp is moist No scars noted. Free from lice, nits and dandruff. No tenderness or masses. Hair is black and white Distributed and covers

11
the whole scalp Face Symmetrical No involuntary muscle movement Eyes Pupils equal, round to light and accommodation The ear lobes are bean shaped, parallel and symmetrical No discharges or lesions noted the whole scalp. Symmetrical There is no involuntary muscle movement. There is "milky" spot over the pupil of the eye Ear lobes are bean shaped, parallel and symmetrical. No discharges or lesions upon inspection of the clients ear There is no nasal flaring. The clients both nares are patent No tenderness noted upon palpation. Neck is straight. No mass, lumps or jugular venous distention upon assessing clients neck Normal breath sounds.

Ears

Nose and sinuses

Paranasal

No nasal flaring

Both nares are patent No tenderness noted on palpation Neck Neck is straight No visible mass or lumps No jugular venous distention Chest Normal breath sounds -vesicular sounds -bronchial sounds -bronchovesicular sounds

Abnormal breath sounds -rales -rochi -wheeze -stridor

12
Normal respiration -adult: 12-20 -children: 15-30 -infants:25-30 -neonates:40-60 Abdomen No lesion No tenderness No muscle guarding Genitalia No inflammation No lesions No tenderness No muscle guarding. The clients genitalia has no inflammation, The client respiration is 20 cycles per minute.

No discharge No bleeding No swelling No itchiness Anus and Rectum Extremities (-) hemorrhoid Both extremeties are equal in size No involuntary movement No edema No discharges No swelling No bleeding No itchiness. anus and rectum has negative hemmoroids. Both extremeties are in equal size. No involuntary movement No edema.

Table 3 presents the head to toe assessment of the client. All findings are normal except for the eye. The eye has "milky" spot over the pupil.

13

Chapter 2 Case Discussion/Presentation This chapter present the case discussion/presentation and the overview of related literature and studies on the subjects made by the researcher during exploration stage of the case finding. Anatomy and Physiology of Human Eye

Figure 1. Anatomy of Human Eye (www.scribd.com)

1. Sclerotic is the outer coating of the eye which is white in colour that protects the interior of the eye and provides the shape to the eye.

14

2. Cornea is the front part of sclerotic is transparent to light and is termed as cornea. The light coming from an object enters the eye through cornea 3. Iris is just at the back of cornea. This controls the size of the pupil. It acts like a shutter of a

photographic camera and allows the regulated amount of light to enter the eye. 4. Eye Lens is a double convex lens with the help of which light. 5. Ciliary Muscles, the eye lens is held by ciliary image is formed at retina by refraction of

muscles. Ciliary muscles help the eye lens tochange its focal length. 6. Pupil. At the centre of the iris there is a hole

through which light falls on the lens, which is called pupil. 7. Aqueous Humour. The space between cornea and eye lens is filled with a transparent fluid called aqueous humour. 8. Vitreous Humour. The space between eye lens and retina is filled with a jelly like transparent fluid called vitreous humour. 9. Retina serves the purpose of a screen in the eye, where the images of the objects are formed. Retina is at the back of the eye lens. Retains is made of light

15

sensitive cells, which are connected to the optical nerve. 10. Optic Nerve carries the information to brain. 11. Blind Spot is the region of eye containing the optic nerve is not at all sensitive to light and is called blind spot. If the image of an object is formed in the blind spot, it is not visible. 12. Yellow Spot is the central part of retina lying on the optic axis of eye is most sensitive to light and is called yellow spot 13. Eye Lids are provided to control the amount of light falling on the eye. They also protect the eye from dust particles etc (www.scribd.com)

16

Pathophysiology Book Based

Figure 2. Pathophysiology of Cataract (www.nursingdepartment.blogspot.com)

17

Pathophysiology Patient Based Predisposing Factor

Aging usually 40 years and above

Precipitating Factor

(+) family history

Unhealthy Diet

Genetics Sex (femae)

Long term ultra violet exposure

Lens becomes Opaque

Watery Discharge

Clouding of Vision

Decrease visual acuity, Blurry vision, Increase glare from lights, frequent changes in eyeglass, presence of whiteness in the pupil as cataract progress

Milky Spot Over the Pupil

Cataract Formation
Figure 3. Patient Based Pathophysiology

18

Changes in the lens proteins (crystallins) affect how the lens refracts light and reduce its clarity, therefore decreasing visual acuity. Chemical modification of these lens proteins fibers leads are to the change in lens color. and lead New to

cortical

produced

concentrically

thickening and hardening of the lens in nuclear sclerosis, which often appears yellow and can increase the focusing power of the natural lens. Increasing myopia can also be evidence of a progressing nuclear sclerotic cataract. In an experimental cataract model, oxidative causing a stress decrease contributed in the level to of

formation,

adenosine triphosphate and glutathione disulphide. Cortical spokes cataracts in are the most often seen as by whitish fluid.

peripherally

lens,

separated

Vacuoles and water clefts can also be seen in these lenses. Posterior sub-capsular cataracts are due to the migration and enlargement of lens epithelial cells (Wedl cells)

posteriorly. Diabetes mellitus is a major factor in the formation of this type of cataract. Osmotic stress due to sorbitol accumulation has been linked with sudden worsening in patients with uncontrolled hyperglycaemia. However,

research has also found that when sorbitol dehydrogenase

19

was

blocked,

preventing

sorbitol

accumulation,

oxidative

stress was connected with slow-developing cataracts. Signs and Symptoms Table 5 Signs and Symptoms Book Based Clouded, blurred or dim vision Increasing difficulty with vision at night Sensitivity to light and glare; Halos around lights The need for brighter light for reading and other activities Frequent changes in eyeglass or contact lens prescription Fading or yellowing of colors Double vision in a single eye Milky spot over the pupil Patient Based Clouded, blurred or dim vision Increasing difficulty with vision at night

Fading or yellowing of colors Double vision in a single eye Milky spot over the pupil

Risk Factors Everyone is at risk of developing cataracts simply

because age is the greatest risk factor. By age 65 about half of all Americans have developed some degree of lens

20

clouding, although it may not impair vision. After age 75, as many as 70 percent of Americans have cataracts that are significant enough to impair their vision. Factors that

increase your risk of cataracts include: Diabetes, Family history of cataracts, previous eye injury or inflammation, previous excessive eye surgery, to prolonged sunlight, use of corticosteroids, to ionizing

exposure

exposure

radiation and smoking (www.healthyway.com.ph).

Tests and Diagnosis To determine whether you have a cataract, your doctor will perform an eye exam that may include: Asking you to read an eye chart (visual acuity test). A visual acuity test uses an eye chart to measure how well you can read a series of letters. Your eyes are tested one at a time, while the other eye is covered. Using a chart or a viewing device with progressively smaller letters, your eye doctor determines if you have 20/20 vision or if your vision shows signs of impairment. Using a light and magnification to examine your eye (slit-lamp examination). A slit lamp allows your eye doctor to see the structures at the front of your eye under

21

magnification. The microscope is called a slit lamp because it uses an intense line of light a slit to illuminate your cornea, iris, lens, and the space between your iris and cornea. The slit allows your doctor makes to it view these to

structures

in

small

sections,

which

easier

detect any tiny abnormalities. Dilating your eyes (retinal examination). To prepare for a retinal examination, your eye doctor puts dilating drops in your eyes to open your pupils wide. This makes it easier to examine the back of your eyes (retina). Using a slit lamp or a special device called an ophthalmoscope, your eye doctor can examine your lens for signs of a

cataract (www.mayoclinic.com) Prevention Regular eye exams remain the key to early detection. If you are over age 65, schedule eye exams at least every other year. Although most cataracts occur with age and

cant be avoided altogether, you can take steps to help slow or possibly prevent the development of cataracts:

Dont smoke. Smoking produces free radicals, increasing your risk of cataracts.

22

Eat

balanced

diet.

Include

plenty

of

fruits

and

vegetables in your diet.

Eating lots of fruits and vegetables may have a modest effect in preventing cataract development, though this hasnt been definitively proved.

Protect yourself from the sun. Ultraviolet light may contribute to the development of cataracts.

Whenever ultraviolet

possible, B (UVB)

wear rays

sunglasses when

that

block outdoors

youre

(www.healthyway.com.ph).

Complications Complications may include retinal disorders, pupillary block, retinal adhesions, acute glaucoma, macular edema, and

detachment.

Following capsule

extracapsular may become

cataract opacified. or aftercells After-

extraction, This

the posterior called when a

condition, occurs lens

secondary

membrane

cataract, regenerate

subcapsular which

lens

epithelial vision.

fibers,

obstruct

cataract is treated by yttrium-aluminum-garnet (YAG) laser treatment cataract to the affected tissue. Without surgery, a

eventually

causes

complete

vision

loss.

(www.scribd.com)

23

Nursing Management Because surgery is performed on an outpatients basis, instruct patient to make arrangements for transportation home, care that evening, and a follow-up visit to the

surgeon the next day (www.rnspeak.com). Medical Management There is no medical treatment for cataracts, although use of vitamin C and E and beta-carotene is being

investigated. Glasses or contact, bifocal, or magnifying lenses may improve vision Mydriatics can be used short

term, but glare is increased (www.rnspeak.com) Surgical Management Two surgical techniques are available: intracapsular cataract extraction (ICCE) and extracapsular cataract

extraction (ECCE) including phacoemulsification. Less than 15% of people with cataracts require surgery. Indications for surgery are loss of vision that

interferes with normal activities or a cataract that is causing glaucoma. on an Cataracts outpatient are basis. removed Lens under local may

anesthesia

replacement

involve aphakic eyeglasses, contact lens, and intraocular

24

lens (IOL) implants. When both eyes have cataracts, one eye is surgically treated at a time (www.rnspeak.com). Nursing Care Plan
ASSESSMENT Subjective : I see dots everywhere , especially around lights as verbalized by the patien t. Objective: A white or "milky" spotover the pupil of the eye DIAGNOSIS Disturbed Visual Sensory Perception r/t changes in sensory acuity. PLANNING After the nursing intervent ions given the patient will be able to: Short term: Participa te in therapeut ic regimen Longterm: Maintain current visual field/acu ity without further l oss Recommend measures to assist client to manage visual limitation Dependent: Demonstrate/ have client to administer eye drops using correct procedure Eye drop treatment is needed to control IOP and prevent further loss of vision INTERVENTION Independent: Ascertain type/degree of visual loss. Affects choice and clients future expectatio ns Although early interventi on scan prevent blindness, the client may have already experience d partial or complet e blindness. Reduces safety hazards related to changes in visual fields RATIONALE EVALUATION After nursing interventi on, the patient maintain current visual field/ acuity without further loss

Encourage expression of feelings about loss/ possibility of loss of vision

25
ASSESSMENT Subjective :Nobody wants to be blind! as verbalized by the patient. Objective: A white or "milky" spot over the pupil of the eye. Shortterm: Appear relaxed and report anxiety is reduced to a manageabl e level; Use resources effective ly DIAGNOSIS Anxiety related to threat of perman ent loss of vision and independen ce. PLANNING After the nursing intervent ions given, the patient will be able to: INTERVENTION Independent: Assess anxiety level, suddenness of symptoms and current knowledge of condition Provide accurate, honest information. RATIONALE These factors affect clients p erception of threat to self poten tiating the cycle of anxiety Reduces anxiety related to unknown/fu ture expectatio ns and provides factual basis for making informed choices about treatment. Provides opportunit y of the client to deal with reality of situati on, clarify misconcept ions and problem solve concerns Provides reassuranc e that client is not alone in dealing with problems EVALUATION After 4hours of nursing interven tion, the patient appeared relax and reduced anxiety into manageab le level.

Discuss probability that careful monitoring and treatment can prevent additional visual loss

Encourage client to acknowledge concerns and express feelings Identify helpful resources/pe ople

26
ASSESSMENT Subjective : I cant see clearly, I sometimes fall and outbalance d as verbalized by the client. Objective: A white or "milky" spotover the pupil of the ey.e DIAGNOSIS High risk for injury related to poor visio n and reduced extremityeyes coordinati on. PLANNING After the nursing intervent ions given, the patient will be able to: Short term: Express understand ing of the factors involved in the possib ility of injury; Long term: Modify environmen t as indicated to enhance safety; Be free of trauma/inj ury INTERVENTION Independent: Ascertain knowledge of safety needs/injury prevention and motivation Instruct to: Maintain clients bed/chair in lowest position; To promote safe physical environmen t and individual safety. To have further assessment and interventi ons regarding health conditions . To prevent injury in home/commu nity setting. RATIONALE EVALUATION After nursing interventi on the patient understand the factors involved in the possibi lity of injury and free from trauma/inju ry

Place assistive devices (walker, crane);Monit or environment for potenti ally unsafe conditions and modify as needed

27

Local Literature In 20th century, a Doctor discovered a cure

for cataract without undergoing surgery by using the right combination of natural elements and herbal combination,

which was termed as Healing Formula. His name is Dok Edgar Lozada Delibo, a and a Doktor member of of Ministry Inventors in Alternative in the

Medicine,

Society

Philippines. He proves that all degenerative diseases can be cured, because our body has the ability to cure itself if it is being provided the right vitamins and minerals needed in the body. He was awarded by the Philippine

government in the office of DOST- TAPI (www.sulit.com.ph). Hidden among the 94 million people in the 7,107

islands of the Philippines are an estimated half a million people who are blind and many more who are visually

impaired. The 3rd National Survey on Blindness in the Philippines of 2004 says prevalence of visual impairment among children (0 to 20 years old) is 0.43. Further quote: Some random

surveys showed increasing dropout among students in public schools in the upper elementary grades and in high school. This could be attributed to eye problems particularly

refractive errors and the high cost of optical services by

28

private

optometrists

that

are

not

affordable

by

vast

majority. Almost half of these cases are either treatable or preventable. Philippines The causes of childhood blindness in the errors, cataract, phthisis

are: refractive

bulbi, corneal opacity, retinopathy of prematurity, optic atrophy, amblyopia / others, glaucoma and uveitis (www.

cataractfoundationphilippines.blogspot.com). Cataract in infancy is a significant cause of visual handicap worldwide.1 The loss of vision is mainly caused by amblyopia.2 About 1.5 million children throughout the world are blind, one million of them in Asia.3 Recent surveys in developing countries have shown that 10 to 40% of childhood blindness is due to cataract. Approximately 75% of childhood blindness in developing countries is associated with an infectious agent that is preventable or curable.3 Rubella is the major infectious agent associated with childhood cataract. In the Philippines, the Third National Survey on

Blindness9 placed the incidence of childhood blindness at 0.44%. Cataract is one of the primary causes. In the developed world, about half of all congenital cataract cases are idiopathic.10 In an Australian study,

29

one

fifth

had

familial

cataract.11

Of

those

with

an

identified etiology, the most common is Down syndrome. In contrast, an increasing percentage of childhood

cataract in India had been traced to congenital rubella syndrome. No data were given on the association of cataract with galactosemia. In the Philippines, aggressive newborn screening in 2001 reported the incidence of galactosemia at 1:71,593.13 Cataracts was not present in the patient that had

galactosemia. Childhood cataract must be diagnosed and managed early to avoid blindness and other serious complications. Longterm rehabilitation, visual assistance, and lost

productivity are serious concerns. This study determined the major causes of childhood cataract among patients seen at the pediatric ophthalmology clinic of the University of the Philippines-Philippine General Hospital (UP-PGH). The data obtained would serve as basis for formulating diagnosis, and policy recommendations of the for

prevention,

management

disease

(www.paojournal.com).

30

Foreign Literature The World Health Report published in 1998 estimated that there were 19.34 million people who are bilaterally blind (less than 3/60 in the better eye) from age-related cataract. This represented 43% of all blindness. The number of blind people in the world and the proportion due to cataract is increasing due to: population growth; 6,000

million people now in the world, will increase to around 8,000 million in 2020; increasing longevity; and true for less economically developed countries as well as the

industrialized world. The result of these two factors means that the

population aged over 60 years will double during the next 20 years from approximately 400 million now, to around 800 million in 2020. This increase in the elderly population will result in a greater number of people with visual loss and blindness from cataract who will need eye services. The incidence of new cases of cataract blindness is unknown. Minassian and Mehra estimated that for India alone 3.8 million people become blind from cataract each year. Globally the incidence figure is probably at least 5

million. A figure of 1000 new blind people from cataract

31

per

million

populations

per

year

is

used

for

planning

purposes in developing countries (www.ncbi.nlm.nih.gov). Cataracts are a leading cause of visual impairment

among aging Americans and a key quality of life issue. Cataract extractions are the most common surgical procedure performed in the U.S., accounting for more than two million procedures each year. Experts have theorized that if the progression of cataracts could be delayed by 10 years, the number of cataract surgeries per year would be reduced by 45 percent. Nutrition is one promising means of preventing or delaying the progression of cataracts ( www.aoa.org). The treatment decision for the patient with cataract

depends on the extent of his or her visual Hence, correction of visual impairment and

disability. disability

should be the primary purpose

of treatment and the primary

basis for choosing intervention. Standardizing the acceptable level of visual acuity using objective measures is difficult. Some patients may be giving more importance to their motor skills than visual acuity. A solution to this is the use of quality of life as another important outcome to consider.

32

Visual impairment invariably leads to some degree of functional loss; the objective of a comprehensive

management for a patient with cataract should include an improvement Loss of of this in potentially turn debilitating lead to condition. diminishing

function

would

activities that the patient can engage in and subsequent loss of productivity. Two longitudinal surgery So this too should be addressed. looking into the of outcomes of in and

studies have as

cataract visual

measured measured

degree by

improvement acuity

impairment

visual

improvement in functional impairment and quality of life as measured by VF-14, self-reported trouble with vision and the Sickness Impact Profile score. With epidemiological data linking some modifiable

factors such as weight, concomitant illness, lifestyle to progression comprehensive of cataracts; of one such goal then in would the be

management

patients

prevention of progression through risk factor modification

(www.pao.org.ph).

Local Studies Based on an estimated population of 86 million, the prevalence of blindness in the Philippines would be about 350,000. Major causes are cataract, glaucoma, diabetes,

33

nutritional deficiencies, need for glasses or low vision aids, infections, and accidents. It is said that, in

general half of all blindness is preventable. And of those who become blind, some 60% are treatable. Recent Study in 2000 shows about 300,000 indigent

cataract patients. However, this study does not count the millions of homeless squatters that have no permanent

address (www.restoringsight.org). Over 4 years, 218 index cases of childhood cataract were identified and included in the study. Fifty percent were male. The youngest patient was 1 month old and the oldest was 20 years old. The median age at the time of consultation was 24.5 months (Table 1). The cataract was bilateral in 70% of cases. There was no presumptive etiology in 133 cases.

Eightytwo were secondary to a systemic or ocular disorder and 3 were familial in nature. Familial Cataract, the cataract was deemed familial when one of the parents was shown to have childhood-onset cataract on clinical history or examination, or was aphakic fromsurgery performed during childhood. There were three (1.4%) cases of familial cataract involving siblings. All were bilateral.

34

Secondary

Cataract,

Among

secondary

cataract

cases,

rubella was the most common identifiable cause in 45 cases of congenital of rubella congenital were syndrome heart present (Figure and 2). Clinical of

findings maternal

defects in these

history

rubella

cases.

Eighteen

cases (8.2%), however, were classified as suspected rubella infection where there was unconfirmed history of maternal rubella illness during the first trimester of pregnancy. Other causes included 7 cases (3.15 %) with central nervous system (CNS) abnormalities manifesting as delayed development, cerebral palsy or epilepsy, 5 cases (2.85%) with Down syndrome, 2 cases with uveitis, and one each with Lowe syndrome and an iridia. Idiopathic Cataract, the cause could not be

ascertained in 133 cases (61%) (www.paojournal.com). Approximately 1.4 million children are blind

worldwide, and millions visually impaired. There are about 3.4 million Filipinos that suffer from eye problems,

500,000 of whom are blind in both eyes, 90% of these people belong to poor communities. According to the statistics of the Cataract Foundation of the Philippines, and one one person blind goes blind every In five our

seconds

child

goes

every

minute.

35

country, 60% of the children die within a year of becoming blind, and the remaining 40% will live out the rest of their lives without ever seeing the world that they are trying to survive in. Ninety percent of children who are blind will never get the chance to receive a proper

education. It is heartbreaking to think that 75% of such cases are unavoidable (mb.com.ph). Foreign Studies Prevalance of Cataracts: 5,500,000 people have a

cataract interfering with their vision in the US (Research to Prevent Blindness, NISE, NSF). Prevalance Rate: approx 1 in 49 or 2.02% or 5.5 million people in USA. Incidence (annual) of Cataracts: 400,000 new cases of cataract occur each year in the US (Research to Prevent Blindness, NISE, NSF). Incidence Rate: approx 1 in 679 or 0.15% or 400,000 people in USA. Incidence extrapolations for USA for

Cataracts: 400,000 per year, 33,333 per month, 7,692 per week, 1,095 per day, 45 per hour, 0 per minute, 0 per second. Note: this extrapolation calculation uses the

incidence statistic: 400,000 new cases of cataract occur each year in the US (Research to Prevent Blindness, NISE, and NSF) (rightdiagnosis.com).

36

Cataract is the leading cause of blindness worldwide, accounting for about 42 percent of all blindness, in spite of the availability of an effective surgical treatment.

With increasing life expectancy, the number of cases of blindness from this disorder may double by the year 2010. Among Medicare beneficiaries, cataract is the most common condition for which eye care services are sought,

accounting for 43 percent of visits to ophthalmologists and optometrists combined. In the United States, cataract

surgery is the most frequently performed surgical procedure among 30 million Medicare beneficiaries. Approximately 1.35 million cataract operations are performed annually at an estimated cost of $3.5 billion (www.nei.nih.gov). Cataract diagnoses and surgeries, though not type of cataract, were successfully identified using electronic

algorithms. Age specific prevalence of both cataract (22% compared to 17.2%) and cataract surgery (11% compared to 5.1%) were higher when compared to the Eye Diseases

Prevalence Research Group. The risk factors of age, gender, diabetes, and steroid use were confirmed (www.biomed

central.com). Cataract diagnoses and surgeries, though not type of cataract, were successfully identified using electronic

algorithms. Age specific prevalence of both cataract (22%

37

compared to 17.2%) and cataract surgery (11% compared to 5.1%) were higher when compared to the Eye Diseases

Prevalence Research Group. The risk factors of age, gender, diabetes, and steroid use were confirmed (www.cataract

central.com). Relieving sufficient outcomes. cataract outcomes cataract blindness but not also only good involves surgical of

surgical Growing

coverage,

concern in

exists

over

the

outcomes The

surgery reported

developing in recent

countries. surveys

surgical

are

noticeably

suboptimal when compared to consolidated data from the US, Canada, Denmark and Spain. In these four developed

countries, 92% of operated eyes achieved a postoperative visual acuity of 20/60 or above, 6% 20/200 or above and below 20/60, of and the 2% below 20/200. conducted Of in note, with the the [i.e.

exception particular

survey

Pakistan, utilized

cataract

surgery

techniques

intracapsular extracapsular

cataract

extraction

(ICCE),

conventional (ECCE), incision

cataract and manual

extraction sutureless small

phacoemulsification

cataract surgery (SICS)] were not specified, and thus these data cannot be used to evaluate and compare the efficacy of these surgical techniques. Surveys in Pakistan and in the

38

Nakaru visual

district, acuity to

Kenya,

attributed error

poor (53.4

postoperative and 33.9%),

refractive

surgical complications (21.4 and 30.4%) and concurrent eye disease (23.5 and 35.7%). Posterior capsular opacification was the most common postoperative complication and due to the unavailability of the Nd: YAG laser, only 0.98% of these patients received YAG capsulotomy. Good postoperative visual outcomes were associated with the use of intraocular lenses (IOLs). Poor postoperative visual outcomes were

associated with ICCE, surgery performed at an eye camp or government hospital, rural dwelling, female gender and

illiteracy (www.v2020la.org).

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CHAPTER III Method and Procedures for Data Gathering This data discusses the method of research employed and the procedure utilized in the study as well as the instrument used to gathered data.

Data Gathering Technique Gathering of data is always a requirement in every study. The researchers gathered their data through the use of survey questionnaire that requires for a short answer by means of checking of items and make several interviews. This supplied the necessary information that the

researchers needed.

Administration of the Instrument The CHN instructors sought permission from the

Municipality Mayor and Barangay Captain of Palayan City for the use of the said questionnaire, upon approval, the

instrument was sent to the residents through home visit. The Student Nurse also visited the different houses in

Block A Barangay Marcos Village Palayan City to personally asked and questioned the residents with the aid of survey form to facilitate fast retrieval of the instrument for data gathering.

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Locale of the Study This study was conducted in Municipality of Palayan, Nueva Ecija November 28 to December 4, 2012. In figure 2 showed the location of Palayan in Brgy. Marcos Village, a first class municipality in the province of Nueva Ecija. Location Map

Figure 3. Location Map (www.google.com)

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Figure 4. Map of Palayan City (www.google.com)

History of Marcos Village Marcos Village is one of the most progressive barangay in the city. it Almost and 250 of families them or are 1,774 individuals from

consist

most

re-settlers

Pantabangan. This is found in east side of the city, and it is located between, General Natividad, Nueva Ecija that is located at the west, SapangBuho, Palayan City in the northwest and Laur, Nueva Ecija at the east. Marcos Village is five kilometers away from Poblacion while fifteen

kilometers from Cabanatuan City.

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The

foundation

of

Marcos

Village

has

significant

connection to City of Palayan and to the whole Pantabangan and Nueva Ecija. When large part of Pantabangan was merge for the construction of the dam, some of the evacuees were from Delacay and Marikit Pantabangan, some were from

Canili, Maria Aurora and some of them were from Bonganbon stock farm that consist of 2,102,911 hectares that were needed to be divided for the families to own through the help of the City government. 1,102 Hectares were preserved to become a resettlement area and the remaining 1,000 hectares were for the

development programs of the city. All the animals contained at the stock farm were needed to bring to Alabang,

Muntinlupa, Rizal, Saul, Pangasinan and Ubay, Bohol. Margonsa was the first name given to this barangay. On behalf of former president Ferdinand E. Marcos, Project

Manager Cesar Gonzales and Project Engineer Carlos Sales, all the residents had their hands together to have their barangay be founded. Days passed by and it was declared as a new barangay called Marcos Village way back 1973. There was also an act to call this Sampaguita village. But the residents were not used to calling it Sampaguita Village thats why until now it is called Marcos Village.

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December 1973 when the first election of the leaders of the Barangay was held through raising of hands and the first elected Barangay Chairman was Ludovico Viernes. When the local election was held, he resigned from his position to run for being a councilor. Year 1980 when Narciso

Agustin was proclaimed by Mayor Apolinario Esquivel as the Barangay Chairman. Meanwhile, because of the electoral protest of former Mayor Elpidio to Then O. Cucio, back the Mr. back Provincial Cucio Viernes to as Trial his the Court

proclaimed position.

bring he

Mayorial Barangay

brought

Chairman of Marcos Village. During the election in the year 1982, Mr. Nestor R. Huerta won the candidacy. But he was unfortunately killed by unknown individuals on 1984. Thats why because of his death, former Councilor SeverinoCamania took his position. Marcos Village in the present is having its continuous progress. Just like a Molave tree, it grows continuously being strong. Through the leadership it was of the present several as the

Barangay awards

chairman

George

Camania, it

received declared

and

citations.

Recently,

First Place Winner in the annual Search for the Cleanest and Greenest Barangay. And even the crowned Miss Palayan was from Marcos Village in the name of Ms. Jesyl Lucas.

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This is just one of the proven matters that from being a small place it is now a progressive and a model to other barangays. Marcos Village had expanded its scope and it is also where the resettlement area for the rebel returnees was placed. And even residents of Cabanatuan City and other towns place. Sampling Design The researcher utilized purposive sampling where a and municipalities are frequently going to this

group of people believed to be typical or average or a group of people specially picked for some unique purpose. Purposive sampling is the best used with small numbers of individuals/ groups which may well be sufficient for

understanding human perceptions, problems, needs, behaviors and contexts, which are the main justification for a

qualitative audience research (Trochim,2006).

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Chapter IV SUMMARY, CONCLUSION AND RECOMMENDATIONS This chapter presents the summary, conclusions and

recommendations made in the study. Summary of the Findings The following are the summary of the study based on the general survey and assessment of the patients. The name of the patient was kept in private, she was called here as Mrs. L. They lived in Barangay Marcos Village for 60 years, they classified as permanent living in the area. They husband, are Nuclear because she is living Their with her

daughter

and

grandchildren.

family

developmental stage was Middle Aged Family. All of the assessment from Mrs. L was normal except the milky spot over the pupil in her eye. Conclusion Based on the findings of the study, the following

conclusions are drawn: 1. The client permanently resides in Brgy. Marcos

Village, Palayan city. 2. The client has family history of cataract

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3. The client has good nutrition based on his daily food intake 4. The client voids normally and has a normal bowel

movement 5. The client has a good sleep pattern and has enough sleep every night 6. There is "milky" spot over the pupil of the eye of the client. 7. The client can maintain current visual field/acuity without further loss. 8. The client appeared relaxed and report anxiety is

reduced to a manageable level. 9. The client can express understanding of the factors involved in the possibility of injury.