5 NANDA Nursing Diagnoses for Cataract - Priority Order

1. Disturbed Sensory Perception (Visual) (HIGHEST PRIORITY)

• Assess visual acuity in both eyes
• Orient the patient to the environment
• Provide adequate, non-glare lighting
• Place objects within the patient's visual field
• Encourage regular ophthalmology follow-up
• Administer prescribed eye drops as ordered

2. Risk for Injury

• Keep the environment well-lit and free of clutter
• Install grab bars, non-slip mats in the bathroom
• Assist with ambulation as needed
• Instruct patient to avoid driving if vision is severely impaired
• Post-operatively: instruct patient to avoid bending, lifting heavy objects, or straining (raises IOP)
• Teach patient to report sudden pain, vision changes, or flashes of light after surgery

3. Anxiety / Fear

• Provide accurate, simple information about the surgery (phacoemulsification)
• Allow the patient to express fears and concerns
• Explain pre-operative and post-operative procedures step by step
• Reassure about the high success rate of cataract surgery
• Encourage family support and presence
• Involve the patient in care planning

4. Deficient Knowledge

• Educate about cataract formation and progression
• Explain surgical options (phacoemulsification with IOL implant)
• Teach proper instillation of post-operative eye drops
• Instruct on activity restrictions: avoid rubbing eyes, bending, lifting >5 lbs, straining
• Teach warning signs to report: sudden pain, redness, decreased vision, fever (signs of infection/endophthalmitis)
• Emphasize the importance of wearing the eye shield at night post-surgery
• Encourage wearing UV-protective sunglasses outdoors

5. Self-Care Deficit (Bathing, Dressing, Feeding) (LOWEST PRIORITY)

• Assess the patient's baseline functional ability
• Assist with ADLs as needed without creating dependence
• Teach use of magnifying glasses or large-print materials
• Organize the patient's environment consistently so objects are predictable
• Involve occupational therapy for adaptive strategies
• Teach family/caregivers how to assist safely

Summary Table

1. Disturbed Sensory Perception (Visual)

Subjective Data (What the patient says):

• "My vision is blurry/cloudy."
• "I see halos around lights, especially at night."
• "Colors look faded or yellowed to me."
• "I have trouble reading - the letters are not clear."
• "Bright light bothers my eyes."
• "I feel like I am looking through a foggy window."
• "My vision has been getting worse gradually."
• "I have double vision sometimes."
• "I find it difficult to drive, especially at night."
• "I need more light to do my work now."

Objective Data (What the nurse observes/measures):

• Decreased visual acuity on Snellen chart testing
• Lens opacity visible on ophthalmoscopic examination
• Presence of white or grayish pupil (leukocoria) in advanced cases
• Patient squinting or holding objects close to the face
• Difficulty identifying objects, colors, or faces
• Reduced contrast sensitivity on testing
• Abnormal pupillary reflex or dull red reflex on fundoscopy
• Patient wearing very thick corrective lenses
• Documented visual field deficits
• Inability to read standard print even with corrective lenses

2. Risk for Injury

Subjective Data (What the patient says):

• "I stumbled on the stairs last week because I couldn't see clearly."
• "I bumped into the furniture in my own house."
• "I tripped and nearly fell in the bathroom."
• "I feel unsteady when walking in dim or bright light."
• "I can't judge distances properly anymore."
• "I have stopped going out alone because I am afraid of falling."
• "I am scared to walk on uneven ground."
• "I spilled hot liquid on myself because I misjudged where the cup was."

Objective Data (What the nurse observes/measures):

• Significantly reduced visual acuity (e.g., 6/60 or worse)
• Evidence of recent falls or bruises on physical examination
• Unsafe home environment (poor lighting, clutter, no grab bars)
• Impaired depth perception on testing
• Unsteady gait or altered balance observed during ambulation
• Patient age >60 years (elderly - higher fall risk)
• Patient on medications that cause dizziness (e.g., antihypertensives)
• Inability to navigate around objects safely
• Glare sensitivity causing sudden vision loss in bright environments
• Patient living alone without caregiver support

3. Anxiety / Fear

Subjective Data (What the patient says):

• "I am scared of going blind."
• "I am nervous about the surgery - what if something goes wrong?"
• "What if I lose my vision permanently after the operation?"
• "I am worried about the pain during surgery."
• "I don't know what to expect - nobody has explained it to me properly."
• "I feel helpless because I cannot see well."
• "I keep thinking about the worst possible outcomes."
• "I am afraid of being dependent on others."
• "I have never had surgery before - this terrifies me."
• "I can't sleep because I keep worrying about my eyes."

Objective Data (What the nurse observes/measures):

• Restlessness, fidgeting, pacing observed
• Increased heart rate (tachycardia) and blood pressure on measurement
• Trembling hands or shaky voice noted during assessment
• Facial expressions of worry, tension, or fear
• Diaphoresis (sweating) without physical exertion
• Difficulty concentrating during patient education sessions
• Repeated questioning about the same topic
• Crying or tearfulness
• Insomnia reported or observed
• High score on anxiety assessment scale (e.g., GAD-7, HADS)
• Muscle tension, clenched jaw, rigid posture

4. Deficient Knowledge

Subjective Data (What the patient says):

• "I don't know what a cataract actually is."
• "Nobody told me why my vision is getting worse."
• "I don't know what the surgery involves."
• "How do I put in eye drops? I've never done it before."
• "Can I shower or wash my face after surgery?"
• "When can I go back to normal activities?"
• "What foods should I avoid after surgery?"
• "I didn't know I needed to stop my blood thinners before surgery."
• "I am not sure which eye drop to use first or how often."
• "Is my other eye going to get a cataract too?"
• "I thought cataracts only happen to old people."

Objective Data (What the nurse observes/measures):

• Incorrect demonstration of eye drop instillation technique
• Unable to state purpose or dosage of prescribed medications
• Cannot describe post-operative activity restrictions when asked
• Does not recognize warning signs of complications (pain, redness, vision loss)
• Incorrect or incomplete answers during knowledge assessment/teach-back
• No prior health education documented in the chart
• Low health literacy or literacy level noted
• First-time surgical patient with no previous exposure to eye surgery
• Absence of discharge teaching documentation in prior records
• Patient or family unable to list any self-care instructions
• Language barrier evident (interpreter needed)

5. Self-Care Deficit (Bathing, Dressing, Feeding)

Subjective Data (What the patient says):

• "I can't button my shirt properly - I can't see the buttons."
• "I burned myself on the stove because I couldn't see the flame clearly."
• "I have difficulty combing my hair or shaving because of my poor vision."
• "I can't read the labels on medicine bottles or food packaging."
• "I spill food while eating because I can't judge the plate properly."
• "I have stopped bathing by myself because I am afraid of slipping."
• "I can no longer cut my nails - I can't see them clearly."
• "I depend on my family for most things now."
• "I feel embarrassed that I need help with basic things."
• "I cannot manage my own medications because the print is too small."

Objective Data (What the nurse observes/measures):

• Poor personal hygiene observed (unkempt appearance, body odor, soiled clothing)
• Improperly matched or misbuttoned clothing
• Evidence of poor nutritional intake or weight loss
• Unable to safely ambulate to bathroom without assistance
• Functional assessment score indicates dependence (e.g., Katz ADL scale)
• Medication errors observed or reported (wrong dose, wrong timing)
• Unable to safely manage cooking or food preparation
• Bruises or burns on hands/arms from kitchen accidents
• Barthel Index or FIM score showing reduced functional independence
• Decreased grip strength or fine motor control compounding visual deficit
• Family or caregiver report of increased dependence on them for ADLs

Quick Reference Summary

Clinical Note: Subjective data = symptoms reported by the patient (S in SOAP/SBAR). Objective data = signs assessed, measured, or observed by the nurse (O in SOAP/SBAR). Both are essential for validating each NANDA diagnosis with proper defining characteristics and related factors as per NANDA-I Taxonomy II (2024-2026 edition).