S.S.

AGRAWAL COLLEGE OF NURSING

TRAINING COLLEGE AND RESEARCH
CENTER,NAVSARI.

SUB - MEDICAL SURGICAL NURSING

TOPIC – Surgical Care plan on Cataract

SUBMITTED TO, SUBMITTED BY,

MRS.NIKITA PATEL MS AVNIPATEL
ASSISTANT PROFESSOR 1st YEAR M.SC (N)
SSAGCON,NAVSARI SSAGCON,NAVSARI

DATE OF SUBMISSION
20-7-21
OUTLINE
 Introduction
 History collection
 Physical examination
 Investigation
 Pharmacological management
 Theory application
 Nursing process
 Diet
 complication
 Health education
 Home remedies
 Summary
 Conclusion
 Bibliography
 INTRODUCTION

Name- Patel Avni c.

Class- First year M.sc Nursing

Topic- Surgical care plan on cataract

Date-20-5-21

Introduction

As a part of our clinical experience in medical surgical nursing,we posted in

yasfeen hospital for training.I selected one patient for my care plan
requirement.

( Cataract)

HISTORY COLLECTION
INFORMATION DATA
Name- Mrs. Laxmiben D. Nayka
Age- 75 year
Sex-Female
Address- Chapra road,Navsari
Education- 10th pass
Religion- hindu
Occupation- house wife
Bed number-5
Ward- FeMale Surgical ward
Medical diagnosis- cataract
Surgery- performed
Date and time of admission-20-7-21

CHIEF COMPLAINT
 Progressively diminished vision in both eyes
 Loss of vision in left eye since 3 year
 Sudden loss of vision in right eye 20 days ago
 Fatigue
 Drowsiness
HISTORY OF PRESENT MEDICAL ILLNESS
Mrs. Laxmiben having present complaints are:
 Vision difficulty
 Faulty vision
 Refraction vision
 Little pain around the eyes
 Difficulty in judging depth
 Difficulty in seeing at night

HISTORY OF PRESENT SURGICAL ILLNESS

Intraocular lens implantation surgery was done.

HISTORY OF PAST MEDICAL ILLNESS

Loss of vision in left eye since 3 years ago
Trauma and accidents-no any history of trauma and external injuries and accidents.
Hospitalization ,operations or special treatment- He had no history of previous
hospitalization,but he treated in opd with same problem before 4 month.
Allergies- according to my patient she has not known allergies to any food,drugs and others.

HISTORY OF PAST SURGICAL ILLNESS

No any significant data about past surgical illness history

HISTORY OF PAST SURGICAL ILLNESS

No any significant data about past surgical illness history.

FAMILY HISTORY

KEY
Dineshbhai (75year) Lakshmi ben(78year)

Male

Darsh(49 year)
Female
 patient

FAMILY COMPOSITION

Name of Ag sex Educatio occupatio Incom Relationshipwit Healt

the e n n e h pt h
family status
member
1.Laxmiben 75 yr femal 10th pass House wife - patient ill
e
2.Dineshbha 78yr male 7th pass farmer - husband healthy
i
3.Darsh 49yr male B.com clerk 1,20,ooo son healthy

FAMILY HISTORY
Mrs Laxmiben living in a nuclear family.No any hereditary disorder present in their
family.All the members are well cooperate with each other.

PERSONAL HISTORY
Mrs Laxmiben is looking poorly nourished,skin colour is yellow,she has a no any bad habit
like alcoholism,tobaco chewing ,smoking.she is a non vegetarian .
Personal hygiene:
Oral hygiene-once a time
Bath- once in a day daily.
Sleep and rest- 7 hours/day
Elimination:
Bowel per day : regular
Urine frequency: 1600ml/day
Mobility and exercise:
She is not doing exercise.
Environmental History:
Type of house-pakka
Ventilation-good
Water supply-municipality
Electricity-good
Drainage-closed drainage
Cooking-separate kitchen
Location of house-In city
Pet animals-No

PHYSICAL EXAMINATION

GENERAL HEALTH:
 Nourishment-poorly nourished
 Body built-normally built
 Health-ill
 Activity-dull
 Facial expression-dull
 Level of consciousness-conscious
Height-3 feet 6 inch
Weight-75kg
Temperature-99 degree c
Pulse-86 beats/min
Respiration-18 breath/min
Blood pressure-120/80mm/Hg
HEAD AND FACE:
 Hair-Black
 Scalp-dandruff present,no injury,
 Skull-normal in shape
 Face – slight edema
 Sinuses-no swelling,tenerness
EYES:
 Eye brow-symmetrical
 Eyelashes-no any infection
 Eye lid-no edema
 Eye ball-euqally not reaction to the light
 Conunctiva-pale
 Sclera-yellowish
 Lens-opaque
 Vision-abnormal
EYE ASSESSMENT
 Cortical
 Most prevalent account for 63% of cases
 Wedge shaped opacities found in anterior and /or cortical posterior lens cortex
 Opacification due to light scatter
 Found in the infero nasal portion of the lens
Nuclear
 Accounts for 41% of cases
 Homogenous increase in light scatter in the lens nucleus
 Can be associated with lens
Posterior sub –capsular(PSC)
 Accounts for 24% of cases
 Occur at back of lens in front of the posterior capsule
 Localised decrease in refractive index and accompanying vaculoe formation
 Centrally positioned
EAR:
 External ear- no discharge
 Tympanic membrane-normal
 Hearing acuity-normal
 Drainage from ear-no discharge ,pus
 Hearing aid-not used
NOSE:
  Location- centrally located
 Nasal deviation-not found
 Bleeding-no
 Patency of the nostrils-patented
 Condition of nasal mucosa-pale in colour
 Flaring nostrils-not presented
 Inflammation-not found
 Nasal polyps-not found
MOUTH:
 Lips-dry
 Oral cavity-pale mucous membrane of oral cavity
 Teeth-normal
 Tounge-slightly dry and coated tounge
 Vocal cord,uvula and tonsils-not enlarged and inflammed
 Speech disorder-not presented
NECK:
 Movement-full and smooth range of movement
 Jugular vein-not enlarged
 Condition of thyroid-no enlargement of thyroid gland
CHEST:
 Respiratory rate-18 breath/min
 Depth of respiration –normal depth
 Quality of respiration- dyspnoea in lying position
CHEST INSPECTION:
- Lateral diameter is wider than anterior posterior diameter
- Sternum is located at the midline
- Even expansion of the chest during breathing
- No intercostals retraction
CHEST PALPATION:
- No tenderness,lump or depression along the ribs.
Percussion
- Deep resonant sound heard all over the lungs.
Auscultation
- Breath sounds are heard in all areas of the lungs
- Inspiration longer than expiration
- No rhonchi,wheezing sounds was presented
HEART
 Pulse rate-74 beats/min
 Character of pulse-normal
 Blood pressure-110/80mm/hg
 Varicosities-absent
 Visible external jugular veins-absent
 Systolic or diastolic murmur-absent

ABDOMEN
 Size and shape of abdomen-distended abdomen
 Inspection-no lesion
 Palpation-moderately enlarged liver,tenderness in right hypocardium
 Shifting dullness-present
 Distended abdominal veins-slightly
 Fluid thrill-present
 Abdominal girth-33 inch
 Bowel sound-present

GENITAL AREA
 Lesion or tumors of rectal area-not found
 Abnormalities of genito urinary area-not found

EXTREMITIES
 Motor strength and mobility-slightly reduced
 Enlargement and stiffness of joint-not present
 Range of motion-active

COMFORT,SLEEP AND REST

 Location of pain-right hypochondrium ,tenderness
INVESTIGATION

OCULAR EXAMINATION
 Head posture is erect
 Facial symmetry maintained
 Ocular posture-30 0 of extropia in left eye
 Extraocular Movement
RETINOSCOPY
 24.0

( oculus dexter)
(with tropicamide dilatation at 1 cm distance)
INTRAOCULAR PRESSURE
Right eye
(12.2 mm/Hg)
Left eye
Unrecordably low
VISUAL FIELDS
Could not be assessed
RIGHT EYE
There are seen two thick convex hyperechoic lines extending from ciliary body to a point on
both sides of papilla creating an obtuse angle suggestive of choroidal detachment.
There is seen an thick echogenic line fixed at the papilla and extending upto ora serrata
forming a typical V shaped with apex at the optic disc with underlying echoes suggestive of
retinal detachment.
Anterior chamber is collapsed
LEFT EYE
There is seen thickening of the anterior and posterior capsule of lens suggestive of
cataractous changes.
Anterior chamber is collapsed

LAB INVESTIGATIONS

HAEMOGRAM PROFILE
PARAMETERS PATIENT VALUE
HB 04.8%
TLC 8,400 cells/cmm
DLC n-69,l-26
ESR 66mm
PCV 16.3%
PLATELET 5.4 lakh
COUNT
EOSINOPHILLIC 225
COUNT
RETICULOCYTE 0.1
COUNT
 RBC COUNT 3.19 million
Blood group A positive

Mini Renal
Serum urea- 23 mg/dl
Serum creatinine-0.6 mg/dl
LIVER FUNCTION TEST
 Total bilirubin – 0.8 mg/dl
 Direct bilirubin-0.2 mg/dl
 Total protein-6.6 g/dl
 Serum albumin-3.3g/dl
 A:G- 1.0
 SGOT-28IU/L
 SGPT-10U/L

MANAGEMENT
There is no medical management for cataract .
SURGICAL MANAGEMENT

INTRA OCCULAR LENS IMPLANTATION

Surgery for cataracts involves removing the natural lens of the eye that contains
the cataract and either replacing it with an artificial lens called an intraocular lens implant
(IOL) or compensating for its absence with eyeglasses or contact lenses.
The most common replacement is an IOL. Before having surgery, review with your doctor
the advantages and disadvantages of each type of replacement lens. A variety of IOL types
are available. Your doctor can help you choose the type that may work best for you.
An IOL is placed inside the eye during surgery. Corrective glasses may be needed after
surgery for reading and close work. But they are not as thick and heavy as traditional cataract
glasses.
Studies are being done to find the age at which children can benefit from an IOL. If your
child needs cataract surgery, talk with your eye specialist (preferably a
pediatric ophthalmologist) about what current studies are showing about the use of IOLs in
children.
For nearsightedness, with or without cataracts
If you have cataracts and you are nearsighted, you may be able to have cataract surgery and
get an IOL to help treat both issues. The chance of having retinal detachment after the
surgery is higher than if you were not nearsighted, though. Talk to your doctor about all the
pros and cons of cataract surgery.
If you don't have cataracts but you are nearsighted, there are two ways that IOLs may be able
to help treat the nearsightedness:
 When the surgeon replaces the eye's natural lens with an IOL, it's called "clear lens
extraction."
 When the surgeon does not remove the eye's natural lens, the IOL implants are called
"phakic intraocular lenses" or "implantable contact lenses." These IOLs are placed in
front of the natural lens, either in front of or behind the iris.
Cataracts that begin in the center of the lens (nuclear cataracts) are the most common cause of
nearsightedness getting worse in adults.
Types of IOLs
Most people choose distance-vision IOLs over near-vision IOLs, and they use glasses for
sharp near vision. But some people choose IOLs that provide better near vision for reading,
and they use glasses for distance vision.
If you are having the lenses in both eyes replaced, your doctor may recommend monovision.
With monovision, the IOL in one eye provides for better near vision, and an IOL that gives
better distance vision is implanted in the other eye. Many people who try monovision can
adjust to it. But it's not an option for everyone. One drawback of monovision is that each eye
must work more independently. This can cause problems with depth perception. You may
have to adjust your gaze more often to allow one eye or the other to see properly.
When thinking about how an IOL will affect your vision following cataract surgery, some
types of IOL to consider are:
 Multifocal (or accommodative) IOLs. This type of intraocular lens design provides
correction for both near and distance vision, and both near and far objects can be in
focus at the same time. Your brain must learn to select the visual information it needs to
form an image of either near or distant objects, so multifocal IOLs may require some
 adjustment. A person may adjust better to multifocal IOLs if they are placed in both
eyes. This type of lens is not an option for some people. It may be considered a premium
lens, so it might cost more than a monofocal IOL.
 Monofocal IOLs. This type of intraocular lens is designed for either near or distance
vision. If you have this type of IOL implanted in your eye(s), you will probably need to
also wear glasses. For example, it is common for the IOLs to be chosen to provide better
distance vision than near vision. Then glasses are used for sharp near vision.
 Toric IOLs. This is a type of monofocal IOL that helps correct astigmatism. It may be
considered a premium lens, so it might cost more than a monofocal IOL.

NURSING MANAGEMENT

The patient with cataract should receive the usual preoperative care for ambulatory surgical
patients undergoing eye surgery.

Nursing Assessment

The nurse should assess:

 Recent medication intake. It is a common practice to withhold any anticoagulant

therapy to reduce the risk of retrobulbar hemorrhage.
 Preoperative tests. The standard battery of preoperative tests such as complete
blood count, electrocardiogram, and urinalysis are prescribed only if they are
indicated by the patient’s medical history.
 Vital signs. Stable vital signs are needed before the patient is subjected to surgery.
 Visual acuity test results. Test results from Snellen’s and other visual acuity tests
are assessed.
 Patient’s medical history. The nurse assesses the patient’s medical history to
determine the preoperative tests to be required.
NURSING THEORY
 Roy adaptation
 Orem self-care deficit theory
 Abdellah theory
 Hendersons theory

THEORY APPLICATION

Mr. Karsandas is having weakness, constipation, decreased urine output and difficulty in
walking & breathing difficulty and unable to do his daily activity so I’m going to apply to
orems self care deficit theory on patient care.

INFORMATION DATA
Name- Mrs. Laxmiben D. Nayka
Age- 75 year
Sex-Female
Address- Chapra road,Navsari
Education- 10th pass
Religion- hindu
Occupation- house wife
Bed number-5
Ward- FeMale Surgical ward
Medical diagnosis- cataract
Surgery- performed
Date and time of admission-20-5-21

ASSUMPTIONS
 Human beings require continuous ,deliberate inputs to themselves and their
environment to remain alive and function according to their capacity.
 Human agency is exercised in the form of care for self and others in identifyig and
meeting needs.
 Mature human beings experience privations in the form of limitations for action and
care for of clustered tasks and alloself and others involving life sustaining and
function regulating inputs.
 Human agency is exercised in discovering developing and transmitting ways and
means to identify needs and make input to self and others.
 Groups of human beings with structured relationship of clustered tasks and allocate
responsibilities for providing care to group members who experience privations for
making required deliberate input to self and others.

PRIORITY OF NURSING PROBLEM ACCORDING TO OREMS THEORY OF

SELF CARE DEFICIT

 Prevent or manage the development threats

 Maintenance of health status
 Awareness and management of the disease process
 Adherence to the medical regimen
 Awareness of potential problem
 Modify self image
 Adjust life style to accommodate health status changes

UNIVERSAL SELF CARE REQUISITES

 Air : Breath without difficulty,no pallor cynosis
 Water:Fluid intake is sufficient .Edema present over ankles.Turgor normal for the age.
 Food: Food intake is not adequate
 Elimination: Voids and elimination bowel without difficulty
 Activity/Rest: Frequent rest is required due to pain.
Pain not completely relieved.
Activity level has come down.
  Social interaction: Communicate well with neighbours and calls the daughter by
phone,need for medical care is communicted to the daughter.
 Prevention of hazards: Need instruction on care of joints and prevention of falls.
Need instruction on improvement of nutritional status.
 Promotion of nonmalcy:Has good relation with daughter.

NURSING PROCESS

NURSING DIAGNOSIS
1.Distrubed visual sensory perception related to changes in sensory acuity as evidenced by
poor visual acuity,blurry vision and difficulty focusing.
2.Anxiety related to threat of permenant loss of vision as evidenced by patient looking
worried.
3.Self care deficit related to cataract decreased strength/endurance as evidenced by inability
to manage their self care activities.
4.Deficient knowledge related to information misinterpretation as evidenced by inaccurate
follow through of instructions.
5. Risk for injury related to decreased vision.
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Distrubed visual By the end of 48 Assess the Assessed the
After providing all the
patient says,” I’am sensory perception hours patient will patient ability to patient ability to
nursing care clients
related to changes regain optimal see see vision is improve some
not able to see
in sensory acuity vision possible . what..
properly. as evidenced by
poor visual Provide sufficient Provided sufficient
acuity,blurry light for the patient light for the patient to
vision and to carry out the carry out the activities.
Objective data: difficulty activities.
focusing.
poor vision
Provided large print
Provide large print objects and visual aid
objects and visual
aid
Demonstrated how to
administer eye drops
Demonstrate how to
administer eye drops Encouraged paient to
see an
Encourage paient ophthalomologistat
to see an least yearly..
ophthalomologist
at least yearly.
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Anxiety related to Within a 4 days Familirazie patient with Familirazied patient with
the environment and the environment and new After providing all the
patient says,” I’am threat of patient should be
nursing care clients
permenant loss of free from anxiety new experience. experience.
having worry about level of anxiety reduce
vision as as evidenced by somewhat.
my vision. evidenced by patient looking Encourage client to Encouraged client to
patient looking worried. acknowledge acknowledge concerns
worried. concerns and express and express feelings.
feelings.
Objective data:
Identified helpful
poor vision Identify helpful resources and pwople.
resources and pwople.

Patient will Patient will verebralize

verebralize understanding of the
understanding of the prognosis the
prognosis the condition.
condition.
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Self care deficit related Client will Assess the physical Assessed the physical
activity level and activity level and After providing all the
patient says,” I’am to cataract decreased demonstrate
nursing care clients
strength/endurance as technique mobility of the client. mobility of the client.
not able to do my evidenced by inability activity level improve
changes to meet somewhat.
work to manage their self self care needs Assess the need for Assessed the need for
care activities. ambulation aids ambulation aids

Encourage the client to Encouraged the client to

Objective data: ambulate with assisitvie ambulate with assisitvie
device device
By physical
Allow patient Allowed patient
examination sufficient time to sufficient time to
complete tasks to complete tasks to
the fullest extent the fullest extent of
(Cataract) of ability. ability.

Consult with Consuletant with

rehabilitation rehabilitation
specialist( occupat specialist( occupati
ional therapist) onal therapist)
 ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Deficient knowledge Client will Assess the physical Assessed the physical
activity level and activity level and After providing all the
patient says,” I don’t related to information verbalize
nursing care clients
misinterpretation as understanding of mobility of the client. mobility of the client.
know how this disease evidenced by clients level of
conditions/progno knowledge is improve
occur inaccurate follow sis, and potential Assess the need for Assessed the need for somewhat.
through of instructions. complications. ambulation aids ambulation aids

Encourage the client to Encouraged the client to

Objective data: ambulate with assisitvie ambulate with assisitvie
device device
By asking
Allow patient Allowed patient
frequent sufficient time to sufficient time to
complete tasks to complete tasks to
question. the fullest extent the fullest extent of
of ability. ability.

Consult with Consultant with

rehabilitation rehabilitation
specialist( occupat specialist( occupati
ional therapist) onal therapist)
DIET

Fruits and Vegetables

Studies show we need between five and nine servings of fruits and vegetables per day for
optimal eye health. More matters when it comes to healthy produce, and it is important to
choose a colorful variety. Fruits and vegetables offer the highest total antioxidant capacity of
all foods, so make these the building blocks of your diet.

While at the grocery store, select a fruit or vegetable for each color of the rainbow. How
about red strawberries, orange tangerines, yellow peppers, green kale, indigo blueberries and
purple eggplant? Try to choose organic fruit and eat the skins of fruits and vegetables since
they are full of vitamins A, C and E, as well as lutein and zeaxanthin.

Whole Grains

To prevent cataracts, eat three servings of 100 percent whole grains. This can include
amaranth, brown rice, bulgur, buckwheat, millet, oatmeal, popcorn, sorghum, quinoa, rye and
wheat. Some of these grains may be unfamiliar to you, but be adventurous. Look up some
recipes and try something new!

You can also boost your eye health by making wiser choices when you purchase bread and
other baked goods. Read food labels carefully, avoiding white bread and bakery items that
contain refined grains and sugars and choosing items that are minimally processed.

Fish

Omega-3 fatty acids are also known to reduce the risk of cataract development and
progression. Good sources of omega-3 fatty acids include shrimp, tuna, cod, salmon, halibut,
trout, herring, walnut, flaxseed oil, canola oil and spinach. Eat fish at least twice per week to
nourish your eyes and protect your vision.

Seeds and Nuts

Nuts and seeds are great sources of vitamin E, an antioxidant that helps protect membranes of
eye cells from free radical damage. Some of the best choices for eye health are almonds,
walnuts, hazelnuts, peanuts and sunflower seeds.

May is Women’s Health Month, a time for women to renew their commitment to their own
health. Ladies, remember that your visual health is just as important as your family’s, so set
aside an hour for yourself and get your eyes examined. A comprehensive eye exam is the best
way to preserve your vision and prevent eye disease before it develops.

Some research shows that eating foods high in antioxidants like vitamins C and E may help
prevent cataracts. If you already have cataracts, it may slow their growth.
Good sources of vitamin C include:

 Citrus (oranges, grapefruit, limes, etc.)

 Tomatoes and tomato juice
 Red and green peppers
  Kiwifruit
 Broccoli
 Strawberries
 Brussels sprouts
 Cantaloupe
 Potatoes

For vitamin E, look to vegetable oils like sunflower, safflower, or wheat germ. Nuts, especially
almonds, are also good sources of vitamin E. So are peanuts. So are green veggies like spinach
and broccoli. Some foods -- maybe even your favorite breakfast cereal -- contain extra vitamin E.
Check the info on the package to be sure.
You may not have heard of lutein and zeaxanthin. These are two more vitamins that could help
protect your eyes from cataracts. Eggs have them, as do green, leafy vegetables.
Make sure you eat fruits and veggies every day. Five servings can provide more than 100
milligrams of vitamin C and 5 to 6 milligrams of lutein and zeaxanthin. Just two servings of nuts
can provide 8 to 14 milligrams of vitamin E. If you find it tough to fit all of this into your daily
diet, consider multivitamins or supplements. But always talk to your doctor first.

COMPLICATION
 Posterior Capsule Rupture/Vitreous loss. Due to the nature of cataract surgery, posterior
capsule tears may occur at any point during the operation. ...
 Cystoid Macular Edema. ...
 Endophthalmitis. ...
 Vitreous/Suprachoroidal Hemorrhage. ...
 Retinal Tears/Detachment. ...
 Lens Dislocation
HEALTH EDUCATION

It is normal to have the following:

 Bruised or bloodshot eye for 7 days

 Itching and mild discomfort for several days
 Some fluid discharge
 Sensitivity to light
 Scratchy, sandlike feeling in the eye for 2 weeks
 Feeling tired, especially during the first 24 hours
Activity level

 Do not drive for 2 days or as instructed by your doctor.

 Do not drink alcohol for at least 24 hours.
 Avoid bending at the waist to pick up objects or lifting anything heavy for 2 days.
 Relax for the first 24 hours after surgery. Watching TV and reading are OK and won’t
harm your eye.

Eye protection

 Do not rub or press on your eye.

 Sleep on your back or on your unoperated side for 2 nights.
 If instructed, wear a bandage over your eye for 2 days and 2 nights.
 If instructed, wear a shield to protect your eye for 2 days and 2 nights.
Using eyedrops

You may be given special eyedrops or ointment. Here is one way to use eyedrops:
 Tilt your head back.
 Pull your bottom eyelid down.
 Squeeze one drop into your eye. Do not touch your eye with the bottle tip.
 Close your eyes for a few seconds.
 If you need more than one drop, wait a few minutes before adding the next one.
Call your doctor right away if you have any of the following:

 Bleeding or discharge from the eye

 Your vision suddenly becomes worse
 Pain medicine you are told to take does not ease your pain
 Nausea or vomiting

SUMMARY
In this assignment I had included the following topic:

 Introduction
 History collection
 Physical examination
 Investigation
 Pharmacological management
 Theory application
  Nursing process
 Diet
 complication
 Health education
 Home remedies
 Summary
 Conclusion
 Bibliography

CONCLUSION
A cataract is a dense, cloudy area that forms in the lens of the eye. A cataract begins when
proteins in the eye form clumps that prevent the lens from sending clear images to the retina.
The retina works by converting the light that comes through the lens into signals. It sends the
signals to the optic nerve, which carries them to the brain.
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MEDICAL SURGICAL NURSING (10th edition).

3. Brunner & siddharts, ‘’ TEXTBOOK OF MEDICAL SURGICAL NURSING’’

Jaypee Brothers medical publishers(p) LTD,13th edition

4.F.A.Davis,”DRUG GUIDE FOR NURSES,” 9th edition, Nursing Robert Martone
Publication.

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NURSING- 1’’, first edition, pee vee publication, 2015

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Publication.

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Jaypee publication.
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