A nurse is reinforcing discharge teaching with a client following a cataract extraction. Which of the following should the nurse include in the teaching?

Choice A rationale The eye shield should not be removed at bedtime; in fact, it is specifically required during sleep to prevent accidental injury. During the night, a patient might unconsciously rub or press against the operative eye, which could rupture the delicate sutures or cause a sudden spike in intraocular pressure. The shield provides a rigid physical barrier that ensures the eye remains protected from external trauma while the patient is not awake to maintain protective behaviors. Choice B rationale Bending at the waist must be avoided because it places the head in a dependent position, which significantly increases intraocular pressure. Elevated pressure in the eye can cause the surgical incision to open or lead to intraocular hemorrhage, threatening the success of the cataract extraction. Patients are taught to bend at the knees while keeping the head upright to perform necessary tasks, thereby keeping the intraocular pressure within a safe, stable range during the healing process. Choice C rationale Seeing flashes of light is not an expected finding and can be a sign of a serious complication like retinal detachment. While some mild blurring or redness is normal, flashes of light or a sudden increase in floaters indicate that the retina may be under traction or separating from the back of the eye. This requires immediate medical evaluation to prevent permanent vision loss, and patients must be taught that this is a surgical emergency. Choice D rationale Limiting the use of laxatives is incorrect advice; patients should actually be encouraged to use them if they are constipated. Straining during bowel movements significantly increases intraocular pressure through the Valsalva maneuver. To protect the surgical site, it is vital to keep stools soft and easy to pass. Reducing intra-abdominal and intrathoracic pressure prevents the transmission of that pressure to the ocular vessels, which is critical for maintaining the stability of the postoperative eye.