This document provides information about cataracts and their management. It discusses what a cataract is, risk factors for cataract formation such as aging, associated ocular conditions, nutritional and physical factors, and systemic diseases. It describes the clinical manifestations of cataracts and the diagnostic evaluation including various visual acuity tests and examinations. Treatment options discussed include medical management using glasses or surgery. The two main surgical procedures mentioned are extracapsular cataract extraction and phacoemulsification. Postoperative care and potential complications are also outlined. Finally, it provides conclusions and references several research articles on prevalence and risk factors of cataracts.
complete information about the retinal detachment , types, , symptoms , sign, etiology, causes, diagnosis, complications, medical management, nursing management, home care, patient teaching. nursing reserch.
complete information about the retinal detachment , types, , symptoms , sign, etiology, causes, diagnosis, complications, medical management, nursing management, home care, patient teaching. nursing reserch.
Retinal detachment is a disorder of the eye in which the retina separates from the layer underneath. Symptoms include an increase in the number of floaters, flashes of light, and worsening of the outer part of the visual field
complete information about the refractive errors due to the problem in the acomodation of eye lense , disturbed image formation in the retina, contains -types of disease condition .
This is a topic of sensory organ and this is detailed topic and can be refered by all nursing students bsc, msc and gnm which give you overall idea and things related to cataractwhich include definition, anat and physio, risk factor, pathophysiology, clinical menifestation, diagnostic evaluation, and management
eye emergency occurs any time we have foreign objects or chemical in our eyes. this slide contain definition, classification, types of injury, identification, management, medical management, nursing management. care of eye in the condition.
Retinal detachment is a disorder of the eye in which the retina separates from the layer underneath. Symptoms include an increase in the number of floaters, flashes of light, and worsening of the outer part of the visual field
complete information about the refractive errors due to the problem in the acomodation of eye lense , disturbed image formation in the retina, contains -types of disease condition .
This is a topic of sensory organ and this is detailed topic and can be refered by all nursing students bsc, msc and gnm which give you overall idea and things related to cataractwhich include definition, anat and physio, risk factor, pathophysiology, clinical menifestation, diagnostic evaluation, and management
eye emergency occurs any time we have foreign objects or chemical in our eyes. this slide contain definition, classification, types of injury, identification, management, medical management, nursing management. care of eye in the condition.
A cataract is a clouding or opacity that
develops in the crystalline lens of the eye or in its envelope, varying in degree from slight opacity to obstructing the passage of light.
Progressive, painless clouding of the natural, internal lens of the eye.
Glaucoma slideshare for medical students NehaNupur8
complete information about glaucoma eye disease contain detail of definition ,classification, types, pathophysiology, risk factor, causes, medical management ,nursing management, drug therapy, nursing process . for medical students, made by students of basic bsc nursing RIMS students
cataract is clouding of the lens inside the eye..
it is very useful topic in medical filed...in this presentation all content is included about cataract like causes, symptoms and treatment...its very useful in your study.
Although optometrists do not perform laser vision correction here in the United States, they can still provide a valuable role in this procedure that is gaining unprecedented popularity.
Cataract Surgery Recovery Timeline: Navigating the Road to Clear Vision. Cataract surgery is a common and safe procedure, but understanding the recovery process can be overwhelming. Our blog is here to guide you through the recovery timeline, from pre-surgery preparation to post-surgery care. We'll cover the most common symptoms, tips for a speedy recovery and help you to set realistic expectations. Join us as we navigate the road to clear vision and regain your confidence.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
3. INTRODUCTION
•A cataract is a lens opacity or cloudiness.
•Cataracts can develop in one or both eyes at any age.
•Visual impairment normally progresses at the same
rate in both eyes over many years or in a matter of
months.
•If cataracts are present in both eyes, one may affect the
patient’s vision more than the other.
4. EPIDEMIOLOGY
•The World Health Organization (WHO) estimates that nearly
18 million people are bilaterally blind from cataract in the
world, representing almost half of all global cases of
blindness.
•By age 65, over 90 percent of people have a cataract and half
of the people between the ages of 75 and 85 have lost some
vision due to a cataract.
•In India cataract is the principal cause of blindness
accounting for 62.6% cases of blindness.
5. Risk Factors for Cataract Formation
Aging
• Loss of lens transparency
• Clumping or aggregation of lens protein
(which leads to light scattering)
• Accumulation of a yellow-brown pigment
due to the breakdown of lens protein
• Decreased oxygen uptake
• Decrease in levels of vitamin C, protein,
and glutathione (an antioxidant)
6. Associated Ocular Conditions
• Retinitis pigmentosa
• Myopia
• Retinal detachment and retinal surgery
• Infection (e.g., herpes zoster, uveitis)
Toxic Factors
• Corticosteroids, especially at high doses and in long-
term use
• Alkaline chemical eye burns, poisoning
• Cigarette smoking
• Calcium, copper, iron, gold, silver, and mercury,
which tend to deposit in the pupillary area of the lens
7. Nutritional Factors
• Reduced levels of antioxidants
• Poor nutrition
• Obesity
Physical Factors
•Dehydration associated with chronic
diarrhea, use of purgatives in anorexia
nervosa, and use of hyperbaric oxygenation
• Blunt trauma, perforation of the lens with a
sharp object or foreign body, electric shock
• Ultraviolet radiation in sunlight and x-ray
8. Systemic Diseases and
Syndromes
• Diabetes mellitus
• Down syndrome
• Disorders related to lipid
metabolism
• Renal disorders
• Musculoskeletal disorders
9.
10.
11. •A nuclear cataract is associated with myopia, which
worsens when the cataract progresses. If dense, the
cataract severely blurs vision. Periodic changes in
prescription eyeglasses help manage this problem.
•A cortical cataract involves the anterior, posterior, or
equatorial cortex of the lens. A cataract in the equator or
periphery of the cortex does not interfere with the passage
of light through the centre of the lens and has little effect
on vision. Cortical cataracts progress at a highly variable
rate. Vision is worse in very bright light. People with the
highest levels of sunlight exposure have twice the risk of
developing cortical cataracts than those with low-level
sunlight exposure.
12. •Posterior subcapsular cataracts occur in front of
the posterior capsule. This type typically develops
in younger people and, in some cases, is
associated with prolonged corticosteroid use,
inflammation, or trauma. Near vision is
diminished, and the eye is increasingly sensitive
to glare from bright light.
23. Keratometry
•A keratometer, also
known as an
ophthalmometer, is a
diagnostic instrument
for measuring the
curvature of the
anterior surface of the
cornea, particularly for
assessing the extent and
axis of astigmatism.
27. Medical Management
•No nonsurgical treatment cures cataracts. Ongoing studies are
investigating ways to slow cataract progression, such as intake of
antioxidants (e.g., vitamin C, beta-carotene, vitamin E)
•In the early stages of cataract development, glasses, contact
lenses, strong bifocals, or magnifying lenses may improve vision.
•Reducing glare with appropriate lighting can facilitate reading.
•Mydriatics can be used as short-term treatment to dilate the
pupil and allow more light to reach the retina, although this
increases glare.
28. Surgical management
•Fewer than 15% of people with cataracts suffer
vision problems severe enough to require
surgery.
•Surgery is performed on an outpatient basis and
usually takes less than 1 hour, with the patient
being discharged in 30 minutes or less afterward.
•When both eyes have cataracts, one eye is
treated first, with at least several weeks,
preferably months, separating the two
operations.
29. Intracapsular Cataract
Extraction
•The entire lens (i.e., nucleus,
cortex, and capsule) is
removed, and fine sutures
close the incision.
•ICCE is infrequently performed
today; however, it is indicated
when there is a need to
remove the entire lens, such as
with a subluxated cataract (i.e.,
partially or completely
dislocated lens).
30. Extracapsular cataract extraction (ECCE)
•Smaller incisional wounds (less trauma to the eye) and
maintenance of the posterior capsule of the lens, reducing
postoperative complications, particularly aphakic retinal
detachment and cystoid macular edema.
•An intact zonular-capsular diaphragm provides the needed
safe anchor for the posterior chamber intraocular lens (IOL).
After the pupil has been dilated and the surgeon has made a
small incision on the upper edge of the cornea, a
viscoelastic substance (clear gel) is injected into the space
between the cornea and the lens. This prevents the space
from collapsing and facilitates insertion of the IOL.
37. Late Postoperative Complications
•Suture-related problems
•Malposition of the IOL
•Chronic endophthalmitis
•Opacification of the posterior capsule
(most common late complication of
extracapsular cataract extraction)
38. PREOPERATIVE CARE
-To reduce the risk for retrobulbar hemorrhage (after retrobulbar
injection), any anticoagulation therapy that the patient is receiving is
withheld, if medically appropriate.
-Aspirin should be withheld for 5 to 7 days, nonsteroidal anti-
inflammatory medications (NSAIDs) for 3 to 5 days, and warfarin
(Coumadin) until the prothrombin time of 1.5 secs is almost reached.
-Dilating drops are administered every 10 minutes for four doses at
least 1 hour before surgery. Additional dilating drops may be
administered in the operating room (immediately before surgery) if
the affected eye is not fully dilated.
-Antibiotic, corticosteroid, and NSAID drops may be administered
prophylactically to prevent postoperative infection and inflammation.
39. POSTOPERATIVE CARE
-After recovery from anesthesia, the patient receives
verbal and written instruction regarding how to protect
the eye, administer medications, recognize signs of
complications, and obtain emergency care.
-The nurse also explains that there is minimal discomfort
after surgery and instructs the patient to take a mild
analgesic agent, such as acetaminophen, as needed.
-Antibiotic, anti-inflammatory, and corticosteroid eye
drops or ointments are prescribed postoperatively.
40. NURSING ASSESSMENT
•Assess the patient's distant and near visual acuity.
•If the patient is going to have surgery, especially note the
visual acuity in the patient's unoperated eye. Use this
information to determine how visually compromised the
patient may be while the operative eye is healing.
•Assess the psychosocial impact of the patient's visual
disability and the level of knowledge regarding the disease
process and therapeutic options.
•Postoperatively, assess the patient's level of comfort and
ability to follow the postoperative regimen.
41. NURSING DIAGNOSIS
Pre-operative
1. Disturbed Sensory Perception: Visual related
to cataract as evidenced by diminished visual
acuity.
2. Anxiety related to surgery that will be
undertaken and the possibility of failure to
obtain a sight again.
3. Risk for injury related to decreased vision.
42. Post-operative
1. Deficient knowledge related to the post-
operative care as evidenced by frequent
questioning by patient and family members.
2.Risk for infection related to trauma to the
incision.
3.Risk for injury related to blurring of vision
after surgery.
43. Promoting home and community-based
care
-To prevent accidental rubbing or poking of the eye, the patient
wears a protective eye patch for 24 hours after surgery, followed
by eyeglasses worn during the day.
-The nurse instructs the patient and family in applying and caring
for the eye shield.
-Sunglasses should be worn while outdoors during the day because
the eye is sensitive to light.
- Importance of complying with postoperative restrictions on head
positioning, bending, coughing, and Valsalva maneuver to
optimize visual outcomes and prevent increased intraocular
pressure.
44. - How to instill eye medications using aseptic
techniques and adherence with prescribed eye
medication routine to prevent infection.
-Slight morning discharge, some redness, and a
scratchy feeling may be expected for a few days. A
clean, damp washcloth may be used to remove
slight morning eye discharge.
-Because cataract surgery increases the risk for
retinal detachment, the patient must know to notify
the surgeon if new floaters (i.e., dots) in vision,
flashing lights, decrease in vision, pain, or increase in
redness occurs.
45. Continuing Care
-The eye patch is removed after the first follow-up
appointment.
-Patients may experience blurring of vision for several days to
weeks. Sutures left in the eye alter the curvature of the
cornea, resulting in temporary blurring and some astigmatism.
-Vision gradually improves as the eye heals.
-How to monitor pain, take pain medication, and report pain
not relieved by medication.
-Importance of continued follow-up as recommended to
maximize potential visual outcomes.
46. RESEARCH ARTICLES
1.The prevalence and risk factors for cataract in rural and urban India
Sumeer singh et al conducted a study to report the prevalence and risk
factors of cataract and its subtypes in older age group in 2017.A total of 6617
subjects were recruited from both rural and urban areas. Lens opacity was
graded according to the Lens Opacity Classification System III (LOCS
III).Cataract was present in 1094 of the rural and 649 subjects in the urban
population. In baseline characteristics history of diabetes, alcohol intake and
presence of age-related macular degeneration were the risk factors in urban
group. Overweight was found to be a protective factor, and lower social
economic status a risk factor for cataract in urban population. It concluded
that the risk factors for any cataract in older age group are increasing age
and HbA1c in rural group. Age and lower social economic status were found
to be the risk factors in urban area. A statistically significant difference was
found on comparison of the prevalence of cataract and its subtypes
between the rural and urban population.
47. 2.Prevalence and Visual Outcomes of Cataract Surgery in Rural South India:
A Cross-Sectional Study.
Paul P et al conducted a cross-sectional survey to determine the prevalence of
cataract surgery and postoperative vision-related outcomes, especially with
respect to gender, socioeconomic status (SES) and site of first contact with eye
care, in a rural area of South India in 2016. 5530 individuals aged 50 years or
older who had undergone cataract surgery in one or both eyes were
identified. Outcomes were classified as good if visual acuity of the operated
eye was 6/18 or better, fair if worse than 6/18 but better than or equal to
6/60, and poor if worse than 6/60. Prevalence of cataract surgery in this age
group (771 persons) was 13.9%. Place of surgery and duration since surgery of
3 years or more were risk factors for blindness, while SES, gender and site of
first eye care contact were not. The high prevalence of avoidable causes of
visual impairment in this rural setting indicates the scope for preventive
strategies.
48.
49. CONCLUSION
•As discussed throughout the presentation, learning
about cataract and its management will help nurses to
care for a cataract patient.
•Nurses can do assessment of a cataract patient,
observe the sign and symptoms, provide the necessary
nursing care and support the patient psychologically.
•Nurses can also counsel the patients and their family
for various options available in treatment for cataract.
50. REFERENCES
1. Janice L. Hinkle, Kerry H. Cheever. Brunner and Suddarth’s Textbook of Medical
Surgical Nursing. 2015. New Delhi. Wolters Kluwer.13th Edition. Volume 2. Pg. no.
1761-1764.
2. Lewis. Medical Surgical Nursing Assessment and Management of clinical
problems.2015. New Delhi. Elsevier. 2nd Edition. Volume I. Pg. no. 409-412.
3. World Health Organization. Blindness and vision impairment prevention.
Available from https://www.who.int/blindness/causes/priority/en/index1.html
[cited 7 April 2020]
4. Singh S, Pardhan S, Kulothungan V, Swaminathan G, Ravichandran JS, Ganesan S,
Sharma T, Raman R. The prevalence and risk factors for cataract in rural and urban
India. Indian J Ophthalmol [serial online] 2019 [cited 2020 Apr 7]; 67:477-83.
Available from: http://www.ijo.in/text.asp?2019/67/4/477/254705 [cited 7 April
2020]
5. PubMed. Prevalence and Visual Outcomes of Cataract Surgery in Rural South
India: A Cross-Sectional Study. Ophthalmic Epidemiol. 2016 Oct;23(5):309-15. doi:
10.1080/09286586.2016.1212991. Epub 2016 Aug 23.
51.
52. Q. Which of the following statement is true regarding the
visual changes associated with cataracts?
A. Both eyes typically cataracts at the same time
B. The loss of vision is experienced as a painless, gradual
blurring
C. The patient is suddenly blind
D. The patient is typically experiences a painful, sudden
blurring of vision.
Ans- B
53. Q. The following are appropriate nursing interventions after cataract
extraction EXCEPT:
A. Place the client in supine position or turn towards unoperated side
B. Advise the client to avoid bending, stooping or lifting heavy objects
for several weeks postop
C. Instruct the client to limit fluid intake
D. Advise the client to protect his eyes with eye pad and eye shield for
a week
Ans- C
54. Q.A 55-year old client underwent cataract removal with
intraocular lens implant. Nurse Oliver is giving the client
discharge instructions. These instructions should include
which of the following?
A. Avoid lifting objects weighing more than 5 lb (2.25 kg).
B. Lie on your abdomen when in bed
C. Keep rooms brightly lit.
D. Avoiding straining during bowel movement or bending at
the waist.
Ans- D