Lippincott Certification Review Medical-Surgical Nursing

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Retinal Detachment

●● Signs and symptoms ●● Signs and symptoms may occur slowly or suddenly.

●● Early symptoms may include flashes of light (photopsias) and new floaters; left untreated, progressive loss of vision or shadow in one area may occur (some describe as if curtain is being pulled before the eye). Early detection and treatment are necessary for the best outcome. ●● An afferent pupillary defect may be seen if the detachment is clinically significant.

●● Asymptomatic detachments can occur. ●● Visual acuity and IOP should be checked. ●● Diagnosis and treatment

●● Diagnosis depends on ophthalmoscopy (both direct and indirect) after full pupil dilation; fundus photography, fundus fluorescein angiography, OCT, visual field examination, and ultrasonography may also be useful. ●● Surgical treatment attempts to close the breaks in the layers by reestablishing contact between the retina and underlying RPE. ●● Without intervention, the risk of blindness in a symptomatic retinal detachment is great. ●● One or a combination of several types of surgery may be performed. ●● Laser photocoagulation uses laser-generated heat to injure the tissue and cause scars, which create a fibrous adhesion to seal the hole. ●● Cryotherapy uses nitrous oxide (also known as laughing gas) or carbon dioxide to injure the tissue by freezing it; the injury leaves a scar, which seals the retinal hole. ●● Scleral buckling places a band around the globe of the eye to bring the choroid into contact with the retina and hold it in place until adhesion occurs. ●● Intraocular tamponade with a gas bubble can push the detached retina toward the eye wall . ●● Vitrectomy may be needed . ●● Preoperative nursing interventions ●● Pretreatment, the patient should be placed on reduced activity, and possibly bilateral eye patching. ●● Place the patient on bed rest, patch the eye as prescribed, and position the patient’s head so that the retinal tear or hole is at the lowest point of the eye (if the detachment is toward the outer side of the head, have the patient lie on the affected side with the bed flat); these interventions help prevent further detachment. ●● Provide emotional support to the patient who may be distraught at the potential loss of vision. ●● Prepare the patient for surgery by cleaning their face and giving them antibiotics and eyedrops, as ordered. ●● Teach the patient about the role of the retina and why floaters, flashes of light, and decreased vision occur. ●● Allow the patient and family to discuss their concerns. ●● Explain the preoperative routines and the surgical procedure. ●● The patient should be aware that intervention may produce an anatomically restored contact between the retina and RPE and is done to prevent further deterioration. Often, visual acuity is mostly restored, but this is not guaranteed. ●● Postoperative nursing interventions ●● Position the patient as directed; the position varies according to the surgical procedure. ●● Tell the patient to avoid activities that increase IOP, such as sneezing, coughing, vomiting, lifting, straining during defecation, bending from the waist, and rapidly moving the head; increased IOP may cause more fluid to flow behind the retina before healing is complete. ●● Administer eyedrops, antiemetics, analgesics, and antibiotics, as ordered; to reduce corneal edema and discomfort, apply ice packs as ordered. ●● Tell the patient to notify the practitioner immediately if they experience floaters, flashes of light, blurred vision, or pain that isn’t relieved with analgesics; these symptoms indicate recurrence of detachment. ●● Teach the patient to recognize and report the signs and symptoms of infection, such as temperature above 100°F (37.8°C), yellow or green discharge, increased redness or pulling of the eye or lid, and vision loss. ●● Show the patient how to administer eye medications and change dressings using sterile technique to decrease the risk of infection. ●● Tell the patient to wear the eye shield at night or when napping to prevent accidental injury to the eye. ●● Discuss when the patient can return to work, resume ADLs, and drive or perform strenuous activities.

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