The nurse is performing an admission assessment on a client with a diagnosis of detached retina. Which of the following is associated with this eye disorder?
1. Total loss of vision
2. Pain in the affected eye
3. A yellow discoloration of the sclera
4. A sense of a curtain falling across the field of vision
Retinal detachment
Description
Detachment or separation of the retina from the epithelium
Retinal detachment occurs when the layers of the retina separate because of the accumulation of fluid between them, or when both retinal layers elevate away from the choroid as a result of a tumor.
Partial detachment becomes complete if untreated.
When detachment becomes complete, blindness occurs.
Assessment
Flashes of light
Floaters or black spots (signs of bleeding)
Increase in blurred vision
Sense of a curtain being drawn over the eye
Loss of a portion of the visual field; painless loss of central or peripheral vision
Immediate interventions
Provide bedrest.
Cover both eyes with patches as prescribed to
prevent further detachment.
Speak to the client before approaching.
Position the client’s head as prescribed.
Protect the client from injury.
Avoid jerky head movements.
Minimize eye stress.
Prepare the client for a surgical procedure as prescribed.
Surgical procedures
Draining fluid from the subretinal space so that the retina can return to the normal position
Sealing retinal breaks by cryosurgery, a cold probe applied to the sclera, to stimulate an inflammatory response leading to adhesions
Diathermy, the use of an electrode needle and heat through the sclera, to stimulate an inflammatory response
Laser therapy, to stimulate an inflammatory response and seal small retinal tears before the detachment occurs
Scleral buckling, to hold the choroid and retina together with a splint until scar tissue forms, closing the tear
Insertion of gas or silicone oil to promote reattachment; these agents float against the retina to hold it in place until healing occurs.
Postoperative interventions
Maintain eye patches as prescribed.
Monitor for hemorrhage.
Prevent nausea and vomiting and monitor for restlessness, which can cause hemorrhage.
Monitor for sudden, sharp eye pain (notify the physician).
Encourage deep breathing but avoid coughing.
Provide bedrest for 1 to 2 days as prescribed.
Position the client as prescribed (positioning depends on the location of the detachment).
Administer eye medications as prescribed.
Assist the client with activities of daily living.
Avoid sudden head movements or anything that increases intraocular pressure.
Instruct the client to limit reading for 3 to 5 weeks.
Instruct the client to avoid squinting, straining and constipation, lifting heavy objects, and bending from the waist.
Instruct the client to wear dark glasses during the day and an eye patch at night.
Encourage follow-up care because of the danger of recurrence or occurrence in the other eye.
The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would the nurse include in the plan of care?
1. Avoid overuse of the eyes.
2. Decrease the amount of salt in the diet.
3. Eye medications will need to be administered for the client’s entire life.
4. Decrease fluid intake to control the intraocular pressure.
Glaucoma Disorders
Description
A group of ocular diseases resulting in increased intraocular pressure
Intraocular pressure is the fluid (aqueous humor) pressure within the eye (normal intraocular pressure is 10 to 21 mm Hg).
Increased intraocular pressure results from inadequate drainage of aqueous humor from the canal of Schlemm or overproduction of aqueous humor.
The condition damages the optic nerve and can result in blindness.
The gradual loss of visual fields may go unnoticed because central vision is unaffected.
Types
Primary open-angle glaucoma (POAG) results from obstruction to outflow of aqueous humor and is the most common type.
Primary angle-closure glaucoma (PACG) results from blocking the outflow of aqueous humor into the trabecular meshwork; causes include lens or pupil dilation from medications or sympathetic stimulation.
Assessment
Early signs include diminished accommodation and increased intraocular pressure.
Primary open-angle glaucoma (POAG): Painless, and vision changes are slow; results in “tunnel” vision.
Primary angle-closure glaucoma (PACG): Blurred vision, halos around lights, and ocular erythema.
Interventions for acute angle-closure glaucoma
Acute angle-closure glaucoma is a medical emergency that causes sudden eye pain and possible nausea and vomiting.
Treat acute angle-closure glaucoma as a medical emergency.
Administer medications as prescribed to lower intraocular pressure.
Prepare the client for peripheral iridectomy, which allows aqueous humor to flow from the posterior to the anterior chamber.
Interventions for the client with glaucoma
Instruct the client on the importance of medications to constrict the pupils (miotics), to decrease the production of aqueous humor (carbonic anhydrase inhibitors), and to decrease the production of aqueous humor and intraocular pressure (b-blockers).
Instruct the client of the need for lifelong medication use.
Instruct the client to wear a Medic-Alert bracelet.
Instruct the client to avoid anticholinergic medications.
Instruct the client to report eye pain, halos around the eyes, and changes in vision to the physician.
Instruct the client that when maximal medical therapy has failed to halt the progression of visual field loss and optic nerve damage, surgery will be recommended.