Medical and Nursing Management of Retinal Detachment

I. Definition

•    Retinal detachment is a separation of the retina from the choroid in the posterior eye.

II. Risk Factors

•    Trauma
•    Age-related degenerative change
•    Cataract removal

III. Pathophysiology

•    Retinal layers separate from the choroid, creating a subretinal space. Vitreous fluid seeps between these layers, disrupting choroidal blood supply.

•    Detachment may be partial, causing various degree of visual deficits, or total causing blindness in the affected eye.

IV. Assessment/Clinical Manifestations/Signs and Symptoms

•    Recurrent flashes of light and floating spots
•    Progressive blurring of vision in the affected eye, followed by visual field deficits, with the area of visual loss depending on the area of detachment.
•    Anxiety, confusion, and fear of becoming blind

Laboratory and diagnostic study findings
•    Ophthalmoscopic examination may reveal an area of gray, opaque retina, possibly with folds, holes or tears.

V. Medical Management

•    The treatment for a tear may be a cryopexy (freezing of the retinal area) or lase photocoagulation performed.
•    Scleral bucking surgery is the most common method of treatment, requires that a piece of silicone, rubber or semihard plastic be placed against the outer surface of the eye and sutured into put. The piece pushes the sclera toward the middle of the eye, allowing the retina to settle back against the wall of the eye.
•    Pneumatic retinopexy is used to reattach the retina, the physician uses a bubble of gas to push the two layers back together again.
•    Vitrectomy is the possible procedure where the surgeon removes the vitreous fluid from the middle of the eye. The physician may then treat the retina with photocoagulation. At the end of the surgery, silicone oil or gas is injected into the ye to replace the vitreous fluid.

VI. Nursing Diagnosis

•    Anxiety related to possible vision loss
•    Disturbed sensory perception related to visual impairment
•    Ineffective health maintenance related to knowledge deficit
•    Risk for injury related to impaired vision
•    Self-care deficit related to impaired vision

VII. Nursing Management

Promote measures that limit mobility to prevent further injury.
•    Position the client in bed preoperatively as prescribed (usually with the detached area dependent), and instruct the client to avoid lying face down, stooping, or bending.
•    Enforce bed rest for 1 day postoperatively, with the client positioned supine or on the unoperated side unless otherwise directed.

Promote measures that assist with the client’s adaptation to the perceptual impairment.
•    Preoperatively, patch both eyes if detachment threatens the macula.
•    Administer sedation as prescribed, promote comfort and relaxation, and minimize eye strain.
•    Administer prescribed medications, which may include adrenergic agonist agents (mydriatic) and anticholinergic (cycloplegic) agents.

Provide postoperative nursing care.
•    Patch the affected eye for 1 to 4 hours
•    Encourage visitors, socialization, sensory stimulation and diversionary activities.
•    Administer mild analgesics for discomfort, and apply cool or warm compresses to edematous eyelids.

Instruct the client on discharge instructions.
•    Discuss allowed and restricted activities.
•    Discuss prescribed positions.
•    Instruct the client on the resumption of activity, including resuming activities of daily living gradually and as tolerated, commonly resuming light work in 3 weeks and normal activity in 6 weeks; avoiding heavy lifting, deep bending or stopping and avoiding bumping or otherwise injuring the head.

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