Detached Retina

  1. General information
    1. Detachment of the sensory retina from the pigment epithelium of the retina
    2. Caused by trauma, aging process, severe myopia, postcataract extraction, severe diabetic retinopathy
    3. Pathophysiology: tear in the retina allows vitreous humor to seep behind the sensory retina and separate it from the pigment epithelium
  2. Medical management
    1. Bed rest with eyes patched and detached areas dependent to prevent further detachment
    2. Surgery: necessary to repair detachment
      1. Photocoagulation: light beam (argon laser) through dilated pupil creates an inflammatory reaction and scarring to heal the area
      2. Cryosurgery or diathermy: application of extreme cold or heat to the external globe; inflammatory reaction causes scarring and healing of area
      3. Scleral buckling: shortening of sclera to force pigment epithelium close to retina
  3. Assessment findings
    1. Flashes of light, floaters
    2. Visual field loss, veil-like curtain coming across field of vision
    3. Diagnostic test: ophthalmoscopic examination confirms diagnosis.
  4. Nursing interventions: preoperative
    1. Maintain bed rest as ordered with head of bed flat and detached area in a dependent position.
    2. Use bilateral eye patches as ordered; elevate side rails to prevent injury.
    3. Identify yourself when entering the room.
    4. Orient the client frequently to time, date, and surroundings; explain procedures.
    5. Provide diversional activities to provide sensory stimulation.
  5. Nursing interventions: postoperative (see also Cataract Surgery)
    1. Check orders for positioning and activity level.
      1. May be on bed rest for 1-2 days.
      2. May need to position client so that detached area is in dependent position.
    2. Administer medications as ordered: topical mydriatics, analgesics as needed.
    3. Provide client teaching and discharge planning concerning
      1. Technique of eyedrop administration
      2. Use of eye shield at night
      3. No bending from waist; no heavy work or lifting for 6 weeks
      4. Restriction of reading for 3 weeks or more
      5. May watch television
      6. Need to check with physician regarding combing and shampooing hair and shaving
      7. Need to report complications such as recurrence of detachment

Monday, May 19, 2008 | Labels: |

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