NCLEX RN Practice Question # 459

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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.

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