Nursing Care Plan for Retinal Detachment
Retinal detachment is the separation of the the retina from the choroid (the middle vascular coat of the eye between the retina and sclera). It occurs when the retina develops a hole or tear and the vitreous seeps between the retina and choroid. If left untreated, retinal detachment can lead vission loss.
The possible causes of retinal detachment are Trauma, Hemorrhage, Myopia, Tumor, Aging, Diabetic neovascularization, Inflammatory process and Familial tendency.
Assessment findings of retinal
detachment :
- Painless change in vision (floaters caused by blood cells in the vitreous and flashes of light as the vitreous humor pulls on the retina).
- Photopsia ( recurrent flashes of light).
- Blurred vision worsening as detachment increases.
- with progression of detachment, painless vision loss that may be described as veil, curtain or cobweb that eliminates part of the visual field.
- Indirect opthalmoscopy shows retinal tear or detachment.
- Slit-lamp examination reveals retinal tear or detachment.
- Ultrasound shows retinal tear or detachment in presence of cataract.
- Complete bed rest and restriction of eye movement to prevent further detachment.
- Laser theraphy, if there's a hole in the posterior portion of the retina
- Scleral buckling to reattach the retina, It is a surgical procedure, which a silicone band or sponge is sewn around the eyeball a little behind the visible portion or the eye. Exactly locates the hole and places the band and tightens it creating a buckle effect and then the outer coats of the eye are indented and in this way the hole in the retina approximates the outer scleral coat.
- Pneumatic Retinopexy, It is a short simple procedure, where a fixed amount of air is injected in the posterior part of the eye, which the air acts as an internal tamponade that helping to push and approximate the tear with the outer coat of the eye ball. Following the tear is sealed with cryo or laser therapy. Post-operatively the patient is advised rest in a specified position, in order to facilitate the air bubble to push the desired area of the retina with the tear against the sclera.
- Sub-retinal fluid drain : make seep the fluid out through the hole behind the retina that can be drained with a small slit made in the outer coats of the eye to flatten the retina. This procedure is usually done along with sclera bucking to flatten the retina.
- Vitrectomy: The procedure involves cutting and removal of the vitreous gel along with removal of all the fibrous tissue causing traction (pull) on the retina and detaching it, or sometimes the space is replaced with gas or silicon oil. ussually the procedure is done with the help of micro instruments and a fiberoptic light source. The procedure is combined with sclera buckling.
- Cyropexy, if there's a hole in the peripheral retina.
Nursing diagnoses for Retinal Detachment :
- Disturbed sensory perception (visual).
- Anxiety.
- Risk for injury.
- The client will remain free from injury.
- The client will be free from permanent visual impairment.
- The client will understand the treatment options.
- Asses visual status and functional vision in the unaffected eye to determine self care needs.
- Prepare the client for surgery by explaining possible surgical interventions and technique to alleviate some of the client's anxiety.
- Discourage straining during defecation, bending down and hard coughing, sneezing or vomiting to avoid activities that increase intraocular pressure.
- Assist with ambulation, as needed, to help the client remain independent.
- Approach the clients from the unaffected side to avoid startling him.
- Provide assistance with activities of daily living to minimize frustation adn strain.
- Orient the client to his environment to reduce the risk of injury.
- Posoperatively instruct the client to lie on his back or on his unoperated side to reduce intraocular pressure in the affected area.
- The client's vision is restored.
- The client will remains free from injury.
- The client will understands all discharge instructions.
Management Nursing Care Plans @ 12:03 AM,
