Desprendimiento de retina

The nurse is caring for a client who has developed retinal detachment. Which of the following actions should the nurse take first?

• A.Instruct the client to restrict activity
  

• B.Establish a vascular access device
  

• C.Review the client’s current medications
  

• D.Educate the client about topical eye ointments

Answer explanation

Choice A is correct. A retinal detachment is an ocular emergency. The client moving may hasten the detachment. It is important to inform the client to restrict their activity, and the nurse should apply an eye patch to the affected eye.

Choices B, C, and D are incorrect. A client with a retinal detachment will likely need surgery. Obtaining the client’s current medications, establishing vascular access, and educating the client about topical eye ointments that will be prescribed does not prioritize over instructing the client to restrict their head movements. Delaying the instruction of informing the client to restrict their head movements may worsen the detachment.

The nurse is assessing a client who has a suspected retinal detachment. Which of the following client statements would be consistent with this diagnosis?

• A.“My vision has a cloudy appearance.”
  

• B.“I have intense pain above my eyebrow.”
  

• 
  C.“I am having trouble with my peripheral vision.”
  

• D.“I can see bright flashes of light.”

Answer explanation

Choice D is correct. A retinal detachment is a medical emergency as it may become progressive and give the client blindness in the affected eye. The client may experience a loss of vision that appears as if a curtain is closing, or they may experience bright flashes of light.

Choices A, B, and C are incorrect. A cloudy-like appearance in vision is a characteristic of cataracts. Intense pain above the eyebrow is a feature of angle-closure glaucoma, which is a medical emergency. This is when the intraocular pressure is quite high and gives a client symptoms such as eyebrow pain, eye redness, headache, and nausea. Alterations in peripheral vision are a characteristic of glaucoma.

The nurse is caring for a client with suspected retinal detachment. Which of the following manifestations would not be consistent with a diagnosis of retinal detachment?

• A.Seeing “floaters” in the field of vision
  

• 
  B.A sense of having a curtain drawn over the eyes
  

• C.Flashes of light
  

• D.Intense pain in the affected eye

Answer explanation

Choice D is correct. Intense pain is not generally associated with retinal detachment. Retinal detachment may present with floaters in the field of vision, partial loss of sight, and increasingly blurred images. Some clients feel like a curtain has been drawn over their eyes. Other individuals may report flashes of bright light. Intense ocular pain may be a manifestation associated with angle-closure glaucoma.

Choice A is incorrect. Floaters in the field of vision are all common symptoms associated with retinal detachment. Clients may also lose sight in a portion of the visual field and have increasingly blurred vision.

Choice B is incorrect. A sense of having a curtain drawn over the eyes is a commonly reported symptom of retinal detachment.

Choice C is incorrect. Seeing flashes of light is a common symptom associated with retinal detachment. Clients may also lose sight in some visual fields and have increasingly blurred vision.

The nurse is reviewing discharge teaching for a client who had surgical repair of a retinal detachment.  Which of the following instructions are appropriate for the nurse to include in the teaching?  Select all that apply.

•  1. Avoid rubbing or scratching the affected eye
   

• 2. Avoid straining when having a bowel movement
  

•  3. Expect occasional flashes of light during recovery
  

•  4. Report any sudden pain to the health care provider
  

•  5. Rest the eyes by refraining from reading and writing

Answer explanation

Retinal detachment is separation of the sensory retina from the underlying pigment epithelium.  Clients experiencing retinal detachment may report a gradual, curtain-like loss of the visual field.  Traumatic retinal detachment may also result in abrupt vision loss.  Retinal detachment requires emergency surgery to attempt to restore vision.  Surgical repair involves rebinding the choroid and retina.  After repair, interventions focus on promoting retinal reattachment.  Postoperative teaching should include:

Avoiding activities that increase intraocular pressure (eg, rubbing the eye, straining) (Options 1 and 2)
Reporting sudden pain, flashes of light, vision loss, or bleeding, which may indicate detachment or infection, to the health care provider (Option 4)
Avoiding focused activities (eg, reading, writing, sewing), which can cause rapid eye movements and increase the risk for detachment (Option 5).
Wearing an eye patch or shield as directed to prevent rubbing/scratching of the eye and minimize eye movement
Ensuring appropriate positioning as instructed by the surgeon because clients may receive intravitreal oil or gas, which holds the retina in a specific position to allow healing
(Option 3)  Signs of retinal detachment include floaters, sudden flashes of light, and loss of vision.  If signs of detachment occur, the surgeon should be notified immediately.

The nurse is caring for a 70-year-old client with diabetic retinopathy.  Which of the following statements by the client would be a priority to follow up?

•   1. "Half of my vision looks like it is being covered by a curtain."  
  

•   2. "I wear reading glasses when reading the newspaper."  
    

• 3. "My vision is cloudy with a glare around bright lights."  

•   4. "Colors appear less bright than when I was younger."  

Answer explanation

Diabetic retinopathy occurs due to microvascular damage to the retina resulting from chronic hyperglycemia (eg, diabetes mellitus).  Diabetic retinopathy can lead to retinal detachment, which is a separation of the retina from the underlying epithelium.  Symptoms of retinal detachment include flashes of light, floaters, or black spots across the field of vision, the sense of a curtain being drawn over the eye, and loss of a portion of the visual field.  Retinal detachment requires emergency surgery to reattach the retina in an attempt to restore vision.  Without rapid intervention, it can lead to permanent blindness (Option 1).

(Option 2)  Presbyopia is a normal age-related process that occurs from loss of accommodation, making it harder to see objects that are near (eg, reading small print).  This can be treated with reading glasses.

(Option 3)  A cataract is an opacity in the lens of the eye causing cloudy vision with a glare.  It is a nonemergency, age-related visual disorder.

(Option 4)  Decreased vibrancy of colors is a sign of diabetic retinopathy but does not indicate retinal detachment; therefore, it is not an emergency.

Educational objective:
Diabetic retinopathy is a complication of diabetes mellitus that occurs due to microvascular damage of the retina resulting from chronic hyperglycemia.  Diabetic retinopathy can lead to retinal detachment, which can cause flashes of light, floaters, or black spots across the field of vision, the sense of a curtain being drawn over the eye, and loss of a portion of the visual field.  Without rapid intervention, it can lead to permanent blindness.

A football player is brought to the emergency department after a helmet-to-helmet collision without loss of consciousness or signs of external trauma.  Which clinical finding warrants immediate intervention?

•   1. Hairnet-like effect across vision  
  

• 2. Loss of memory about the collision  
  

•   3. Temporal headache  

•   4. Tongue laceration oozing blood  

Answer explanation

Blunt-force trauma to the head is associated with potentially severe complications (eg, brain damage and herniation, retinal detachment, seizures).  Prompt recognition of potential complications is essential to prevent irreversible changes to the client's neurological status and level of function.

Retinal detachment is a separation of the retina from the posterior wall of the eye that may occur following head trauma.  This is an ocular emergency as permanent blindness may result without intervention.  Signs of retinal detachment include perception of lightning flashes or floaters and a curtain-like or gnats/hairnet/cobweb effect throughout the visual field (Option 1).

(Option 2)  Loss of memory about the accident, or retrograde amnesia, is commonly reported after mild head injuries.  The client should be monitored for decreased level of consciousness or alterations in mental status, which may indicate intracranial bleeding.

(Option 3)  Headache is expected after mild head injury, and is not innately concerning except if the pain acutely worsens or is not relieved by over-the-counter analgesics (eg, acetaminophen, ibuprofen).

(Option 4)  A bleeding tongue laceration may occur when the force of the trauma causes the client to accidentally bite the tongue.  Oozing blood, although disturbing to the client, does not pose an immediate threat.