NCM 116: Care of Clients with Problems in

Nutrition and Gastrointestinal, Metabolism and Endocrine,

Perception & Coordination, Acute and Chronic

WILFREDO ADORIO, RN, MSN

CLINICAL INSTRUCTOR
 FOCUS CONCEPTS
Care of Patient with Neuro-
sensory Disorders
- Cataract
- Glaucoma
- Retinal Detachment
- Macular Degeneration
- Blindness
- Hearing Loss
- Meniere’s Disease
Retinal Detachment
 Retinal detachment is a medical emergency in which a thin
layer of tissue at the back of the eye (the retina) pulls away
from its normal position.

 Retinal detachment occurs when the retinal cells become

detached from the layer of blood vessels that supplies
oxygen and nourishment. The longer you wait to treat a
retinal detachment, the greater your risk of permanent
vision loss in the affected eye.

 The sudden appearance of floaters and flashes, as well as

reduced vision, are all warning signs of retinal detachment.
Causes / Risk factors
Modifiable
 Trauma
 Hemorrhage
 Exudates that occur in front of or behind the retina
 Sudden, severe physical exertion especially in persons who are debilitated.

Non-modifiable
 Myopic degeneration
 Aphakia (absence of crystalline lens)
NURSING MANAGEMENT

1. Get the patient ready for surgery.

 Instruct the patient to remain quiet in the prescribed (dependent) position in
order to keep the detached retina in the dependent position.
 Both eyes should be patched.
 Antibacterial solution should be applied to the patient's face.
 To avoid contamination, instruct the patient not to touch his or her eyes.
 Preoperative medications should be administered as directed.

2. Take precautions to avoid postoperative complications.

 Warn the patient not to bump his or her head.
 Encourage the patient not to cough or sneeze, or to engage in any other strain-
inducing activities that will cause intraocular pressure to rise.

3. Encourage ambulation and independence to the extent that it is tolerated.

4. As directed, administer pain, nausea, and vomiting medication.
5. Provide quiet diversional activities such as radio listening or audio books.
6. Teach proper eye medication administration technique.
7. For several weeks, advise the patient to avoid rapid eye movements, as well as
straining or bending the head below the waist.
8. Inform the patient that driving will be restricted until the ophthalmologist clears
them.
9. Teach the patient to recognize and report symptoms of recurring detachment, such
as floating spots, flashing lights, and progressive shadows, as soon as they occur.
10. Advise the patient to return for a follow-up appointment.
7
POST-OPERATIVE 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 HCP)

 encourage deep breathing but avoid coughing

 provide bed rest for 1 to 2 days as prescribed (position depends on the location of the

detachment).
POST-OPERATIVE INTERVENTIONS

 administer eye medications as prescribed

 assist the client with activities of daily living

 avoid sudden head movement 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.
 THANK
YOU!!
Reference: https://www.slideshare.net/sunnymumu/cataract-easy-ppt-for-nursing-students
CASE SCENARIO
A 49-year-old man comes to the ophthalmology clinic because he has been
seeing floating dark spots on the right side in the last few days. Examination of
the eye reveals right and left pupils 4/2 and 4/2. Pupils are equal, round, react
to light and accommodation. Conjunctiva is clear bilaterally, sclera is white,
and the cornea and iris are intact. The left eye retina background has even color
with no hemorrhages or exudates. The right eye has a retinal detachment. He
has gastrointestinal reflux disease and takes an over-the-counter antacid. He has
smoked for 15 years, one pack per day.
Guide questions:
1)Document a nursing note using review of body systems format.
2) Describe the signs and symptoms of retinal detachment.
3) Discuss the treatment for retinal detachment.
4) Discuss the nursing management of retinal detachment.
Next Topic: Macular Degeneration
 FOCUS CONCEPTS
Care of Patient with Neuro-
sensory Disorders
- Cataract
- Glaucoma
- Retinal Detachment
- Macular Degeneration
- Blindness
- Hearing Loss
- Meniere’s Disease
 Macular degeneration is a progressive eye disease wherein the central portion of the

retina gradually deteriorates.

 Macular degeneration develops as a result of deterioration to the central portion of the

retina, known as the macula. As we grow older, degenerative spots, called drusen, start

to form within the retina and can cause progressive retinal damage and vision loss.
 There are two types of age-related macular degeneration that occur.

1. The dry or atrophic form is characterized by atrophic pigment epithelial changes

and is most often associated with slow, progressive, and mild vision loss.

2. The wet type is characterized by subretinal neovascularization that causes leakage,

hemorrhage, and fibrovascular scar formation, which produce a significant loss of

central vision.
Nursing Care Plans

 Nursing management of macular degeneration involves supportive

lifestyle changes to adapt to the decrease in vision, unless the
degeneration is new and caused by abnormal blood vasculature, then
laser surgery can sometimes slow or halt the deterioration by sealing
off the leaking vessels. Reversal of damage that has already occurred is
not possible.

 Here are two nursing care plans (NCP) and nursing diagnosis for
Macular Degeneration:

- Disturbed Sensory Perception: Visual

- Risk for Injury
CASE STUDY: AMD (age-related macular degeneration)

A referral was sent to the on-call ophthalmologist. The initial exam results
show a scar in the central area (macula), suggesting age-related macular
degeneration. The ophthalmologist feels at this point that the treatment
should be aimed at preventing further vision loss and schedules patient for
photodynamic therapy.

1. What are the early signs of age-related macular degeneration (AMD)?

2. What tests can be done to determine if the patient has age-related
macular degeneration?
3. What risk factors are associated with macular degeneration?
4. What diet related teaching will you provide to the patient?