10. Retinal detachment: separation of neural retina from underlying retinal pigment epithelium.
1. Risk factors:
1. Trauma.
2. Degeneration.
2. Assessment:
1. Subjective data:
1. Flashes of light before eyes.
2. Vision: blurred, sooty (sudden onset); sensation of floating particles; blank areas of vision.
2. Objective data-ophthalmic exam: retina is grayish in area of tear; bright red, horseshoe shaped tear; B-scan ultrasonography.
3. Analysis/nursing diagnosis:
1. Visual sensory/perceptual alteration related to blurred vision.
2. Anxiety related to potential loss of vision.
3. Risk for injury related to blindness.
4. Nursing care plan/implementation:
1. Preoperative:
1. Goal: reduce anxiety and prevent further detachment.
1. Encourage verbalization of feelings; answer all questions; reinforce physician’s explanation of surgical procedures.
2. Activity: bed rest; eyes usually covered to promote rest and maintain normal position of retina; side rails up.
3. Position: according to location of retinal tear; involved area of eye should be in a dependent position.
4. Give medications as ordered: cycloplegic or mydriatics to dilate pupils widely and decrease intraocular movement.
5. Relaxing diversion: conversation, music.
2. Goal: health teaching. Prepare for surgical intervention (often combination used):
1. Cryopexy or cryotherapy-supercooled probe is applied to the sclera, causing a scar, which pulls the choroid and retina together.
2. Laser photocoagulation-a beam of intense light from a carbon arc is directed through the dilated pupil onto the retina; seals hole if retina not detached.
3. Scleral buckling-the sclera is resected or shortened to enhance the contact between the choroid and retina; frequently combined with cryopexy.
4. Banding or encirclement-silicone band or strap is placed under the extraocular muscles around the globe.
5. Pneumatic retinopexy-instillation of expandable gas or oil to tamponade tear.
2. Postoperative:
1. Goal: reduce intraocular stress and prevent hemorrhage.
1. Position: flat or low Fowler’s; sandbags may be used to position head; turn to nonoperative side if allowed, retinal tear dependent; special positions may be prone, side-lying, or sitting with face down on table if gas or oil bubble injected; position may be restricted 4-8 days.
2. Activity: bed rest; decrease intraocular pressure by not stooping or bending and avoiding prone position.
3. Give medications as ordered:
1. Cycloplegics (atropine).
2. Antibiotics.
3. Corticosteroids to reduce eye movements and inflammation and prevent infection.
4. ROM-isometric, passive; elastic stockings to avoid thrombus related to immobility.
2. Goal: support coping mechanisms.
1. Plan all care with patient.
2. Encourage verbalization of feelings, fears.
3. Encourage family interaction.
4. Diversional activities.
3. Goal: health teaching.
1. Eye care: eye patch or shield at night for about 2 weeks to prevent touching eye while asleep; dark glasses; avoid rubbing, squeezing eyes.
2. Limitations: no reading, needlework for 3 weeks, no physical exertion for 6 weeks; OK to watch TV, walk, except with bubble restrictions.
3. Medications: dosage, frequency, purpose, side effects: avoid nonprescription medications.
4. Signs of redetachment: flashes of light, increase in “floaters,” blurred vision, acute eye pain.
5. Evaluation/outcome criteria:
1. Vision restored.
2. No further detachment-recognizes signs and symptoms.
3. No injury occurs-accepts limitations.


11. Blindness: legally defined as vision less than 20/200 with the use of corrective lenses, or a visual field of no greater than 20 degrees; greatest incidence after 65 years.
1. Risk factors:
1. Glaucoma.
2. Cataracts.
3. Macular degeneration.
4. Diabetic retinopathy.
5. Atherosclerosis.
6. Trauma.
2. Analysis/nursing diagnosis:
1. Visual sensory/perceptual alteration related to blindness.
2. Impaired social interaction related to loss of sight.
3. Risk for injury related to visual impairment.
4. Self-care deficit related to visual loss.
3. Nursing care plan/implementation:
1. Goal: promote independence and provide emotional support.
1. Familiarize with surroundings; encourage use of touch.
2. Establish communication lines; answer questions.
3. Deal with feelings of loss, overprotectiveness by family members.
4. Provide diversional activities: radio, CDs, talking books, tapes.
5. Encourage self-care activities; allow voicing of frustrations when activity is not done to satisfaction (spilling or misplacing something), to decrease anger and discouragement.
2. Goal: facilitate activities of daily living.
1. Eating:
1. Establish routine placement for tableware, plate, glass.
2. Help person mentally visualize the plate as a clock or compass (“3 o’clock” or “east”).
3. Take person’s hand and guide the fingertips to establish spatial relationship.
2. Walking:
1. Have person hold your forearm: walk a half step in front.
2. Tell the person when approaching stairs, curb, incline.
3. Talking:
1. Speak when approaching person; tell them before you touch them.
2. Tell them who you are and what you will be doing.
3. Do not avoid words such as “see” or discussing the appearance of things.
3. Goal: health teaching.
1. Accident prevention in the home.
2. Community resources:
1. Voluntary agencies:
1. American Foundation for the Blind-provides catalogs of devices for visually handicapped.
2. National Society for the Prevention of Blindness-comprehensive educational programs and research.
3. Recording for the Blind, Inc.-provides recorded educational books on free loan.
4. Lion’s Club.
5. Catholic charities.
6. Salvation Army.
2. Government agencies:
1. Social and Rehabilitation Service-counseling and placement services.
2. Veterans Administration-screening and pensions.
3. State Welfare Department, Division for the Blind-vocational.
4. Evaluation/outcome criteria:
1. Acceptance of disability-participates in selfcare activities, remains socially involved.
2. Regains independence with rehabilitation.