CABOG Case Analysis On Retinal Detachment Sensory RLE

1
Nursing Department
NCM116 (RLE)
INDIVIDUAL CASE ANALYSIS ON RHEGMATOGENOUS RETINAL DETACHMENT
Name: Cabog, Tseng Weichei Grade:

Year and Section: III-NUR181 Date:06-07-2021
A female client (age: 67 years-old, weight: 53 kg, height: 165 cm) visited the clinic on April 18, 2020.
She complained of painless reduction of visual acuity (VA) in her right eye for the previous 6 months.
She did not take any medication before onset of VA reduction. Her left eye was normal. No history of
ocular disorders existed in her family. Extensive ophthalmic examinations were conducted. The best
corrected visual acuity (BCVA) on her right eye was light perception (LP) and Tonometry examination
was conducted which yielded an intraocular pressure (IOP) of 5.5 mmHg.
Slit lamp microscopy revealed that the anterior chamber of her right eye was filled with inflammatory
exudates. Pupil diameter was about 5 mm with posterior synechia to the lens. B-scan indicated a
retinal detachment on her right eye. Ten days later, the BCVA was recovered to finger counting (FC)
and a dramatic reduction of anterior inflammation was observed. However, posterior synechia of the
iris and cataracts were still presented. Optical coherence tomography (OCT) was conducted on April
20, 2020 showed a full-thickness macular hole on her right eye. Rhegmatogenous retinal detachment,
posterior synechia of the iris, and cataracts may have derived from uveitis.
On April 28, 2020, an experienced vitreoretinal surgeon performed pars plana vitrectomy,
lensectomy, and air-fluid exchange with silicone oil tamponade on her right eye. To control
postoperative inflammation, the patient received dexamethasone 5 mg daily for 5 days, a topical
corticosteroid (tobramycin/dexamethasone, Tobradex®) four times a day, and 1% atropine eyedrops
twice a day. After 3 months, the silicone oil was removed with an intraocular lens placement. During
her last visit, the BCVA on her right eye reached to 0.90 (converted to LogMAR scale). The macular
hole was completely closed, and the retina was reattached.
Postoperatively, the patient received Dexamethasone 10 mg intravenously daily for 5 days. This was
then reduced to 5 mg for another 5 days. Additionally, topical corticosteroids
(tobramycin/dexamethasone, Tobradex®) and 1% atropine eyedrops were administered four times
and twice per day, respectively. She was closely followed up daily.
< NCM116RLE <3rd Term AY 2020-2021>Prepared by: <Dennis B. Brosola > dbbrosola@national-u.edu.ph
<Alfred Raymund C. Panopio> acpanopio@national-u.edu.ph
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Nursing Department
INTRODUCTION
Retinal detachment describes an emergency situation in which a thin layer of tissue (the retina) at the
back of the eye pulls away from its normal position. Retinal detachment separates the retinal cells
from the layer of blood vessels that provides oxygen and nourishment. The longer retinal detachment
goes untreated, the greater your risk of permanent vision loss in the affected eye.
NURSING THEORY
Virginia Henderson
Virginia Henderson’s Need Theory addresses the issue and helps nurses help patients so that they
can care for themselves when they leave the healthcare facility. As a patient receives treatment and
is on the road to recovery, it’s important that the patient is able to take care of him or herself after
being released from medical care. To that end, nurses should be caring for the patient while, at the
same time, be helping the patient become more independent and reach goals and milestones on the
road to health.
Virginia Henderson’s theory, Need Based, which is derived from the Principles and Practice of
Nursing is a grand theory that focuses on nursing care and activities of daily living. This theory is
appropriate to this patient with retinal detachment, it is important to maintain patients who is done to
surgery to function independently after the treatment and promoting health and basic needs of the
patient.
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Nursing Department
CHAPTER I- ASSESSMENT
NURSING HEALTH HISTORY: PHYSICAL EXAMINATION
Skin No information was given

Hair No information was given
Nails No information was given
Head No information was given

Neck No information was given
Eyes Slit lamp microscopy revealed that the anterior chamber of her right eye
was filled with inflammatory exudates. Pupil diameter was about 5 mm
with posterior synechia to the lens. B-scan indicated a retinal
detachment on her right eye.
Ears No information was given
Mouth No information was given

Throat No information was given
Nose No information was given
Sinuses No information was given
Thorax No information was given

Lungs No information was given
Cardiovascular No information was given
Abdomen No information was given
Musculoskeletal No information was given
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Nursing Department
Neurologic No information was given
Genitourinary No information was given
Genital No information was given
DIAGNOSTIC PROCEDURES
Name of the Date Ordered Normal Values Values Interpretation and

Procedure Obtained Analysis
Best Corrected April 18, 2020 20/20 Right eye was Indicate that the right eye
Visual Acuity light perception there’s a slow perception
(BCVA) (LP) in brain's ability to
receive, interpret, and act
upon visual stimuli.
Tonometry April 18, 2020 10-21 mmHg Intraocular Value obtained indicate
Examination pressure (IOP) that there’s a hypotony
of 5.5 mmHg on which means that
there is decreased vision
in the patient’s eyes.
Slit Lamp April 18, 2020 No inflammation Anterior There’s an inflammation

Microscopy on the eyes. chamber of her on the anterior chamber
right eye was of her right eye which
Pupil diameter is filled with indicates an optical
2-5 mm inflammatory phenomenon of an
exudates. Pupil aqueous flare that is
diameter was caused by light scattering
about 5 mm within the anterior
with posterior chamber of the eye.
synechia to the
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Nursing Department
lens.
B-Scan April 18, 2020 Through the Retinal This indicates that at the
retrobulbar fat, the detachment on back of the eye, a vital
optic nerve can be her right eye. layer of tissue (the retina)
seen. pulls away from the layer
of blood vessels that
supplies it with oxygen
and nutrients.
Optical April 20, 2020 Normal size of the Showed a full- This results in
Coherence macular hole. thickness devastating central vision
Tomography macular hole loss and a reduction in
(OCT) on her right patient quality of life
eye.
ANATOMY and PHYSIOLOGY
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Nursing Department
DISCUSSION
Retinal detachment occurs when subretinal fluid accumulates in the potential space between the
neurosensory retina and the underlying retinal pigment epithelium (RPE). Depending on the
mechanism of subretinal fluid accumulation, retinal detachments traditionally have been classified into
hematogenous, tractional, and exudative.
PATHOPHYSIOLOGY: CONCEPT MAP
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Nursing Department
CHAPTER II- PLANNING
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Nursing Department
LIST OF PRIORITIZED NURSING DIAGNOSIS
Nursing Diagnosis Number of Priority Supporting Data Justification

Disturbed Sensory  The patient Gradually developing
Perception: visual complained of opacity of the of the lens or
related to decreased painless reduction lens capsule of the eye. It is
vision as evidenced of visual acuity (VA) the most common cause of
by patient in her right eye for correctable vision, loss.
complained of the previous 6
painless reduction of months.
1
visual acuity (VA) in  Tonometry
her right eye for the examination was
previous 6 months conducted which
yielded an
intraocular pressure
(IOP) of 5.5 mmHg.
Risk for Injury  The patient An emergency situation in

related to decreased complained of which a thin layer of tissue
vision as evidenced painless reduction (the retina) at the back of
by patient of visual acuity (VA) the eye pulls away from its
complained of in her right eye for normal position.
painless reduction of the previous 6
visual acuity (VA) in months.
2
her right eye for the  Tonometry
previous 6 months. examination was
conducted which
yielded an
intraocular pressure
(IOP) of 5.5 mmHg.
Anxiety related to  The best corrected Activation of the autonomic

vision reduction as visual acuity nervous system in
evidenced by patient (BCVA) on her right response to an external or
complained of eye was light internal stimulus that can
3 perception (LP)
painless reduction of have behavioral, emotional,
visual acuity (VA) in cognitive, and physical
her right eye for the symptoms due to
previous 6 months. decreased vision
Non-compliance to 4  Patient did not take Fails to coincide with a
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Nursing Department
medication related any medication health-promoting or
to decreased vision before onset of VA therapeutic plan agreed on
as evidence by She reduction by the person (and/or family
did not take any and/or community) and
medication before health care professional.
onset of VA
reduction
Activity intolerance  The patient  Reduction of visual
related to decreased complained of acuity (VA) in her right
vision painless reduction eye affects patients
of visual acuity (VA) daily activities such us
5
in her right eye for reading
the previous 6
months.
NURSING CARE PLAN
Nursing Scientific
Assessmen Implementatio
Diagnos Explanati Planning Rationale Evaluation
t n
is on
 The best Disturbe An LTG:  Assess the  Provides a Goal Met:

correcte d emergenc patient’s baseline for
d visual Sensory y situation After 1 ability to determinati LTG:
acuity Percepti in which a week of see and on of
nursing After 1
(BCVA) on: thin layer perform changes
intervention week of
on her visual of tissue activities. affecting the
, the nursing
right eye related to (the patient’s
patient will intervention
was light decrease retina) at visual
regain , the
perceptio d vision the back acuity.
optimal patient
n (LP) as of the eye  Encourage  Can monitor
vision regained
 The evidence pulls patient to progressive
possible optimal
patient d by away from see an visual loss
and will vision
complain patient its normal ophthalmol or
adapt to possible
ed of complain position. ogist at complicatio
permanent and
painless ed of least yearly. ns.
visual adapted
reduction painless Decreases
changes permanent
of visual reduction in visual visual
acuity of visual acuity can changes
(VA) in acuity increase
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Nursing Department
her right (VA) in STG: confusion in
eye for her right the elderly
the eye for After 3 patient. STG:
previous the hours of  Provide  Elderly
nursing After 3
6 previous sufficient patients
intervention hours of
months. 6 months lighting for need twice
, the nursing
 The the patient as much intervention
patient patient will to carry out light as
be able to , the
did not activities. younger patient
take any verbalize people.
understand verbalized
medicati  Elderly understand
on ing of patient’s
visual loss  Provide ing of
before eyes are visual loss
and lighting that
onset of more and
diseases of avoids glare
VA sensitive to diseases of
eyes. on surfaces
reduction glare and eyes.
of walls,
. cataracts
reading
 Tonomet diffuse and
materials,
ry glare so
and so
examinat that the
forth.
ion was patient has
conducte more
d which difficulty
yielded with vision.
an  Patient’s
intraocul eyes may
ar require
pressure longer
(IOP) of  Provide accommoda
5.5 night light tion time to
mmHg. for the changes in
patient’s lighting
room and levels.
ensure Provision of
lighting is adequate
adequate lighting
for the helps to
patient’s prevent
needs. injury.
 Provides
knowledge
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Nursing Department
and
facilitates
compliance
 Prepare with the
patient for regimen.
cataract  Helps
surgery as increase the
warranted. patient’s
understandi
ng of visual
 Instruct changes
patient and to
regarding make
normal age- informed
related choices
visual about
changes, options as
cataracts, the patient
and ages, the
methods of lens
dealing with becomes
visual denser and
acuity has less
changes. elasticity
thus
accommoda
tion is
decreased.
 Assists
patient to
see larger
print and
promotes a
 Provide sense of
large print independen
objects and ce.
visual aids
for
teaching.
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Nursing Department
Nursing Scientific
Implementati Evaluatio
Assessment Diagnosi Explanati Planning Rationale
on n
s on
 The best Risk for An LTG:  Assess  Increases Goal Met:

corrected Injury emergency patient for awareness
visual related to situation in After 1 degree of of the LTG:
acuity decrease which a week of visual problem
nursing After 1
(BCVA) d vision thin layer impairment and
interventio week of
on her as of tissue . identifies
n, Patient nursing
right eye evidence (the retina) severity to
will be free interventio
was light d by at the back allow for
of injury n, Patient
perceptio patient of the eye the
and will be will is free
n (LP) complain pulls away establishm
able to from injury
 The ed of from its ent of a
perform and able
patient painless normal plan of
activities to perform
complaine reduction position. care.
within activities
d of of visual  Ensure the  Provides a
parameter within
painless acuity room safe
s of parameter
reduction (VA) in environme environmen
sensory s of
of visual her right nt is safe t to reduce
limitation. sensory
acuity eye for with the limitation
(VA) in the adequate potential for and no
her right previous lighting injury. accident
eye for 6 months. STG: and reported.
the furniture
previous After 3 moved
6 months. hours of toward the
 The nursing walls. STG:
patient interventio Remove all
n, Patient After 3
did not rugs, and
and/or hours of
take any objects
family will nursing
medicatio that could
be able to interventio
n before be
modify the n, Patient
onset of potentially
environme and family
VA hazardous.
nt to modified
reduction.  Keep
ensure the
 Tonometr patient’s environme
y patient glasses
safety. nt to
examinati and call  Provides
ensure
on was bell within for
patient
easy assistance
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Nursing Department
conducte reach. for the safety.
d which  Instruct patient and
yielded an patient for optimal
intraocula and/or visual
r pressure family acuity.
(IOP) of regarding  Reduced
5.5 the need to visual
mmHg. maintain a acuity puts
safe the patient
environme at risk for
nt. injury.
 Instruct
patient
and/or
 These
family
techniques
regarding
help
safe
enhance
lighting.
visual
The patient
discriminati
should
on and
wear
reduce the
sunglasses
potential for
to reduce
injury.
glare.
Advise
family to
use
contrasting
bright
colors in
household
furnishings
.
CHAPTER III- IMPLEMENTATION
1
Nursing Department
MEDICAL MANAGEMENT: DRUG STUDY
Date Name of Classifica

Dose, Mechanism Contraind Side Nursing
orde the drug tion &
route of action ication effects responsibiliti
red indication
& es
frequ
ency
Generic  It D: 5  Anti-  Inactive  Upset  Increase
name: relieves mg inflammato tubercu stomac dosage
dexameth inflam R: iv ry and losis. h. when
asone mation F: immunosu  Herpes  Stoma patient is
(swellin daily ppressive simplex ch subject to
Brand g, heat, for 5 effects of infectio irritatio stress.
name: rednes days dexametha n of the n.  Taper
dexasone s, and sone are eye.  Vomitin doses
pain) approximat  A g. when
and is ely 30 herpes  Heada discontinui
used to times more simplex che. ng high-
treat potent than infectio  Dizzine dose or
certain cortisol. n. ss. long-term
forms Anti-  An  Insomn therapy.
of inflammato infectio ia.  Do not
arthritis ry effects n due  Restles give live
; skin, are to a sness. virus
blood, complex, fungus. vaccines
 Depres
kidney, but  Intestin with
sion.
eye, primarily al immunosu
thyroid, via infectio ppressive
and inhibition n doses of
intestin of caused corticoster
al inflammato by the oids.
disorde ry cells roundw  For
rs (e.g., and orm respiratory
colitis); suppressio strongy inhalant,
severe n of loides. intranasal
allergie expression  A preparatio
s; and of conditio n, do not
asthma inflammato n with use
. ry low respiratory
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Nursing Department
mediators. thyroid inhalant
hormon during an
e acute
levels. asthmatic
 Diabete attack or to
s. manage
status
asthmaticu
s.
Generic  Topical D: n/a  The anti-  Untreat  Perma  Apply the
name: corticos R: oral inflammato ed nent drug
topical teroids F:4 ry effect of bacteri stretch sparingly.
corticoste play a times topical al, marks  Avoid
roid major a day corticoster fungal, (striae) contact
role in oids or viral  Bruisin with eyes.
Brand the consists of skin g  Report any
name: treatme vasoconstr lesions,  Discolo irritation or
tobramyci nt of iction,  Acne, ration infection at
n many inhibition  Rosace  Thin the site of
dermat of the a spidery application
ologic release of  Perioral blood .
conditio phospholip dermati vessels
ns ase a2, tis
and a
direct
inhibitory
effect on
dna and
inflammato
ry
transcriptio
n factors.
Generic  Used D: 1%  Atropine  Patient  Eye  Void
name: before R: blocks the s with sensitiv driving or
atropine eye ophth action of narrow ity to operating
eyedrops examin almic acetylcholi angle light, heavy
ations F: 2 ne, a betwee  Increas machinery
Brand to times neurotrans n the ed while
name: dilate a day mitter that iris and blood under the
isopto (open) causes the the pressur influence
atropine the contraction cornea e, of atropine.
1
Nursing Department
pupil, of two since it  Eye  Reduce
the types of may pain lighting to
black muscle, raise and decrease
part of smooth intra- stingin photophobi
the eye and ocular g upon a. Monitor
through cardiac pressur instillati gi motility
which muscles. It e and on of (bms and
you also has precipit drops, flatus) and
see. It other ate an  Blurred urine
is also neurologic acute vision, output
used to al effects. attack  Eye while
relieve Ophthalmi of inflam patient is
pain c atropine closed mation receiving
caused is used angle (superfi atropine.
by during eye glauco cial  Atropine is
swellin examinatio ma. keratiti a common
g and ns to dilate s) and pre-
inflam the pupil. decrea operative
mation sed agent, and
of the tearing, can be
eye.  Conjun given im,
ctivitis, sc, po, or
 Contac iv.
t
dermati
tis,
 Eyelid
swellin
g,
TREATMENT
Name of Treatment Indication/ Purposes Nursing Responsibilities

No information was given No information was given No information was given
DIET
1
Nursing Department
Sample Menu Plan
Meal Serving
Breakfast Cereals 1 serving
Snack ( if applicable) Sugar-free gelatins 1 serving
Lunch Steamed chicken breast
1 serving
without skin
Snack (if applicable) Air popped pop corns 1 serving
Dinner Whole grain bread 1 serving
ACTIVITY/ EXERCISE
Type of Activity Use of

Allowed/ to be Procedure/ Steps Equipment Restrictions Rationale
continued (if any)
No information No information No information No information was No information
was given was given was given given was given
SURGICAL MANAGEMENT (If any)
Brief description Purpose Nursing responsibilities
 Enables access to the  Instruct the patient to remain quiet

posterior segment for in prescribed (dependent)
treating conditions such position, to keep the detached
as retinal detachments, area of the retina in dependent
vitreous hemorrhage, position.
Pars plana vitrectomy endophthalmitis, and  Patch both eyes.
macular holes in a  Wash the patient’s face with
controlled, closed antibacterial solution.
system.  Instruct the patient not to touch
the eyes to avoid contamination.
Lensectomy  Removal of the  Assist the patient with the actions

crystalline lens through a of daily living as needed to
transscleral retro ciliary remedy any self-care deficit.
1
Nursing Department
incision (usually the pars  Encourage the patient to verbalize
plana) under clinical or keep a log on his or her fears
conditions in which the and anxiety about visual loss or
vitreous gel has to be impending surgery.
partially or totally  Help plan events to solve the
removed problems with social isolation.
 Substitution of fluid in the  Monitor patient’s behavior and

posterior cavity of eye mental status for onset of
with air with the aim to restlessness, agitation, confusion,
drain the subretinal fluid and (in the late stages) extreme
(SRF) and achieve a flat lethargy.
retina.  Monitor for alteration in BP and
Air-fluid exchange with
HR.
silicone oil tamponade on
 Monitor oxygen saturation
her right eye
continuously, using pulse
oximeter.
 Monitor the effects of position
changes on oxygenation (abgs,
venous oxygen saturation [svo2],
and pulse oximetry.
CLIENT’S DAILY PROGRESS CHART
Diagnosti Diet Activity Medication Treatmen Surgery

c t
Procedur
e
Admissio No No No No
n informatio informatio informatio No information informatio No information
n was n was n was was given n was was given
given given given given
No No No  dexamethason No  Pars plana

informatio informatio informatio e informatio vitrectomy
April 28, n was n was n was  topical n was  Lensectom
2020 given given given corticosteroid given y
 Air-fluid
1
Nursing Department
 atropine exchange
eyedrops with
silicone oil
tamponade
on her right
eye

CHAPTER IV- EVALUATION
DISCHARGE PLANNING
MEDICATION
Dosage & Curative

Name of drug Route Time Side effects
frequency effects
Dexamethason D: 5 mg IV Daily  rheumatic  Upset stomach.

e problems, a  Stomach
F: Daily number of irritation.
skin  Vomiting.
diseases,  Headache.
severe  Dizziness.
allergies,  Insomnia.
asthma,  Restlessness.
chronic
 Depression
obstructive
lung
disease,
croup, brain
swelling,
eye pain
following
eye
surgery,
and along
with
antibiotics
1
Nursing Department
in
tuberculosis
EXERCISE
Type of Use of
activity/allowed/to Procedure/steps equipment Restrictions Rationale
be continued (if any)
No information was No information No information No information No information was

given was given was given was given given
TREATMENT
Name of treatment Indication/purposes Nursing Responsibilities
No information was given No information was given No information was given
HEALTH TEACHING
 Teach the patient to use warm or cold compresses for comfort several times a day.
 Teach the patient to avoid vigorous activities and heavy lifting for the immediate postoperative
period.
 Teach the patient the symptoms of retinal detachment and the action to take if it occurs again.
 Instruct the patient about the importance of follow-up appointments, which may be every few
days for the first several weeks after surgery.
OUT-PATIENT DEPARTMENT
Follow-up consultation: After three months.

Room No.: 69 Date: 06/24/2021 Time: 11:00 am
Attending Physician: Cabog, Tseng Weichei, M.D.
Institution: Chinese General Hospital
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Nursing Department
SPIRITUALITY
 Encourage the client to have a close relationship with God, through a prayer.
 Teach the client about anger management like take the time out, calming down, and do deep
breathing exercise. This will help take your mind off the situation.
 Emphasize the importance of communication in the family.
 Praise the client for their efforts and health achievements.
 Encourage the client to join in some religious organizations.
 Emphasize the importance of forgiveness and reconciliation.
 Recommend spiritual forgiveness and confessions.

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CABOG Case Analysis On Retinal Detachment Sensory RLE

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1

Name: Cabog, Tseng Weichei Grade:

NURSING HEALTH HISTORY: PHYSICAL EXAMINATION

Skin No information was given

Head No information was given

Ears No information was given

Mouth No information was given

Thorax No information was given

Cardiovascular No information was given

Abdomen No information was given

Musculoskeletal No information was given

Genitourinary No information was given

Genital No information was given

Name of the Date Ordered Normal Values Values Interpretation and

Slit Lamp April 18, 2020 No inflammation Anterior There’s an inflammation

ANATOMY and PHYSIOLOGY

PATHOPHYSIOLOGY: CONCEPT MAP

CHAPTER II- PLANNING

Nursing Diagnosis Number of Priority Supporting Data Justification

Risk for Injury  The patient An emergency situation in

Anxiety related to  The best corrected Activation of the autonomic

NURSING CARE PLAN

 The best Disturbe An LTG:  Assess the  Provides a Goal Met:

 The best Risk for An LTG:  Assess  Increases Goal Met:

CHAPTER III- IMPLEMENTATION

MEDICAL MANAGEMENT: DRUG STUDY

Date Name of Classifica

Name of Treatment Indication/ Purposes Nursing Responsibilities

Type of Activity Use of

SURGICAL MANAGEMENT (If any)

Brief description Purpose Nursing responsibilities

 Enables access to the  Instruct the patient to remain quiet

Lensectomy  Removal of the  Assist the patient with the actions

 Substitution of fluid in the  Monitor patient’s behavior and

CLIENT’S DAILY PROGRESS CHART

Diagnosti Diet Activity Medication Treatmen Surgery

No No No  dexamethason No  Pars plana

CHAPTER IV- EVALUATION

Dosage & Curative

Dexamethason D: 5 mg IV Daily  rheumatic  Upset stomach.

No information was No information No information No information No information was

Name of treatment Indication/purposes Nursing Responsibilities

No information was given No information was given No information was given

Follow-up consultation: After three months.

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