ANGELES UNIVERSITY FOUNDATION

Angeles City, Pampanga

COLLEGE OF NURSING

RETINAL
DETACHMENT
CASE REPORT

OPERATING ROOM

SUBMITTED BY:
AYEN, CHARLENE
JOCO, JOVENA ELOISA
LLACER, CARLO JOSEPH
TIATCO, SARAH MAE
VIDAL, KRISTIA APRILYN
BSN III-A
STUDENT NURSES

SUBMITTED TO:
 Ma Teresa S. Cabanayan, RN, MN
CLINICAL INSTRUCTOR

I. 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.

The retina is the light-sensitive tissue lining the back of our eye. Light rays are
focused onto the retina through our cornea, pupil and lens. The retina converts the light
rays into impulses that travel through the optic nerve to our brain, where they are
interpreted as the images we see. A healthy, intact retina is key to clear vision.

The middle of our eye is filled with a clear gel called vitreous (vi-tree-us) that is
attached to the retina. Sometimes tiny clumps of gel or cells inside the vitreous will cast
shadows on the retina, and you may sometimes see small dots, specks, strings or
clouds moving in your field of vision. These are called floaters. You can often see them
when looking at a plain, light background, like a blank wall or blue sky.

The vitreous moves away from the retina without causing problems. But sometimes
the vitreous pulls hard enough to tear the retina in one or more places. Fluid may pass
through a retinal tear, lifting the retina off the back of the eye — much as wallpaper can
peel off a wall. When the retina is pulled away from the back of the eye like this, it is
called a retinal detachment.

Retinal detachment itself is painless. But warning signs almost

always appear before it occurs or has advanced, such as, sudden
appearance of many floaters a tiny specks that seem to drift through
your field of vision, flashes of light in one or both eyes (photopsia),
blurred vision, gradually reduced side (peripheral) vision, a curtain-like
shadow over your visual field and for late manifestation of retinal
detachment would consider be the tunnel vison.
There are three types of detached retina:

Rhegmatogenous retinal detachment is a break, tear, or hole in the retina. This hole
allows liquid to pass from the vitreous space into the subretinal space between the
sensory retina and the retinal pigment epithelium. The pigment epithelium is the
pigmented cell layer just outside the neurosensory retina.

Secondary retinal detachment is also known as exudative retinal detachment or

serous retinal detachment. It happens when inflammation, vascular abnormalities, or
injury cause fluid to build up under the retina. There is no hole, break, or tear.

Tractional retinal detachment is when an injury, inflammation, or neovascularization

causes the fibrovascular tissue to pull the sensory retina from the retinal pigment
epithelium.

Related to the Current Studies

Laser Retinopexy When a small retinal tear occurs, laser treatment may be
applied to prevent further accumulation of fluid beneath the retina, thereby minimizing
the risk of extensive vision-threatening RDs. The laser is applied around the retinal hole
and, over the course of a few weeks, the treated area develops a scar which forms a
tight seal between the retina and the underlying tissue. This procedure is sometimes
Polymers 2010, 2 291 performed around weak retinal areas in patients who may be at
higher risk for RD. Laser retinopexy (endophotocoagulation) can be performed in
conjunction with pneumatic retinopexy, scleral buckling and vitrectomy. In addition, laser
therapies are often used to prevent a potential RD. When abnormal retinal blood vessel
growth occurs in diseases such as proliferative diabetic retinopathy or retinal vein
occlusion, laser must be applied to large areas of the peripheral retina that, having poor
blood flow (ischemia), are responsible for releasing growth factors causing
neovascularization.
If untreated, retinal neovascularization often leads to vitreal hemorrhage, neovascular
glaucoma and/or TRD. After laser therapy is applied, the blood vessels tend to stabilize
or regress. Retinal Cryopexy The final result of cryotherapy is similar to that obtained by
laser retinopexy: in fact, cryopexy stimulates scar formation allowing the edges of a
retinal tear to seal. This is typically done by looking into the eye using an indirect
ophthalmoscope, while pushing gently on the outside of the eye using the cryopexy
probe. The probe produces a small frozen area that includes the retina and the tissues
immediately underneath it, thereby sealing the retinal tear. Cryopexy is used for treating
large breaks and in areas that may be hard to reach by laser; it can be used in
conjunction with pneumatic retinopexy, scleral buckling and vitrectomy. Pneumatic
Retinopexy Pneumatic retinopexy involves the injection of an expansive gas into the
eye posterior chamber to flatten the retina, thereby allowing the sub-retinal fluid to be
pumped out from beneath it. The patient‘s head is properly positioned so that the gas
bubble floats to the detached area and presses against the detachment. A freezing
probe (cryopexy) or laser beam (photocoagulation) can be used to seal the retinal tear.
The gas bubble is gradually absorbed by the eye while a seal forms between the retina
and the underlying tissue.

The procedure of pneumatic retinopexy is commonly considered a good surgical option

for treating uncomplicated RRDs with a 90% success rate, but often repeated
operations are necessary. It summarizes and compares the advantages and
disadvantages of gases used in pneumatic retinopexy procedures. The first procedure
of pneumatic retinopexy was attempted in 1911 who injected purified air into the
vitreous cavity to adhere the retina to the inner wall of the eye. Air, however, cannot be
used as a long-term vitreous substitute, as its intravitreal residence time only lasts a few
days. In recent years, air has only occasionally been used in pneumatic retinopexy
procedures . It has been used in conjunction with other vitreous tamponade agents
during vitrectomy procedures, but some evidences suggested that its use is unhelpful.
Furthermore, air can be used in the course of the so-called D-ACE procedure
 According to National Eye institute the incidence of retinal detachment in otherwise
normal eyes is around 5 new cases in 100,000 persons per year. Detachment is more
frequent in middle-aged or elderly populations, with rates of around 20 in 100,000 per
year. The lifetime risk in normal individuals is about 1 in 300.

North America
Retinal detachment is relatively rare and occurs in about one in 15,000 (0.3 percent) of
the U.S. population. It is most common in people middle-aged and older. About 6
percent of the population has retinal holes, but most of these do not lead to retinal
detachment as of 2016.

Patients who are severely myopic (usually greater than 10 diopters) have a 5 percent
risk for developing a detachment and patients who undergo cataract surgery have a 1
percent risk. The most common predisposing factor is myopia, accounting for 40 to 50
percent of detachments. About 33 percent have undergone cataract removal and 10–20
percent have experienced eye trauma.

Implication of the above information for Nurses as a productive member of

the society

Nursing is a profession that made a large impact on our society. Nursing roles is
rapidly evolving covering a wider range of responsibilities. In hospitals, clinics, and care
centers, nurses are rising to meet these challenges. Today, they are not just caring for
the sick because nurses are known for being flexible. Nurses plays a major role in our
society because nurses are flexible. They act as a teacher that provides information
and helps the client acquire new knowledge. Known for being an advocate for health
promotion, educating patients and the community on the prevention of different illnesses
and injury, provide medical assistance, and participates in rehabilitation. A counselor
that helps client to recognize and cope with stressful situations, develop interpersonal
relationship and provides emotional, intellectual, and psychological support. They
help families learn to become healthy by helping them understand the importance of
health.Nurses do more than care for individuals.Nursing is committed to promoting
individual, family, community, and national health goals in its best manner possible.
ANATOMY AND PHYSIOLOGY

\\

The eye is the organ of sight, a nearly spherical hollow globe filled with fluids
(humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and
protective. The middle layer (choroid, ciliary body and the iris) is vascular. The
innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by
the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the
lens). The lens itself is flexible and suspended by ligaments which allow it to change
shape to focus light on the retina, which is composed of sensory neurons.
 The retina is the light-sensitive tissue lining the back of our eye. Light rays are
focused onto the retina through our cornea, pupil and lens. The retina converts the light
rays into impulses that travel through the optic nerve to our brain, where they are
interpreted as the images we see. A healthy, intact retina is key to clear vision.

The middle of our eye is filled with a clear gel called vitreous (vi-tree-us) that is
attached to the retina. Sometimes tiny clumps of gel or cells inside the vitreous will cast
shadows on the retina, and you may sometimes see small dots, specks, strings or
clouds moving in your field of vision. These are called floaters. You can often see them
when looking at a plain, light background, like a blank wall or blue sky.

As we get older, the vitreous may shrink and pull on the retina. When this
happens, you may notice what look like flashing lights, lightning streaks or the sensation
of seeing “stars.” These are called flashes
 PATHOPHYSIOLOGY OF RETINAL DETACHMENT

NON-MODIFIABLE RISK MODIFIABLE RISK

FACTORS: FACTORS:

-Age -High Myopia

-Gender -Previous cataract surgery

-Ethnicity -Severe eye injury

-Family history -Previous detachment in

the other eye

Traction from Exudation of material

A hole, tear, or break in inflammatory or vascular into the subretinal
the neuronal layer fibrous membranes on space from retinal
the surface of the retina vessels

Accumulation of fluid between the

sensory and pigmented layers

Separation of neurosensory layer of retina

from the underlying choroid and pigment
epithelium

Deprives sensory layers of nutrients and oxygen

Damage to the nerve tissue in the sensory layer

Flashes of light, burst of Shadow or curtain

CLINICAL MANIFESTATIONS falling across the field of
black spots or floaters
vision

Partial or complete loss

of vision
IV.Clinical Intervention

1.1 SURGERY TO BE PERFORMED

A. Scleral buckling

Scleral buckling is a surgical procedure used to repair a retinal detachment. The

scleral, or the white of the eye, is the outer supporting layer of the eyeball. In this
surgery, a surgeon attaches a piece of silicone or a sponge onto the white of the eye at
the spot of a retinal tear. The buckle is designed to repair retinal detachment by pushing
the sclera toward the retinal tear or break. This surgery involves placing a flexible band
(scleral buckle) around the eye to counteract the force pulling the retina out of place.
The ophthalmologist often drains the fluid under the detached retina, allowing the retina
to settle back into its normal position against the back wall of the eye .The retina is a
layer of tissue on the inside of the eye. It transmits visual information from the optic
nerve to your brain. A detached retina shifts from its normal position. If left untreated,
retinal detachment can cause permanent loss of vision. Sometimes, the retina doesn’t
completely detach from the eye, but instead forms a tear. (Retrieved at
https://www.aao.org/eye-health/diseases/detached-torn-retina-treatment February
18,2019 @10pm)

How does scleral buckling work?

Scleral buckling takes place in a surgical setting. Your doctor may give you the option of
general anesthesia where you’ll sleep through the procedure. Or your doctor may allow
you to remain awake.

Your doctor will provide specific instructions beforehand so you can prepare for the
procedure. You’ll likely be required to fast before surgery and avoid eating after midnight
on the day of surgery. Your doctor will also provide information as to whether you need
to stop taking certain medications.
Here is what you can expect during surgery:

1. You’ll receive anesthesia before surgery and fall asleep. If you’re remaining awake
during your surgery, your doctor will apply eye drops or give you an injection to numb
your eye. You’ll also receive eye drops to dilate your eyes. Dilation widens your pupil,
allowing your doctor to see the back of your eye.

2. Your doctor will make an incision to the outer layer of your eye (sclera).

3. A buckle or sponge is then stitched around this outer layer of the eye and surgically
sewn in place so that it doesn’t move. Buckling is designed to support the retina by
pushing the scleral toward the middle of the eye, which can reattach your retina and
close retina tears.

4. To prevent a tear or detachment from reopening. Your doctor may also perform one of
the following:

 Laser photocoagulation. In this procedure, your doctor uses a laser beam to

burn the area surrounding a retinal tear or detachment. This creates scar tissue,
which helps seal a break and stops fluid leakage.
 Cryopexy. In this procedure, your doctor uses extreme cold to freeze the outer
surface of the eye, which can cause scar tissue to develop and seal a break.

5. After surgery, your doctor drains any fluid behind your retina and applies antibiotic
eye drops to prevent infection.

Scleral buckling is often permanent. But if you have minor retinal detachment, your
doctor may use a temporary buckle that can be removed once the eye heals.
1.2 .Indication of prescribed surgical treatment

General Indication:

Scleral Buckling is indicated for patient who has severe myopia (near-sightedness),
trauma in the eye, or usually after cataract surgery if developed any complication

Specific Indication:

Scleral Buckling is the recommended treatment for the patient who had undergone
other eye surgery specifically cataract surgery if there is complication that needs a
repair of the eye.

Benefit:

Low complications rate with patients who undergo Scleral Buckling

Risks:
 The most common cause of failure in surgery for retinal detachment is a type of
scarring on the retina, called proliferative vitreoretinopathy (PVR), that can cause the
retina to detach again. PVR usually requires additional treatment, including
vitrectomy surgery.
 Detachment of the choroid (a part of the tissue that forms the eyeball) or swelling in
the retinal area may delay healing.
 The pressure of the scleral buckle can raise the fluid pressure inside the eyeball.
People with cataract surgery or glaucoma may have a higher risk of this
complication.
 Bleeding in the eye can impair vision.
 The eye may become infected. You may need antibiotics and corticosteroids to
reduce redness or discharge from the eye and treat the infection. Sometimes it is
necessary to remove the buckling implant to treat the infection.
 The plastic or rubber of the buckling device may rub on other parts of the eye, move
out of place, or become a site of infection. In some cases, the buckling device may
need to be removed.

Prior to the surgery, the patient is asked to:

 To have bed rest

 Cover both eyes with patches as prescribed
 Avoid jerky head movement and minimize eye stress

After the surgery:

 Maintain eye patch

 You will receive ye drops to reduce any inflammation and to prevent infection.
We will explain how and when you should use them.
  Don’t rub your eye as this may increase infection and lead to complications. If
you experience discomfort, we suggest that you take a pain reliever, such as
paracetamol – take care not to exceed the dose stated on the packaging.
 It is normal to feel itching, and have sticky eyelids and mild discomfort (gritty
sensation due to the stitches) in the operated eye for five to ten days following
retinal detachment surgery.
 It is also common for some fluid to leak from around your eye. Occasionally, the
area surrounding your eyes can become slightly bruised – this is especially
common after a scleral buckle procedure. Any discomfort should ease after one
to two days.
 If your doctor used a gas bubble to flatten your retina during surgery, you may
have to keep your head in a special position for a few days or longer.

Indication of prescribed surgical treatment

General Indication:

Scleral Buckling is indicated for patient who has severe myopia (near-sightedness),
trauma in the eye, or usually after cataract surgery if developed any complication

Specific Indication:

Scleral Buckling is the recommended treatment for the patient who had undergone
other eye surgery specifically cataract surgery if there is complication that needs a
repair of the eye.

Benefit:

Low complications rate with patients who undergo Scleral Buckling

Risks:

 The most common cause of failure in surgery for retinal detachment is a type of
scarring on the retina, called proliferative vitreoretinopathy (PVR), that can cause the
retina to detach again. PVR usually requires additional treatment, including
vitrectomy surgery.
 Detachment of the choroid (a part of the tissue that forms the eyeball) or swelling in
the retinal area may delay healing.
 The pressure of the scleral buckle can raise the fluid pressure inside the eyeball.
People with cataract surgery or glaucoma may have a higher risk of this
complication.
 Bleeding in the eye can impair vision.
 The eye may become infected. You may need antibiotics and corticosteroids to
reduce redness or discharge from the eye and treat the infection. Sometimes it is
necessary to remove the buckling implant to treat the infection.
 The plastic or rubber of the buckling device may rub on other parts of the eye, move
out of place, or become a site of infection. In some cases, the buckling device may
need to be removed.

1.2REQUIRED INSTRUMENTS
A. Scleral buckling
 Retractor 60°Angled Large used to separate the edges of a surgical incision or wound
 Needle Suturing DESCHAMP Type Left used in scleral buckling. is a ligature
carrier used for guiding suture material into difficult to reach areas or deep
muscle and tissue

 Needle Suturing DESCHAMP Type Right used in scleral buckling. is a

ligature carrier used for guiding suture material into difficult to reach areas or
deep muscle and tissue

 Localizator MEYER-SCHWICKERATH- a Transscleral instrument used to

depress the sclera.

 ASPIRATING SPATULA- use to retract the mobile capsular fragment from the
cortex and the cannula.
Forceps Plug Encircling FUKAMI- tying suture, placing and removing iris hooks

 Retractor Spoon Type- to pull and hold overlying tissue out of the operating field

 Caliper Retinal Detachment- may be used to measure the distance between the suture
bites

 Retractor with Apertures 135°- to pull and hold overlying tissue out of the operating
field
 Retractor with Apertures 90°- use to retract tissue our operating field in scleral
buckling

 Retractor 90°Large- use to retract tissue our operating field in scleral buckling

Castroviejo .12mm tissue (aka .12 forceps) – workhorse of ophthalmology;

holding sclera, fixing eye for suture, tying platform
Forcep Thumb, McPherson typing iris straight (aka straight tie forceps) –
tying suture, placing and removing iris hooks

Kellman-McPherson Angled T (aka Kellman’s forceps) – very useful

instrument; substitute for angled tie; removing material from AC
Before the Operation

From the time of arrival up to the time before the incision, the scrub nurse and
circulating nurse may start performing their activities.

The Scrub Nurse

 At this time, the scrub nurse can now perform surgical hand-washing, gowning,
and gloving.
 Serve gloves and other sterile materials to the surgeon and other members of the
sterile team;
 Prepare sterile materials and equipment on the mayo table.
 May start initial counting of sponges, needles, sharps, and other tiny materials
that will be used;

The Circulating Nurse

  Receive the endorsement (client, chart, and supplies) and note the time;
 Counter-check the client’s identity and procedure/operation to be done;
 Review laboratory results
 Recheck the consent
 Ensures functionality of everything to be used;
 Recheck administration (time, dosage, by whom) and effects of the pre-
anesthesia agents;
 Ensures safety while transporting patient from the lobby to the OR table/bed;
 Assists in positioning the client in the induction of anesthesia, notes the time of
induction;
 Place straps, restrains, and other protective materials for safety;
 Assists in dressing (gowning) of the sterile nurse;
 Calls for any other request and corrections among surgical team members;
 Prepares/put anticipated additional materials within accessible areas.

During the Operation

The scrub nurse will focus on taking care of the sterile field, materials, and other sterile
team members. While the circulating nurse focuses on relevant activities and materials
distal to the sterile field.

The Scrub Nurse

 Assembles the mayo table.

 Charges parts of instruments and materials like blade to blade holder
 Serves sterile draping materials like towels, clips and others;
 Serves the “knife” or scalpel and note the time of incision
 Serves sponges to stop or minimize bleeding;
 Anticipates needed materials to be used next;
  Keep on organizing the mayo table to prevent dropping and contaminating
instruments and materials;
 Monitors dropped materials for tallying and possible replacements;
 Collects the specimen tissue and put it in container for possible laboratory
workouts;
 Serves suturing instruments and materials;
 Notes the closing time which marks the ending of the operation;
 Collects all instruments, materials, and equipment.

The Circulating Nurse

 Noting the time when the operation starts.

 Records and check the instruments with the scrub nurse
 Anticipates the serving of additional materials
 Assists the anesthesiologist and other unsterile team members
 Continuously monitors dropped materials and document it, prepares possible
replacements;
 Does the documentation of everything done and happened during the
operation/procedure in chronological order;
 Assists in the final counting of sponges, needles, blades, and tiny materials used;
 Notes the time of closure;

After the Operation

Both scrub nurse and circulating nurse:

 Immediately after the surgery, nurses count everything from sponges to

surgical tools to ensure that everything is accounted for.
 They sterilize and clear away surgical tools, and remove the drapes that
covered the patient and dispose chemical waste.
  After their role performance, both will go back to the vacated operating room
to final check the arrangement of every details; returning it back to their
original places, keeping it ready to cater the next operation.

1.4. Perioperative tasks and responsibilities of the Nurse

An Operating room nurse provides a continuity of care throughout the

perioperative period, using scientific and behavioral practices with the eventual goal of
meeting the individual needs of the patient undergoing surgical intervention. Their
knowledge and skills are constantly challenged depending on the demands of the
procedure and their surgical team mates.

An operating room nurse can perform either of the two roles at a time, a scrub
nurse or a circulating nurse. A scrub nurse works directly with the surgeon within the
sterile field by passing instruments, sponges, and other items needed during the
surgical procedure. While the circulating nurse works outside the sterile field.
Responsible for managing the nursing care within the O.R. by observing the surgical
team from a broad perspective and assisting the team in creating and maintaining a
safe, comfortable environment.

1.5. Expected outcomes of surgical treatment performed

 Patients usually have minimal post-operative pain.

 Patients usually experience faster recovery than open gallbladder surgery
patients.
 Most patients go home the same day of the surgery and enjoy a quicker return to
normal activities.
 A unique postoperative pain may be experienced in the right shoulder. 
 Some people may experience occasional loose stool after the procedure
NURSING CARE PLANS

NCP#1: ISTURBED SENSORY PERCEPTION (VISUAL) RELATED TO DECREASE IN

VISUAL ACUITY AND CLARITY OF VISION
NCP#2: RISK FOR INJURY RELATED TO DECREASE VISUAL ACUITY AS EVIDENCE BY
BLURRED VISION OR PRESENCE OF “FLOATERS”
NCP#3: FEAR RELATED TO UPCOMING SURGERY
NCP#4: RISK FOR BLEEDING RELATED TO SURGICAL INTERVENTIONS
NCP#5: RISK FOR INFECTION RELATED TO POST OPERATION
 A. PREOPERATIVE
NCP#1: Disturbed Sensory Perception (Visual) Related To Decrease In Visual Acuity And
Clarity Of Vision
Assessment Nursing Scientific Objectives Intervention Rationale Expected
Diagnosis Explanation s Outcome
 
S: NONE Disturbed Retinal SHORT TERM: 1.Assess the 1.Identify the SHORT TERM:
O: The patient sensory detachment >After 15-30 client's client visual >After 15-30
may manifest: perception(Vis results from minutes of visual acuity capabilities. minutes of
 Decreased ual) separation of health health teachings
visual field related to the sensory teachings 2.Approach 2. Provide regarding the
examination. decrease in layer of the regarding the the clients of sensory patients’
 Decreas visual acuity a retina patients’ the healthy stimulation, condition, the
ed ability to nd clarity of containing condition, the side. reducing the patient shall be
identify the vision the rod and patient will be sense of able to
environment cones from able to isolation / understand
(objects, the understand alienation. patient’s
people, pigmented patient’s condition.
places) epithelial condition. 3.Identificatio 3. Giving
 Flashes layer n of sight accuracy a LONG TERM:
of light beneath. LONG TERM: alternatives nd > After 1-2 days
 Burst of > After 1-2 to optimize maintenance. of nursing
black spots or days of nursing the stimulus interventions,
floaters interventions, source. the patient shall
the patient will be able to
be able to 4. Adjust the 4. Improving report a greater
report a greater environment the ability of ability to
ability to to optimize sensory process visual
process visual vision: perception. stimuli and
stimuli and communicate
communicate  Orient the visual
the visual the client to changes
 changes the ward.
 Place
the tool that
is often used
near a client
or on the
sides of the
eyes
healthier.
 Provid
e sufficient
lighting.
 Put in
place a
fixed tool.
 Avoid
glare.

5. Encourage 5. Improving
the use of the ability of
alternative response to
acceptable environmental
environmenta stimuli.
l stimuli:
auditory,
tactile.

NCP#2: Risk For Injury Related To Decrease Visual Acuity As Evidence By Blurred Vision Or
Presence Of “Floaters”
Assessment Nursing Scientific Objectives Interventions Rationale Expected
 Diagnosis Explanation Outcome

S: NONE Risk for Retinal SHORT TERM: 1. Assess 1.failureto SHORT TERM:
O: The patient injury related detachment >After 15-30 home assess and >After 15-30
may manifest: to decrease results from minutes on environment intervene can minutes on
>Shadow or visual acuity separation of health for threats to place the health
curtain falling as evidence the sensory teachings, the safety patient at teachings, the
across the field by blurred layer of the patient will be needless risk patient shall be
of vision vision or retina able to able to
>Flashes of presence of containing verbalize, 2.Note 2. Affect’s verbalize,
light “floaters” the rod and understanding patient’s age, patients ability understanding
>Burst of black cones from of individual gender, and to to protect of individual
spots or the factor that decision self and factor that
“floaters” pigmented contribute to making ability , influences contribute to
epithelial possibility of level of choices of possibility of
layer beneath injury. consciousness interventions injury.
which results / competence and teachings
in presence LONG TERM: LONG TERM:
of floaters. After 1-3 days 3.Assess 3.it may result After 1-3 days
on nursing mood, coping in on nursing
interventions, abilities and carelessness interventions,
the patient will personality or increased the patient shall
be able to styles. risk taking be able to
demonstrate without demonstrate
behavioral consideration behavioral
changes that of changes that
reduces risk consequences reduces risk
factors and factors and
protect self 4.Assess protect self from
from injury. patient’s 4.to identify injury.
muscle risk for falls
strength, gross
and fine motor
 coordination

NCP#3: Fear Related To Upcoming Surgery

Assessment Nursing Scientific Objectives Interventions Rationale Expected
Diagnosis Explanation Outcome

S: NONE Fear related Retinal SHORT TERM: 1. Open up 1. This SHORT TERM:
O: The patient to upcoming detachment >After 15-20 about your approach >After 15-20
may manifest: surgery results from minutes of awareness of validates the minutes of
>Reports of separation of nursing the patient’s feelings the nursing
apprehension the sensory interventions, fear. patient is interventions, the
> verbalization layer of the the patient will holding and patient shall be
of being scared retina be able to demonstrates able to
> alarm containing acknowledge recognition of acknowledge
>panic the rod and and discuss those and discuss
> increased cones from fears, feelings. fears,
alertness the recognizing recognizing fears
pigmented fears and and unhealthy
epithelial unhealthy fear 2. Discuss the 2.This fear
layer situation with approach
beneath. LONG TERM: the patient helps the LONG TERM:
>After 15-24 and help patient deal >After 15-24
hours of differentiate with fear. hours of nursing
nursing between real interventions, the
interventions, and imagined patient shall be
the patient will threats to well- able to display
be able to being. lessened fear as
display evidence by
lessened fear 3.Tell patient 3. This verbalization of
as evidence by that fear is a reassurance lessened fear.
verbalization of normal and places fear
lessened fear. appropriate within the
 response to field of
circumstances normal
in which pain, human
danger, or experiences.
loss of control
is anticipated
or felt.

4. Be with the 4. The

patient to physical
promote connection
safety with a trusted
especially person helps
during the patient
frightening feel secure
procedures or and safe
treatment. during a
period of fear.

5. Provide 5. Replacing
accurate inaccurate
information if beliefs into
irrational fears accurate
based on information
incorrect reduces
information anxiety.
are present.

B. POST OPERATIVE
NCP#4: Risk For Bleeding Related To Surgical Interventions
 Assessment Nursing Scientific Objectives Interventions Rationale Expected
Diagnosis Explanation Outcome

S: NONE Risk for Retinal SHORT TERM: 1.Screen the 1.To prevent SHORT TERM:
O: The patient bleeding detachment >After 10 client for risk any risk >After 10
may manifest: related to results from minutes of for bleeding factors for minutes of
surgical separation of nursing care, bleeding nursing care,
interventions the sensory client will be client shall be
layer of the able to be 2.Monitor 2.Asssess able to be aware
retina aware of the patient for any signs and of the signs and
containing signs and signs and symptoms of symptoms for 
the rod and symptoms for  symptoms of bleeding after bleeding by
cones from bleeding by bleeding such procedure screening of the
the screening of th as risk factors of  
pigmented e tachycardia, bleeding
epithelial risk factors of   pallor and
layer bleeding blood at LONG TERM:
beneath. dressing site.
LONG TERM:
3.Monitor the 3.To observe
incision sight incision site
for any signs
of bleeding

4.Istruct the 4.To make

client to the patient
observe for aware of
bleeding after what will
the procedure contribute to
the bleeding
5.obtain
baseline data 5.To have
of vital signs baseline data
 in case of
bleeding
NCP#5: Risk For Infection Related To Post Operation
Assessment Nursing Scientific Objectives Interventions Rationale Expected
Diagnosis Explanation Outcome

S: NONE Risk For Retinal SHORT 1.Note risk 1. To help the SHORT TERM:
O: The patient Bleeding detachment TERM: factors patient identify
may manifest: Related To results from for occurrenc the present risk LONG TERM:
Surgical separation of LONG TERM: e of infection factors that may
Interventions the sensory in the incision add up to the
layer of the infection
retina
containing 2. To evaluate
the rod and 2. Observed if the character,
cones from for localized presence and
the sign condition of
pigmented of infection at the present
epithelial insertion sites infection
layer of invasive
beneath. lines, surgical
incisions
or wounds 3. Patients with
poor nutritional
3. Assess and status may be
monitor anergic or
nutritional unable to
status, muster a
weight, cellular immune
history of response to
weight loss, pathogens
and serum making them
albumin. susceptible to
infection.

4. Helps
support the
4. Encourage immune system
intake of responsiveness
protein-rich .
and calorie-
rich foods.
LEARNING DERIVED

I have learned that a detached retina is a serious problem that can cause blindness
unless it is treated. If any part of the retina is lifted or pulled from its normal position, it is
considered detached and will cause some vision loss. I also learned the importance of
caring for the eyes and interventions like regular breaks while doing computer work and
other tasks that mostly involve your eyes. Wear your glasses. This sounds obvious, but
many people with low to moderate vision loss leave them at home or tucked in a pocket
or purse because of vanity or forgetfulness.Wear sunglasses when out of doors. Wear
sunglasses that protect your eyes from UVA and UVB rays. Wear them even on cloudy
days. Closely follow the recommended schedule for cleaning and wearing contact
lenses. Know your family's eye history and share this information with your healthcare
providers. If you have high blood pressure, high cholesterol, or diabetes, make sure
these conditions are under control.

-Ayen, Charlene

The study about our case, Retinal Detachment made me learn what the
definition, the factors that might cause this disease, its signs and symptoms, the
treatments, medications and interventions that may be implemented to a certain person
who is suffering from this disease.

Throughout the case study, I was able to discover what happens to a person who
is suffering from Retinal Detachment, in which the retina does not work when it is
detached and vision becomes blurry. A retinal detachment is a very serious problem
that almost always causes blindness unless it is treated with detached retina surgery.
During the case reporting, I have learned that if Retinal Detachment is left untreated
may cause blindness.

-Tiatco, Sarah Mae

 In doing this case report, I Have learned that Retinal Detachment is a serious eye
disorder that can lead to blindness. I also learned that there are three types of retinal
detachment which are Rhegmatogenous detachment, Traction Retinal Detachment and
Exudative retinal Detachment. Rhegmatogenous detachment are those common in with
severe myopia as their eyes are longer and their retina is stretched. Throughout the
study, I have learned that as early as now we should take care of our eyes. We should
eat food rich in beta carotene. If not our chances of having eye disorders such as retinal
detachment will most likely increase.
-Vidal, Kristia Aprliyn P.

Through this study I have learned that we should equally take care of every parts
of our body each has a function and that function is important. Also, we need to keep in
mind not to neglect thing our body is trying to tell us. Our eyes play an important role in
our lives to see the surroundings and so we can appreciate the beauty of God’s
creation. In NCM we learned different etiology and risk factors for eye problems and we
are aware of what to avoid to protect our eyes from getting blind. Also, we need to be
sensitive and nourish our bodies with proper diet and exercise as it will generally
improve our bodily functions in everyday life.

- Llacer, Carlo Joseph I.