NURSING CARE RELATED TO THE SENSORY AND
NEUROLOGICAL SYSTEMS
1-21
1-21. PREOPERATIVE NURSING CARE OF THE PATIENT UNDERGOING OPHTHALMIC SURGERY
The eye is a delicate and important organ, and its care and protection are of the utmost importance. Common conditions of the eye that may require surgical intervention include trauma, cataract, glaucoma, and detached retina. The ophthalmologist will determine the treatment required and procedure of choice in each patient's case. The procedure may vary from a simple incision to facilitate drainage to total removal of the eyeball (enucleation).
a. Physical Orientation. The patient will require a thorough orientation to his immediate hospital environment. This is done to help the patient during the postoperative period, since he may be blind as a result of the procedure or the need for the eyes to be patched.
(1) Assist the patient to learn details of his room such as the location of furniture, doors, windows, and so forth.
(2) Familiarize the patient with the voices of those who will care for him after surgery. Familiarize him with the daily sounds and noises in the environment, since he will be more aware of sound without his vision.
b. Observation. The patient should be observed for tendencies to cough or sneeze (smoker's cough, allergies, and so forth). Such observations should be reported to the professional nurse for consideration in the plan of care. Such violent movements of the head during the postoperative course may cause increased intraocular pressure, leading to hemorrhage or rupture of incisions.
c. Education. The patient must receive a thorough education about the postoperative course of events and his responsibilities and restrictions. The patient must understand the objective of resting the eyes and avoiding actions that increase intraocular pressure.
(1) The head must be kept very still.
(2) No reading.
(3) No showers, no shampooing, no tub baths.
(4) No bending over at the waist.
(5) No lifting of heavy objects.
(6) No sleeping on the operative side. If both eyes are affected, the patient must sleep on his back.
d. Physical Preparation.
(1) A bowel prep is done the evening prior to surgery to prevent the patient from straining at stool during the immediate post-op period.
(2) Shaving of eyebrows, cutting of eyelashes, and shaving of face should be done only on the order of the surgeon.
(3) After the patient has been taken to surgery, prepare a post-op bed, ensuring that the bed is equipped with side rails.
(4) Sand bags should be made available for use in immobilizing the head.
e. Family. Often, if the patient must be kept absolutely still or will be temporarily blinded after surgery, a member of the family may be asked to stay with the patient. If this is the case, the family member should receive the same orientation and education given to the patient.
