Patient education is a dynamic, ong...

Patient education is a dynamic, ongoing proces that present itselfs from admission to discharge. Intradepartmental communication, planning, and team coordination are essential factors in promoting prosperous surgical results. A knowledgeable, organized team of perioperative RN in the ambulatory surgery department can play a dynamic part in properly educating surgical patients for eventual domicile care.

OCULAR ANATOMY

Before perioperative nurtures can serve as effective team members who provide patient education for retinal surgery they ne to understand ocular anatomy, pathophysiology, and surgical interventions. A midsaggital view of the observation reveals the major components of the estimate (Figure 1), including the

* protuberant cornea,

* sclera,

* limbus,

* iris,

* crystalline lens

* choroid, and

* retina.

[FIGURE 1 OMITTED]

The transparent gibbous cornea contributes approximately 70% of the refractive power of the view The sclera is the white, tough exterior protective layer of the notice that merges with the cornea to form the corneoscleral junction or limbus. The iris rules the amount of light entering the pupil from coordinating its two opposing muscles (ie, the sphincter pupillae muscle, the dilator pupillae muscle). The sphincter pupillae muscle contracts to constrict the pupil, relaxes to dilate it, and is in a less degree than the control of the parasympathetic nervous body and the dilator pupillae muscle dilates the pupil by the agency of direct stimulation of the sympathetic nervous hypothesis The crystalline lens, which provides approximately 30% of the refractive power, is biconvex and has the ability to change its shape to increase or decrease its focusing power. (1) The cornea, iris, and crystalline len work together to focus light onto the retina. (2) The choroid is the middle vascular layer that nourishes the watch and the thin inner layer is the retina, which forms images and propels them to the brain on way of the optic might (3)

The retina is compos of pair layers, including the stratified inner sensory layer, which is closest to the vitreous, and a single exterior layer of retinal pigment epithelium, which is attached to the choroid by way of Bruch's membrane. The innermost layer of the sensory retina (ie, the manhood fiber layer) forms the optic steadiness The outermost layer, which is adjacent to the retinal pigment epithelium, consists of photoreceptors, cudgels and cones. The entire sensory retina expands from the optic nerve posteriorly to the ora serrata anteriorly. The peripheral portion of the sensory retina comprises canes that function in dim light and are used to diocese gray scales. (4)

The macula is located in the center of the retina. It is approximately 6 mm in diameter, and it primarily consists of cone that function in bright illumination and are used to diocese color. In the center of the macula is the fovea, which is approximately 1 mm in diameter. The fovea creates the in the greatest degree finely detailed vision for like daily tasks as reading, threading a needle or driving a car. To maintain its spherical shape, the eyeball is filled with approximately 5 mL of a jelly-like substance called vitreous humor. (5)

BASIC PATHOPHYSIOLOGY

Breaks in the continuity of the retina may be caused on degeneration, holes, or tearing. (6) As a [i]role[/i] ages, the vitreous jelly liquifies and falls away from the retina. This is a normal result occurring in people 40 to 70 years of age. This phenomenon is referr to as a posterior vitreous detachment. As the vitreous contracts and chances away from the retina, patients may complain about seeing floaters, which ofttimes are depicted as dots, blemishs bugs, or curly lines. The shrinking and pulling of the vitreous also may stimulate the retina to yield a flash of light known as photopsia. The tractional force created by means of the shrinking vitreous also may burst blood vessels. The patient papal courts this as a shower of marks or a large dark vesicle if a hemorrhage occurs.

Vitreous hemorrhage may be described as a large visual field los or an overall decrease in a patient's vision. If the vitreous is exceptionally adherent to a weak point onward the retina, a tear, lair or detachment may develop. (7) the same proposed mechanism of macular lair formation suggests that the vitreous shrinks and twitchs toward the front of the judgment while a portion of the vitreous remains firmly attached to the central part of the retina. Fluid may seep by the and of the hole, causing a localized separation of the retina around the cavern The longer the macula is detached, the more likely there will be irreversible vision los to be paid to photoreceptor cell damage. (8) Patients may complain of visual distortion with reading or notice a decrease of central vision for the pair distance and near activities. (9)

"A retinal detachment is a progressive painless los of peripheral vision or visual field that can at hand in any quadrant and can also be asymptomatic." (10) There are sum of two units major types of retinal detachments--rhegmatogenous and nonrhegmatogenous. (11) A rhegmatogenous retinal detachment, which is the greatest in quantity predominant type, usually is affiliated with a excavation or tear in the sensory retina. Liquefied vitreous, serous fluid, or posterity may collect in the subretinal space between the sensory retina and the underlying layer of retinal pigment epithelium. (12) The potential for tears is related to degenerative changes in the retina or vitreous and increases with age. Other predisposing ocular conditions include myopia; aphakia, which is absence of the crystalline len of the sight congenitally, from trauma, or from surgical extraction of a cataract; pseudophakia from intraocular len implantation; and pointless or penetrating trauma, including sports injuries. Moderate trauma, of the like kind as stooping or lifting weights, may precipitate retinal detachments in a predisposed judgment (13) Patients present with diminished vision and may complain of flashing lights, a shower of floaters, seeing cobwebs, or a dark shade or curtain folding through the eye. (14)