# A nurse is caring for a 58-year-old client who presents to the emergency department with sudden onset of flashing lights, floaters, and a 'curtain-like' shadow in the peripheral vision of the right eye, diagnosed with rhegmatogenous retinal detachment scheduled for immediate surgical repair. Which nursing intervention should be the nurse's first priority?

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## 문제

A nurse is caring for a 58-year-old client who presents to the emergency department with sudden onset of flashing lights, floaters, and a 'curtain-like' shadow in the peripheral vision of the right eye, diagnosed with rhegmatogenous retinal detachment scheduled for immediate surgical repair. Which nursing intervention should be the nurse's first priority?

## 보기

1. Position the client with the head of the bed elevated and the affected eye facing downward **✔ 정답**
2. Administer prescribed analgesics to manage eye pain
3. Apply bilateral eye patches to prevent eye movement
4. Encourage the client to perform deep breathing exercises to reduce anxiety

**정답: 1**

## 해설

Positioning with the head elevated and affected eye facing downward is the first priority to minimize further detachment and promote reattachment using gravity. Other interventions like pain management or eye patches are less urgent in this acute setting.

## 심화 해설

Preoperative Priority for Rhegmatogenous Retinal Detachment

The correct answer is Position the client with the head of the bed elevated and the affected eye facing downward. While the provided meta-analysis focuses on postoperative positioning, the physiological principle it highlights—using gravity to manipulate the position of the detached retina and any associated gas or fluid—is the critical concept that also guides preoperative nursing care. In a rhegmatogenous retinal detachment (RRD), a tear or hole allows vitreous fluid to seep under the retina, separating it from the underlying retinal pigment epithelium. The goal of immediate preoperative positioning is to prevent the progression of detachment and keep the macula safe. By positioning the client with the head elevated and the affected eye dependent (facing downward), gravity helps the detached retina fall back toward its anatomical position and prevents subretinal fluid from tracking under the macula, which is the central area responsible for sharp, detailed vision [1]. This intervention directly addresses the underlying pathophysiology and aims to preserve visual acuity before surgical repair can be performed.

Administering analgesics (Option 2) addresses the client's comfort, but RRD is typically painless; the primary sensation is visual disturbance, not acute pain. Pain management is a secondary priority to a measure that can directly limit the extent of permanent vision loss. Applying bilateral eye patches (Option 3) is an outdated and inappropriate intervention. While minimizing eye movement is a consideration, bilateral patching can cause sensory deprivation and anxiety without reliably immobilizing the eyes, as the eyes still move conjugately during sleep and with stimuli. The specific, gravity-dependent positioning is a far more targeted and effective intervention. Encouraging deep breathing exercises (Option 4) is a supportive measure for anxiety, which is a psychosocial need. In the hierarchy of nursing priorities, a physiological intervention that can directly alter the trajectory of a sight-threatening condition takes precedence over managing the emotional response to it. The immediate physical stabilization of the retinal detachment through positioning is the highest priority to optimize the client's visual outcome.References (research sources)

- [1]Impact of postoperative positioning on surgical and visual outcomes after pars plana vitrectomy for rhegmatogenous retinal detachment: a systematic review and meta-analysis.Meta-analysis/systematic reviewAl-Shammari YM, Al-Shammari AM, Alrabiah M. (2026) · DOI: 10.1186/s40942-026-00890-7

## 임상 시나리오

Preoperative Positioning for Retinal DetachmentUsing Gravity to Protect the Macula
The immediate priority is to position the client with the head of the bed elevated and the affected eye dependent (facing downward). This uses gravity to settle the detached retina and prevents subretinal fluid from tracking under the macula.

Rhegmatogenous detachment is typically painless, presenting with visual disturbances like flashing lights, floaters, and a curtain-like shadow. Pain management is a secondary concern.

CautionDo not apply bilateral eye patches as a first action; this does not halt the progression of detachment and can increase patient anxiety. The goal is to limit detachment spread, not to immobilize the eye.

## 핵심 개념

- **Rhegmatogenous Retinal Detachment** — The most common type of retinal detachment, occurring when a tear or hole allows vitreous fluid to seep under the retina, separating it from the pigment epithelium.
- **Macula** — The central area of the retina responsible for sharp, detailed central vision; its detachment is a major threat to visual acuity.
- **Preoperative Positioning** — Placing the patient with the head elevated and the affected eye dependent to use gravity to settle the retina back and prevent subretinal fluid from tracking under the macula.

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