# A nurse is caring for a client diagnosed with ocular melanoma who is scheduled for enucleation surgery tomorrow. Which nursing intervention is most appropriate for this client?

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> subject: Adult Health

## 문제

A nurse is caring for a client diagnosed with ocular melanoma who is scheduled for enucleation surgery tomorrow. Which nursing intervention is most appropriate for this client?

A 58-year-old client has been diagnosed with ocular melanoma in the right eye and is scheduled for enucleation surgery in the morning. The client appears anxious and states, "I'm scared about losing my eye and how I'll look afterward."

## 보기

1. Encourage the client to avoid discussing fears about the surgery to reduce anxiety
2. Reassure the client that the prosthetic eye will look exactly like the natural eye
3. Advise the client that vision loss is temporary and will improve after surgery
4. Provide emotional support and discuss realistic expectations about prosthetic options **✔ 정답**

**정답: 4**

## 해설

Emotional support and realistic education about prosthetics are essential for coping with permanent vision loss and cosmetic changes from enucleation. Other options are inappropriate or misleading.

## 심화 해설

Understanding the Client's Experience

The client's statement reveals a profound fear that extends beyond the surgical procedure itself. A diagnosis of ocular melanoma and the prospect of enucleation trigger a complex emotional response tied to body image, identity, and survivorship. Research exploring the patient experience with this specific condition identifies a central theme of "the entangled self," where the physical loss of an eye is deeply interwoven with a perceived loss of self and identity. The client's anxiety is not just about the surgery, but about the existential threat to how they see themselves and how they believe the world will see them [1].

Analysis of Nursing Interventions

Option 1 is incorrect and potentially harmful. Encouraging a client to avoid discussing their fears invalidates their emotional state and blocks therapeutic communication. This approach would prevent the nurse from understanding the client's specific concerns and providing tailored support, which is essential given the "perils of survivorship" that these clients face, including psychological distress [1].

Option 2 offers false reassurance. While modern ocular prosthetics are highly realistic, a nurse cannot truthfully guarantee an outcome that is "exactly like the natural eye." Making a promise that may not be perfectly fulfilled can shatter trust and undermine the client's long-term coping and adaptation. The goal is to foster realistic hope, not to create an expectation that could lead to further distress if unmet [1].

Option 3 provides factually incorrect information. Enucleation involves the complete surgical removal of the eye, resulting in permanent, irreversible vision loss in that eye. Telling the client that vision loss is temporary is a serious medical error that misrepresents the procedure and prevents the client from beginning the necessary psychological process of adapting to permanent monocular vision.

Option 4 is the most appropriate intervention. This approach directly addresses the client's expressed fears through therapeutic presence and honesty. Providing emotional support validates the client's feelings of being "scared," while discussing realistic expectations about prosthetic options acknowledges the physical reality of the loss and offers a tangible pathway toward reconstruction. This intervention aligns with the identified need for "self-advocacy" in patients with ocular melanoma, as it equips the client with accurate information, allowing them to participate in their recovery and body image reconstruction with a sense of agency [1].References (research sources)

- [1]The Patient Experience of Ocular Melanoma: An Interpretive Description.Research articleStephens JML, Williams C. (2025) · DOI: 10.1177/23743735251383212

## 임상 시나리오

Preoperative Care for EnucleationAddressing Body Image and Anxiety
The primary psychosocial intervention is to provide emotional support and discuss realistic expectations regarding prosthetic options. The client's anxiety stems from an "entangled self," where loss of the eye threatens identity.

A prosthetic eye is typically fitted 4 to 6 weeks post-surgery to allow for healing. It will have a natural appearance but will not restore vision or have full natural movement.

CautionAvoid false reassurance by promising the prosthetic will look "exactly" the same. Do not encourage the client to suppress their fears, as this blocks therapeutic communication.

## 핵심 개념

- **Enucleation** — Surgical removal of the eye, leaving the eye muscles and remaining orbital contents intact.
- **Ocular Melanoma** — A rare cancer of the pigment-producing cells in the eye, often requiring surgical intervention.
- **Therapeutic Communication** — A face-to-face process focusing on the client's physical and emotional well-being, using techniques like open-ended questions and empathy.
- **False Reassurance** — A nontherapeutic communication block where the nurse offers unfounded guarantees or clichés to alleviate anxiety.
- **Body Image Disturbance** — A subjective concept involving a person's perception of their physical self, often altered by disfiguring surgery or trauma.

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