# Situation: A 49-year-old woman has had type 2 diabetes mellitus for 12 years and hypertension for 8 years. A dilated eye examination shows proliferative diabetic retinopathy in both eyes. Panretinal photocoagulation (laser) is done in both eyes. Two weeks later she describes four changes. Which one requires evaluation the same day?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630540  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 49-year-old woman has had type 2 diabetes mellitus for 12 years and hypertension for 8 years. A dilated eye examination shows proliferative diabetic retinopathy in both eyes.

Panretinal photocoagulation (laser) is done in both eyes. Two weeks later she describes four changes. Which one requires evaluation the same day?

## 보기

1. A shadow moving across the left eye's vision **✔ 정답**
2. Poorer vision when walking outdoors at night
3. A dull ache in both eyes that eased by the next day
4. Narrower side vision when she crosses the street

**정답: 1**

## 해설

Panretinal photocoagulation destroys ischemic peripheral retina to stop new vessel growth, so reduced peripheral and night vision are expected effects. A shadow or curtain moving across the visual field suggests retinal detachment, a sight-threatening emergency that needs same-day evaluation.

## 심화 해설

What panretinal photocoagulation does
Panretinal photocoagulation (PRP) is a laser treatment for proliferative diabetic retinopathy. The laser makes many small burns across the peripheral retina, destroying ischemic tissue that produces the growth signals for fragile new vessels. With less ischemic retina, the new vessels regress and the risk of bleeding and detachment falls. The trade-off is that the treated peripheral retina no longer works as well, which leads to predictable changes in vision.

Expected effects versus a warning sign
Because PRP sacrifices peripheral retina, reduced peripheral (side) vision and poorer night vision are expected effects. A dull ache after laser that eases by the next day is also expected. A shadow or curtain moving across the field of vision suggests retinal detachment, a sight-threatening emergency that needs evaluation the same day. In proliferative retinopathy, scar tissue from new vessels can pull on the retina and detach it, so this symptom is never written off as a laser effect.

| Reported change | Expected? | Action |
| --- | --- | --- |
| Shadow moving across the left eye's vision | No: possible retinal detachment | Same-day evaluation |
| Poorer vision at night outdoors | Yes | Teach safety in low light |
| Dull ache that eased by the next day | Yes | Reassure |
| Narrower side vision crossing the street | Yes | Teach to scan by turning the head |

Why the other changes are not urgent
The night vision and side vision changes are what the laser was expected to cause; they are not signs of a new problem. The nurse still teaches safety: use good lighting at night, take extra care on stairs and in dim areas, and turn the head to scan before crossing streets. The ache resolved on its own, which is the usual course. None of these needs same-day ophthalmology.

Teaching after PRP
The nurse teaches the client to report at once any new floaters, flashes of light, a shadow or curtain, or sudden loss of vision. Regular follow-up, glucose and blood pressure control, and adherence to further laser or injection treatment protect remaining vision.

Exam takeaway
Watch out After panretinal photocoagulation, reduced peripheral and night vision are expected. A shadow or curtain across vision is retinal detachment until proven otherwise.

## 임상 시나리오

After Panretinal PhotocoagulationExpected effects and red flags
Panretinal photocoagulation destroys ischemic peripheral retina to stop new vessel growth in proliferative diabetic retinopathy.

Reduced peripheral vision, poorer night vision, and a brief ache are expected. Teach her to scan by turning her head and to use good lighting.

A shadow or curtain moving across vision suggests retinal detachment and needs same-day evaluation.

CautionNever attribute a spreading shadow, new floaters, or flashes of light to the laser. These need urgent ophthalmology review.

## 핵심 개념

- **Panretinal photocoagulation** — Laser treatment of the peripheral retina to stop abnormal new vessel growth in proliferative retinopathy.
- **Retinal detachment** — Separation of the retina from the back of the eye, often seen as a shadow or curtain; a vision-threatening emergency.
- **Peripheral vision** — Side vision outside the central line of sight, reduced after panretinal laser.
- **Floaters** — Spots or strands that drift across vision, caused by debris or blood in the vitreous.

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