# 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. The right-eye hemorrhage does not clear, and she undergoes vitrectomy with an intraocular gas bubble. At discharge, while the bubble is still present, she describes these plans: 1. Fly back to her home province 5 days after surgery 2. Wear the gas-bubble alert wristband until the bubble is gone 3. Have a tooth extracted next week with nitrous oxide sedation 4. Visit relatives in a highland mountain town next week Which plans must be changed?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630542  
> 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.

The right-eye hemorrhage does not clear, and she undergoes vitrectomy with an intraocular gas bubble. At discharge, while the bubble is still present, she describes these plans:
1. Fly back to her home province 5 days after surgery
2. Wear the gas-bubble alert wristband until the bubble is gone
3. Have a tooth extracted next week with nitrous oxide sedation
4. Visit relatives in a highland mountain town next week
Which plans must be changed?

## 보기

1. 1 and 3
2. 1, 3 and 4 **✔ 정답**
3. 2 and 4
4. 1, 2 and 3

**정답: 2**

## 해설

An intraocular gas bubble expands at altitude, whether by air or mountain travel, and with nitrous oxide anesthesia, raising intraocular pressure dangerously. These are avoided until the gas is absorbed, and an alert wristband is worn so that any anesthetist knows about the bubble.

## 심화 해설

Why a gas bubble changes the rules
After vitrectomy, the surgeon may fill the eye with an intraocular gas bubble that presses the retina into place while it heals. The gas is absorbed slowly over days to weeks. Gas obeys a simple physical rule: when the surrounding pressure falls, the gas expands, and inside the closed space of the eye that expansion raises intraocular pressure sharply. A sudden rise can cause severe pain, block blood flow to the retina and optic nerve, and cause permanent vision loss. Any situation that lowers outside pressure or adds gas to the bubble must be avoided until the bubble is gone.

Plans 1, 3, and 4 must change
Flying home five days after surgery exposes the eye to lower cabin pressure at altitude, so the bubble expands. Visiting a highland mountain town has the same effect by road; altitude lowers atmospheric pressure whether the client flies or drives. Nitrous oxide sedation for a tooth extraction is dangerous for a different reason: nitrous oxide diffuses into the gas bubble faster than the bubble's gas diffuses out, so the bubble enlarges rapidly. All three plans must be postponed until the surgeon confirms the gas has been absorbed.

| Plan | Change needed? | Reason |
| --- | --- | --- |
| 1. Fly home 5 days after surgery | Yes | Lower cabin pressure expands the gas |
| 2. Wear the alert wristband | No | Warns staff not to give nitrous oxide |
| 3. Tooth extraction with nitrous oxide | Yes | Nitrous oxide enlarges the bubble |
| 4. Highland mountain trip | Yes | Altitude expands the gas |

Why the wristband stays
Plan 2 is correct and should continue. The gas-bubble alert wristband tells any anesthetist, dentist, or emergency team that gas is in the eye, so nitrous oxide is not used. The distractors that list plan 2 as needing change are wrong because removing the wristband would take away a safety measure. The option listing only 1 and 3 is wrong because it forgets that mountain altitude has the same effect as air travel.

Other discharge teaching
The nurse also reviews head positioning as prescribed by the surgeon, often face-down or a specific side, which keeps the bubble against the area of the retinal repair. Vision through the bubble is poor and improves as it is absorbed. She should report severe pain, nausea and vomiting, or a sudden drop in vision, which can signal raised eye pressure.

Exam takeaway
Key point With an intraocular gas bubble, avoid air travel, high altitude, and nitrous oxide until the gas is absorbed, and keep wearing the alert wristband.

## 임상 시나리오

Intraocular Gas Bubble SafetyAltitude and nitrous oxide
A gas bubble placed during vitrectomy expands when outside pressure falls, raising intraocular pressure dangerously.

Avoid air travel, high-altitude travel by any route, and nitrous oxide anesthesia until the surgeon confirms the gas is absorbed.

Keep the alert wristband on so any anesthetist knows about the bubble, and follow the prescribed head position.

CautionSevere eye pain, nausea, or sudden loss of vision may signal a pressure rise and needs urgent review.

## 핵심 개념

- **Vitrectomy** — Surgical removal of the vitreous gel, often to clear blood or repair the retina.
- **Intraocular gas bubble** — Gas injected into the eye after surgery to hold the retina in place while it heals.
- **Intraocular pressure** — The fluid pressure inside the eye; a sudden rise can damage the optic nerve.
- **Nitrous oxide** — An anesthetic gas that diffuses into an eye gas bubble and enlarges it.

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