Ophthalmic Sub Specialty Nursing Care

Retina

1. The patient's blood pressure and pulse should be checked after the surgery.
2. Antibiotic and painkiller tablets will be given to the patients after ½ an hour.
3. For the first four hours liquid diet will be suggested for the patients.
4. Medications are given to the patients if there is any complication like vomiting and pain.
5. If the patients were given SOI / C3F8 / SF6 / AIR then the patients are to lie in the prone position. After 5 hours the ophthalmologist will check the intra ocular pressure in the eye. If the intraocular pressure is high then antigluacoma medicines are to be started.
6. According to the surgeon's instruction the patients will be positioned after the surgery.

Post operative instructions

1. Medication

• Patient has to follow the instructions on applying drops as given by the OA at the time of discharge for a period of 30 days.
• The patient should apply drops after washing their hands thoroughly.
• In addition to eye medication, patients with diabetes, high B.P. heart disease and asthma should continue their medicines regularly.

2. Instruction concerning eye

• The patient has to protect the eye with green shade for 40 days and wear the black glass for the day time.
• Redness, watering of eyes and a little irritation are common and the patient need not worry about it. But if it is unbearable it is best to consult an ophthalmologist.
• Instruct the patient not to rub the operated eye.

3. Body wash

• Body wash can be taken from the next postoperative day. Head bath could be taken after one month.

4. Food

• Regular food can be taken except the hard foodstuffs that are to be avoided.
• Tobacco chewing, smoking and taking alcoholic drinks are strictly prohibited.

5. Activities

• Walking, reading, writing, watching T.V. etc. should not be performed.
• Jumping, swimming, lifting heavy objects, cooking, gardening, yoga, should be avoided during the first month after surgery.
• Avoid playing games like basket ball, football, cricket and tennis for a certain period of time.
• Self-shaving is allowed after 2 weeks.

Special instruction

The patients who were given SOI / C3F8 / SF6 / AIR should lie in the prone position for 15 days.

Cornea

Corneal transplantation and corneal suturing

1. Medication

• Follow medications as per ophthalmologist's instruction.
• Close the bottle (antibiotic drops) after use and store it in a cool place.
• In addition to eye medication, patients with diabetes, high B.P. heart disease and asthma should continue their medicines regularly.

2. Instruction concerning eye

• Do not rub the operated eye.
• Any discharge from the eyes should be wiped gently with sterile cotton. The cotton should be placed in boiled warm water for 10 minutes, cooled, squeezed and then be used.
• Do not lie on the side of the operated eye, because it should not be subjected to pressure or stress.
• Wear dark glasses during the day and green shade during night for the first 4 weeks.
• If symptoms like redness, profuse watering, pain and reduced vision occurs in the operated eye, consult an ophthalmologist.

3. Face wash

• The face should not be washed for seven days. A soft wet towel should be used to wipe the face without rubbing the operated eye.

4. Activities

• Shaving can be done.
• Normal activities like walking, reading, writing, watching T.V. etc., can be performed.
• Jumping, swimming, lifting heavy objects, cooking, gardening, yoga, should be avoided during the first month after surgery.
• Avoid playing games like basketball, football, cricket and tennis for a year after surgery.

5. Bath

• After surgery, body bath can be taken daily and head bath after one month.

6. Food

• No diet restriction except in diabetics.

7. Special instruction

• If any other health problem arises, consult a physician immediately.

8. Follow up

• Come for the first follow up after a month and then confirm the second follow up date.
• Pterygium transplantation, bowman's catery, excision piopsy & pterygium excision

General instructions

• Do not rub operated eye
• Cleaning: Any discharge from the eyes should be wiped gently with sterile cotton. (Put the cotton in boiling water for 10 minutes, cool, squeeze and then use it).
• Do not wash your face for the first 7 days; use a soft wet towel instead to wipe the face.
• Shaving can be done.
• After surgery, take body bath daily and head bath after 10 days.
• Do not lie on the side of the operated eye, because it should not be subjected to pressure or stress.
• Normal activities like walking, reading, writing, watching T.V. etc., can be performed.
• Jumping, swimming, lifting heavy objects, cooking, gardening, yoga, should be avoided during the first month after surgery.
• Avoid playing games like basketball, football, cricket and tennis for a year after surgery.
• No diet restriction except in diabetics.
• If any, other health problem arises, consult a physician immediately.

Corneal ulcer

Counselling and instructions

• The patient is instructed to take only body bath.
• The OA will give the medicines according to the ophthalmologist's prescription.
• Cleaning: Any discharge from the eyes should be wiped gently with sterile cotton. (Put the cotton in boiling water for 10 minutes, cool, squeeze and then use it).
• Drops should be applied after washing the hands.
• Food: No diet restriction except in diabetics. Diabetic patients should control their sugar level.
• If any other health problem arises, consult a physician immediately.

Orbit

Post operative instruction and care

Monitoring

• The patient's blood pressure and pulse should be checked after the surgery.
• The OA should check for bleeding or edema in the operated eye.

Medication

• Antibiotic and painkiller tablets are given to the patients half an hour after the surgery

Patient counselling

• Patients should take normal food except hard foodstuffs.
• The OA should enquire the patients regarding allergy to any medicines.
• The patient should be told that the suture will be removed after 5 days.

DCR patients

• The patients will be fitted with nose pack which will be removed after 24 to 48 hours. The patient should not remove the nose pack.
• The patient should be instructed to breathe through their mouth as they cannot breathe normally through nose due to nose pack.
• They should lay on a flat surface and not use pillow
• They should avoid coughing and sneezing because this may lead to bleeding through the nose. Notify the doctor immediately in case of nasal bleeding.

Evisceration

• For evisceration patients the OA assists the ophthalmologist in removing the betadine pack.
• Instructions are given to the patients regarding cleaning the eye and medicine intake.
• Cleaning: Any discharge from the eyes, should be wiped gently with sterile cotton. (Put the cotton in boiling water for 10 minutes, cool, squeeze and then use it).
• The patient should not rub the operated eye and wound.
• Tobacco chewing, smoking and taking alcoholic drinks are strictly prohibited.
• Self-shaving is allowed after 2 weeks.
• The patient should continuously wear the green shade for 15 days. Once in two days the green shade should be washed using medicated soap.
• After 15 days the patient can take head bath.
• Patient has to consult the ophthalmologist after 30 days.

Paediatric Ophthalmology

Post operative care

• Receive the patient from the operation theatre
• Maintain clear airway
• Maintain proper position
• Check the vital signs
• Recognize the immediate complications, both ocular and systemic and inform the ward doctor.
• Check patient passes urine after surgery
• Management of acute emergencies like administration of O2
• Instruction to the parents regarding feeding, possibility of vomiting in cases of GA patients, systemic medication (injections or oral) as advised.
• Assisting the ward doctor in examination of the children
• Taking care of application of medications as advised by the ward doctor.
• Discharge summary with the postoperative instructions according to the case sheet.
• Follow up date for the next visit
• Additional care to ensure complete satisfaction of the parents
• Report any problem to the concerned doctor

Summary

The outcome of the surgery is dependent on the post operative evaluation and treatment. Clear instructions to the patient will give the best outcome. Printed instructions should be given to the patient for reference at home.

Key points to remember

• OA must make the patient aware of following instructions completely for optimum surgical results.
• OA will instruct the patients to use medications appropriately.
• OA must be aware of different instructions to speciality patients and ensure that the correct instructions are given and understood by the patients.
• Importance of follow up visits is stressed to the patient