Question

A client developed hyphema of the left eye after being hit with a ball. Which position is recommended for the client with hyphema? A. Semi-Fowler's B. Supine C. Prone D. Low Trendelenburg

Short answer

Answer: The most appropriate position for a client with hyphema is the Semi-Fowler's position.

Step-by-step solution

Understanding Hyphema

Hyphema is a condition in which blood collects in the anterior chamber of the eye, usually as a result of trauma. This can cause pain, blurry vision, and increased pressure within the eye, which can lead to further complications if not managed properly.

Evaluate the Different Positions

Now we will evaluate the four positions mentioned in the question: A. Semi-Fowler's position - This position involves the client lying on their back with the head elevated at an angle of 30-45 degrees. This position can help promote drainage of blood from the anterior chamber and reduce intraocular pressure. B. Supine position - This position involves the client lying flat on their back. Although this position might be comfortable for the client, it doesn't actively promote drainage of blood from the anterior chamber. C. Prone position - This position involves the client lying on their stomach, with their face down. This position is not recommended for hyphema, as it can increase the intraocular pressure and prevent proper blood drainage. D. Low Trendelenburg position - This position involves the client lying on their back with their feet elevated higher than their head. Although it may help in promoting venous return, it's not ideal for hyphema as it doesn't actively promote blood drainage from the anterior chamber.

Choose the Best Position

Based on the information above, the Semi-Fowler's position (A) is the most recommended position for a client with hyphema because it promotes blood drainage from the anterior chamber of the eye and helps reduce intraocular pressure. The other positions either do not promote blood drainage or may worsen the condition. Therefore, the correct answer is A. Semi-Fowler's.

Key concepts

Nursing Care Procedures

In the context of managing a client with hyphema, which is the accumulation of blood in the anterior chamber of the eye, nursing care procedures play a critical role in recovery and minimizing complications. Effective nursing management involves close monitoring of the patient's visual acuity, pain levels, and signs of increasing intraocular pressure.

Key to the care process is the implementation of physician-prescribed interventions such as administering medication to reduce inflammation and pain, as well as monitoring for side effects. Counselling the patient on the importance of maintaining a proper position, in this case, the Semi-Fowler's position, ensuring limited head movement, and avoiding activities that could further elevate intraocular pressure, is vital.

Education on the avoidance of NSAIDs, which may exacerbate bleeding, and the significance of wearing protective eyewear as a preventative measure in the future, are also essential components of nursing care procedures for a patient with hyphema.

Semi-Fowler's Position

The Semi-Fowler's position is recommended for patients with hyphema as it involves them lying on their back with the head elevated to an angle of 30-45 degrees. This position maximizes gravitational drainage of the blood from the anterior chamber without excessively increasing intraocular pressure, which could be detrimental in this condition.

By facilitating the settling of blood away from the visual axis, the Semi-Fowler's position often helps in improving the patient’s ability to see and contributes to overall comfort and recovery. Nurses should educate patients on how to maintain the Semi-Fowler's position correctly, ensuring consistent elevation of the head, which may necessitate the use of pillows or specialized medical beds.

Intraocular Pressure

Intraocular pressure (IOP) is the fluid pressure inside the eye, which can have significant implications for ocular health. Maintaining a normal IOP is critical, especially in conditions such as hyphema, wherein elevated pressure can lead to additional complications like optic nerve damage or glaucoma.

The goal of managing hyphema is to prevent a rise in IOP. Nursing interventions, including the Semi-Fowler's position, avoiding strenuous activities, and administering prescribed eye drops, are geared towards maintaining IOP within a normal range. Regular IOP monitoring through tonometry is an essential aspect of evaluating the effectiveness of the chosen management strategies.

Anterior Chamber of the Eye

The anterior chamber is a fluid-filled space immediately behind the cornea and in front of the iris and lens. When a patient experiences hyphema, blood enters this chamber, which can interfere with vision and potentially elevate intraocular pressure if drainage is obstructed.

Understanding the anatomy and physiology of the anterior chamber is crucial when considering the implications of hyphema. The blood needs to clear from this space to restore visual acuity and prevent elevated IOP. Nursing care, including proper patient positioning and monitoring, aims to support the natural drainage process and return the anterior chamber to its normal state.