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Retinopathy of prematurity, pediatric

Terms in this set (19)

Overview
Characterized by abnormal blood vessel development in the retina of a preterm infant
May be mild or severe, potentially leading to retinal detachment and blindness
Classified according to one of three zones of the retina affected
Categorized into one of five stages of increasing severity:

Stage I: Blood vessel growth is mildly abnormal.

Stage II: Blood vessel growth is moderately abnormal.

Stage III: Blood vessel growth is severely abnormal.

Stage IV: Blood vessel growth is severely abnormal and the retina is partially detached.

Stage V: The retina is totally detached.
Stage I: Blood vessel growth is mildly abnormal.
Stage II: Blood vessel growth is moderately abnormal.
Stage III: Blood vessel growth is severely abnormal.
Stage IV: Blood vessel growth is severely abnormal and the retina is partially detached.
Stage V: The retina is totally detached.
Previously called retrolental fibroplasia; also known as ROP
Overview-Pathophysiology
Exact mechanisms aren't clearly understood.
With premature birth, eye development is disrupted, and believed to involve two mechanisms:

Initial injury from hypotension, hypoxia, or hyperoxia leads to the formation of free radicals and injury to the newly developing blood vessels, disrupting normal angiogenesis.

Subsequently, the vessels resume normal growth or new abnormal vessels begin to grow out of the retina.
Initial injury from hypotension, hypoxia, or hyperoxia leads to the formation of free radicals and injury to the newly developing blood vessels, disrupting normal angiogenesis.
Subsequently, the vessels resume normal growth or new abnormal vessels begin to grow out of the retina.
Vascular endothelial growth factor (VEGF) and insulinlike growth factor 1 (IGF-1) stimulate vessel growth.
The abnormal new vessels are highly permeable, leading to retinal edema and hemorrhage.
Abnormal fibrovascular tissue that may form along with these abnormal vessels contracts, pulling on the retina.
Eventually, IGF-1 levels return to normal but act on VEGF, which causes abnormal vessel growth.
Overview-Causes
Exact cause unknown
Overview-Risk Factors
Preterm birth, especially in neonates weighing less than 1,500 grams or at less than 32 weeks' gestation
Assisted ventilation for more than 1 week
Surfactant therapy
High blood transfusion volume
Multiple, severe, concurrent illnesses
Elevated arterial oxygen tension
Overview-Incidence
The incidence of ROP is directly proportional to birth weight.
ROP may be slightly more common in males than females.
Overview-Complications
Vision loss
Amblyopia
Strabismus
Nystagmus
Glaucoma
Retinal detachment
Assessment-History
Preterm birth
Evidence of risk factors
Assessment-Physical Findings
Asymmetrical corneal light reflex
Vascular immaturity on ophthalmoscopic examination
Diagnostic Procedures-Other
Dilated funduscopic examination with scleral depression reveals the zone, stage, and extent of the disease.
Treatment-General
Early screening
Treatment-Diet
Tube feedings with special preterm formula or total parenteral nutrition
Treatment-Surgery
Cryotherapy or laser photocoagulation for ablation
Scleral buckling or vitrectomy for retinal detachment
Nursing Considerations-Nursing Diagnoses
Anxiety
Compromised family coping
Risk for impaired parent/infant/child attachment
Risk for injury
Nursing Considerations-Expected Outcomes
verbalize strategies to control anxiety
demonstrate positive coping skills
exhibit optimal vision
demonstrate appropriate parent-child interactions
remain free from signs and symptoms of injury.
Nursing Considerations-Nursing Interventions
Help the parents and family members deal with the patient's illness and diagnosis; encourage them to verbalize feelings and assist them with working through feelings of guilt and the grieving process.
Encourage the use of positive coping strategies as well as participation in patient care and decision making.
Model positive coping strategies and interactions with the child.
Assist with measures to promote vision; keep necessary items within the child's reach, as appropriate.
Institute safety precautions, as necessary.
Arrange for the child and family to speak with families who have gone through similar experiences.
Prepare the child and family for surgery, including preoperative and postoperative care measures and monitoring.
Nursing Considerations-Monitoring
Vital signs
Visual status
Coping status and adaptation to diagnosis
Anxiety level
Safety
Skin integrity
Signs and symptoms of infection
Nursing Considerations-Associated Nursing Procedures
Blood pressure assessment, pediatric
Diapering an infant
Feeding tube insertion
Feeding tube removal
Gavage feeding, neonate
Health history interview and physical assessment, pediatric
IV bottle preparation, vented
IV catheter insertion, pediatric
IV catheter removal, pediatric
IV dressing change, pediatric
IV fat emulsion administration, pediatric
IV pump use
IV solution change
IV tubing change, pediatric
Neonatal screening
Parenteral nutrition administration, pediatric
Parenteral nutrition monitoring
Parenteral nutrition preparation at home
Parenteral nutrition, changing equipment
Protective environment (PE) guidelines
Pulse assessment, pediatric
Respiration assessment
Vision screening, pediatric
Patient Teaching-General
disorder, diagnosis, and treatment, including surgery
adaptive measures for visual impairment
safety measures
importance of interacting and participating in the child's care and ways to foster the child's growth and development in light of visual challenges
importance of adhering to follow-up care, including frequent screening examinations, such as every 1 to 2 weeks initially and then decreasing in frequency.
Patient Teaching-Discharge Planning
Arrange for social services to assist in accessing necessary services and supports.
Refer the parents to home health care for follow-up support as appropriate.
Refer the parents to local support groups for parents of infants with ROP.
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