The nurse is caring for a client following enucleation.
The nurse notes the presence of bright red drainage on the dressing. Which nursing action is appropriate?
- a) Notify the physician.***
- b) Document the finding.
- c) Continue to monitor the drainage.
- d) Mark the drainage on the dressing and monitor for any increase in bleeding.
Yes, the nurse should notify the physician if they note the presence of bright red drainage on the dressing of a client following enucleation. Bright red drainage is a sign of active bleeding and may indicate a complication, such as a hemorrhage or infection.
Enucleation is a surgical procedure to remove the eyeball. It is typically performed to treat eye tumors, eye infections, or severe eye injuries.
Postoperative complications:
Postoperative complications of enucleation are rare but can occur. Some of the most common post-operative complications include:
- Hemorrhage.
- Infection.
- Pain.
- Swelling.
- Discharge from the eye socket.
- Double vision.
- Loss of vision in the remaining eye.
Bright red drainage from the eye socket is a sign of active bleeding and may indicate a hemorrhage. A hemorrhage can be caused by a variety of factors, such as damage to blood vessels during surgery, infection, or increased blood pressure.
If the nurse notes the presence of bright red drainage on the dressing of a client following enucleation, they should notify the physician immediately. The physician will assess the client's condition and determine the best course of treatment.
Treatment for bright red drainage:
Treatment for bright red drainage following enucleation may include:
- Applying pressure to the eye socket.
- Administering intravenous fluids.
- Transfusing blood.
- Performing surgery to stop the bleeding.
The nurse should also monitor the client's vital signs and signs of infection. If the client develops any signs of infection, such as fever, chills, or redness and swelling around the eye socket, the nurse should notify the physician immediately.
By notifying the physician promptly and monitoring the client closely, the nurse can help to ensure that the client receives the best possible care and has a successful recovery.
