Chapter 19: Retinopathy of Prematurity (ROP) (Newborn)

Question 1

Retinopathy of Prematurity (ROP)

Answer 1

result of immature retinal vasculature followed by hypoxia
-the concentration and duration of supplemental oxygen are thought to play a role
-earlier the gestational age, the greater the likelihood of developing (the retinal vessels of the preterm newborn are frail and immature)
>because ROP may be a complication of oxygen therapy, the nurse must maintain the lowest level of oxygen to maintain the pulse oximetry reading above 92%

Question 2

Risk Factors For ROP

Answer 2

• gestational age of less than 32 weeks
• birth weight of less than 1500 g
• respiratory distress syndrome (ROP)
• patent ductus arteriosus that needs surgery
• hypothermia
• sepsis and meningitis
• high-intensity lighting

Question 3

Signs and Symptoms of ROP

Answer 3

limited to those that can be assessed by expert exam of the retina by ophthalmological procedures
>a newborn who has visual impairment might not react to a human face

Question 4

Diagnosis

Answer 4

examination of the retina by an ophthalmologist based on five stages, ranging from mild to severe

Question 5

Prevention of ROP

Answer 5

preventing premature birth
-preventing respiratory distress syndrome (RDS)
-the more premature a newborn is, the more likely the development of ROP
>if premature birth cannot be avoided, monitoring the amount of oxygen the premature infant is exposed to decreases the risk

Question 6

Stages of ROP

Answer 6

-Stage I: abnormal blood vessel growth is mild
-Stage II: abnormal blood growth is moderate
-Stage III: abnormal blood vessel growth is severe
-Stage IV: the retina is partially detached
-Stage V: completely detached retia. This is the end stage of the disease
>the extent of retinal damage in the preterm newborn is dependent on three criteria:
1. the gestational age
2. the length of exposure to oxygen
3. arterial pressure

Question 7

Nursing Care

Answer 7

during oxygen administration; fluctuations in arterial concentrations of oxygen must be prevented
-the Pao2 is not set greater than 80 mm hg, and the preterm newborn is weaned off oxygen ASAP
-decrease constant bright lights in environment
-a blanket, to provide shading can be placed over incubator during the day
-nap time can be designated in the NICU during which the lights are lowered and other environmental stimuli are decreased
>treatment and follow-up care is imperative to the newborn’s maintenance of sight, and nurse is coordinator of care

Question 8

Medical Care

Answer 8

-preterm newborn is checked routinely for signs of ROP by an ophthalmologist
-examinations started at 4 to 6 weeks of age and continue until vascularization of the retina is complete to reduce the risk of visual impairment and blindness
-usually infants have stage I or II
>if ROP left untreated, it can destroy newborns vision

Question 9

Surgical Care

Answer 9

cryotherapy “cold therapy” is used to treat ROP
>additional options: laser surgery, and for detached or partially detached retinas, scleral buckling surgery and/or vitrectomy