A nurse at the local Senior Center made the following notation about a client: A 74-year-old female client wearing eyeglasses with bifocal lenses and hearing aid in her left ear. Walks with a shuffling gait, using a cane for support. Wearing house slippers and housedress. States, “My other doctor says I should have my eyes looked at by an expert. It’s been a while, and my eyes seem to be acting up lately. I can’t see so good anymore.” The client states that she takes medication for “sugar” and her blood pressure and has worn glasses for years with the last prescription changed about 3 years ago. “I was a seamstress for many years and quit when I couldn’t see to thread the needles anymore-just in time too. These new materials are too hard to work with!” Denies using any eye drops. Describes vision changes as difficulty seeing well at night, especially if trying to read. Uses a magnifying glass to help when reading. No eye pain or discharge, although eyes sometimes feel “dry and scratchy,” with the left eye being worse than the right. Admits to rubbing eyes but without relief.

Develop a Plan of Care for this patient that includes:

• 2 Nursing Diagnosis
• 2 goals for each Nursing Diagnosis
• Interventions with rationales

ANSWER

Plan of Care for the Elderly Client with Vision Changes

Caring for elderly clients with vision changes requires a comprehensive plan of care that addresses their unique needs and challenges. Based on the provided information, here is a plan of care that includes nursing diagnoses, goals, and interventions:

Nursing Diagnosis 1: Impaired Visual Sensory Perception related to age-related changes in vision and difficulty seeing at night.

Goals

1. The client will report improved ability to see and navigate in low-light environments within two weeks.
2. The client will demonstrate proper use of assistive devices and techniques to enhance visual perception.

Interventions with Rationales

Assess Visual Acuity: Perform a thorough assessment of visual acuity and night vision to establish a baseline and identify areas of concern. Rationale: A baseline assessment helps track progress and tailor interventions to the client’s specific needs.
Provide Proper Lighting: Ensure that the client’s living environment is adequately lit, especially during the evening. Use nightlights in hallways and bathroom to enhance visibility. Rationale: Adequate lighting minimizes the risk of falls and promotes safe mobility.
Educate About Magnifying Glass: Teach the client proper use of the magnifying glass when reading to maximize visual perception. Rationale: The magnifying glass can assist in reading by enhancing the size of the text.
Instruct in Contrast Techniques: Educate the client on using high-contrast materials, such as dark writing on light paper, to facilitate reading. Rationale: High contrast enhances visibility and improves the client’s ability to distinguish text.
Discuss Regular Eye Exams;Encourage the client to schedule regular eye exams with an eye specialist to monitor vision changes and ensure appropriate corrective measures. Rationale: Regular eye exams can detect and address vision issues in a timely manner.

Nursing Diagnosis 2: Risk for Injury related to impaired visual perception, shuffling gait, and use of a cane.

Goals

1. The client will demonstrate safe use of assistive devices, including the cane, to prevent falls and injuries.
2. The client will report increased awareness of potential hazards in the environment and take appropriate precautions.

Interventions with Rationales

Assess Mobility and Gait: Evaluate the client’s mobility and gait pattern to identify areas of instability and assess the need for assistive devices. Rationale: Understanding the client’s mobility status helps tailor interventions to enhance safety.
Demonstrate Proper Cane Use: Teach the client how to use the cane correctly, including techniques for maintaining balance and preventing falls. Rationale: Proper use of the cane improves stability and reduces the risk of falls.
Conduct Home Safety Assessment: Collaborate with the client to identify potential hazards in the home environment, such as loose rugs or cluttered pathways. Rationale: Identifying hazards helps the client take proactive steps to mitigate risks.
Educate About Footwear: Advise the client to wear appropriate footwear with proper traction to prevent slips and falls. Rationale: Proper footwear enhances stability and reduces the risk of accidents.
Provide Fall Prevention Tips: Educate the client on strategies to prevent falls, such as taking time to stand up, using handrails, and avoiding sudden movements. Rationale: Fall prevention strategies promote client safety and well-being.

In conclusion, a comprehensive plan of care for the elderly client with vision changes addresses their unique needs, challenges, and goals. By focusing on impaired visual sensory perception and the risk of injury, nurses can provide targeted interventions to enhance the client’s quality of life and safety. Regular assessments, education, and collaboration with the client are essential components of effective care for this population.