698

CHAPTER 19

NURSING CARE PLAN

GOAL

The Child with a Visual Impairment

Secondary to Retinopathy
of Prematurity

INTERVENTION

RATIONALE

EXPECTED OUTCOME

1. Sensory/Perceptual Alteration related to altered reception, transmission, and integration resulting from retinopathy
of prematurity
NIC Priority Intervention: Visual
Deficit Enhancement: Assistance in
accepting and learning alternate
methods for living with diminished
vision.
The child will receive adequate
sensory input

Provide kinesthetic, tactile, and

auditory stimulation during play
and in daily care (e.g., talking and
playing). Provide music while
bathing an infant using bells and
other noises on each side of infant.
Verbally describe to a child all
actions being carried out by adult.

NOC Suggested Outcome:

Developmental Progression:
Compensate for sensory deficits by
maximizing use of impaired senses.

Because visual sensory input is not

present, the child needs input from
all other senses to compensate and
provide adequate sensory
stimulation.

The child demonstrates minimal signs

of sensory deprivation.

2. Risk for Injury related to impaired vision

NIC Priority Intervention: Fall
Prevention. Instituting special
precautions with patients at risk for
injury.
The child will be protected from
safety hazards that can lead to injury.

Evaluate environment for potential

safety hazards based on age of
child and degree of impairment. Be
particularly alert to objects that
give visual cues to their dangers
(e.g., stoves, fireplaces, candles).
Eliminate safety hazards and
protect the child from exposure.
Take the child on a four of new
rooms, explaining safety hazards
(e.g., schools, hotel room, hospital
room).

NOC Suggested Outcome: Risk

Control: Actions to eliminate or
reduce modifiable health threats.

The child may be at risk for injury

related both to developmental
stage and inability to visualize
hazards.

The child will experience no injuries.

3. Risk for Altered Growth and Development related to impaired vision

NIC Priority Intervention:
Developmental Enhancement:
Facilitating or teaching parents
caregives to facilitate optional growth
& development of children.
The child has experiences necessary
to foster normal growth and
development.

NOC Suggested Outcome: Child

Growth and Development:
Milestones of developmental
progression.

Help parents plan early, regular

social activities with other children.

The visually impaired child benefits

developmentally from contact with
other children.

Provide opportunities and

encourage self-feeding activities.

To obtain adequate nutrients, the

child needs to feel comfortable
feeding self.

Provide an environment rich in

sensory input.

Sensory input is needed for normal

development to occur.

Assess growth and development

during regular examinations to
identify the childs strengths and
needs.

Regular examinations aid in early

identification of growth problems
or developmental delays, so that
appropriate interventions can be
planned.

The child demonstrates normal

growth and development milestones.

Alterations in Eye, Ear, Nose, and Throat Function

NURSING CARE PLAN

GOAL

699

The Child with a Visual Impairment

Secondary to Retinopathy
of Prematurity (continued)

INTERVENTION

RATIONALE

EXPECTED OUTCOME

4. Risk for Ineffective Family Coping related to childs prolonged disability from sensory impairment
NIC Priority Intervention: Family
Mobilization: Utilization of family
strengths to influence childs health
positively.
The family identifies methods for
coping with their visually impaired
child.

NOC Suggested Outcome: Positive

Coping: Extent to which family can
mobilize resources to deal with the
childs needs.

Provide explanation of visual

impairment as appropriate.

The parents may feel guilt about

the childs visual impairment, which
can be allayed by knowledge of the
cause.

Refer parents to organizations, early

intervention programs, and other
parents of visually impaired
children.

The parents will receive needed

information and support from
others.

Assist parents to plan for meeting

developmental, educational, and
safety needs of their visually
impaired child. Offer resources for
changing home environment to
assist visually impaired child.

The child may require an enhanced

environment in order to faster
developmental progress.

ventilation equipment is properly set to deliver the correct amount of oxygen. Note the cumulative risks in a particular case and suggest the need for a referral to an ophthalmologist,
as necessary.
The accompanying nursing care plan outlines several nursing diagnoses for a child such
as Raeanne with a visual impairment secondary to retinopathy of prematurity. Following
are other nursing diagnoses that may be appropriate for an infant with the potential to develop ROP or a child with resulting visual impairment:

Sensory/perceptual alteration (visual), related to altered transmission of impulses

Impaired gas exchange, related to ventilation-perfusion imbalance
Alteration in growth and development, related to effects of visual impairment
Altered family processes, related to a child with a visual impairment

Planning and Implementation

The nurse plays an important role in preventing retinopathy of prematurity. Encourage
early and regular prenatal care to prevent unnecessary premature births. Administer oxygen only to newborns who need it, and in the amount specified by the physician. Ensure
that the proper ventilatory settings are used. Be alert for infants with multiple risk factors
and refer them, when appropriate, for ophthalmologic examination. Parents of infants at
risk for ROP require information about the disorder, as well as support, as the long-term
effects on the childs vision are often identified only after subsequent examinations as the
child grows.
The accompanying nursing care plan summarizes care for the child with a visual impairment resulting from retinopathy of prematurity. The nurse is instrumental in case management for such children. Reinforce to parents the importance of follow-up eye examinations. Teach methods of stimulating development for the visually impaired child (refer to
the next section).

The family successfully copes with the

experience of having a visually
impaired child.

Skill 10-12: Assisted Ventilation