Skip to main content

Risk for Injury - Nursing Diagnosis and Interventions for Glaucoma

 Nursing Diagnosis and Interventions for Glaucoma

Risk for Injury


Glaucoma is a group of eye diseases which result in damage to the optic nerve (or retina) and cause vision loss. The most common type is open-angle (wide angle, chronic simple) glaucoma, in which the drainage angle for fluid within the eye remains open, with less common types including closed-angle (narrow angle, acute congestive) glaucoma and normal-tension glaucoma. Open-angle glaucoma develops slowly over time and there is no pain. Peripheral vision may begin to decrease, followed by central vision, resulting in blindness if not treated. Closed-angle glaucoma can present gradually or suddenly. The sudden presentation may involve severe eye pain, blurred vision, mid-dilated pupil, redness of the eye, and nausea. Vision loss from glaucoma, once it has occurred, is permanent. Eyes affected by glaucoma are referred to as being glaucomatous.

Nursing Diagnosis :

Risk for Injury related to decreased visual field


Risk Factors:

External

  • Physical (example: design of community structures and codes, buildings and or equipment; mode of transport or mode of movement; people or service providers)
  • Biological (pattern: level of immunization in the community, microorganisms)
  • Chemicals (drugs: pharmaceutical agents, alsohol, caffeine, nicotine, preservatives, cosmetics; nutrients: vitamins, types of food; toxins; pollutants)

Internal

  • Psychologic (affective orientation)
  • Malnutrition
  • Abnormal blood form, pattern: leukocytosis/leukopenia
  • Changes in clotting factors
  • Thrombocytopenia
  • Sickle cell
  • thalassemia,
  • decrease in Hb,
  • Immune doesn't work.
  • Biochemistry, regulatory functions (e.g. sensory dysfunction)
  • Dough dysfunction
  • Effector dysfunction
  • Tissue hypoxia
  • Age development (physiological, psychosocial)
  • Physical (example: skin damage/not intact, related to mobility)


Nursing Interventions :

Goals / Outcome Criteria: 

NOC :

Risk Control

Immune status
Safety Behavior
After nursing actions for…. The client does not experience injury with the following criteria:

  • Client free from injury
  • Clients can explain ways/methods to prevent injury/injury
  • The client can explain risk factors from the environment / personal behavior
  • Able to modify lifestyle to prevent injury
  • Using existing health accommodation
  • Able to recognize changes in health status


NICs :

Environment Management

  • Provide a conducive environment for the patient
  • Identify the patient's safety needs, according to the patient's physical condition and cognitive function and the patient's previous medical history
  • Avoiding hazardous environments (e.g. moving furniture)
  • Installing the bed side rail
  • Provide a comfortable and clean bed
  • Place the light switch in a place that is easily accessible to the patient.
  • Restrict visitors
  • Provide sufficient explanation
  • Encourage the family to accompany the patient.
  • Control the environment from noise
  • Move items that can be dangerous
  • Provide clarification to the patient and family or visitors of any changes in health status and causes of illness.

Source : https://nandacareplan.blogspot.com/2021/08/risk-for-injury-nursing-diagnosis-and.html

Labels

Labels:

Popular posts from this blog

Appendectomy - Nursing Care Plan for Preoperative and Postoperative

Definition of Appendicitis Appendicitis is an inflammation that often occurs in the appendix which is a serious case of abdominal surgery are the most common. Appendectomy An appendectomy is the surgical removal of the vermiform appendix. This procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis. In the absence of surgical facilities, intravenous antibiotics are used to delay or avoid the onset of sepsis; it is now recognized that many cases will resolve when treated perioperatively. In some cases the appendicitis resolves completely; more often, an inflammatory mass forms around the appendix, causing transruptural flotation. This is a relative contraindication to surgery. Etiology of Appendicitis Appendicitis is a bacterial infection caused by obstruction or blockage due to: Hyperplasia of lymphoid follicles Fecalith presence in the lumen of the appendix Appendix tumor The presence of foreign objects suc...
Read more

Activity Intolerance - Nursing Care Plan for Hypoglycemia

Hypoglycemia, also known as low blood sugar or low blood glucose, is when blood sugar decreases to below normal. The most common cause of hypoglycemia is medications used to treat diabetes mellitus such as insulin, sulfonylureas, and biguanides. Risk is greater in diabetics who have eaten less than usual, exercised more than usual, or drunk alcohol. Other causes of hypoglycemia include kidney failure, certain tumors, liver disease, hypothyroidism, starvation, inborn error of metabolism, severe infections, reactive hypoglycemia, and a number of drugs including alcohol. This may result in a variety of symptoms including clumsiness, trouble talking, confusion, loss of consciousness, seizures, or death. A feeling of hunger, sweating, shakiness, and weakness may also be present. Symptoms typically come on quickly. ( wikipedia ) Activity Intolerance - Nursing Care Plan for Hypoglycemia Activity Intolerance related to imbalance of oxygen supply and demand, weakness. Defining charac...
Read more

6 Nursing Diagnosis for Empyema

  Empyema Empyema is defined as a collection of pus in the pleural cavity, gram-positive, or culture from the pleural fluid. Empyema is usually associated with pneumonia but may also develop after thoracic surgery or thoracic trauma. ( www.ncbi.nlm.nih.gov ) Empyema is usually caused by an infection that spreads from the lung. It leads to a buildup of pus in the pleural space. There can be 2 cups (1/2 liter) or more of infected fluid. This fluid puts pressure on the lungs. Risk factors include: Bacterial pneumonia, Tuberculosis, Chest surgery, Lung abscess, Trauma or injury to the chest. In rare cases, empyema can occur after thoracentesis. This is a procedure in which a needle is inserted through the chest wall to remove fluid in the pleural space for medical diagnosis or treatment. ( medlineplus.gov ) Symptoms of empyema may include: having a case of pneumonia that does not improve, a fever, chest pain, a cough, pus in mucus, difficulty breathing, a crackling sound from the c...
Read more