698 ■ CHAPTER 19
The Child with a Visual Impairment
NURSING CARE PLAN Secondary to Retinopathy
of Prematurity
GOAL INTERVENTION
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 ■ Provide kinesthetic, tactile, and
sensory input 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.
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 ■ Evaluate environment for potential
safety hazards that can lead to injury. 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).
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 ■ Help parents plan early, regular
to foster normal growth and social activities with other children.
development.
■ Provide opportunities and
encourage self-feeding activities.
■ Provide an environment rich in
sensory input.
■ Assess growth and development
during regular examinations to
identify the child’s strengths and
needs.
RATIONALE EXPECTED OUTCOME
NOC Suggested Outcome:
Developmental Progression:
Compensate for sensory deficits by
maximizing use of impaired senses.
■ Because visual sensory input is not The child demonstrates minimal signs
present, the child needs input from of sensory deprivation.
all other senses to compensate and
provide adequate sensory
stimulation.
NOC Suggested Outcome: Risk
Control: Actions to eliminate or
reduce modifiable health threats.
■ The child may be at risk for injury The child will experience no injuries.
related both to developmental
stage and inability to visualize
hazards.
NOC Suggested Outcome: Child
Growth and Development:
Milestones of developmental
progression.
■ The visually impaired child benefits The child demonstrates normal
developmentally from contact with growth and development milestones.
other children.
■ To obtain adequate nutrients, the
child needs to feel comfortable
feeding self.
■ Sensory input is needed for normal
development to occur.
■ Regular examinations aid in early
identification of growth problems
or developmental delays, so that
appropriate interventions can be
planned.
 Alterations in Eye, Ear, Nose, and Throat Function ■ 699

The Child with a Visual Impairment

NURSING CARE PLAN Secondary to Retinopathy
of Prematurity (continued)
GOAL INTERVENTION RATIONALE EXPECTED OUTCOME

4. Risk for Ineffective Family Coping related to child’s prolonged disability from sensory impairment

NIC Priority Intervention: Family NOC Suggested Outcome: Positive

Mobilization: Utilization of family Coping: Extent to which family can
strengths to influence child’s health mobilize resources to deal with the
positively. child’s needs.

The family identifies methods for
coping with their visually impaired
child.
■ Provide explanation of visual
impairment as appropriate.
■ Refer parents to organizations, early
intervention programs, and other
parents of visually impaired
children.
■ 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 parents may feel guilt about The family successfully copes with the
the child’s visual impairment, which experience of having a visually
can be allayed by knowledge of the impaired child.
cause.
■ The parents will receive needed
information and support from
others.
■ 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 cu-
mulative risks in a particular case and suggest the need for a referral to an ophthalmologist,
as necessary. Skill 10-12: Assisted Ventilation
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 de-
velop 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 oxy-
gen 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 child’s 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 im-
pairment resulting from retinopathy of prematurity. The nurse is instrumental in case man-
agement for such children. Reinforce to parents the importance of follow-up eye examina-
tions. Teach methods of stimulating development for the visually impaired child (refer to
the next section).