ASSESSMENT SUBJECTIVE: Nahulog na ako noon sa hagdan namin sa bahay.

Mabuti nalang hindi nabagok ulo ko as verbalized by the client.

PLANNING Within 4 hours of nursing interventions the patient will effectively vebalize understanding of individuals risk factors that contribute to the possibility of fall.

INTERVENTIONS Orient patient to environment

RATIONALE Orientation reduces fear related to unfamiliar environment Patient and family need information to plan strategies for assisting the visually impaired patient to cope

EVALUATION After 4 hours of nusing intrventions the patient has effectively verbalized understanding of individuals risk factors in preventing possibility of fall.

OBJECTIVE: Right eye blindness Slightly blurred vision on left eye

Involve caregiver in patients care and instructions. Help patient understand nature and limitations of disease.

Do not make unnecessary changes in environment. Provide adequate lighting.

This ensures safety and maintains what patient has arranged. The use of natural/halogen lighting is preffered to improve vision for patients with diminished vision These ensure safety and sense of independence.

Diagnosis: Risk for falls related to partial blindness as evidenced by fall history

Place meal tray, tissues, water, and call light within patients range of vision or reach. Encourage use of sense of touch.

Touch encourages patient to become familiar with unfamiliar objects. Diversional activities should be encouraged. Radio and television increase awareness of day and time. Fully open or closed doors reduce the risk for injury among the vision-impaired.

Encourage use of radios, tapes, and talking books.

Discourage doors from being left partially open