is this care plan acceptable?

if there is something you don't understand--ask. all my comments are in purple.

nursing diagnosis: disturbed sensory perception (visual, auditory)

related to: legal blindness secondary to glaucoma (if we know that glaucoma is the specific cause of the blindness you need to include here, in physiological terms, how it is causing the blindness. did you read about glaucoma and how it leads to blindness?

http://www.merck.com/mmpe/sec09/ch103/ch103a.htm

better: related to: optic nerve damage secondary to glaucoma

major: as evidence by: uses cane (this is a professional treatment/intervention for the problem)

requires assist in ambulation (this is a nursing intervention)

glasses, hearing aid (this is a professional treatment/intervention for the problem)

people who are "legally" blind still have some vision. it may only be that they can see light and blurs of movement, but you should describe that since that is part of the assessment of the patient's vision when you asked, "what are you able to see?" people with glaucoma have very blurred vision, see halos around lights and sometimes have nausea and vomiting from the constant blurring they see.

better: as evidence by: statement by patient that the only vision he/she has is moving blobs of colored light with bright halos around them.

nursing diagnosis:

disturbed sensory perception (visual, auditory)

related to:

glaucoma, legal blindness (change to: optic nerve damage secondary to glaucoma)

as evidenced by:

uses cane, requires assist in ambulation, glasses, hearing aid (needs to be changed to something like:statement by patient that the only vision he/she has is moving blobs of colored light with bright halos around them.)

the definition of this diagnosis is as follows: change in the amount of patterning of incoming stimuli accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli. (page 195, nanda-i nursing diagnoses: definitions & classification 2007-2008). what this means is that the patient is like mr. magoo and interprets the environment incorrectly as a result of their sensory misperception. in this case, because of the patient's blindness, what is happening? is the patient bumping into walls, stubbing their toe, tripping over furniture, walking out into the street when they think the light is green? these, by the way, could be aeb items for your diagnostic statement. i saw "encourage the use of hearing aid". is there an auditory problem here too? what's going on with orientation? that is not really a component of this problem--that is a part of dementia and belongs with another nursing diagnosis entirely.

-orient patient to environment (not appropriate to this diagnosis - disorientation was not one of the aeb items of evidence)

-make sure there are no changes to patients environment (changes as in, how? movement of objects? state that.)

-provide adequate lighting

-encourage use of hearing aid

-identify self when entering room and space

-build on patients remaining vision (i understand what you mean, but you have not identified what vision the patient has in the first place as part of the aeb evidence. what am i supposed to build?)

- orient to time, place, person, and surroundings (orienting to person and probably the time of day is not appropriate to this diagnosis because it has to do with disorientation which was not one of the aeb items of evidence and has to do with level of consciousness and not visual acuity)

- converse with and touch the client frequently during care if frequent touch is within the client's cultural norm

-keep call light button within reach (and tell patient where it is placed)

-pay close attention to patients emotional needs (how?)

- pay attention to background noise and reduce it to a minimum when attempting conversation (i would just say "keep background noise to a minimum to facilitate the patient's ability to focus on interpersonal communications")

-speak slowly and distinctly, use simple sentences

-lower pitch of voice and speak in tone that does not include shouting

nursing diagnosis: at risk for impaired skin integrity

related to: urinary incontinence, personal care deficit (toileting)

impaired verbal communication, hemorrhoids (since you don't want this to sound like it has been slanderous or copied, just say "external hemorrhoids and urinary incontinence due to difficulty communicating the need/and urgency to get to the bathroom".)

better: related to: urinary incontinence due to difficulty communicating the need/and urgency to get to the bathroom

nursing diagnosis:

at risk for impaired skin integrity

related to:

urinary incontinence, personal care deficit (toileting), impaired verbal communication, hemorrhoids (change to: external hemorrhoids and urinary incontinence due to difficulty communicating the need/and urgency to get to the bathroom)

-note presence of compromised vision, hearing, speech that may impact self care as it relates to skin care (i don't think this applies)

-evaluate client's skin care practices and hygiene issues. incontinence may result in client's skin care (you specified in the "related to" part of the diagnostic statement that urinary incontinence is the culprit here: evaluate client's hygiene following episodes of voiding. then, monitor the number of episodes of incontinence and whether patient is aware of the incontinence. maybe this patient needs to be on bladder training which nursing homes do all the time with incontinent patients who are partially incontinent and still do manage to be continent.

• http://familydoctor.org/online/famdocen/home/seniors/common-older/798.html
  
• http://www.urogynspecialists.com/training.htm
  
• http://www.thewomens.org.au/bladdertraining)

-pay special to bony premises and other pressure points (ok, i've paid special attention to them. what is "special attention"? spell it out--describe what you mean by "special attention".)

-provide preventative skin care to incontinent patients. changing briefs frequently (describe specifically what you mean by "preventative skin care". are you talking about washing with soap and water, using desitin ointment, vaseline intensive care lotion or something else? how frequently is "frequently"? only when the diaper is wet? how often is that? most facilities do minimal q2h checks.)

-keep bed free of wrinkles, dry, use nonirritating materials. (what are "nonirritating materials"? that's a new one on me.)

-minimize contact with irritants (urine, stool) (how?)

-perform routine skin inspections, assessing color, temperature, texture and contours. (when? every day? every shift? every time you feel like it?)

how are you going to help this person communicate the need to get to the bathroom or that they need to pee? that seemed to me to be what you were conveying as a risk factor: the patient is at risk for skin breakdown because they can't get to the bathroom so they pee and sit in it. is that right?

what are you doing about these hemorrhoids to prevent skin breakdown with them? i assume you want to do something about wiping after a bm that is going to avoid skin breakdown of the hemorrhoids if the stools haven't already caused a problem. how about using baby wipes such as huggies? i'm not sure what is in them, but a quick trip to the market and looking on the package will tell you what the ingredients are as well as the other brands on the market (i only know huggies because it is what i use for my cats). don't even go into diet and fiber because it doesn't belong here.

these websites have the signs and symptoms of stage i skin breakdown. you need those signs and symptoms to help you formulate your monitoring interventions and outcomes for this diagnosis:

• http://www.hill-rom.com/usa/pdf/ctg285.pdf - guidelines for staging of pressure ulcers
  
• http://www.medicaledu.com/staging.htm - staging of ulcers
  
• http://ame-medical.com/staging_ulcers_guidelines.pdf - staging pressure ulcers
  
• http://www.nursingquality.org/ndnqipressureulcertraining/module1/default.aspx - pressure ulcer training tutorial (includes photos)

see https://allnurses.com/forums/2751313-post8.html for some guidance on how to focus your interventions on these "risk for" diagnoses.