The Nursing Process

The reason of decrease of vision can be various. It may have genetic predisposition. Moreover, it depends on the lifestyle and working conditions. Jessica came with the decrease of vision in the left eye. Here is the time to perform the nursing process. It is the way of implementing the nursing care individual to each patient. It requires a proper organization and systematization of actions. It aims at the identification and treatment of human responses, relevant or presumptive health problems (Alfaro, 2009). It consists of 5 stages: assessment, diagnosis, planning, implementation, documentation, and evaluation, during which the nurse takes thoughtful action to achieve the goals of nursing (Newfield, 2007). Before the fulfillment of her task, the nurse gathered all the information about the patient’s condition to define the diagnosis.

During this definition phase, the nurse should collect and examine information to obtain the necessary data in order to determine health of the patient and describe the problem and present possibility of the patient to decide (Newfield, 2007). She is obliged to note all complaints. In addition to all the other findings, the exact diagnosis needs more examinations. Such procedures as visometry, perimetry, ophthalmoscopy, examination of the colored vision, biomicroscopy through the use of funduscope, tonometry, radiography of the paranasal sinuses, and MRI scan of the brain and orbits are the necessary ones. After the doctor’s prescription, nurse performs the required laboratory tests: complete blood analysis, urinalysis, as well as blood test on RW, sugar level, and HBs-antigen. The nurse leads the patient to therapist, neurologist, ENT specialist, and dentist. Sometimes, the patient attends the other experts too.

The nurse pays attention to such findings as painful eye movement, severe visual impairment, and vision problems in the twilight, deterioration of color vision, blurred vision of peripherals, white spot in the middle of the field of view, feverish condition, headaches and dizziness, emetic impulses, severe visual impairment after physical exertion and with increasing temperature. It is necessary to know if there is a dragging pain in the affected nerve with the impact on the surrounding tissue in the form of an attack, the slack muscle atrophy, or paralysis. She must also determine restriction in the field of view (hemianopsia), violations of eye movements or other abnormal visual perception. The nurse leads the patient to the doctors. Two doctors can help to deal with the vision decrease: ophthalmologist and neurologist. In case of the sudden loss of vision in one eye, the ophthalmologist must first delete local pathological process in the retina, such as separation retinal artery or occlusion of the central retinal vein thrombosis. Neurologist with the help of history taking and examination should determine whether the patient has equilateral hemianopsia for the decrease of vision in one eye. The nurse looks through the patient’s history whether she had any traumatic brain injury, and whether the patient during the last weeks or months experienced pain in the temples, fatigue, anorexia, weight loss and joint pain. All these factors can be a suspicion of ischemic optic neuropathy. The vision decrease can be transient and persistent (Eye Emergency Manual, 2009). The bundle retina is more common in patients with myopia and is responsible for optometrists. The nurse also checks it. The acute attack of glaucoma as a cause of severe vision loss identifies the accompanying symptoms, such as eye redness, pain and seal eyeball. The nurse must find out whether, before the patient’s decrease of vision, she had a headache and other symptoms of increased intracranial pressure. The nurse determines any respective changes with the help of ophthalmoscope because there may be amblyopiogenic attack of congestive optic disc. Rarely, the retinal migraine happens to be diagnosed in cases where morphological changes in the eye are not defined, intermittent episodes of blindness and end of a full recovery. The diagnosis is most likely to be revealed in the presence of headache during an attack of blindness or other different forms of migraine episodes in the history. During the ophthalmoscopic examination, the other reason of the vision decrease can be defined. It may be provoked by the physical stress.

Once the nurse has received all necessary facts, she can analyze the data to identify
capabilities of the patient (to be reviewed again and used in the development of care plans), as well as actual and potential problems. This information will be the basis of the care plan. She must also determine which problems will be solved through independent nursing interventions and which problems require interventions prescribed by doctor or other qualified health care assistants. According to all symptoms, factors and analyses, the nurse can determine a presumptive nursing diagnosis. In case with Jessica, it can be optic neuritis. After the assessment and diagnosis stages, the nurse performs the next stage of the nursing process. It is planning.

Planning is the phase when the nurse identifies the problem and opportunities to address them. She is ready to work with the patient to develop an action plan that will reduce or remove the problem and promote health. Planning involves the following key steps: setting priorities and goals, identifying the nursing interventions, documenting nursing care plan (Newfield, 2007). In case with the optic neuritis, the urgent hospitalization is necessary. This is the setting of priorities. Until the clarification of the aetiology of optic neuritis, treatment aims at suppressing infections and inflammatory reactions, dehydration, desensitization, as well as improving metabolism in tissues of the central nervous system and immune system. The nurse and the patient should decide when and how they are going to perform the plan. After the determining of the aetiology, the treatment of the disease is based on the dealing with the cause and, in most cases, carries appointment of the steroid and non-steroid anti-inflammatory medicines and antibiotics. Rarely, optic neuritis requires surgical intervention. During the long-term Optic Neuritis Treatment Trial, doctors found that the injection of steroid hormones in the vein, but not its consumption in pills, reduces the risk of multiple sclerosis in the future. This finding is significant because half of patients with optic neuritis have a threat of multiple sclerosis in the future. Although this treatment has a minimal effect on vision, it is important for the overall health of the patient. In addition to that, it is necessary to improve the blood supply, to perform the dehydration and desensitizing therapies, glucocorticoid local injections, and pulse therapy with the use of methylprednisolone. The nurse implements prescribed treatment. She is responsible for the patient’s adherence to the instruction. It is the next stage of the implementation. The evaluation is the following. The nurse observes the results and notes whether they have reached the goals.

The nurse helps the patient to deal with the health problems in the future. She creates the teaching plan, which is important to avoid the new attack of an illness. For a person with neuritis, it is important to make the daily ration completely healthy. The patient should be fed with the dishes rich in vitamins, mostly in group B. They are mostly in brewer’s yeast, pork, grains (oats and buckwheat), peas, beans, and wheat bread. The vitamin B6 is found in yeast, beef liver, kidney, meat, egg yolk, cheese, and milk. Patients are encouraged to drink plenty of fresh fruit and vegetable juices, especially carrot juice. Moreover, it is necessary to avoid or, at least, limit contact with the previous causative agents. The patient should regularly take a course of diagnostic treatment and undergo medical tests.

Using the nursing process helps nurses provide care in a systematic and organized way. This allows nurses to make well-informed steps to identify all the problems of the patient as a unique individual, set realistic goals and implement individualized nursing interventions. During the process, the nurse and patient solve the health problems together. The documenting of the care plan contributes to its continuation, including omissions and duplication of care plan for the patient. Unlike the medical model, which focuses on treating illnesses, nursing process has a holistic nature. It examines the condition of the patient’s problem at the moment, and the impact of health complications on the person as a biopsychosocial being. Supporting the holistic direction in the work next to a doctor, a nurse can detect health problems in a patient and solve them before the development of the disease.

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