RESIDENT_____________________________________

DATE

PROBLEM

GOAL

TO DATE

INTERVENTIONS

RESP

DISC

Visual Impairment

related to

Blindness

Glaucoma

Macular degeneration

Cataract

Poor vision

Visual field disturbance

As evidenced by:

Impaired: Sees large print, but not regular print in newspapers / books

Moderately Impaired: Not able to see newspaper headlines, but can identify objects

Highly Impaired: Object identification in question, but eyes appear to follow objects

Severely Impaired: No vision or sees only light, colors, or shapes; eyes do not appear to follow objects

Decreased peripheral vision

Resident will negotiate environment safely and participate in ADLs to maximum potential

Ensure glasses are appropriate for resident, in good repair, and assist with placement if necessary – Keep glasses in consistent place

Monitor for the need for eye exam, and refer if indicated

Investigate if resident stops wearing glasses or begins rubbing eyes

Keep most frequently used items in a consistent area within reach

Keep furniture in same place – do not rearrange

Keep room and pathways free from clutter

Provide large print reading materials or talking books

Instruct resident to notify nurse if any changes in current visual level

Announce self when entering room, and explain all procedures

Refer to OT for adaptive equipment and assistive devices if indicated