Scenario
       Mrs. Alicea is a 73-year-old woman who is at the senior health center for her 
       routine 6-month checkup. She has been visiting the senior center on a regular 
       basis for the past 8 years. Mrs. Alicea has lived alone since her husband died 1 
       year ago. She lives in a single-story, four-room home a few miles from 
       the health center.   Her son, Rico, lives 5 minutes away. Rico drives 
       Mrs. Alicea to her visits. Six months ago, 
       Mrs. Alicea reported progressive hearing loss. Today she reports “having trouble 
       seeing.” Peter Morris, a 33 year old nursing student assigned to the senior 
       center, is learning to conduct assessments and to develop health promotion 
       plans for patients.
       
       For the past month, Peter has been attending his clinical rotation and 
       participating in teaching health promotion activities . He is enjoying this 
       rotation because he is learning more about geriatric patients and is finding that 
       they are very independent and capable of having productive lifestyles. Mrs. 
       Alicea reports that at her last visit to the ophthalmologist, she was told she had 
       a cataract.
       
       Peter learns that Hispanic/Latino individuals in the United States have higher 
       rates of visual impairment and blindness compared with members of other 
       ethnic groups. Visual field loss has a negative impact on health related quality 
       of life: driving, distance and peripheral vision activities, and a sense of 
       independence.
        
     1. What are some possible nursing assessment 
     steps for Peter to use with Mrs. Alicea ?
       Answer
        Nursing Assessment :
        Review with Mrs. Aliceaat each visit the importance of early 
         intervention through regular vision examinations.
        Provide information about side effects of visual impairment, and 
         encourage the use of visual and adaptive devices when possible.
        Ask Mrs. Aliceahow she is coping with visual alterations.
        Ask Mrs. Aliceaabout her social networks and supportive 
         relationships.
        Assess for changes in mood and depression.
        Determine whether Mrs. Aliceahas experienced new limitations of 
         activities of daily living or a change in participation in leisure 
         activities.
        Refer her to community resources and activities.
    Case Study (cont’d)
    Mrs. Alicea states, “I’m having difficulty 
     reading and moving around the house. I 
     cannot judge the steps clearly. I have difficulty 
     judging distances between objects, which is 
     worse at night.”
    Results of a home hazard assessment show 
     that Mrs. Alicea’s home has dim lighting, stairs 
     without handrails, and numerous throw rugs 
     on the floor.
     Goal/Outcome: Mrs. Alicea’s home environment is safe and 
     free of hazards within 4 weeks.
     2. What other expected outcomes would you 
     include?
        Answer
       Mrs. Alicea will report an increased sense of 
         home safety and independence within 2 weeks
       Mrs. Alicea and her son will make 
         recommended changes to home environment 
         within 4 weeks
     2. What fall prevention interventions would 
     Peter choose?
       Answer
     • Help Rico identify potential trip hazards, such as 
       throw rugs, and suggest that they be modified or 
       removed.
     • For fall prevention, teach Rico methods to improve 
       environmental safety, such as installing handrails 
       along stairs, securing carpeting, removing throw 
       rugs, and painting stairs. Suggest that Rico place 
       a nonslip surface such as a nonskid mat in the 
       bathtub and shower.