Nursing Clinical Practice Guide
Clinical Scenario: You are a nurse in a primary care clinic. Mr. Jones, a 68-year-old patient with a history of type 2 diabetes mellitus (DM), is here for his annual physical. As part of your assessment, you need to check his visual acuity.
Nursing Intervention Strategy:- 1Assessment- Explain the procedure: "Mr. Jones, I'm going to check how well you can see the letters on that chart on the wall. Please cover your left eye with this occluder and read the smallest line you can see clearly."
- Position the patient 20 feet from the Snellen chart in a well-lit room.
- Test each eye separately, then both eyes together. Record the smallest line where the patient correctly identifies more than half the letters (e.g., "OD 20/30, OS 20/40, OU 20/30").
- Ask about any difficulty with near vision (reading) and if he wears corrective lenses. If he does, test with them on (recording as "corrected vision").
- 2Nursing Diagnosis & PlanningIf the finding is abnormal (e.g., 20/60), a potential nursing diagnosis could be Risk for injury related to impaired vision. The plan includes safety education and referral.
- 3Implementation- For a diabetic patient, a finding of reduced acuity should raise suspicion for Diabetic retinopathy. Document findings accurately and report to the provider.
- Provide patient education on the importance of regular dilated eye exams with an ophthalmologist.
- 4EvaluationEvaluate the patient's understanding of safety precautions and ensure follow-up is scheduled.
Patient Safety and Precautions:
- Ensure the pathway between the patient and the chart is clear to prevent tripping.
- If the patient cannot see the largest letter (20/200) at 20 feet, move them closer (e.g., 10 feet) and record as "10/200" or "counts fingers at 3 feet."
- Never diagnose the cause of vision loss; your role is to screen and refer.
Nursing Procedure & Medication Flow
Procedure: Performing a Snellen Chart Assessment
1. Wash hands, introduce yourself, explain the procedure.
2. Have patient stand or sit with heels on the 20-foot mark.
3. Provide an occluder. Test the right eye (OD) first, then left eye (OS), then both eyes (OU).
4. Ask patient to read each line from top to bottom.
5. Record the smallest line where the patient reads more than half the letters correctly.
6. Document: OD: __/__, OS: __/__, OU: __/__ (with or without correction).
A Word from Your Senior Nurse
"Remember, that Snellen chart isn't just a bunch of letters on the wall—it's a window into your patient's world and safety. A change from 20/20 to 20/40 might be the first clue to a cataract, worsening diabetes, or a medication side effect. In clinical practice, you're the detective who connects these dots. When you study, don't just memorize that 20/20 is normal; think about the patient behind the number. What does 20/200 vision *feel* like? How would you help that patient navigate their room safely? That kind of thinking builds the clinical judgment the NCLEX is testing and, more importantly, makes you a compassionate and effective nurse."