5.5.4: FRAME 4- Generate Solutions

CORRECT Answer

Question Type: Multiple Response Select All That Apply

Scoring: +/-

NCSBN Item Type and Scoring: https://www.ncsbn.org/public-files/p...main_stage.pdf

What social factors play an important role in vision loss?

\(\bigotimes \) Education

\(\bigotimes \) Food insecurity

\(\bigotimes \) Access to quality health care

\(\bigotimes \) Neighborhood Safety

\(\bigcirc \) Heredity

(CDC, 2022b)

RATIONALE

The following social factors play an important role in vision loss:

• Income: People with lower incomes are less likely to have had preventive care, including an eye exam, or to be able to afford eyeglasses and are more likely to have vision loss due to diabetic retinopathy.
• Education: People with less than a high school education are less likely to have had an eye care visit in the last year compared with people who have more than a high school education.
• Neighborhood: Neighborhood safety could affect diabetes-related stress, physical activity, weight management, and blood sugar levels—all of which are risk factors for chronic conditions that can lead to vision loss.
• Access to care: People living with a disability such as vision impairment or blindness report having more problems in accessing care, such as cost of care, availability of insurance coverage, transportation issues, and refusal of services by providers. People who have vision impairment are more likely to be uninsured compared with people who do not.

Addressing these barriers is key to eliminating health disparities and reaching vision health equity. Although heredity contributes to vision loss, it is not a social factor (CDC, 2022b).

The nurse must identify expected outcomes and use hypotheses to define a set of interventions to identify health promotion/disease prevention activities that are age appropriate for aggregate children and youth as well as individual students. Schools and school nurses play a significant role with health promotion/disease prevention. The school nurse role is one of the broadest nursing roles, and school nursing is one of the few subspecialties responsible for direct care of individuals as well as care of the school community and environment. School nurses provide hearing and vision screening and can apply topical fluoride varnish to primary teeth.

Schools help to decrease health disparities by fostering learning, striving to enhance health literacy, providing health screening, nutritional lunches, opportunities for physical education, and counseling, social support, and mental health promotion (WHO, n.d.). Further, schools Strive to improve the health of school personnel, families, and community members as well as pupils; and works with community leaders to help them understand how the community contributes to, or undermines, health and education (WHO, n.d.).

FOCUSED GUIDE

Bullying in school adversely affects a child’s well-being. The CDC reports that about 1 in 5 high school students reported being bullied on school property. More than 1 in 6 high school students reported being bullied electronically (CDC 2021b).

An important component of the second cranial nerve (optic nerve) exam is testing visual acuity. Functional testing of the optic nerve requires multiple operational assessments to assess the integrity of the nerve. Testing includes evaluation of visual acuity, the visual fields, pupillary light reflexes, the accommodation reflex, and fundoscopy (ophthalmoscopy) (Reese et al., 2023).

Visual acuity is tested using a Snellen eye chart. The Snellen Chart uses a geometric scale to measure visual acuity, with normal vision at a distance being set at 20/20. The numerator represents the distance that the individual is standing from the chart (in feet), while the denominator represents the distance from which a person with perfect eyesight is still able to read the smallest line that the client can clearly visualize. For example, a person standing 20 feet away from the chart who can clearly read until the line of font that a person with normal visual acuity can read from 40 feet away would be measured as 20/40 vision (Azzam et al., 2023).

To assess visual acuity via a Snellen chart, place the client 20 feet away from the chart. Have the client read the smallest line they can see and record the corresponding visual acuity fraction listed beside the row on the chart. Each eye is assessed individually, while the client covers the other eye. Test the weaker eye first, and ensure the client is wearing glasses or corrective lenses they have for distance vision (Reese et al., 2023).

If the individual cannot read the largest (top) line at 20 feet, have them move closer three feet at a time until they can read the top line. Adjust the top portion of the visual acuity fraction accordingly. If the person cannot read the letters at three feet, have them count fingers at a distance of fewer than 3 feet. Testing light perception is the last resort if the person cannot count fingers. Charts with pictures instead of letters can be used for clients who cannot read letters due to language or literacy (Reese et al., 2023).

Healthy People 2030 affirm many people in the United States will have a sensory or communication disorder in their lifetime. This includes problems with vision, hearing, balance, smell, taste, voice, speech, or language. Healthy People 2030 focuses on preventing, diagnosing, and treating these disorders in people of all ages. Many vision problems start before children enter first grade (HP 2030). Sensory or communication disorders can have a major impact on social, emotional, and physical well-being. People who are diagnosed or treated later often have poorer outcomes (HP 2030).