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holistic patient care, paying attention to possible factors that may trigger related risk factors or the aggravation of pathologies resulting from ICU hospitalization. Nurses mustpredict complications and prevent risk factors from advancing to actual problems whenever possible by promoting health within this environment (Morton, Fontaine, Hudak, & Gallo, 2005). Eye care is an integral component of nursing care in the patient experiencing sedative-induced coma; however, it may not be viewed as a priority for care. Additionally, even when it is identified as an important aspect of nursing care, few studies identify the most effective care practice to be implemented to prevent eye-related pathologies in this patient population (Morton et al., 2005). A complication of sedation and coma is that some patients are unable to maintain effective eyelid closure. These patients present a higher risk of developing exposure keratitis (corneal ulcer). This pathology may cause serious consequences for the patient after leaving ICU, jeopardizinghis/her quality of life and active participation in society. In addition, in potential organ donors, inefficient nursing care can result to loss of a potentially harvestable cornea. Nursing care is critical to avoid corneal injury, its associated complications and prognosis. NANDA-I (Herdman, 2012) identifies a nursing diagnosis related to the risk for damage to the cornea and conjunctiva due to reduced quantity or quality of tears to moisten the eye: risk for dry eye (00219). Although this condition is an
important one that requires nursing knowledge and intervention, the condition that is encountered within ICU environments must be differentiated from this diagnosis, as it is not necessarily due to reduced quantity or quality of tears to moisten the eye. A second nursing diagnosis, related to corneal injury, has recently been proposed to the NANDA-I Diagnosis Development Committee: risk for corneal injury
(see Table 1). It is important to differentiate between these diagnoses and to consider their risk factors to ensure effective and efficient nursing intervention for adult patients in ICU who exhibit risk for corneal injury. It is equally as important to consider evidence-based practice in order to determine the best interventions possible for these diagnoses. However, currently, there is limited evidence available to compare efficacy of nursing interventions to determine the most effective evidence-based practice for these patients (Korollof et al., 2004). Therefore, the purpose of this study was to identify best practice interventions to prevent exposure keratitis in patients with risk for corneal injury in the ICU environment
A Systematic Review
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