Transcript chap 14 Sensation, Hearing, Vision, Taste, Touch and Smell lecture

14
Lecture Note PowerPoint Presentation
Sensation: Hearing,
Vision, Taste, Touch,
and Smell
LEARNING OUTCOME 1
Explain normal changes associated with the aging
process on the five senses—vision, hearing, taste, smell,
and touch.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGING-RELATED SENSORY CHANGES
Smell
 Hearing
 Taste
 Touch
 Vision

Gerontological Nursing, Second Edition
Patricia A. Tabloski
TABLE 14-1
AGE-RELATED CHANGES IN THE EYE AND NURSING IMPLICATIONS
Gerontological Nursing, Second Edition
Patricia A. Tabloski
OTHER RESULTS OF SENSORY
DYSFUNCTION
Functional impairment
 Injury
 Social isolation
 Depression

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NORMAL AGE-RELATED CHANGES IN
VISION
Typically gradual
 Limit functional ability
 External changes
 Internal changes
 Visual acuity
 Light sensitivity

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NORMAL AGE-RELATED EYE CHANGES

External changes
Graying and thinning of the eyebrows and lashes
 Subcutaneous tissue atrophy



Wrinkling of skin around eyes
Decreased orbital fat
Drooping eyelids
 Sunken appearance of eye

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NORMAL AGE-RELATED EYE CHANGES

Internal changes

Cornea and lens
Reduced ocular sensitivity
 Thickening and hardening of lens
 Loss of lens clarity
 Reduced color discrimination
 Reduced drainage of aqueous humor



Increases risk of glaucoma
Reduced pliability (flexibility) of lens
 Contributes to presbyopia (decreased near vision)
Gerontological Nursing, Second Edition
Patricia A. Tabloski
NORMAL AGE-RELATED EYE CHANGES

Internal changes

Pupil
Reduced diameter
 Reduces light to the retina
 Decreased dilation and constriction
 Reduced ability to respond to changes in light


Iris

Reduced color: eyes appear gray or light blue
Gerontological Nursing, Second Edition
Patricia A. Tabloski
NORMAL AGE-RELATED EYE CHANGES


Visual acuity
 Slight reduction after age 50
 Rapid decrease after age 70
Light sensitivity
 Declines with age
 Brightness contrast (older adults require very high contrast to resolve
small objects)
 Color perception: The ability to discriminate among colors peaks in
the early twenties and declines steadily with advancing age.
 Dark adaptation: Aging causes a dramatic slowing in dark adaptation
that can be attributed to delayed regeneration in the retinal
photreceptors. This age related delay in dark adaptation may also
contribute to night vision problems commonly experienced by the
elderly
 Recovery from glare (The ability to adapt the eyesight to varying light
conditions)
Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGING-RELATED HEARING CHANGES

External ear
Auricle wrinkles and droop
 Cerumen

Becomes dryer
 Accumulates in ear canal

Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGING-RELATED HEARING CHANGES

Inner ear





Increased pruritis
Easily irritated and injured
Atrophy of organ of Corti and cochlear neurons
Loss of sensory hair cells
Degeneration of stria vascularis which lines the outer
wall of the cochlea
Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGING-RELATED TASTE CHANGES

Decreases noted after age 70


Salt and sweetness impacted most
Impact of impairments
Weight loss
 Malnutrition
 Impaired immunity
 Worsening of medical illness

Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGING-RELATED CHANGES TO SENSE OF
SMELL
Affects 50% of adults over age 60
 May be attributed to
 Injury of olfactory mucosa
 Reduction in sensory cells
 Reduction in neurotransmitters
 Structural alterations

Upper airway
 Olfactory tract and bulb
 Hippocampus: s a major component of the brains of humans plays
important roles in long-term memory.
 Hypothalmus

Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGING-RELATED TACTILE SENSATION
CHANGES
Diminishes with aging
 Reduced ability to detect temperature extremes
 Tactile Sensation: the sensation produced by
pressure receptors in the skin

Gerontological Nursing, Second Edition
Patricia A. Tabloski
LEARNING OUTCOME 2
List common nursing diagnoses of older persons related
to sensory problems.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
PRIMARY CAUSES OF VISUAL IMPAIRMENT
Cataracts
 Macular degeneration
 Glaucoma
 Diabetic retinopathy

Gerontological Nursing, Second Edition
Patricia A. Tabloski
VISUAL IMPAIRMENT
Typically classified as vision < 20/20
 Increases with aging

Gerontological Nursing, Second Edition
Patricia A. Tabloski
BLINDNESS
Defined as visual acuity of 20/200 by Snellen
chart
 Increases with age
 Peaks at age 85

Gerontological Nursing, Second Edition
Patricia A. Tabloski
IMPACTS OF VISUAL IMPAIRMENTS
Loss of independence
 Social isolation
 Depression
 Reduced quality of life

Gerontological Nursing, Second Edition
Patricia A. Tabloski
SIGNS OF DIFFICULTY WITH VISION
Squinting or tilting head to see
 Changes in ability to drive
 Changes in ability to read or write
 Changes in ability to watch TV
 Holding objects close to face
 Difficulty with color discrimination
 Difficulty navigating stairs
 Hesitation in reaching for objects
 Inability to find objects

Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGE-RELATED MACULAR DEGENERATION
(ARMD)
Leading cause of blindness in adults over age 65
 Degenerative disorder of retina
 Impacts central vision and visual acuity
 Types


Dry (atrophic)
Atrophy
 Retinal pigment degeneration
 Causes slow, progressive sight loss

Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGE-RELATED MACULAR DEGENERATION
(ARMD)

Types

Wet
Known as neurovascular exudates
 Blood or serum leeks from new blood vessels causing scar
formation and visual impairments

Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGE-RELATED MACULAR DEGENERATION
(ARMD)

Risk factors
Over age 50
 Cigarette smoking
 Family history
 Exposure to UV light
 Caucasian
 Light-colored eyes
 Hypertension or cardiovascular disease
 Dietary deficits of antioxidants (vit C & E) and zinc

Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGE-RELATED MACULAR DEGENERATION
(ARMD)

Manifestations
Increased light needed for vision
 Blurred vision
 Central scotomas (may include and enlarge the
normal blind spot)
 Metamorphopsia: a defect of vision in which objects
appear to be distorted; usually due to a defect in the
retina

Gerontological Nursing, Second Edition
Patricia A. Tabloski
CATARACTS
Opacity or yellowing of the lenses
 Reduce the light able to reach the retina
 Slow and painless
 Unilateral or bilateral
 Classifications

Nuclear
 Cortical
 Posterior subcapsular
 Mixed

Gerontological Nursing, Second Edition
Patricia A. Tabloski
CATARACTS

Manifestations






Blurry vision
Glare
Halos around objects
Double vision
Difficulty sensing contrasting colors
Poor night vision
Gerontological Nursing, Second Edition
Patricia A. Tabloski
CATARACTS

Risk factors









Increased age
Smoking
Alcohol use
Diabetes
Hyperlipidemia
Eye trauma
Exposure to the sun and UVB rays
Long-term corticosteroid medications
Caucasian
Gerontological Nursing, Second Edition
Patricia A. Tabloski
GLAUCOMA
Caused by an increase in intraocular pressure
(IOP) resulting in optic nerve damage and vision
loss
 2nd most common cause of vision loss

Gerontological Nursing, Second Edition
Patricia A. Tabloski
GLAUCOMA

Types

Open-angle
A slowed flow of aqueous humor (is a thick watery substance
filling the space between the lens and the cornea ) through the
trabecular meshwork (is an area of tissue in the eye located around
the base of the cornea, near the ciliary body, and is responsible for
draining the aqueous humor from the eye via the anterior
chamber)
 Manifestations
 Painless, gradual loss of vision
 Midperipheral visual fields lost

Gerontological Nursing, Second Edition
Patricia A. Tabloski
GLAUCOMA

Types

Open-angle “normal tension”
Normal IOP but damage to optic nerve results in vision
changes
 Manifestations
 Enlargement of optic cup
 Small hemorrhages near the optic disc

Gerontological Nursing, Second Edition
Patricia A. Tabloski
GLAUCOMA

Types

Angle-closure
Results from a sudden infection or trauma
 Manifestations
 Unilateral headache
 Visual blurring
 Nausea
 Vomiting
 Photophobia

Gerontological Nursing, Second Edition
Patricia A. Tabloski
GLAUCOMA

Risk factors





Increased ocular pressure
Older than age 60
Family history
Personal history of myopia, diabetes, hypertension,
migraines
African-American ancestry
Gerontological Nursing, Second Edition
Patricia A. Tabloski
DIABETIC RETINOPATHY
Microvascular disease associated with diabetes
mellitus
 Damage to ocular microvascular system
impairing perfusion to the eyes

Gerontological Nursing, Second Edition
Patricia A. Tabloski
DIABETIC RETINOPATHY

Types

Nonproliferative
Damage to the endothelium of blood vessels results in
microaneurysms
 Leakage of microaneurysms results in edema and visual
impairment


Proliferative (Growing and increasing in number rapidly)
More advanced
 Neovascularization results in fragile, leaking blood vessels and
damage to the retina

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSES FOR VISIONIMPAIRED OLDER PATIENTS

Assess and evaluate abilities

Activities of daily living
Drive or take public transportation
 Ambulate safely in familiar and strange environments
 Shop and pay for food and personal hygiene items
 Prepare food
 Engage in recreational and leisure activities

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSES FOR VISIONIMPAIRED OLDER PATIENTS

Diagnoses

Sensory/perceptual alterations visual
Encompasses a variety of nursing goals and interventions
 Communication
 Safety
 Mobility
 Self-care activities
 Mood assessment

Gerontological Nursing, Second Edition
Patricia A. Tabloski
HEARING IMPAIRMENTS

Statistics
Common in older adults
 >30% people 65–74 are hearing impaired
 40–66% of people over age 75 are hearing impaired
 More prevalent in white men and women than
African-American men and women

Gerontological Nursing, Second Edition
Patricia A. Tabloski
HEARING IMPAIRMENTS

Risk factors








Long-term exposure to excessive noise
Impacted cerumen
Ototoxic medications
Tumors
Diseases affecting sensorineural hearing
Smoking
History of middle ear infections
Chemical exposure
Gerontological Nursing, Second Edition
Patricia A. Tabloski
HEARING IMPAIRMENTS

Hearing Loss

Temporary threshold shift (TTS)
Results from moderate exposure to loud noises
 Sounds < 75 decibels results in a temporary loss
 Sounds > 85 decibels with repeated exposures associated
with permanent hearing losses
 Examples include concerts or sporting events

Gerontological Nursing, Second Edition
Patricia A. Tabloski
HEARING IMPAIRMENTS

Hearing Loss

Conductive
Sounds are not transmitted to inner ear
 Results in problems with reception and amplification problems
 Potential causes
 Otitis externa
 Impacted cerumen
 Otitis media
 Benign tumors
 Carcinoma
 Perforation of tympanic membrane
 Foreign bodies
 Otosclerosis

Gerontological Nursing, Second Edition
Patricia A. Tabloski
FIGURE 14-9
STRUCTURE OF THE EAR.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
HEARING IMPAIRMENTS

Hearing Loss

Sensorineural
Cochlea and auditory nerve creates sound distortion
 Potential causes
 Presbycusis :a progressive bilateral symmetrical age-related
sensorineural hearing loss
 Excessive noise exposure
 Meniere’s disease (is a disorder of the inner ear that can affect
hearing and balance to a varying degree.)
 Tumors
 Infections
 Age related changes

Gerontological Nursing, Second Edition
Patricia A. Tabloski
HEARING IMPAIRMENTS

Hearing Loss

Sensorineural

Assessment
 History
 Physical examination
 Hearing Handicap Inventory for the Elderly (HHIES): The purpose of this scale is to identify the problems
your hearing loss
 Review reports from family members
Gerontological Nursing, Second Edition
Patricia A. Tabloski
HEARING IMPAIRMENTS
Hearing Loss
 Tinnitus (ringing in the ears)


Categories
 Objective

Hearing of pustatile sounds caused by turbulent blood flow
within the ear
Gerontological Nursing, Second Edition
Patricia A. Tabloski
HEARING IMPAIRMENTS

Tinnitus (ringing in the ears)

Categories
 Subjective






Perception of sound without sound stimulus
Potential causes
Medications
Infections
Neurological conditions
Disorders related to hearing loss
Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSES ASSOCIATED WITH
HEARING IMPAIRMENT

Assess and evaluate abilities

Activities of daily living
Communication
 Travel
 Safety awareness
 Leisure and recreational activities

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSES ASSOCIATED WITH
HEARING IMPAIRMENT

Diagnosis

Sensory/Perceptual Alterations: Hearing with a
variety of nursing goals and interventions
Communication
 Safety
 Self-care activities
 Mood
 Recreation and leisure activities

Gerontological Nursing, Second Edition
Patricia A. Tabloski
TASTE

Contributing factors to taste alterations

Oral conditions
Poor dentition
 Improperly fitting dentures
 Infections





Olfactory function
Medications
Diseases
Surgical interventions
Gerontological Nursing, Second Edition
Patricia A. Tabloski
TASTE

Focused assessment for taste disturbances
Head and neck
 Mucous membranes
 Review past dietary habits


Education
Gerontological Nursing, Second Edition
Patricia A. Tabloski
XEROSTOMIA (DRY MOUTH)
Results from salivary gland dysfunction
 Potential causes

Systemic diseases
 Radiation

Gerontological Nursing, Second Edition
Patricia A. Tabloski
XEROSTOMIA (DRY MOUTH)

Potential causes

Medications
Anticholinergics
 Antidepressants
 Antihistamines
 Diuretics
 Sedatives
 Antipsychotics


Sjogren’s syndrome ; is a systemic autoimmune disease in which
immune cells attack and destroy the exocrine glands that produce tears and
saliva
Gerontological Nursing, Second Edition
Patricia A. Tabloski
XEROSTOMIA (DRY MOUTH)

Implications
Altered taste
 Dysphagia



Risk of aspiration
Periodontal disease
Dental caries
 Gingivitis
 Oral lesions

Gerontological Nursing, Second Edition
Patricia A. Tabloski
XEROSTOMIA (DRY MOUTH)

Implications

Speech difficulties
Embarrassment
 Social isolation


Dry lips and mucosa
Increased infections
 Dental caries

Halitosis
 Sleeping problems

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSES ASSOCIATED WITH
TASTE IMPAIRMENT
Sensory/Perceptual Alterations: Gustatory (‫)ذوقي‬.
 Intake less than necessary for caloric
requirements

Gerontological Nursing, Second Edition
Patricia A. Tabloski
OLFACTORY DYSFUNCTION
Impacts 50% of adults over age 60
 Age-related changes are attributed to injury of
olfactory mucosa and reduction of number of
sensory cells and neurotransmitters

Gerontological Nursing, Second Edition
Patricia A. Tabloski
OLFACTORY DYSFUNCTION

Potential causes
Olfactory nerve damage
 Upper respiratory infections
 Head trauma
 Inflammatory conditions
 Neurodegenerative diseases
 May be associated with early onset of Alzheimer’s
and Parkinson diseases
 Chemotherapy
 Radiation

Gerontological Nursing, Second Edition
Patricia A. Tabloski
OLFACTORY DYSFUNCTION

Potential causes

Medications
Anesthetics
 Antihypertensives
 Antibiotics
 Opiates
 Antidepressants
 Sympathomimetics
 Cocaine hydrochloride
 Diltiazem, nifedipine

Gerontological Nursing, Second Edition
Patricia A. Tabloski
OLFACTORY DYSFUNCTION

Potential causes

Medications
Streptomycin
 Codeine, hydromorphone, morphine
 Amitriptyline
 Amphetamines
 Antihistamines
 Chemicals and pesticides

Current or past cocaine or tobacco use
 Poor dentition

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSES ASSOCIATED WITH
HYPOSMIA

Sensory/Perceptual Alterations: Olfactory
Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING DIAGNOSIS FOR CHANGES IN
PHYSICAL SENSATIONS

Sensory/Perceptual Alterations: Tactile
Gerontological Nursing, Second Edition
Patricia A. Tabloski
LEARNING OUTCOME 3
Recognize nursing interventions that can be
implemented to assist the aging patient with sensory
changes.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
EYE EXAMINATIONS
Healthy adults need an eye examination every
other year
 Items included in the eye examination

Complete eye assessment
 Visual acuity
 Examination of the retina
 Assessment of intraocular pressure


Diabetic patients should be examined annually
Gerontological Nursing, Second Edition
Patricia A. Tabloski
VISION ASSESSMENT
Observe appearance
 Clothing cleanliness
 Self-care
 Indications of bumps and bruises

Gerontological Nursing, Second Edition
Patricia A. Tabloski
PATIENT INTERVIEW
Adequacy of vision
 Recent visual changes
 Visual problems






Red eye
Excessive tearing or discharge
Headache or feeling of eyestrain
Foreign body sensation
New onset of double vision
Gerontological Nursing, Second Edition
Patricia A. Tabloski
PATIENT INTERVIEW

Visual problems








Haziness (lack of clarity), flashing lights, or moving spots
Loss of central or peripheral vision
Trauma or eye injury
Date of last examination
Inspection
Movement of eyelids
Abnormally colored sclera
Abnormal or absent papillary response
Gerontological Nursing, Second Edition
Patricia A. Tabloski
PATIENT INTERVIEW

Vision
Snellen chart
 Visual field testing


Extraocular movements
Gerontological Nursing, Second Edition
Patricia A. Tabloski
VISUAL AIDS
Helpful for visually impaired
 Used by less than 2% of patients > age 70
 Examples








Telescopic lenses
Books in Braille
Computer scanners and readers
Tinted glasses
Large print reading materials
Seeing eye dogs
Canes
Gerontological Nursing, Second Edition
Patricia A. Tabloski
VISUAL AIDS
Expensive and may not be covered by Medicare
 Commission for Blind

Books on tape
 Tape player
 Telephones with large numbers
 High-intensity lights

Gerontological Nursing, Second Edition
Patricia A. Tabloski
VISUAL DIFFICULTIES MAY LIMIT
INDEPENDENCE
Interference with driving
 Difficulty reading and writing
 Problems with ADLs

Gerontological Nursing, Second Edition
Patricia A. Tabloski
INTERVENTIONS TO PROMOTE SAFETY AT
HOME
Lighting in high-traffic areas
 Motion sensors
 Lampshades to prevent glare
 Contrast painting to promote discrimination
between surfaces
 Avoid reflective floors

Gerontological Nursing, Second Edition
Patricia A. Tabloski
INTERVENTIONS TO PROMOTE SAFETY AT
HOME

Use “hot colors”



Orange
Red
Yellow
Use of supplementary lamps
 Avoid “poor contrast” colors

Soft blues
 Gray
 Light green

Gerontological Nursing, Second Edition
Patricia A. Tabloski
INTERVENTIONS TO PROMOTE SAFETY AT
HOME
Use of red colored tape or paint near stairways
 Avoid complicated rug patterns
 Teach patient to enter rooms slowly

Gerontological Nursing, Second Edition
Patricia A. Tabloski
MOTOR VEHICLE ACCIDENTS AND
ACCIDENTAL DEATH

Statistics



Leading cause of death for persons > age 65
Second leading cause of death > age 75
Family responsibilities
Drive with elder family member to assess safety
 Report unsafe driver to Department of Motor
Vehicles
 AARP(American Association of Retired Persons)
 Safe driver course

Gerontological Nursing, Second Edition
Patricia A. Tabloski
AGE-RELATED MACULAR DEGENERATION
(ARMD)

Preventive measures





UV protective lenses in sunlight
Smoking cessation
Regular exercise
Zinc
High-dose antioxidants
Vitamin C
 Vitamin E
 Beta-carotene

Gerontological Nursing, Second Edition
Patricia A. Tabloski
EDUCATION AND CARE OF OLDER
PATIENTS WITH CATARACTS
Cause
 Symptoms
 Prevention

Wearing hats and sunglasses
 Smoking cessation
 Low-fat diet
 Avoid ocular injury

Gerontological Nursing, Second Edition
Patricia A. Tabloski
EDUCATION AND CARE OF OLDER
PATIENTS WITH CATARACTS

Treatment and management
Will require additional light when reading
 Repeated adjustments in corrective lens prescriptions

Gerontological Nursing, Second Edition
Patricia A. Tabloski
EDUCATION AND CARE OF OLDER PATIENTS WITH
CATARACTS

Treatment and management

Surgery
Removal of affected lens and insertion of replacement lens
 Laser photolysis


Phacoemulsification (refers to modern cataract surgery in
which the eye's internal lens is emulsified with an ultrasonic
handpiece and aspirated from the eye)

Contraindications
 Satisfactory vision with corrective lens or visual aids
 Lack of lifestyle impact
 Inability to lie supine for 30 minutes or more
 Poor surgical risk
Gerontological Nursing, Second Edition
Patricia A. Tabloski
EDUCATION AND CARE OF OLDER
PATIENTS WITH CATARACTS

Treatment and management

Surgery

Postoperative education
 Signs and symptoms to report





Pain
Conjunctival infection
Vision loss
Sparks and floaters in visual field
Nausea, vomiting, or excessive coughing
Gerontological Nursing, Second Edition
Patricia A. Tabloski
EDUCATION AND CARE OF OLDER
PATIENTS WITH CATARACTS

Treatment and management

Surgery

Postoperative education
 Patients should avoid



Lifting heavy objects
Straining at stool
Bending at the waist
Gerontological Nursing, Second Edition
Patricia A. Tabloski
EDUCATION AND CARE OF OLDER
PATIENTS WITH CATARACTS

Treatment and management
Postoperative complications
 Infection
 Wound dehiscence
 Hemorrhage
 Severe pain
 Uncontrolled, elevated intraocular pressure
 Special concerns
 Patients with cognitive impairments require supervision
for 24 hours after discharge

Gerontological Nursing, Second Edition
Patricia A. Tabloski
ADMINISTRATION OF EYE MEDICATIONS
Wash hands
 Ask patient to tip head back and look upward
 Pull lower lid down
 Drop medication into eyelid pouch
 Do not pace dropper on eye

Gerontological Nursing, Second Edition
Patricia A. Tabloski
ADMINISTRATION OF EYE MEDICATIONS
Allow for complete absorption between doses
 Blot any excessive medication from patient’s face
 Wash hands
 Document

Gerontological Nursing, Second Edition
Patricia A. Tabloski
DIABETIC RETINOPATHY

Tight glycemic control
80–120 mg/dL
 Bedtime capillary blood glucose of 100–140 mg/dL
 HbA1c less than 7 : Glucose sticks to the haemoglobin to make a

'glycosylated haemoglobin' molecule, called haemoglobin A1C or
HbA1C. The more glucose in the blood, the more haemoglobin A1C or
HbA1C will be present in the blood.
Manage hypertension
 Manage hyperlipidemia

Gerontological Nursing, Second Edition
Patricia A. Tabloski
MANAGEMENT OF PATIENTS WITH
DIABETES

Proper nutrition
Low-carbohydrate diet
 Low-cholesterol diet

Exercise
 Monitoring glucose

Gerontological Nursing, Second Edition
Patricia A. Tabloski
CERUMEN IMPACTION
Hygiene
 Cerumen removal


Contraindications
Perforation of tympanic membrane
 Ear trauma
 Tumors
 Cholesteatoma: s a destructive and expanding growth
consisting of keratinizing squamous epithelium in the
middle ear and/or mastoid process
 Use caution in diabetics

Gerontological Nursing, Second Edition
Patricia A. Tabloski
CERUMEN IMPACTION

Cerumen removal

Curette method (is more likely to be used by otolaryngologists when the ear canal is
partially occluded and the material is not adhering to the skin of the ear canal. Cotton
swabs, on the other hand, push most of the earwax further into the ear canal and remove
only a small portion of the top layer of wax that happens to adhere to the fibres of the
swab)
Uses no water
 Lower risk of infection
 Procedure requires skill
 Risk for injury to tympanic membrane


Lavage or irrigation
May soften cerumen for up to 3 days with mineral oil or Debrox
 Risk for infection

Gerontological Nursing, Second Edition
Patricia A. Tabloski
HEARING AIDS

Documentation on admission




Type
Model number
Serial number
Assessment
Integrity of ear mold
 Battery
 Dials
 Switches
 Tubing behind the ears

Gerontological Nursing, Second Edition
Patricia A. Tabloski
HEARING AIDS

Care





Remove at bedtime
Clean with warm water or saline
No alcohol or harsh soaps
Use cotton pad
Remove cerumen carefully
Gerontological Nursing, Second Edition
Patricia A. Tabloski
HEARING AIDS

Other devices
Cochlear implants
 Assistive listening devices

Amplifiers
 Telephone device for the deaf (TDD)

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING INTERVENTIONS WHEN
SPEAKING WITH HEARING IMPAIRED
PATIENTS
Eliminate extraneous noises
 Stand 2–3 feet from the patient
 Get patient’s attention before speaking
 Lower pitch of voice
 Pause at end of each sentence
 Assist with devices as needed
 Assess illumination in room
 Face patient during all interactions

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING INTERVENTIONS WHEN
SPEAKING WITH HEARING IMPAIRED
PATIENTS
Do not cover mouth
 Do not chew gum
 Avoid talking with others during interaction to
avoid confusion
 Speak slowly
 Do not shout
 Rephrase instead of repeating when needed

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NURSING INTERVENTIONS WHEN
SPEAKING WITH HEARING IMPAIRED
PATIENTS
Use gestures as needed
 Use written communication as needed
 Assess patient’s comprehension of interaction

Gerontological Nursing, Second Edition
Patricia A. Tabloski
HYPOGEUSIA (DIMINISHED TASTE)
Cannot be treated with medications
 Assess for potential causes

Check dentures for fit and cleanliness
 Inspect oral cavity
 Review medications
 Review dietary intake

Gerontological Nursing, Second Edition
Patricia A. Tabloski
HYPOGEUSIA (DIMINISHED TASTE)
Use additives and seasonings to enhance flavor
 Aroma may amplify taste
 Vary foods to avoid sensory exhaustion
 Promote positive environment during mealtimes
 Allow for appetizing smells

Gerontological Nursing, Second Edition
Patricia A. Tabloski
XEROSTOMIA (DRY MOUTH)
Assess for potential causes
 Nonpharmacological management techniques







Artificial saliva
Oral lubricants
Drink fluids with meals
Humidifier
Regular dental care
Low-sugar diet
Gerontological Nursing, Second Edition
Patricia A. Tabloski
XEROSTOMIA (DRY MOUTH)

Nonpharmacological management techniques
Sugar-free candies
 Mints
 Chewing gum


Pharmacological management techniques
Anticholinergics during the day
 Divide doses from once a day to twice a day

Gerontological Nursing, Second Edition
Patricia A. Tabloski
NEED FOR TOUCH
Tactile sense of interpretation
 Environmental orientation
 Psychological benefits

Comfort
 Love

Communication
 Protective by stimulating withdrawal

Gerontological Nursing, Second Edition
Patricia A. Tabloski
TACTILE IMPAIRMENT
Monitor for intactness of skin
 Assessment of safety risks
 Development of a safety plan

Gerontological Nursing, Second Edition
Patricia A. Tabloski
LEARNING OUTCOME 4
Identify medications that may cause or aggravate
sensory dysfunction.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
MEDICATIONS WITH SIDE EFFECTS OF
VISUAL DISTURBANCES
Hydroxychloroquine (Plaquenil): retinopathy,
blurred vision, and difficulty focusing
 Tamoxifen (Nolvadex): decreased visual acuity
and blurred vision

Gerontological Nursing, Second Edition
Patricia A. Tabloski
MEDICATIONS WITH SIDE EFFECTS OF
VISUAL DISTURBANCES
Thioridazine (Mellaril): blurred vision, impaired
night vision, and color discrimination problems
 Levadopa: blurred vision
 Propranolol: dry eyes, visual disturbances

Gerontological Nursing, Second Edition
Patricia A. Tabloski
OPHTHALMIC SOLUTIONS WITH
POTENTIAL ADVERSE EFFECTS

Beta-blockers (Betagan, Timoptic, Ocupress)







Bradycardia
Congestive heart failure
Syncope
Bronchospasm
Depression
Confusion
Sexual dysfunction
Gerontological Nursing, Second Edition
Patricia A. Tabloski
OPHTHALMIC SOLUTIONS WITH
POTENTIAL ADVERSE EFFECTS

Adrenergics (Lopidine, Alphagan, Epinal)
Palpitation
 Hypertension
 Tremor
 Sweating

Gerontological Nursing, Second Edition
Patricia A. Tabloski
OPHTHALMIC SOLUTIONS WITH
POTENTIAL ADVERSE EFFECTS

Miotics/cholinesterase inhibitors (philocarpine,
Humorsol)





Bronchospasm
Salivation
Nausea, vomiting, diarrhea
Abdominal pain
Lacrimation
Gerontological Nursing, Second Edition
Patricia A. Tabloski
OPHTHALMIC SOLUTIONS WITH
POTENTIAL ADVERSE EFFECTS

Carbonic anhydrase inhibitors (Trusopt, Azopt)







Fatigue
Renal failure
Hypokalemia
Diarrhea
Depression
COPD
Exacerbation
Gerontological Nursing, Second Edition
Patricia A. Tabloski
OPHTHALMIC SOLUTIONS WITH
POTENTIAL ADVERSE EFFECTS

Prostaglandin analogues (Xalatan, Lumigan)
Changes in eye color and periorbital tissues
 Itching

Gerontological Nursing, Second Edition
Patricia A. Tabloski
DRUGS WITH RISK OF HEARING CHANGES
Aminoglycoside antibiotics (gentamycin)
 Antineiplastics (cisplatinum)
 Loop diuretics (furosemide)
 Baclofen
 Propranolol (Inderal)

Gerontological Nursing, Second Edition
Patricia A. Tabloski
POTENTIAL PHARMACOLOGICAL IMPACT
ON TASTE
Alteration in peripheral receptors
 Alteration in chemosensory pathways

Gerontological Nursing, Second Edition
Patricia A. Tabloski