CH 23: Vision and Hearing Flashcards
effects of aging on vision
- Reduced elasticity and stiffening of muscle fibers in lens decreased ability to focus presbyopia increased use of corrective lenses
- Reduced pupil size, opacification of lens and vitreous, loss of photoreceptor cells in retina decline in visual acuity
- Light perception threshold decreases difficult with vision at night
- Cataract formation Sensitivity to glare
- Cells in retina are less sensitive distorting blue and green tones
- Smaller visual fields reduced peripheral vision
- Decreased tear production dry eyes
- Changes in depth perception ability to judge height of walking surfaces challenging
- Impaired communication changes in vision
- Increase prevalence of blindness (diabetes, catiracs, macular)
older adults less likely to see things up close
presbiopia
effects of aging on hearing
Sensorineural hearing loss (presbycusis) decreased ability to hear s, sh, f, ph, and w & inaudible speech
Impacted cerumen decreased hearing
Decreased hearing impaired communication and social isolation
conductive hearing loss
something blocking hearing on the outside
- wax
-
sensoneuronal
something from the brain causing hearing loss
- tumors
-ototoxicity
age related hearing loss
presbycusis
how to promote vision with older adults
- Significant issues should be recognized early to prevent visual damage
- Routine, thorough annual eye exams
- Nurse can assess financial ability to afford visual care items
- Prompt evaluation for significant problems
- Ensure diet of vit A,B,C,E; zinc, flavonoid**
- Manage diseases causing vision issues (diabetes and hypertension)
- Implement techniques to maximize sensory functioning
how to promote hearing with older adults
- start teaching them early in life
Good care of ears throughout life - Prevention of trauma to ear
- Prompt treatment for ear infections
- Regular audiometric exams
- Protect exposure from loud noise using ear-plugs or sound-reducing devices
Cerumen removal via irrigation - positioning, warm water - avoid cotton tip applicators and their friends
- fall precautions for potential
- assistance for irrigation
- don’t continuously irrigate - perforation of eardrum
- implement techniques to maximize sensory functioning**
clouding of the lens from calcium deposits
leading cause of low vision in older adults
cataract
clear sign of cataracts**
blurred vision
causes of cataracts
exposure of UVB-B light, diabetes, cigarettes, alcohol use, eye injury
S/S of cataracts
no pain, decreased night vision, glare from sunlight, nuclear sclerosis (lens becomes yellow or yellow-brown), pupil changes to cloudy white, increased nearsightedness
ONLY treatment for cataracts**
surgery is the only cure
only one eye at a time (4-6 wks recovery)
increased intraocular pressure
second leading cause of blindness
glaucoma
demographics for glaucoma
Increases in prevalence with age,
ethnicity (African Americans and Hispanic/Latino), endocrine imbalance (diabetes)
family history
anticholinergic meds - increase intraocular
acute glaucoma vs chronic glaucoma
acute (narrow-angle)
- more severe
- vision loss in hours - EMERGENT
- eye pain
- N/V/HA/eyebrow pain**
- usually from trauma
- IOP: >30
- treatment: mannitol
chronic (open angle)
- no pain**
- loss of peripheral vision**
- more gradual
- IOP: 20s
- treatment: prostaglandins, sx
normal intraocular pressure
10-20
activities to avoid to prevent glaucoma
- sneezing/ coughing
-bending over - heavy lifting
nursing considerations for glaucoma
Avoid activities that increase IOP
Wear a medical alert bracelet
Barriers to treatment leading to lack of adherence
Vision loss cannot be restored
Periodic ophthalmologist eval
tonometry testing
air test for IOP
Most common cause of blindness >65 years old
Damage of macula Central vision loss
macular degeneration = central vision
interventions for macular degeneration
use of magnifying glasses, reading lamps, and other aids
s of macular degeneration
whole in the vision
Forward displacement of retina from its normal position
detached retina
s of detached retina
floating spots
curtain over the eye
treatment for detached retina
bedrest, bilateral eye patches, prompt treatment, frequent checks, safety precautions; surgery
Inflammation of the cornea; caused by febrile states, irritation, dietary deficiencies, CVA, lowered resistance
corneal ulcer
causes of corneal ulcers
bloodshot eye, increased lacrimation, photophobia
tears
treatment of corneal ulcers
Early care with cycloplegics (resting the eye)
sedatives, antibiotics, and heat; sunglasses, treat underlying cause (foreign body, abrasion, infection)
measures to compensate for visual deficits
- Face the person when speaking
- With glaucoma, come to the person from the front
- Exaggerate facial expressions and gestures
- Use several soft indirect lights instead of one
- Avoid glare from windows using sheer curtains/stained windows
- Use large print reading material
- Place frequently used items in the visual field
- Avoid low-tone colors and use bright-toned colors
- Use contrasting, bold colors
- Identify personal belongings differently
hearing deficits and older adults
very common
NOT a normal part of aging - underlying cause
higher incidence in MEN with loud occupations
tinnitus
causes of hearing deficits
ototoxic drugs (aspirin, ibuprofen, naproxen, Lasix, -mycins)**
diseases
otosclerosis
vascular problems
viral infections
otitis media
neoplasms
cysts
cerumen - ear wax
dermatoses
exposure to loud noise
nursing considerations for hearing problems
- Audiometric examination
- Prepare for anger, frustration, impatience, confusion during conversation, inappropriate reactions, social isolation, limited ability to hear danger help with coping strategies
- Place near nurses’ station -
- Provide education in written form
- NEVER purchase a hearing aid without consulting an otologist
- Hearing aids
use of hearing aids
- Help to improve, not restore hearing to normal level
- Speech is amplified and all environmental noise
- Checked regularly
- Hearing aid care
- Connect with hearing and speech associations
general nursing considerations for vision and hearing loss
Stimulate all senses during routine daily activities
Face the individual while speaking and exaggerate gestures and facial expressions
For peripheral vision loss, approach them from the front rater the side
Ample lighting
Use large print games, playing cards, and telephone dials
nursing considerations for high-frequency hearing loss
high: talk slowly, distinctly
low-frequency voice; raising the voice/shouting can raise frequency and make hearing worse
how to improve communication with loss of hearing/vision
Talk into the less impaired ear
face the individual when talking
use visual speech (sign language)
allow person to lip read
use a stethoscope
use flashcards and communication boards
