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Gero > Hearing and Vision (HEARING PORTION) > Flashcards

Hearing and Vision (HEARING PORTION) Flashcards

Exam 2

1
Q

What happens to the external ear?

A

Auricle wrinkles and sags
Increased cerumen production

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2
Q

Hearing:

What does a dry canal lead to?

A

Pruritis

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3
Q

Hearing:

Increased cerumen production with age: What kind? Why does increased cerumen occur?

A

Hard cerumen

Decreased apocrine gland activity –> accumulation

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4
Q

Hearing:

Internal ear:
What occurs?

A

Atrophy of organ of Corti and cochlear neurons

Loss of sensory hair cells

Degeneration of the stria vascularis

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5
Q

Age-Related Changes That Affect Hearing

How are sounds coded?

A

Sounds are coded according to intensity and frequency

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6
Q

Age-Related Changes That Affect Hearing

Intensity or amplitude reflects what? How is it measured?

A

Intensity or amplitude reflects loudness or softness of sound; measured in decibels (dB)

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7
Q

Age-Related Changes That Affect Hearing

Sounds at what levels are considered ototoxic?

A

Sounds louder than 80 to 85 (dB) are considered potentially ototoxic

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8
Q

Age-Related Changes That Affect Hearing

What determines pitch?

A

Frequency determines the pitch: high or low

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9
Q

Age-Related Changes That Affect Hearing

The human auditory system is most sensitive to what frequencies?

A

The human auditory system is most sensitive to frequencies between 2,000 and 5,000 Hz. ( but is able to hear lower or higher frequencies as well)

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10
Q

Age-Related Changes That Affect Hearing

When are people diagnosed with high frequency hearing loss? How is it measured?

A

People are diagnosed with high frequency hearing loss if they are unable to hear sounds between 2,000 Hz and 8,000 Hz, which is measured on an audiogram

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11
Q

Structure of the Ear and age-related changes

Where does hearing begin?

A

Hearing begins with external ear

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12
Q

Structure of the Ear and age-related changes

What are the three main parts of the ear?

A

External ear

Middle ear

Inner ear

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13
Q

Structure of the Ear and age-related changes

External ear: Pinna

A

Pinna: cartilaginous structure

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14
Q

Structure of the Ear and age-related changes

External ear: Pinna- what does it not do?

A

Does not affect the change in conduction of sound

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15
Q

Structure of the Ear and age-related changes

External ear: Auditory canal- what is it made up of?

A

Auditory canal: covered with skin, lined with hair follicles, and cerumen-producing glands

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16
Q

Structure of the Ear and age-related changes

External ear: Cerumen

A

Aging increases the potential for cerumen accumulation—complaint is hearing loss No additional s/s, painless.

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17
Q

Structure of the Ear and age-related changes

Middle ear: What is included in it?

A

Tympanic membrane:

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18
Q

Structure of the Ear and age-related changes

Middle ear:

Tympanic membrane: What is it?

A

separates outer and middle ear

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19
Q

Structure of the Ear and age-related changes

Middle ear:

Tympanic membrane: What does it do?

A

transmit sound energy and protect middle and inner ear

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20
Q

Structure of the Ear and age-related changes

Middle ear:

Tympanic membrane: How do sound vibrations pass?

A

Sound vibrations pass through tympanic membrane to three auditory ossicles

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21
Q

Structure of the Ear and age-related changes

Middle ear:

What can interfere with transfer of sound vibrations?

A

Calcification of the bones can interfere with transfer of sound vibrations.

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22
Q

Structure of the Ear and age-related changes

Middle ear:

Sound vibrations pass through tympanic membrane to three auditory ossicles. Calcification of the bones can interfere with transfer of sound vibrations.

What are the three things?

A

Malleus

Incus

Stapes

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23
Q

Structure of the Ear and age-related changes

Middle ear:

With age, what happens?

A

Middle ear muscles and ligaments become weaker and stiffer with age -weakens protection from loud noises

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24
Q

Structure of the Ear and age-related changes

Inner ear:

Where are vibrations transmitted?

A

vibrations transmitted to cochlea

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25
Q

Structure of the Ear and age-related changes

Inner ear:

Age-related changes: What is there a loss of?

A

Loss of hair cells and neurons

Few hair cells and neurons

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26
Q

Structure of the Ear and age-related changes

Inner ear:

Age-related changes: What is there reduction of?

A

Reduction of blood supply

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27
Q

Structure of the Ear and age-related changes

Inner ear:

Age-related changes: What is there a decrease in? What is a degeneration of?

A

Decreased basilar membrane flexibility

Degeneration of spiral ganglion

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28
Q

Structure of the Ear and age-related changes

Inner ear:

Age-related changes: What is there a diminution of?

A

Diminution of endolymph production

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29
Q

Structure of the Ear and age-related changes

Any degeneration of the inner ear structures will lead to what?

A

Any degeneration of the inner ear structures will lead to hearing loss

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30
Q

Structure of the Ear and age-related changes

Ototoxic medication: What do they do?

A

Affect the sensory cells in the inner ear that detect sound and motion

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31
Q

Auditory Nervous System

What is it affected by?

A

Affected by age-related changes

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32
Q

Auditory Nervous System

Affected by age-related changes like?

A

Degenerative changes in inner ear

Narrowing of auditory meatus from bone apposition

Diminished blood supply

Central nervous system changes

33
Q

Risk Factors That Affect Hearing Wellness:

What is hearing loss associated with?

A

Hearing loss associated with

lifestyle,

heredity /genetic*

non modifiable environmental factors,

medications,

impacted cerumen,

disease conditions

34
Q

Risk Factors That Affect Hearing Wellness:

Risk factors for hearing impairment:

A

male gender,

increased age,

genetic predisposition,

exposure to loud noise(NIHL-Noise Induced Hearing Loss),

impacted cerumen,

smoking,

exposure to secondhand smoke,

ototoxic medications (NSAID’s) and

certain medical conditions

35
Q

Risk Factors That Affect Hearing Wellness:

What are modifiable risk factors for hearing loss?

A

*Modifiable and preventable risk factors for hearing loss include noise, medications and impacted cerumen

36
Q

Exposure to Noise

Noise-induced hearing loss (NIHL): How is it viewed?

A

Noise-induced hearing loss (NIHL): preventable

37
Q

Exposure to Noise

Noise-induced hearing loss (NIHL): How does it occur?

A

Prolonged or intermittent exposure to noise

Associated with occupations (OSHA, NIOSH) and recreational activities

Exposure to toxic chemicals: risk factor for loss

38
Q

Which is the most prevalent risk factor for impaired hearing?

A. Use of ototoxic medications
B. Exposure to noise
C. Age-related changes of the ear
D. Genetic factors

A

B. Exposure to noise

The most prevalent risk factor for impaired hearing is exposure to noise, which can be viewed as both a lifestyle choice and an environmental factor. Prolonged or intermittent exposure to noise during occupational or leisure activities is a common and usually avoidable risk factor for damage to the auditory system

38
Q

Exposure to Noise

What is the leading cause of hearing loss? How is it viewed?

A

Impacted cerumen/impacted wax: leading cause of hearing loss which is preventable and treatable

39
Q

Ototoxic Medications:

What can cause or contribute to hearing loss?

A

Adverse medication effects can cause or contribute to hearing loss

40
Q

Ototoxic Medications:

What do these meds do specifically?

A

These medication damage the sensory cells in the inner ear that detect sound and motion.

41
Q

Ototoxic Medications:

These medication damage the sensory cells in the inner ear that detect sound and motion.

What is included?

A

Aminoglycosides ( Gentamicin, Neomycin)

Aspirin *not 81mg –higher doses

Loop diuretics (Furosemide, Bumetanide)

Chemotherapy

42
Q

Ototoxic Medications:

What does not increase the risk of ototoxicity alone?

A

*Age alone does not increase the risk for Ototoxicity

43
Q

Ototoxic Medications:

*Older adults are more likely to have conditions that increase the risk for medication related ototoxicity such as:

A

*Older adults are more likely to have conditions that increase the risk for medication related ototoxicity such as

renal failure,

dehydration and for interaction between two ototoxic medications.

44
Q

Ototoxic Medications:

How can ototoxicity be potentially viewed?

A

*Ototoxicity is potentially reversible;

.

45
Q

Ototoxic Medications:

Why may meds be overlooked as a causative factor of hearing loss?

A

medications may be overlooked as a causative factor if the hearing loss is mistakenly ascribed to inevitable and irreversible degenerative changes

46
Q

Disease Processes:

How can disease processes be?

A

Hereditary :

Auditory System Disease:

Medical conditions and systemic diseases:

47
Q

Disease Processes:

Hereditary: like?

A

Otosclerosis

48
Q

Disease Processes:

Auditory System Disease: like?

A

Ménière’s disease
Acoustic neuromas

49
Q

Disease Processes:

Medical conditions and systemic diseases: like?

A

Diabetes

Cerebrovascular disorders

Hypothyroidism

Radiation to the head or neck

Hypertension

Viral infections

Head injury

Meningitis

Hyperthermia

50
Q

Hearing impairment by site

Conductive hearing loss- Where is the problem occurring?

A

External and Middle ear

51
Q

Hearing impairment by site

Conductive hearing loss- What is exactly the problem?

A

Physical obstruction of sound wave

52
Q

Hearing impairment by site

Sensorineural hearing loss - What exactly is the problem?

A

defect in the cochlea. eight cranial nerve or the brain

53
Q

Hearing impairment by site

Sensorineural hearing loss - Where is the problem?

A

Sensory and neural structures of the inner ear causing sound distortion

54
Q

Hearing impairment by site

Mixed conductive: What kind of hearing loss is this?

A

Mixed conductive-sensorineural hearing loss and conductive hearing loss

55
Q

Hearing impairment by site

Hearing impairment types include:

A

Conductive hearing loss

Sensorineural hearing loss

Mixed hearing loss

56
Q

Hearing impairment by site

Hearing impairment types include:
Conductive hearing loss

A

abnormalities of external and middle ear interfering with sound conduction

57
Q

Hearing impairment by site

Hearing impairment types include:
Sensorineural hearing loss:

A

abnormalities of sensory and neural structures of inner ear, usually age related or noise induced

58
Q

Hearing impairment by site

Hearing impairment types include:
Mixed hearing loss:

A

involves both conductive and sensorineural impairments

59
Q

Effects on Communication

Presbycusis: What is it?

A

sensorineural hearing loss as a result of aging, bilateral

60
Q

Effects on Communication

Presbycusis: What is there a diminished ability to do?

A

Diminished ability to hear high-pitched sounds, especially in the presence of background noise

Diminished speech discrimination (difficult with consonants)

61
Q

Effects on Communication

Presbycusis: What is a nursing intervention for this?

A

*Nursing -Ensuring that the patient can directly visualize you when you provide instructions speak with a low tone/low pitch voice

Presbycusis -has huge quality of life implications. Helping the client develop coping strategies and find social support systems is the most important thing that the nurse can do.

62
Q

Effects on Communication

Cerumen impaction: What kind of hearing loss is it?

A

Conductive Hearing Loss

63
Q

Effects on Communication

Cerumen impaction: What kind of hearing loss is it?

A

Reduced intensity of sounds and difficulty hearing low pitched tones.

64
Q

Effects on Communication

Interventions include:

A

Hygiene

Cerumen removal

65
Q

Effects on Communication

Cerumen removal
Contra-indications:

A

Tumors,

Perforated TM,

ear trauma otitis externa,

ear surgery

66
Q

Effects on Communication

Cerumen removal
How is it done?

A

Lavage or irrigation-with bulb syringe (Curette- by APN)

67
Q

Effects on Communication

Why may people not be aware of hearing change?

A

One in 3 adults over age 65 has hearing loss.

Because of the gradual change in hearing, some people are not aware of the change at first.

68
Q

Effects on Communication

Hearing loss often effects what kind of hearing? What is not effected?

A

Most often, it affects the ability to hear high-pitched noises such as a phone ringing or beeping of a microwave.

The ability to hear low-pitched noises is usually not affected.

69
Q

Nursing Assessment of Hearing

A

Interviewing question

Behavioral cues related to hearing

Otoscopic examination for impacted cerumen

Tuning fork tests for hearing

Screening tool:

Family history with past and present risks

Attitudes about hearing aids if impairment is present

Impact of hearing impairment on communication and quality of life

70
Q

Assessment Tool: (HHIE-S)Hearing Handicap Inventory for the Elderly:

How many questions is it? How long does it take to administer?

A

Ten questions
Administered in 5 minutes

71
Q

Assessment Tool: (HHIE-S)Hearing Handicap Inventory for the Elderly:

What does it assess? What is interpreted?

A

Interpretation of the raw score

72
Q

Care of the Person with a Hearing Disability

What should you encourage?

A

Encourage audiometric testing

73
Q

Care of the Person with a Hearing Disability

Encourage audiometric testing- Why?

A

Problem may not be age-related and could be readily treatable

74
Q

Care of the Person with a Hearing Disability

What should patient learn?

A

Learning to live with a hearing deficit (safety, home adaptation)

75
Q

Care of the Person with a Hearing Disability

Nursing interventions include?

A

adequate light,

low pitched tone,

reduce background noise(turn TV off ) face the person,

low tone voice.

76
Q

Care of the Person with a Hearing Disability

What can seriously be effected for patient?

A

Physical, emotional, and social health can be seriously affected

77
Q

Hearing Aids:

How does it impact hearing? How do you get hearing aids?

A

Hearing can improve but will not return to normal

Purchase only by prescription

78
Q

Hearing Aids:

How does someone obtain hearing aids?

A

Need for complete audiometric examination by an audiologist

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