care of the older person with vision and hearing problems september 21, 2012
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CARE OF OLDER PERSONSWITH VISION AND
HEARING
PROBLEMSBY: Evangeline B. Mananquil, RN, MN
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Objectives: After studying this module,
you will be able to:
1. Describe vision and hearing problems amongolder persons.
2. Describe the incidence of altered vision andhearing in the Philippines.
3. Explain the causes that bring about thesealterations.
4. Describe the impact of the above conditions on
patient/family/caregiver; and5. Enumerate ways caregivers can help clients withthese problems.
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Altered Sensory
Perception
Problems in
1. Vision
2. Hearing
3. Thought Processes
Understanding how to care
for clients with vision and
hearing problems will help in
ensuring good care of older
persons
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organized thought processes
Intact sensory organs needed
Intact vision and hearing
1. To be able to respond to stimuli presented by
ones environment
2. Makes possible verbal and written
communication.
3. To enjoy meaningful activities and socialinteractions.
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1. Increase risk of Injury- sensory deficits.
2. Isolationlimited interactions.3. Risk for emotional distress.
4. Prone to suffer mental health problems.
Boredom Shorter attention span.
Difficulty in coherent thinking.
Confused
Needs more time and attention.
Becomes a
behavioral
managementproblem.
(Koplac, 1983)
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SAFETY
SELF-CARE NEEDS
Spendmore
time!
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VISION PROBLEMS
Impaired Vision
Decreased or is lacking in the ability to see.
Brought about by MAJOR VISUAL CHANGESusually starts at age 50- leading to visual
impairment
Preceded by functional changes
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1. Decreased sensitivity to light. Decrease in the size of the pupil.
Increase in lens thickness
2. Increased sensitivity to glare.
3. Decreased in adaptability
to changes in light. Cones of the eye becomes slower in reacting to light.
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4. Altered colored vision. Lens becomes yellowish a one ages
This filters out colors of short wavelength such as violet,
Blue and green.
5. Presbyopia or farsightedness Problem of accommodation
Or the ability to focus clearly
and quickly on objects at various distances.
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VISION PROBLEMS RELATED TO DISEASES OF THE FOLLOWING:
1. Cataracts - common; due to the clouding or
opacity of the normally clear, crystalline lens.
2. Glaucoma - blockage in the drainage of the
aqueous humor
Fluid in the anterior chamber of the ye.
Usually reabsorbed by the venous circulation
What happened if there is increased production and
failure of reabsorption? Increased intraocularpressure leads to
1. degeneration and cupping of the optic disc
2. Atrophy of the optic nerve head
3. Narrowing of the visual field.
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Glaucoma
insidious, chronic condition
Called thief in the night because of the
sudden loss of vision ( no noticeable
symptoms.
Starts
1. Decreasing peripheral vision but central
vision remains intact
2. Does not limit the vision of the client.
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3. Senile macular degeneration
- results from
a. Decreased blood supply
b. Accumulation of waste products.
c. Tissue atrophy
Macula is on the retina.
Retina is where the
focusing area isfound.
Degeneration of the
macula results in a declinein central visual acuity that
makes daily tasks requiring
close vision hard to
perform.
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4. Diabetic Retinopathy
Diminished retinal blood flow
Promoting Vision (good eyesight)
1. Decrease environmental risk.
Prolonged exposure to UV rays
2. Regular biannual check-up. Early detection
3. Distinguish among an optician, an
optometrist, and an
opthalmologist.
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Ophthalmologist-medical doctor who
specializes in the care and
management of eyeproblems
OPTOMETRISTis one whorefracts ones eyes to determine
the best kind of eyeglasses to use.
OPTICIANfits, adjusts and dispenses eyeglasses and
contact lenses prescribed by optometrists andophthalmologists.
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CARING FOR CLIENTS WITH LOSS OF VISION
IndependenceMUST BE ALLOWED as much as
possible in various levels of blindness Ebersoleand Hess (2001)
1. When approaching a blind client
a. Speak before touchingso as not to startle him. Sometimes a
handshake will do.b. Facing the client when talking for better communication.
c. Never leave a blind client for long periods of timeleads to panic and
hallucination.
d. Work out a daily routine. Work with schedule. Abrupt and unannounced
changes can be disorienting. Remember they dont have dawn and dusk
reminders anymore.
e. Use other sensory stimulation such as touch, sounds and smell.
Increased external stimulation is necessary especially if there are signs of
apathy. (clocks and chime)
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BUT if the cause of visual impairment is a
common disorder- additional interventions are
quite necessary
1. Cataracts
a. Immediate medical attention is needed.
b. Surgery. Post-cataract removal management.
b.1 No rubbing or pressing the eye. Limitactivities.
b.2 Discourage shampooing and showers.
b.3 Always protective gear to the eye.
b.4 Discourage reading during the first week-movement of the eye can loosen the stitches.
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c. Prevent increase intraocular pressure.
c.1 Not allowed to bend or stoop.
c.2 Avoid straining during bowel movement.
c.3 No lifting of heavy objects.(not carry more
than 5 kilos)c.4Avoid strong emotions during the early post-
operative period.
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2. Glaucoma
Requires continual lifelong treatment.
Visual loss- is quite permanent.
2.1 Eye drops (miotics)are usually prescribed.
Prevent increased IOP. Continuously giveneven if symptoms are relieved. Given as
scheduled.
2.2 If symptoms will not be relieved by miotics-surgery is required. Post-operative care is
the same with cataract extraction.
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3. Diabetic Retinopathy
no early and advanced symptoms
3.1 DM clients- undergo annual opthalmoscopic
examination.
3.2 Control the main cause. DM- maintaining
blood sugar (foremost goal) Maintaining
balance between food intake and energy use.
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Behavioral Modifications(changes in behavior that will facilitate adaptation to visual impairment)
1. Face the person when speaking.2. Pockets in their clothing for carrying treasured
things.
3. Important to have a transistor radio.
4. Provision of detailed instructions for any activity to
be done.
5. If client wants to be independent/alone- advise
him/her to pause in doorways when going from light
to dark rooms or vice-versa. Teach him to use
feet/hands as probes to feel for steps, edges offloors, and the like.
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HEARING PROBLEMS
1. RECEIVES2. INTERPRETS
3. SENSE WARNING
SIGNALS
Impaired Hearing
is lack of or
decrease in ability tohear.
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Behavioral Cues for a Hearing Deficit
1. Inappropriate responses to questions, especially in the
absence of lip reading.2. Inability to follow verbal directions without cues.
3. Short attention span. Easy distractibility.
4. Frequent requests for repetition or clarification of verbal
communication.
5. Intense observation of the speaker.6. Mouthing of words spoken by the speaker.
7. Turning of one ear toward the speaker.
8. Unusual physical proximity to the speaker.
9. Lack of response to environmental noises.10.Too loud or inarticulate speech.
11.Abnormal voice characteristics, such as monotony.
12.Perception that others are talking about him or her.
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HEARING LOSS
1. CONDUCTIVEHEARING LOSStalks normally
But can hear better if others talk
loudly
Due to abnormality in the
external ear canal, tympanic
membrane and/or middle ear
ossicles
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2. SENSORINEURAL HEARING LOSS
Talks loudly because he cannot hear his own voice.
PRESBYCUSIS
LESS COMMON CAUSE
1. DM2. Renal failure
3. Radiation therapy
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CARING FOR CLIENTS WITH HEARING IMPAIRMENT
1. ELIMINATION OF RISKS FACTORS
a. Cerumen Impactiondue to thinner and drier skinin the ear canal and increased keratin.
b. Ototoxicity due to drugs
b.1 aspirins
b.2 most antibiotics
2. ENVIRONMENTAL MODIFICATIONS
2.1 eliminate background noise.
2.2 enhance your voice
a. No shouting
b. Lowering pitch of voice
c. Moderate volume.
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2.3 Face clients when talking.
2.4 Use of gestures and body language.
2.5 Rephrasing messages.
2.6 Use of written communication.
3. Use of hearing aids3.1 Initially; Aid should be worn 15 to 20 minutes daily.
3.2 Gradually increase time until 10-12 hours.
3.3 Inform the client that hearing aid will initially makethem uneasy.
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3.4 Insert aid with canal portion pointing into
ear; press and twist until snug.
3.5 Whistling sound- indicates incorrect ear
mold insertion.
3.6 Turn aid slowly to 1/3 or volume.
3.7 Adjust volume to a level comfortable for
talking at a distance of one yard.
3.8 Concentrate on conversations.
3.9 sit close to speaker.
4.0 Be observant to non-verbal cues.
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4.1 Remove aid when
bathing.
4.2 Dont wear aid under
heat lamps or hair dryer
or in very wet, cold
weather.
4.3 Be patient and realize
the process of adaptation
is difficult but ultimatelyrewarding.
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