Care of the Older Person With Vision and Hearing Problems September 21, 2012

8/13/2019 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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Documents

Care of the Older Person With Vision and Hearing Problems September 21, 2012