Sensation: Hearing, Vision, Taste, Touch, and Smell 14 Lecture Note PowerPoint Presentation.

Sensation: Hearing, Vision, Taste, Touch, and Smell

14Lecture Note PowerPoint Presentation

Gerontological Nursing, Second EditionPatricia A. Tabloski

LEARNING OUTCOME 1Explain normal changes associated with the aging process on the five senses—vision, hearing, taste,

smell, and touch.


AGING-RELATED SENSORY CHANGES

Smell Hearing Taste Touch Vision


TABLE 14-1AGE-RELATED CHANGES IN THE EYE AND NURSING IMPLICATIONS


OTHER RESULTS OF SENSORY DYSFUNCTION

Functional impairment Injury Social isolation Depression


NORMAL AGE-RELATED CHANGES IN VISION

Typically gradual Limit functional ability External changes Internal changes Visual acuity Light sensitivity


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



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)



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


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)


AGING-RELATED HEARING CHANGES

External ear Auricle wrinkles and droop Cerumen

Becomes dryer Accumulates in ear canal


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


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


AGING-RELATED CHANGES TO SENSE OF SMELL Affects 50% of adults over age 60 May be attributed to

Injury of olfactory mucosaReduction in sensory cellsReduction in neurotransmittersStructural 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


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


LEARNING OUTCOME 2List common nursing diagnoses of older persons

related to sensory problems.


PRIMARY CAUSES OF VISUAL IMPAIRMENT

Cataracts Macular degeneration Glaucoma Diabetic retinopathy


VISUAL IMPAIRMENT

Typically classified as vision < 20/20 Increases with aging


BLINDNESS

Defined as visual acuity of 20/200 by Snellen chart

Increases with age Peaks at age 85


IMPACTS OF VISUAL IMPAIRMENTS

Loss of independence Social isolation Depression Reduced quality of life


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


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


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


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



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


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


CATARACTS

Manifestations Blurry vision Glare Halos around objects Double vision Difficulty sensing contrasting colors Poor night vision


CATARACTS Risk factors

Increased age Smoking Alcohol use Diabetes Hyperlipidemia Eye trauma Exposure to the sun and UVB rays Long-term corticosteroid medications Caucasian


GLAUCOMA

Caused by an increase in intraocular pressure (IOP) resulting in optic nerve damage and vision loss

2nd most common cause of vision loss


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


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


GLAUCOMA

Types Angle-closure

Results from a sudden infection or trauma Manifestations

Unilateral headache Visual blurring Nausea Vomiting Photophobia


GLAUCOMA

Risk factors Increased ocular pressure Older than age 60 Family history Personal history of myopia, diabetes,

hypertension, migraines African-American ancestry


DIABETIC RETINOPATHY

Microvascular disease associated with diabetes mellitus

Damage to ocular microvascular system impairing perfusion to the eyes


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


NURSING DIAGNOSES FOR VISION-IMPAIRED 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


NURSING DIAGNOSES FOR VISION-IMPAIRED OLDER PATIENTS

Diagnoses Sensory/perceptual alterations visual

Encompasses a variety of nursing goals and interventions

Communication Safety Mobility Self-care activities Mood assessment


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


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


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


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


FIGURE 14-9STRUCTURE OF THE EAR.


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


HEARING IMPAIRMENTS

Hearing Loss Sensorineural

Assessment History Physical examination Hearing Handicap Inventory for the Elderly (HHIE-S):

The purpose of this scale is to identify the problems your hearing loss

Review reports from family members


HEARING IMPAIRMENTS

Hearing Loss Tinnitus (ringing in the ears)

Categories Objective

Hearing of pustatile sounds caused by turbulent blood flow within the ear


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


NURSING DIAGNOSES ASSOCIATED WITH HEARING IMPAIRMENT

Assess and evaluate abilities Activities of daily living

Communication Travel Safety awareness Leisure and recreational activities


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


TASTE

Contributing factors to taste alterations Oral conditions

Poor dentition Improperly fitting dentures Infections

Olfactory function Medications Diseases Surgical interventions


TASTE

Focused assessment for taste disturbances Head and neck Mucous membranes Review past dietary habits

Education


XEROSTOMIA (DRY MOUTH)

Results from salivary gland dysfunction Potential causes

Systemic diseases Radiation


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



Implications Altered taste Dysphagia

Risk of aspiration Periodontal disease

Dental caries Gingivitis Oral lesions



Implications Speech difficulties

Embarrassment Social isolation

Dry lips and mucosa Increased infections Dental caries

Halitosis Sleeping problems


NURSING DIAGNOSES ASSOCIATED WITH TASTE IMPAIRMENT

Sensory/Perceptual Alterations: Gustatory .(ذوقي)

Intake less than necessary for caloric requirements


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


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


OLFACTORY DYSFUNCTION

Potential causes Medications

Anesthetics Antihypertensives Antibiotics Opiates Antidepressants Sympathomimetics Cocaine hydrochloride Diltiazem, nifedipine


OLFACTORY DYSFUNCTION Potential causes

Medications Streptomycin Codeine, hydromorphone, morphine Amitriptyline Amphetamines Antihistamines Chemicals and pesticides

Current or past cocaine or tobacco use Poor dentition


NURSING DIAGNOSES ASSOCIATED WITH HYPOSMIA

Sensory/Perceptual Alterations: Olfactory


NURSING DIAGNOSIS FOR CHANGES IN PHYSICAL SENSATIONS

Sensory/Perceptual Alterations: Tactile


LEARNING OUTCOME 3Recognize nursing interventions that can be implemented to assist the aging patient with

sensory changes.


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


VISION ASSESSMENT

Observe appearance Clothing cleanliness Self-care Indications of bumps and bruises


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


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


PATIENT INTERVIEW

Vision Snellen chart Visual field testing

Extraocular movements


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


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


VISUAL DIFFICULTIES MAY LIMIT INDEPENDENCE

Interference with driving Difficulty reading and writing Problems with ADLs


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


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


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


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



Preventive measures UV protective lenses in sunlight Smoking cessation Regular exercise Zinc High-dose antioxidants

Vitamin C Vitamin E Beta-carotene


EDUCATION AND CARE OF OLDER PATIENTS WITH CATARACTS

Cause Symptoms Prevention

Wearing hats and sunglasses Smoking cessation Low-fat diet Avoid ocular injury



Treatment and management Will require additional light when reading Repeated adjustments in corrective lens

prescriptions



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




Postoperative education Signs and symptoms to report

Pain Conjunctival infection Vision loss Sparks and floaters in visual field Nausea, vomiting, or excessive coughing




Postoperative education Patients should avoid

Lifting heavy objects Straining at stool Bending at the waist



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


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


ADMINISTRATION OF EYE MEDICATIONS

Allow for complete absorption between doses Blot any excessive medication from patient’s

face Wash hands Document


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


MANAGEMENT OF PATIENTS WITH DIABETES

Proper nutrition Low-carbohydrate diet Low-cholesterol diet

Exercise Monitoring glucose


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


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


HEARING AIDS Documentation on admission

Type Model number Serial number Assessment

Integrity of ear mold Battery Dials Switches Tubing behind the ears


HEARING AIDS

Care Remove at bedtime Clean with warm water or saline No alcohol or harsh soaps Use cotton pad Remove cerumen carefully


HEARING AIDS

Other devices Cochlear implants Assistive listening devices

Amplifiers Telephone device for the deaf (TDD)


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


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


NURSING INTERVENTIONS WHEN SPEAKING WITH HEARING IMPAIRED PATIENTS Use gestures as needed Use written communication as needed Assess patient’s comprehension of

interaction


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


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


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



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


NEED FOR TOUCH

Tactile sense of interpretation Environmental orientation Psychological benefits

Comfort Love

Communication Protective by stimulating withdrawal


TACTILE IMPAIRMENT

Monitor for intactness of skin Assessment of safety risks Development of a safety plan


LEARNING OUTCOME 4Identify medications that may cause or aggravate

sensory dysfunction.


MEDICATIONS WITH SIDE EFFECTS OF VISUAL DISTURBANCES

Hydroxychloroquine (Plaquenil): retinopathy, blurred vision, and difficulty focusing

Tamoxifen (Nolvadex): decreased visual acuity and blurred vision


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


OPHTHALMIC SOLUTIONS WITH POTENTIAL ADVERSE EFFECTS

Beta-blockers (Betagan, Timoptic, Ocupress) Bradycardia Congestive heart failure Syncope Bronchospasm Depression Confusion Sexual dysfunction



Adrenergics (Lopidine, Alphagan, Epinal) Palpitation Hypertension Tremor Sweating



Miotics/cholinesterase inhibitors (philocarpine, Humorsol) Bronchospasm Salivation Nausea, vomiting, diarrhea Abdominal pain Lacrimation



Carbonic anhydrase inhibitors (Trusopt, Azopt) Fatigue Renal failure Hypokalemia Diarrhea Depression COPD Exacerbation



Prostaglandin analogues (Xalatan, Lumigan) Changes in eye color and periorbital tissues Itching


DRUGS WITH RISK OF HEARING CHANGES

Aminoglycoside antibiotics (gentamycin) Antineiplastics (cisplatinum) Loop diuretics (furosemide) Baclofen Propranolol (Inderal)


POTENTIAL PHARMACOLOGICAL IMPACT ON TASTE

Alteration in peripheral receptors Alteration in chemosensory pathways

Sensation: Hearing, Vision, Taste, Touch, and Smell 14 Lecture Note PowerPoint Presentation.

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