sensation: hearing, vision, taste, touch, and smell 14 lecture note powerpoint presentation
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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.
Gerontological Nursing, Second EditionPatricia A. Tabloski
AGING-RELATED SENSORY CHANGES
Smell Hearing Taste Touch Vision
Gerontological Nursing, Second EditionPatricia A. Tabloski
TABLE 14-1AGE-RELATED CHANGES IN THE EYE AND NURSING IMPLICATIONS
Gerontological Nursing, Second EditionPatricia A. Tabloski
OTHER RESULTS OF SENSORY DYSFUNCTION
Functional impairment Injury Social isolation Depression
Gerontological Nursing, Second EditionPatricia A. Tabloski
NORMAL AGE-RELATED CHANGES IN VISION
Typically gradual Limit functional ability External changes Internal changes Visual acuity Light sensitivity
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
NORMAL AGE-RELATED EYE CHANGES
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)
Gerontological Nursing, Second EditionPatricia A. Tabloski
NORMAL AGE-RELATED EYE CHANGES
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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)
Gerontological Nursing, Second EditionPatricia A. Tabloski
AGING-RELATED HEARING CHANGES
External ear Auricle wrinkles and droop Cerumen
Becomes dryer Accumulates in ear canal
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 2List common nursing diagnoses of older persons
related to sensory problems.
Gerontological Nursing, Second EditionPatricia A. Tabloski
PRIMARY CAUSES OF VISUAL IMPAIRMENT
Cataracts Macular degeneration Glaucoma Diabetic retinopathy
Gerontological Nursing, Second EditionPatricia A. Tabloski
VISUAL IMPAIRMENT
Typically classified as vision < 20/20 Increases with aging
Gerontological Nursing, Second EditionPatricia A. Tabloski
BLINDNESS
Defined as visual acuity of 20/200 by Snellen chart
Increases with age Peaks at age 85
Gerontological Nursing, Second EditionPatricia A. Tabloski
IMPACTS OF VISUAL IMPAIRMENTS
Loss of independence Social isolation Depression Reduced quality of life
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
AGE-RELATED MACULAR DEGENERATION (ARMD)
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
CATARACTS
Manifestations Blurry vision Glare Halos around objects Double vision Difficulty sensing contrasting colors Poor night vision
Gerontological Nursing, Second EditionPatricia A. Tabloski
CATARACTS Risk factors
Increased age Smoking Alcohol use Diabetes Hyperlipidemia Eye trauma Exposure to the sun and UVB rays Long-term corticosteroid medications Caucasian
Gerontological Nursing, Second EditionPatricia A. Tabloski
GLAUCOMA
Caused by an increase in intraocular pressure (IOP) resulting in optic nerve damage and vision loss
2nd most common cause of vision loss
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
GLAUCOMA
Types Angle-closure
Results from a sudden infection or trauma Manifestations
Unilateral headache Visual blurring Nausea Vomiting Photophobia
Gerontological Nursing, Second EditionPatricia A. Tabloski
GLAUCOMA
Risk factors Increased ocular pressure Older than age 60 Family history Personal history of myopia, diabetes,
hypertension, migraines African-American ancestry
Gerontological Nursing, Second EditionPatricia A. Tabloski
DIABETIC RETINOPATHY
Microvascular disease associated with diabetes mellitus
Damage to ocular microvascular system impairing perfusion to the eyes
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
FIGURE 14-9STRUCTURE OF THE EAR.
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
HEARING IMPAIRMENTS
Hearing Loss Tinnitus (ringing in the ears)
Categories Objective
Hearing of pustatile sounds caused by turbulent blood flow within the ear
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
NURSING DIAGNOSES ASSOCIATED WITH HEARING IMPAIRMENT
Assess and evaluate abilities Activities of daily living
Communication Travel Safety awareness Leisure and recreational activities
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
TASTE
Contributing factors to taste alterations Oral conditions
Poor dentition Improperly fitting dentures Infections
Olfactory function Medications Diseases Surgical interventions
Gerontological Nursing, Second EditionPatricia A. Tabloski
TASTE
Focused assessment for taste disturbances Head and neck Mucous membranes Review past dietary habits
Education
Gerontological Nursing, Second EditionPatricia A. Tabloski
XEROSTOMIA (DRY MOUTH)
Results from salivary gland dysfunction Potential causes
Systemic diseases Radiation
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
XEROSTOMIA (DRY MOUTH)
Implications Altered taste Dysphagia
Risk of aspiration Periodontal disease
Dental caries Gingivitis Oral lesions
Gerontological Nursing, Second EditionPatricia A. Tabloski
XEROSTOMIA (DRY MOUTH)
Implications Speech difficulties
Embarrassment Social isolation
Dry lips and mucosa Increased infections Dental caries
Halitosis Sleeping problems
Gerontological Nursing, Second EditionPatricia A. Tabloski
NURSING DIAGNOSES ASSOCIATED WITH TASTE IMPAIRMENT
Sensory/Perceptual Alterations: Gustatory .(ذوقي)
Intake less than necessary for caloric requirements
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
OLFACTORY DYSFUNCTION
Potential causes Medications
Anesthetics Antihypertensives Antibiotics Opiates Antidepressants Sympathomimetics Cocaine hydrochloride Diltiazem, nifedipine
Gerontological Nursing, Second EditionPatricia A. Tabloski
OLFACTORY DYSFUNCTION Potential causes
Medications Streptomycin Codeine, hydromorphone, morphine Amitriptyline Amphetamines Antihistamines Chemicals and pesticides
Current or past cocaine or tobacco use Poor dentition
Gerontological Nursing, Second EditionPatricia A. Tabloski
NURSING DIAGNOSES ASSOCIATED WITH HYPOSMIA
Sensory/Perceptual Alterations: Olfactory
Gerontological Nursing, Second EditionPatricia A. Tabloski
NURSING DIAGNOSIS FOR CHANGES IN PHYSICAL SENSATIONS
Sensory/Perceptual Alterations: Tactile
Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 3Recognize nursing interventions that can be implemented to assist the aging patient with
sensory changes.
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
VISION ASSESSMENT
Observe appearance Clothing cleanliness Self-care Indications of bumps and bruises
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
PATIENT INTERVIEW
Vision Snellen chart Visual field testing
Extraocular movements
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
VISUAL DIFFICULTIES MAY LIMIT INDEPENDENCE
Interference with driving Difficulty reading and writing Problems with ADLs
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
AGE-RELATED MACULAR DEGENERATION (ARMD)
Preventive measures UV protective lenses in sunlight Smoking cessation Regular exercise Zinc High-dose antioxidants
Vitamin C Vitamin E Beta-carotene
Gerontological Nursing, Second EditionPatricia A. Tabloski
EDUCATION AND CARE OF OLDER PATIENTS WITH CATARACTS
Cause Symptoms Prevention
Wearing hats and sunglasses Smoking cessation Low-fat diet Avoid ocular injury
Gerontological Nursing, Second EditionPatricia A. Tabloski
EDUCATION AND CARE OF OLDER PATIENTS WITH CATARACTS
Treatment and management Will require additional light when reading Repeated adjustments in corrective lens
prescriptions
Gerontological Nursing, Second EditionPatricia A. Tabloski
EDUCATION AND CARE OF OLDER PATIENTS WITH CATARACTS
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
EDUCATION AND CARE OF OLDER PATIENTS WITH CATARACTS
Treatment and management Surgery
Postoperative education Signs and symptoms to report
Pain Conjunctival infection Vision loss Sparks and floaters in visual field Nausea, vomiting, or excessive coughing
Gerontological Nursing, Second EditionPatricia A. Tabloski
EDUCATION AND CARE OF OLDER PATIENTS WITH CATARACTS
Treatment and management Surgery
Postoperative education Patients should avoid
Lifting heavy objects Straining at stool Bending at the waist
Gerontological Nursing, Second EditionPatricia A. Tabloski
EDUCATION AND CARE OF OLDER PATIENTS WITH CATARACTS
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
ADMINISTRATION OF EYE MEDICATIONS
Allow for complete absorption between doses Blot any excessive medication from patient’s
face Wash hands Document
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
MANAGEMENT OF PATIENTS WITH DIABETES
Proper nutrition Low-carbohydrate diet Low-cholesterol diet
Exercise Monitoring glucose
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
HEARING AIDS Documentation on admission
Type Model number Serial number Assessment
Integrity of ear mold Battery Dials Switches Tubing behind the ears
Gerontological Nursing, Second EditionPatricia A. Tabloski
HEARING AIDS
Care Remove at bedtime Clean with warm water or saline No alcohol or harsh soaps Use cotton pad Remove cerumen carefully
Gerontological Nursing, Second EditionPatricia A. Tabloski
HEARING AIDS
Other devices Cochlear implants Assistive listening devices
Amplifiers Telephone device for the deaf (TDD)
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
NURSING INTERVENTIONS WHEN SPEAKING WITH HEARING IMPAIRED PATIENTS Use gestures as needed Use written communication as needed Assess patient’s comprehension of
interaction
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
XEROSTOMIA (DRY MOUTH)
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
NEED FOR TOUCH
Tactile sense of interpretation Environmental orientation Psychological benefits
Comfort Love
Communication Protective by stimulating withdrawal
Gerontological Nursing, Second EditionPatricia A. Tabloski
TACTILE IMPAIRMENT
Monitor for intactness of skin Assessment of safety risks Development of a safety plan
Gerontological Nursing, Second EditionPatricia A. Tabloski
LEARNING OUTCOME 4Identify medications that may cause or aggravate
sensory dysfunction.
Gerontological Nursing, Second EditionPatricia A. Tabloski
MEDICATIONS WITH SIDE EFFECTS OF VISUAL DISTURBANCES
Hydroxychloroquine (Plaquenil): retinopathy, blurred vision, and difficulty focusing
Tamoxifen (Nolvadex): decreased visual acuity and blurred vision
Gerontological Nursing, Second EditionPatricia A. Tabloski
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
Gerontological Nursing, Second EditionPatricia A. Tabloski
OPHTHALMIC SOLUTIONS WITH POTENTIAL ADVERSE EFFECTS
Beta-blockers (Betagan, Timoptic, Ocupress) Bradycardia Congestive heart failure Syncope Bronchospasm Depression Confusion Sexual dysfunction
Gerontological Nursing, Second EditionPatricia A. Tabloski
OPHTHALMIC SOLUTIONS WITH POTENTIAL ADVERSE EFFECTS
Adrenergics (Lopidine, Alphagan, Epinal) Palpitation Hypertension Tremor Sweating
Gerontological Nursing, Second EditionPatricia A. Tabloski
OPHTHALMIC SOLUTIONS WITH POTENTIAL ADVERSE EFFECTS
Miotics/cholinesterase inhibitors (philocarpine, Humorsol) Bronchospasm Salivation Nausea, vomiting, diarrhea Abdominal pain Lacrimation
Gerontological Nursing, Second EditionPatricia A. Tabloski
OPHTHALMIC SOLUTIONS WITH POTENTIAL ADVERSE EFFECTS
Carbonic anhydrase inhibitors (Trusopt, Azopt) Fatigue Renal failure Hypokalemia Diarrhea Depression COPD Exacerbation
Gerontological Nursing, Second EditionPatricia A. Tabloski
OPHTHALMIC SOLUTIONS WITH POTENTIAL ADVERSE EFFECTS
Prostaglandin analogues (Xalatan, Lumigan) Changes in eye color and periorbital tissues Itching
Gerontological Nursing, Second EditionPatricia A. Tabloski
DRUGS WITH RISK OF HEARING CHANGES
Aminoglycoside antibiotics (gentamycin) Antineiplastics (cisplatinum) Loop diuretics (furosemide) Baclofen Propranolol (Inderal)
Gerontological Nursing, Second EditionPatricia A. Tabloski
POTENTIAL PHARMACOLOGICAL IMPACT ON TASTE
Alteration in peripheral receptors Alteration in chemosensory pathways