421 Sensory - Professor Quay PDF

Preview

Summary

Professor Quay...

Description

Sensation, Hearing, Vision, Taste, Touch, and Smell Introduction  Changes in vision, hearing, smell, taste, and touch occur naturally throughout the aging process.  Impairments in sensory functioning can greatly alter the capabilities of older adults to complete everyday activities, affecting quality of life and safety.  Older adults with sensory dysfunction may suffer functional impairment, injury, social isolation, and depression. Vision  Visual impairment - is defined as visual acuity of 20/40.  Legal blindness or severe visual impairment is 20/200 or more.  Older patients should be questioned regarding o adequacy of vison o recent changes in vision o visual problems o date of their last complete visual examination. Normal Changes of Aging  Graying and thinning of the eyebrows and eyelashes  Wrinkling of the skin surrounding the eyes  Eyes appear sunken  Eyelids sag  Thinning of the skin surrounding the eyes  Arcus Senilis

Age Related Changes and Functional Impications  Thickening of the lens o Causes light to scatter, reduces space for aqueous humor to drain  Increased opacity & yellowing of the lens o Interferes with color discrimination  Hardening and decreased pliability of the lens o Impaired accommodation, Presbyopia- decrease in near vision (someone putting the paper away from their face)  Decreased pupil diameter o Less light reaching the retina  Night driving, cooking, nocturia, risk for falls and injuries  Takes longer to adapt to the change of light  Delayed pupillary reaction o Difficulty adapting to changes in light  Increased light sensitivity o More sensitive to glare  Decrease in production of tears  Overall- gradual decrease in acuity and depth perception o Will impact communication

Vision  The nurse should inspect the eyes for any abnormalities. o Movement of the eyelids o Abnormal discharge o Excessive tearing o Abnormally colored sclera o Abnormal or absent pupillary response Risk for Injury  Falls- Falls are leading cause of accidental death in older adults  Home safety  Medication Safety  Driving – if there is an impairment, make sure you are talking with family, realize and be sensitive when talking about no more driving Preventing Risks & Injuries  Home Safety o Provide adequate lighting in high-traffic areas o Recommend motion sensors to turn on lights when an older person walks into a room o Use proper lampshades to prevent glare. Use shears on windows o Use contrast when choosing paint colors so that the older person can easily discriminate between walls, floors, and other structural elements of the environment o Avoid reflective floors o No throw rugs o Use supplementary lamps near work and reading areas. o Use red-colored tape or paint on the edges of stairs and in entryways to provide warning and signal the need to step up or down. o Avoid complicated rug patterns that may overwhelm the eye and obscure steps and ledges.  Medication Safety o Use of pill organizers o Large print labels  Driving Safety o Eye exams, discuss with provider Causes of Visual Impairment in Older Adults  Visual impairment and blindness in the older person is often the result of four main causes:  Cataracts  Age-related macular degeneration (ARMD)  Glaucoma  Diabetic retinopathy

Cataracts     

Leading cause of blindness in the world. Development is slow and painless May be unilateral or bilateral. Opacities of the lenses Decrease the amount of light able to reach the retina, inhibits vision.

A. Simulation of vision with cataracts

Symptoms  Blurry vision  Glare  Halos around objects  Double vision  Difficulty seeing contrasting colors  Poor night vision Cataract: Risk Factors  Increased age  Smoking and alcohol  Obesity  Diabetes, hyperlipidemia, hypertension  Trauma to the eye or history of previous eye surgery  Exposure to the sun and UVB rays  Long-term corticosteroid medications  Caucasian race Treatment for Cataracts  Surgery is the treatment of choice – they remove the lens and do a lens implant  No medication to treat cataracts  Corrective lenses may be affective in the early phases  Patient education and support  avoid ocular pressure (bending over, sneezing, coughing etc)  Implement preventive measures

Age Related Macular Degeneration  





Leading cause of blindness in adults over the age of 65. ARMD o degenerative disorder of the macula o affects both central vision (scotoma) and visual acuity o Two forms ARMD: Dry and Wet Dry – most common o atrophy, retinal pigment degeneration, and drusen accumulations o most common form of ARMD. o GRUADUAL, CHRONIC Wet – or neovascular exudate ARMD o blood or serum leaks from newly formed blood vessels beneath the retina. o Straight lines appear crooked or wavy. o ACUTE, EMERGENCY SITUTAION

ARMD: Risk Factors  Age above 50  Cigarette smoking  Family history of ARMD  Increased exposure to ultraviolet light  Caucasian race and light-colored eyes  Hypertension or cardiovascular disease  Lack of dietary intake of antioxidants and zinc o Consuming high doses of antioxidants (vitamins C and E and Beta-carotene) and zinc. May decrease the risk by 25%. Treatment for ARMD  Dry ARMD – currently, there is no treatment o Educate on nutrition, protecting eye from sun, coping (how are we helping adapt to decrease in vision), safety measures o STOP SMOKiNG – cause vasoconstriction and cause the disease to be progressive  Wet ARMD treatment includes: o Laser therapy – repair leaking vessels that’s causing the damage o Photodynamic therapy o Injections

Glaucoma     

Result of optic nerve damage Due to an increase in IOP (intraocular pressure) Loss of peripheral vision first – EXTREMELY GRADUAL, DON’T KNOW UNTIL ITS ADVANCE Leads to vision loss Second most common cause of blindness in US

Open – Angle Glaucoma  CHRONIC  Drainage of aqueous humor is slowed  Fluid builds up, increases IOP  Results in peripheral vision loss.  POOR VISION IN DIM LIGHT, MORE SENSITVE TO GLARE Angle-Closure Glaucoma  ACUTE AND SUDDEN  Angle of the iris obstructs drainage of the aqueous humor o Structural change  May occur suddenly  Symptoms include unilateral headache, visual blurring, nausea, vomiting and photophobia  Uncommon & Urgent  COMPAIN OF EYE PAIN AND HEADACHE Simulated glaucoma vision

Glaucoma: Risk Factors  Increased intraocular pressure  Older than 60 years of age, especially those of Mexican-American heritage  Family history of glaucoma  Personal history of myopia, diabetes, hypertension, and migraines  African Americans over the age of 40 – want them to receive eye exams at a younger age Symptoms patients may experience with glaucoma  Symptoms often not reported until advanced stages of the disease.  Monitoring the IOP during routine ophthalmic examinations and the above risk factors is key for prevention of glaucoma.  Patients over the age of 65 should be examined and screened for glaucoma at least every 1 to 2 years.  Intraocular pressure should remain below 20mmHg. Treatment for glaucoma  Managing glaucoma involves lowering the IOP – must take these meds everyday for rest of life o Pt with glaucoma cant not take anticholinergic meds, Benadryl acts as an anticholinergic  Medications (oral or topical): o Beta-Blockers (Betagan, Timoptic, Ocupress). o Adverse effects: bradycardia, congestive heart failure, syncope, bronchospasm, depression, confusion, and sexual dysfunction o Andrenergics, Miotics/cholinesterase inhibitors – helps with the outflow of the drainage o Carbonic anhydrase inhibitors and Prostaglandin analogues  Surgery – a small opening is made at the base of the iris (iridotomy) to allow the IOP to equalize on either side and prevent the iris from obstructing the outflow channel.

Administration of Eye Drops  Hygiene, gloves  Have older adult tip head backwards and look upwards.  Pull lower lid down slighty  Place drop into the eyelid pouch, not directly on eye  Do not contaminate eye dropper  Wait 3-5 minutes before additional drops are placed in the same eye  Provide patient with a tissue  Educate patient, must always administer eye drops. Should not miss doses.

Diabetic Retinopathy  

Diabetic retinopathy – is a microvascular disease of the eye occurring in both type 1 and type 2 diabetes. Damage to the ocular microvascular system impairs the transportation of oxygen and nutrients to the eye (Huether & McCace, 2012).

Diabetic Retinopathy  Prevention of diabetic retinopathy is dependent on tight glycemic control and managing hypertension and hyperlipidemia.  Goals of treatment for the older person include: o Maintaining an average preprandial blood glucose of 80 to 120 mg/dl o Hemoglobin (HbA1c) of less than 7 o Treatment includes: laser therapy or panretinal laser photocoagulation (PRP) to repair leaking microaneurysms. Does not reverse vision loss. o Refer for ophthalmic examinations after diagnosis of diabetes Hearing  Approximately 30% over age 65 and 40% to 50% over age 75 have hearing loss (American SpeechLanguage-Hearing Association [ASLH], 2012).  Hearing loss can interfere with o Communication o Enjoyment of certain forms of entertainment o Safety o Social interactions o Independence.

Age Related Changes with Hearing Loss  Auricle tends to wrinkle and sag.  Cerumen or earwax buildup is a normal finding.  Decreased activity of apocrine glands o Drier and harder cerumen o Cerumen impaction common  Bilateral hearing loss(sensorineural) in many individuals starting as early as age 20 to 30  Appearing more commonly in the 50s and 60s. Types of Hearing Loss  Conductive hearing loss – is related to a problem in the external or middle ear canal, typmpanic membrane, bones in the outer and middle ear, or the ossicles (NORMAL)  Causes o external ear infection (otitis externa) o impacted cerumen o middle ear infection (otitis media) o perforation of the tympanic membrane o foreign bodies  reversible when it is related to cerumen build up  visually assess the ear canal Types of Hearing Loss  Sensorineural hearing loss – is a manifestation of problems within the inner ear.  Sound is transmitted to the inner ear, but problems with the cochlea and auditory nerve (eighth cranial nerve) create sound distortion. (AGE RELATED LOSS, NOT REVERSIBLE_  Causes o Presbycusis  Age related hearing loss o Presbycusis affects approximately 75% of people over the age of 60. o Occurs gradually and is usually bilateral, impairing the ability to hear high-pitched tones. o Damage due to excessive noise exposure, Meniere’s disease, tumors, and infections (ASLH, 2012).  Asymptomatic adults should be screened every 10 years until the age of 50 and then every 3 years with an audiometric battery test (The American Speech Language Hearing Association, 2012).

 

Loss high pitch tone Also diminished in differentiating speech

Hearing Loss: Risk Factors  Long-term exposure to excessive noise  Impacted cerumen (earwax)  Ototoxic medication – antibiotics (anything that is nephrotoxic is also toxic to the ears) o If u have a problem with one then you have problem with the other  Tumors  Diseases that affect sensorineural hearing  Smoking  Head injury  History of middle ear infection  Chemical exposure (e.g., long duration of exposure to trichloroethylene) Nursing Assessment of the Older Adult with Hearing Loss  A thorough history and physical examination is important to help determine the cause of the hearing loss.  Social history to understand what they have been exposed to – environmental exposure etc  Visual examination of the ear – screening  The whisper, Weber, and Rinne tests can be performed  Hearing aids amplify sounds and deliver them directly into the ear. o Not having them puts them at higher risk for delirium.  Immediately, identify patients wearing hearing aids on admission to the hospital or nursing home

Communication Guidelines  Actively Listen – speak less and listen more. – providing acknowledgement that you’re hearing them o Sit down at bedside  Pay attention to non-verbal’s, comprises 80% of communication.  Be within field of vision and at eye level.  Do not speak too loudly. Use a lower pitch, calm voice. – esp women  Use touch as appropriate.  Ensure that assistive devises are being used (eye glasses, hearing aids).  Provide both verbal and written instructions.  Avoid demeaning terms (sweetie, honey). TASTE

 

  

A diminished sense of taste, or hypogeusia, is a normal sensory change. Taste deficits can result in o weight loss o Malnutrition – not eating as much  Going to impact chronic conditions as well as healing abilities o impaired immunity o worsening of medical illness Assessment of the head, oral cavity and neck should be performed to rule out obvious deformity, injury, infection, or obstruction. Assess mucous membranes for dryness, ulceration, or presence of candidiasis. We can enhance their food by adding: butter, seasoning, herbs, lemon

Smell  Hyposmia may be due to age-related changes or olfactory-nerve damage (atrophy)  Upper respiratory infections, head trauma, inflammatory conditions, and neurodegenerative diseases are the major causes of olfactory damage.  The sense of smell triggers memories and pleasurable experiences  Preparing the food where their eating help stimulate their senses, olfactory nerve Physical Sensation  Tactile sensation diminishes  Slower conduction of nerve impulses and diminished function of peripheral nerves.  Decreased perception of pain, vibration, touch, pressure, and temperature extremes. o Less sensitive to extreme cold or extreme hot  Lack of physical caring touch is associated with diminished quality of life  Touch is associated to emotional and mental well being...