CH 23: Vision and Hearing

Question 1

effects of aging on vision

Answer 1

• Reduced elasticity and stiffening of muscle fibers in lens  decreased ability to focus  presbyopia  increased use of corrective lenses
• Reduced pupil size, opacification of lens and vitreous, loss of photoreceptor cells in retina  decline in visual acuity
• Light perception threshold decreases  difficult with vision at night
• Cataract formation  Sensitivity to glare
• Cells in retina are less sensitive distorting blue and green tones
• Smaller visual fields  reduced peripheral vision
• Decreased tear production  dry eyes
• Changes in depth perception  ability to judge height of walking surfaces challenging
• Impaired communication  changes in vision
• Increase prevalence of blindness (diabetes, catiracs, macular)

Question 2

older adults less likely to see things up close

Answer 2

presbiopia

Question 3

effects of aging on hearing

Answer 3

Sensorineural hearing loss (presbycusis)  decreased ability to hear s, sh, f, ph, and w & inaudible speech
Impacted cerumen  decreased hearing
Decreased hearing  impaired communication and social isolation

Question 4

conductive hearing loss

Answer 4

something blocking hearing on the outside
- wax
-

Question 5

sensoneuronal

Answer 5

something from the brain causing hearing loss
- tumors
-ototoxicity

Question 6

age related hearing loss

Answer 6

presbycusis

Question 7

how to promote vision with older adults

Answer 7

• Significant issues should be recognized early to prevent visual damage
• Routine, thorough annual eye exams
• Nurse can assess financial ability to afford visual care items
• Prompt evaluation for significant problems
• Ensure diet of vit A,B,C,E; zinc, flavonoid**
• Manage diseases causing vision issues (diabetes and hypertension)
• Implement techniques to maximize sensory functioning

Question 8

how to promote hearing with older adults

Answer 8

• start teaching them early in life
  Good care of ears throughout life
• Prevention of trauma to ear
• Prompt treatment for ear infections
• Regular audiometric exams
• Protect exposure from loud noise using ear-plugs or sound-reducing devices
  Cerumen removal via irrigation - positioning, warm water
• avoid cotton tip applicators and their friends
• fall precautions for potential
• assistance for irrigation
• don’t continuously irrigate - perforation of eardrum
• implement techniques to maximize sensory functioning**

Question 9

clouding of the lens from calcium deposits
leading cause of low vision in older adults

Answer 9

cataract

Question 10

clear sign of cataracts**

Answer 10

blurred vision

Question 11

causes of cataracts

Answer 11

exposure of UVB-B light, diabetes, cigarettes, alcohol use, eye injury

Question 12

S/S of cataracts

Answer 12

no pain, decreased night vision, glare from sunlight, nuclear sclerosis (lens becomes yellow or yellow-brown), pupil changes to cloudy white, increased nearsightedness

Question 13

ONLY treatment for cataracts**

Answer 13

surgery is the only cure
only one eye at a time (4-6 wks recovery)

Question 14

increased intraocular pressure
second leading cause of blindness

Answer 14

glaucoma

Question 15

demographics for glaucoma

Answer 15

Increases in prevalence with age,
ethnicity (African Americans and Hispanic/Latino), endocrine imbalance (diabetes)
family history
anticholinergic meds - increase intraocular

Question 16

acute glaucoma vs chronic glaucoma

Answer 16

acute (narrow-angle)
- more severe
- vision loss in hours - EMERGENT
- eye pain
- N/V/HA/eyebrow pain**
- usually from trauma
- IOP: >30
- treatment: mannitol
chronic (open angle)
- no pain**
- loss of peripheral vision**
- more gradual
- IOP: 20s
- treatment: prostaglandins, sx

Question 17

normal intraocular pressure

Answer 17

10-20

Question 18

activities to avoid to prevent glaucoma

Answer 18

• sneezing/ coughing
  -bending over
• heavy lifting

Question 19

nursing considerations for glaucoma

Answer 19

Avoid activities that increase IOP
Wear a medical alert bracelet
Barriers to treatment leading to lack of adherence
Vision loss cannot be restored
Periodic ophthalmologist eval

Question 20

tonometry testing

Answer 20

air test for IOP

Question 21

Most common cause of blindness >65 years old
Damage of macula  Central vision loss

Answer 21

macular degeneration = central vision

Question 22

interventions for macular degeneration

Answer 22

use of magnifying glasses, reading lamps, and other aids

Question 23

s of macular degeneration

Answer 23

whole in the vision

Question 24

Forward displacement of retina from its normal position

Answer 24

detached retina

Question 25

s of detached retina

Answer 25

floating spots curtain over the eye

Question 26

treatment for detached retina

Answer 26

bedrest, bilateral eye patches, prompt treatment, frequent checks, safety precautions; surgery

Question 27

Inflammation of the cornea; caused by febrile states, irritation, dietary deficiencies, CVA, lowered resistance

Answer 27

corneal ulcer

Question 28

causes of corneal ulcers

Answer 28

bloodshot eye, increased lacrimation, photophobia tears

Question 29

treatment of corneal ulcers

Answer 29

Early care with cycloplegics (resting the eye) sedatives, antibiotics, and heat; sunglasses, treat underlying cause (foreign body, abrasion, infection)

Question 30

measures to compensate for visual deficits

Answer 30

- Face the person when speaking - With glaucoma, come to the person from the front - Exaggerate facial expressions and gestures - Use several soft indirect lights instead of one - Avoid glare from windows using sheer curtains/stained windows - Use large print reading material - Place frequently used items in the visual field - Avoid low-tone colors and use bright-toned colors - Use contrasting, bold colors - Identify personal belongings differently

Question 31

hearing deficits and older adults

Answer 31

very common NOT a normal part of aging - underlying cause higher incidence in MEN with loud occupations tinnitus

Question 32

causes of hearing deficits

Answer 32

ototoxic drugs (aspirin, ibuprofen, naproxen, Lasix, -mycins)** diseases otosclerosis vascular problems viral infections otitis media neoplasms cysts cerumen - ear wax dermatoses exposure to loud noise

Question 33

nursing considerations for hearing problems

Answer 33

- Audiometric examination - Prepare for anger, frustration, impatience, confusion during conversation, inappropriate reactions, social isolation, limited ability to hear danger  help with coping strategies - Place near nurses’ station - - Provide education in written form - NEVER purchase a hearing aid without consulting an otologist - Hearing aids

Question 34

use of hearing aids

Answer 34

- Help to improve, not restore hearing to normal level - Speech is amplified and all environmental noise - Checked regularly - Hearing aid care - Connect with hearing and speech associations

Question 35

general nursing considerations for vision and hearing loss

Answer 35

Stimulate all senses during routine daily activities Face the individual while speaking and exaggerate gestures and facial expressions For peripheral vision loss, approach them from the front rater the side Ample lighting Use large print games, playing cards, and telephone dials

Question 36

nursing considerations for high-frequency hearing loss

Answer 36

high: talk slowly, distinctly low-frequency voice; raising the voice/shouting can raise frequency and make hearing worse

Question 37

how to improve communication with loss of hearing/vision

Answer 37

Talk into the less impaired ear face the individual when talking use visual speech (sign language) allow person to lip read use a stethoscope use flashcards and communication boards