What are thefour major diseases that frequently cause impaired vision in Americans age 40and over?
- Age-related macular degeneration
- diabetic retinopathy.
What happenswhen someone has a sensory deficit?
- Pts not able to receive light and sound
- Have blurred vision from cataracts
- Abnormaltaste sensation from xerostomia
What doessudden sensory loss due to an injury or side effect to medication cause?
Fear, anger, feelings of helplessness
Why is sensoryloss dangerous?
Pts safety is threatened b/c the person isunable to respond normally to stimuli
Example of sensory compensation?
Pt who is blind often develops an acute sense ofhearing.
Name somefactors that influence sensory function and how they influence sensoryfunction.
Adults ages40-50. How does this age group influence sensory function?
- Cornea becomes flatter and thicker
- Leads to astigmatism
- Pigment is lost from iris
- Collagen fibers build in the anterior chamberincreasing
- risk of glaucoma
Older Adults.How does this age group influence sensory function?
Decreased hearing acuity, speechintelligibility, and pitch discrimination.. referred to as presbycusis
Low-pitched sounds easiest to hear Difficult to hear conversation over backgroundnoises Difficult to discriminate consonants (f, z, s,th, ch, p, k, t, and g)
Visual changes include reduced visual fields,increased glare sensitivity, impaired night vision, reduced accommodation,reduced depth perception, and reduced color discrimination, due to pupils inolder adult take longer to dilate and constrict secondary to weaker irismuscles.
Color vision decreases because the retina isduller and the lens yellows
Olfactory changes begin around 50 Reduced sensitivity to odors
Small decrease in the number of taste cellsaround 60
Reduced sour, salty, and bitter tastediscrimination
Ability to detect sweet tastes seems to remainin tact
Proprioceptive changes in some older adultsinclude an increased difficulty with balance, spatial orientation, andcoordination.
Cannot avoid obstacles as quickly nor prevent anaccident that may harm them when fast action is necessary
Sometimes experience tactile changes- decliningsensitivity to pain, pressure, and temperature secondary to peripheral vasculardisease and neuropathies.
Medications.How do medications influence sensory function?
Ototoxic meds like analgesics, antibiotics,& diuretics, affect hearing acuity, balance, or both, most common symptombeing tinnitus (ringing in the ears)
Ototoxicity causes a progressive or continuinghearing loss that in many pts goes unnoticed
Hearing loss not always permanent
Pts w/ renal failure have an increasedsensitivity to ototoxic drugs
Environment.How does environment influence sensory function?
Excessive environmental stimuli result insensory overload, marked by confusion, disorientation, and inability to makedecisions
Restricted environmental stimulation leads tosensory deprivation
Poor quality of environment worsens sensoryimpairment.
PreexistingIllnesses. How do illnesses influence sensory function?
Peripheral vascular disease causes reducedsensation in the extremities and impaired cognition
Diabetes often causes reduced vision or blindnessor peripheral neuropathy
Some neurological disorders such as stroke impair sensory reception.
Smoking. Howdoes smoking influence sensory function?
Chronic tobacco use atrophies the taste buds andaffects olfactory function.
Noise Levels.How do noise levels influence sensory function?
Constant exposure to high noise levels causeshearing loss
What doespresbyopia cause?
Reduces ability to see near objects clearly
What do cataractscause?
Usually develop gradually and result in cloudyor blurry vision, glare, and poor night vision.
What does dry eyescause?
Itching, burning, possible reduced vision
What does glaucomacause?
Slowly progresses, at first vision stays normalw/ no pain, if untreated…will be loss of peripheral (side vision), andstraight-ahead vision may decrease until no vision remains.
What does diabeticretinopathy cause?
Hemorrhage, macular edema, reduced vision, orvision loss
What is age related macular degeneration?
Occurs when macula degenerates as a result ofaging and loses its ability to function efficiently. Early sign includesdistortion that causes edges or lines to appear wavy. Later stages pts may seedark or empty spaces that block center of vision.
What is presbycusis?
A common progressive hearing disorder in older adults
What is cerumen accumulation?
Buildup and hardening of earwax in the externalauditory canal causing conduction deafness
Explain dizzinessand disequilibrium?
Common condition in older adulthood, usually resulting from vestibular dysfunction and precipitated by change in position ofthe head to the rest of the body
Explain Meniere’s disease?
Cause is unknown but diagnosis is based onmedical history interview, physical examination, and clinical symptoms ofintermittent hearing loss, vertigo, tinnitus, and full feeling or pressure inthe affected ear.
Decrease in salivary production that leads tothicker mucus and a dry mouth. Interferes with the ability to eat and leads toappetite and nutritional problems.
Explain Peripheral neuropathy?
Most commonly associated with diabetes.Alcoholism, peripheral vascular disease, traumatic injury, medication effects,infections, and immune system disease.
symptoms include numbness and tingling of theaffected area and stumbling gait.
Name three types of sensory deprivation?
- Reduced sensory input (hearing loss)
- Restricted environment (bed rest)
What type of cognitive changes do these sensory deprivations cause?
Inability to problem solve
Poor task performance
What type of affective changes do these sensory deprivations cause?
What type of perceptual changes do these sensory deprivations cause?
Reduction in attention span
Disorganized visual and motor coordination
Confusion of sleeping and walking states
What is sensory overload?
When a person receives multiple sensory stimuli,the brain has difficulty distinguishing the stimuli, which causes a sensoryoverload to occur
Preventing a meaningful response to a stimulusby the brain
What is happening to the person in sensory overload?
Person no longer perceives the environment in away that makes sense.
Attention moves in many directions Restlessness
What are signs and symptoms of sensory overload?
How can the hospital setting contribute to developing sensory overload?
Noise from equipment
Nursing activities of turning, repositioning,and administering treatments
Give some examples of medications reported to cause ototoxicity.
- Antibiotics- Aminoglycosides Vancomycin
- Nsaids- Ibuprofen
- Diuretics- Ethacrynic acid, Furosemide, Bumetanide
- AntineoplasticAgents- Cisplatin
What patients are at high risk for sensory alterations?
Older adults are a high-risk group of normal physiological changes associated with aging.
What is important of the assessment for sensory status?
Assessment categories include the type and extent of sensory impairment, the onset and duration of symptoms, and whether there are factors that aggravate or relieve symptoms.
What should we assess about the patient’s lifestyle?
Ask pt to describe any problems the sensory alteration creates for their normal daily routines and lifestyle.
“Does a sensory alteration change your abilityto retain social relationship, continue performing at work or school, orfunction within the home?”
How is your pt’s socialization when it comes to sensory factors?
Assess if patient lives alone and whether family, friends, or neighbors frequently visit.
Self-CareManagement plays a part in assessment for sensory factors how?
Consider the activities patients normally do for themselves and how the sensory alteration impairs their functioning.
What should we look for in psychosocial adjustment?
Has pt shown any recent mood swings such asoutbursts of anger, depression, or fear?
Does the pt avoid interactions with others?
How do weassess health promotion practices?
Assess the daily routines pts follow in maintaining sensory function.
Assess for hazards. How?
Make sure the home environment is healthy,comfortable, and safe.
First assess the home setting, including the outdoors and all rooms in the home, for any hazards that increase the risk for injury (e.g., poorly lit stairs, obstacles in walking paths, uneven side-walks)
What contributes to sensory overload in a hospital setting and how can you make surea sensory overload in an environmental setting can be reduced for a pt?
Location of a pts room near repetitive or loudnoises (e.g., nurses’ station or supply room)
Explore a loud television or roommate or abright room light as possible contributing factors.
How can you assess the quality of pt’s communication?
Sit facing pt, speak in normal tone
- Assess whether they have troube lspeaking
- understanding, reading, or writing
Ask pt what communication method they prefer
What includes a physical examination for sensory deficit pt?
Assess the extent of sensory loss
Observe the pt’s physical appearance, measure genitive ability, and assess emotional stability
How do you assess patient expactations?
Ask patients what they expect.
“What do you expect from the nursing staff to feel you are being well cared for?”
“Now that I better understand what affects your ability to see/hear, what do you expect in the care we will be providing you?”
What is the most common vision problem in children?
How can you detect problems in vision early?
What are three interventions to help prevent visual impairment in children?
Screening women considering pregnancy forrubella and syphilis
Advocating adequate prenatal care to prevent premature birth
Periodic screening of all children for congenital blindness and visual impairment caused by refractive errors and strabismus.
How often do adults over 40 yrs old need an eye examination?
Every 2 to 4 years
How often do adults 65 yrs and older need an eye examination?
1 to 2 years
How can pregnant women avoid ototoxic drugs?
Seek early prenatal care
What are common causes of hearing impairment in children? What can this health promotion be?
Chronic middle ear infections
Advise both children and parents to take precautions and use earplugs or earphones to block high-decibel sounds.
What are different types of assistive aids for pts with sensory deficits?
Corrective lenses, eyeglasses, hearing aids. Need to know how to clean them properly
How can you make the pts environment more stimulating?
Reduce glare by eliminating waxed floors and shiny surfaces, install tinted glass, sheer curtains, soft and diffused lighting
Teach use of assistive devices to improve visualacuity
Recommend brighter colors into the home
Explain how to maximize hearing reception or minimize effects of hearing loss
Promote sense of taste through good oral hygiene, well-seasoned foods
Enhance sense of smell by removing unpleasantodors from environment and introduce pleasant smells such as flowers
A. How can we create a safe environment for our pt?
Visual adaptations- remove clutter likefootstools, electrical cords, arrange furniture so they don’t trip, flooring isin good repair, remove throw rugs, stairwells needs to be lighted w/ handrails,and lights lights lights anywhere you can put them
Hearing Adaptations – Change or amplify thesound of alarm type devices to a low-pitched quality.
Set up signaling devices such as flashing light on a phone to allow pts w/ hearing impairment greater independence.
Smell and tactile adaptations – Smoke detectorsand put cigs in water. Make sure temp on water heater is never higher than 120F.
How can you promote safety measures for your pt?
- Assist pt w/ acute visual impairment w/ walking.
- Stand on pts strong side, pt grasps your elbow or upper arm, walk one half step ahead and slightly to the pts side.
Relax and walk at comfortable pace.
Warn the pt when approaching doorways, and tellthe pt whether the door opens in or out.
Do not leave a pt alone in an unfamiliar area.
How can you keep a pt from becoming overly fatigued?
Reduce sensory overload by organizing the pts care to control for excessive stimuli.
Combine activities such as dressing changes,bathing, and vital sign assessment in one visit prevents the pt from becomingoverly fatigued.