Vision and Hearing
What interventions can the nurse do for a patient experiencing altered communication related to hearing loss?
1. Ensure that all caregivers are aware of the person's hearing problem. 2. If the aging person is hard of hearing, avoid startling him or her. Approaches should be made so that the older individual can see the nurse. 3. Keep messages as simple as possible, use easily understood words, and speak clearly. Reword a statement if the first attempt is not understood. Avoid information overload. Written information should be clear and large enough to be seen easily. 4. Speak in a low tone of voice because hearing losses are usually in the higher frequencies of sound. Stand in good light while facing the person and speak slowly. Do not chew gum or eat while conversing. Speak into the good ear. Keep background noise to a minimum. Facial expressions, gestures, and other visual cues that are appropriate to the message should be used. Instead of using the intercom, respond promptly to the call bell. 5. Verify that hearing aids are functional.
For an older patient with hemianopsia, which intervention is the nurse most likely to use? 1. Face the patient and speak slowly in a low tone of voice 2. Teach the patient to turn the head and visually sweep the environment 3. Use a calendar to point out important events, such as holidays 4. Clean eyeglasses regularly and make sure that they fit properly
Answer 2: Hemianopsia is loss of a portion of the visual field (e.g., may not be able to see things on one side of the table), so the nurse would teach the patient to turn the head back and forth to scan the environment and maximize the use of remaining vision.
The nurse is discharging a client who just had cataract removal and intraocular lens implantation. What statements indicate that the client understands discharge instructions? Select all that apply. a. "I understand the schedule for my eye drops and will use the medications." b. "I feel good and am ready to drive home now." c. "I will call in the morning if I cannot see clearly." d. "I will wear the eye shield at night to protect my eye." e. "I will avoid lifting or pulling anything over 15 pounds (6.8 kg)." f. "I will call if I still have eye pain after taking acetaminophen."
Answer: a., d., e., f. Rationale: To promote success of lens implant without complication (infection, inflammation, hemorrhage), it is important for the client to instill eye drops as prescribed, protect the eye, and avoid placing any stress on the eye by lifting, pulling, or pushing objects that weigh more than 15 lb (6.8 kg). Pain should be minimal and relieved with acetaminophen; if not, the client should notify the health care provider (HCP). Clients should not expect to drive or see clearly immediately following lens implant; it may take several days for vision to clear, and limitations will be discussed at the follow-up appointment.
The most effective health-promotion measure related to glaucoma that the nurse could teach clients is: a. prompt treatment of all eye infections. b. avoidance of extended-wear contact lenses by older people. c. annual intraocular pressure measurements for people older than 40 years. d. appropriate blood pressure control.
Answer: c. Rationale: The most effective health promotion measure associated with glaucoma is annual intraocular pressure measurements after 40 years of age. People who are at risk for developing glaucoma, such as those with diabetes or hypertension, African ancestry, and a family history of glaucoma, should have their intraocular pressure checked annually after 35 years of age. Glaucoma is insidious, basically asymptomatic, and must be diagnosed before the client becomes aware of any vision changes. Eye infections should be treated promptly; however, they are not a risk factor for glaucoma. Contact lens use is not associated with glaucoma. Blood pressure control has multiple health benefits but is not implicated in glaucoma.
Which client requires increased sensory stimulation to prevent sensory deprivation? a. a 24-year-old client who has been admitted with an anxiety disorder and appears very agitated b. a 60-year-old client who is blind, reads books through use of Braille, listens to the radio, and regularly takes walks around the unit c. a 65-year-old client who has employment-induced presbycusis and advanced glaucoma d. an 84-year-old client who has hemiparesis and ambulates with a walker
Answer: c. a 65-year-old client who has employment-induced presbycusis and advanced glaucoma Rationale: There is more risk of sensory deprivation when the primary senses are impaired. This client is most at risk for sensory deprivation because of two sensory deficits: hearing and vision. These two are primary senses that help a person stay oriented and communicate with others. The 24-year-old client has senses intact but is experiencing an anxiety disorder. The 60-year-old client has one sensory deficit, blindness, but is compensating by reading books and listening to tapes. An elderly person with mobility problems, who is using mobility aids, and hence can still socialize is not experiencing sensory deficits.
What information about vision would be most important for the nurse to include in the discharge plan of a client who had cataract removal? a. "You'll need to wear corrective glasses or contact lenses." b. "You'll need to wear glasses only until the eye heals." c. "You'll need to wear cataract glasses that correct vision by magnifying objects." d. "You'll need to relearn to judge distances accurately."
Answer: d. Rationale: Although clients who have had cataract surgery should be informed of the need to wear glasses or contact lenses to correct visual acuity, it is more important to inform them of potential changes in depth perception, since that presents a potential safety issue. The client may need to relearn to judge distances accurately to walk safely. There is no need to wear glasses that magnify objects.
Hearing aids are worn by many older people. Which statement regarding hearing aids is false? 1. Batteries should be stored in the refrigerator. 2. Ear molds should be cleaned regularly. 3. Most people easily adjust to hearing aid use. 4. Hearing aids are fragile.
Correct answer: 3 Hearing aids do not duplicate normal hearing and are not beneficial for everyone. Many persons have difficulty adjusting to hearing aids and complain that they are bothersome. When first fitted with a hearing aid, the person may be able to tolerate it only for a few minutes a day. Hearing aids require care and maintenance. Because they are fragile, care should be taken not to drop them, ear molds should be cleaned regularly, and batteries should be stored in the refrigerator to prolong their life.
List modifications of the home environment and assistive devices that will help the older adult who has visual impairment to function more safely at home.
Increase the amount of light. Apply contrasting strips to areas where there is a change in elevation, such as shower entrances and steps. Contrasting door frames, dishes, pillows, personal care items, and toilet seats will help older adults distinguish these items more easily. Telephone dials can be modified with overlay rings that have large numbers to assist in dialing. Program commonly used phone numbers for one-button dialing. Handheld or floor standing magnifying devices help with reading or close work. Suggest large-print books and magazines. Computer settings can be altered for viewing large print. Talking clocks are available.
What are the possible indicators of hearing loss?
Possible Indicators of Hearing Loss • Difficulty understanding high-pitched voices • Trouble following a conversation when more than one person is talking • Difficulty hearing over the phone • Difficulty hearing when there is background noise • Complaints that other people are mumbling • Increased volume of radio or television • Straining to hear conversation at a normal volume
What teaching points would the nurse use for an older adult patient who just started using a hearing aid?
When first fitted with a hearing aid, the person may be able to tolerate it only for a few minutes a day; the amount of time it is worn should be gradually increased. The older adult should be reassured that feeling nervous or jumpy to hear so many sounds is normal and that the jumpiness will go away. "Tinny" or "noisy" feedback, whistles, or hums are usually caused by incorrect insertion or improper adjustment of the controls on the device. Hearing aids are fragile; take care not to drop them. They should be kept away from very hot or very cold places. Before being inserted into the ear, the hearing aids should be checked for cracks or rough edges that could injure the ear. Clean the ear mold regularly. Pay special attention to the removal of cerumen, which may plug the canal and reduce the effectiveness of the device. Check and clean batteries regularly. To prolong battery life, shut the hearing aid off when it is not in use.
