Tabloski ch14 lecture

Gerontological Nursing

CHAPTER

THIRD EDITION

Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.All Rights Reserved

Sensation: Hearing, Vision, Taste, Touch, and Smell

14

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Explain normal changes associated with the aging process on the five senses—vision, hearing, taste, smell, and touch.

2. List common nursing diagnoses of older persons related to sensory problems.


Learning Objectives

3. Recognize nursing interventions that can be implemented to assist the aging patient with sensory changes.

4. Identify medications that may cause or aggravate sensory dysfunction.


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.


Vision

• Visual impairment is defined as visual acuity of 20/40 or worse while wearing corrective lenses, and legal blindness or severe visual impairment is 20/200 or more as measured by a Snellen wall chart at 20 feet.


Vision

• Visual impairment and blindness in the older person is the result of four main causes:

–Cataracts

–Age-related macular degeneration (ARMD)

–Glaucoma

–Diabetic retinopathy


Vision

• Older patients should be questioned regarding adequacy of vision, recent changes in vision, visual problems, and the date of their last complete visual examination.


Vision

• The gerontological nurse should inspect the eyes for any abnormalities, including movement of the eyelids, abnormal discharge, excessive tearing, abnormally colored sclera, and abnormal or absent pupillary response.


Visual Problems

• Age-related macular degeneration is the leading cause of blindness in adults over the age of 65.

• Cataracts cloud the lens, decrease the amount of light able to reach the retina, and inhibit vision.


Visual Problems

• Glaucoma is associated with optic nerve damage due to an increase in IOP (intraocular pressure), which can ultimately lead to vision loss.

• Diabetic retinopathy is a microvascular disease of the eye occurring in both type 1 and type 2 diabetes.


Nursing Diagnoses Associated with Visual Impairment

• Nursing diagnoses associated with visual impairment are diverse and depend upon the older person’s ability to compensate for visual problems.

• The gerontological nurse should consider the older patient’s functional ability and not just the results of visual acuity testing using the Snellen chart.


Hearing

• Hearing loss can interfere with communication, enjoyment of certain forms of entertainment such as music and television, safety, and ultimately, independence.

• Hearing impairments also may endanger individuals living alone, due to their inability to hear a smoke detector or security alarm.


Hearing

• A thorough history and physical examination is important to help determine the cause of the hearing loss.


Hearing Aids

• Professional nurses can serve as role models, educators, and instructors for nursing assistants who are unfamiliar with the care of expensive items.


Nursing Diagnoses Associated with Hearing Impairment

• Nursing diagnoses associated with older patients with hearing impairment are diverse and depend upon the ability to compensate for hearing problems.


Taste

• Taste deficits can result in weight loss, malnutrition, impaired immunity, and worsening of medical illness.

• A diminished sense of taste, or hypogeusia, is a normal sensory change usually occurring after the age of 70.


Nursing Assessment of the Older Patient with Taste Disturbances

• A thorough assessment of the head and neck should be performed to rule out obvious deformity, injury, infection, or obstruction. Mucous membranes should be assessed for dryness, ulceration, or presence of candidiasis.


Nursing Assessment of the Older Patient with Taste Disturbances

• Hypogeusia can lead to malnutrition because a decreased ability to sense flavor in foods can lead to lack of motivation and enjoyment in preparing and consuming a well-balanced diet.


Smell

• Loss of sensation can also affect the older adult emotionally and psychologically because the sense of smell triggers memories and pleasurable experiences such as smelling fragrant flowers.


Touch

• As people age, tactile sensation diminishes, due to slower conduction of nerve impulses and diminished function of peripheral nerves. As a result, older adults have decreased perception of pain, vibration, touch, and temperature extremes.


Physical Sensation

• Institutionalized older persons deprived of caring touch and nurturing physical contact experience a diminishing quality of life, a lessening of their desire to relate to others, and a weakening of what may already be a fragile relationship with physical reality.


Nursing Diagnoses Associated with Tactile Impairment

• For patients with impaired sense of touch, nursing interventions may focus on continuous monitoring of the intactness of the skin, assessment of safety risks, and the development of a safety plan with instructions to minimize injury.

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