January 18, 2022 • 11 mins
Nursing care of patients with visual or auditory issues.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Unknown (00:00):
Hey and welcome to nursing with Dr. Hobbick. Today
I am thinking about patientswith sensory issues. Patients
who have visual or auditoryissues as those are our most
common. The first thing that Iwant to think about are changes
that are normal with aging.
Let's talk about eyes first. Forelderly persons. As we age, we
(00:20):
get a little bit of a sunkenappearance that's not abnormal.
We also see something called anArcus Senlis it's most
noticeable in people who havedark eyes, dark colored eyes,
and it usually shows up as ablue ring on the outside of the
iris. This is something that wesee in older folks, we also
(00:40):
might see a little bit of ayellow or blue tinge to the
sclera. Making that and not anaccurate place to look for
jaundice. Of course, we oftensee some changes in visual
function. So if this person hada stigmatism, we'd see a little
bit of worsening there, we mightsee some problems with
(01:01):
discrimination between blues andgreens and violets. We see some
structural changes. So as weage, it's harder for the eyes to
dilate. So they're more likelyto be very small pupils. It also
makes it difficult for us toperform any testing for
pupillary constriction. And ofcourse, we have this thing
(01:23):
called presbyopia, that causespeople to need reading glasses
as we get older, because it'sharder to focus on things that
are near us, especially writing.
Now, if you're recognizing cues,meaning we're doing our
assessment, we are looking forthings like age demographics,
most importantly, what thingsare putting the patient
(01:44):
potentially at risk. So what aretheir leisure activities? What
kind of occupation do they have?
Do they have any systemic healthproblems? Specifically, we think
about hypertension, or diabetes,those two problems are going to
cause issues with the retina andthe blood flow. We want to know
if the patient has anymedications that they take that
(02:04):
could be affecting their eyes,their nutrition, family history,
things that we might see headtilting might be some squinting,
we're looking for symmetry, weof course are observing the
areas around the eyes, the eyesthemselves, and maybe doing some
vision testing. Now as a nursewe don't typically do in depth
(02:25):
vision testing, we might usesome charts, but mostly this is
going to fall into the realm ofthe ophthalmologist or
optometrist, especially thediagnostic testing. Now there's
three big problems with theeyes, not big but rather more
most common that I'm going totalk about. The first one is
cataracts. Cataracts aresomething that happens usually
(02:46):
with aging or a lot of exposureto UV light, the lens itself
becomes opaque and distorts theimage, these patients will begin
to complain of cloudiness intheir vision, they could have
cataracts in both eyes, and theyprogress at different rates. You
don't necessarily have acataract in both eyes at the
(03:06):
same time, it could be just oneand you may go on for years with
the other eye until it needs tobe managed. We could also have
cataracts that are congenital,the patient can be born with
them or pathologic. There aresome diseases and other eye
disorders that can happen at thesame time as cataracts. But most
of the time they're age relatedor they're caused by trauma or
(03:29):
exposure, most Americans willhave developed a cataract by the
age of 75. The things that wecan educate our patients to do
to help them prevent gettingcataracts or things like
avoiding the sun, avoid UV lightexposure, wear sunglasses every
time you're outside, wear eyeand head protection and of
course, stop smoking, smoking.
(03:49):
As far as cataracts, we want tohelp our patient as best we can.
But really, the only thing thatcan be done is surgery. This is
where they'll go in and break upthat lens and then actually
replace it. These patients oncethey've had surgery on their
eyes, they're going to need acouple of different types of
eyedrop that they'll need togive themselves and they'll need
(04:10):
to know things like don't bendover. Don't do any heavy
lifting, avoid straining, wedon't want to do anything that's
going to increase that interocular pressure for a little
bit. The next condition we'regoing to talk about is glaucoma.
And some of the things to knowabout glaucoma is it's an
increase in intra ocularpressure. So these patients have
(04:30):
pressure on the inside of theireyes that can actually cause
damage to the optic nerve. Folkswho are at risk are African
Americans over 40 and thenanybody over 60 If you have a
family history, that patient hashypertension, Corneal thinness
or optic nerve abnormalities.
These patients will begin tothey don't normally have
(04:51):
pressure that they complain ofbut they'll start to complain of
losing the peripheral visionthey will have blackness that
comes in From the outside thingsthat we can do for them non
surgical management, there aresome eyedrops the patients can
use that will help them andotherwise maybe some surgical
management. The last condition,at least for eyes that I wanted
(05:11):
to talk about is maculardegeneration. And this usually
starts as a mild blurring andvisual distortion and it's right
in the central field, thesepatients eventually can lose
their vision to the point wherethey can't really see anything
that they're looking at thedifference between the three
conditions, we have a cataractthat causes blurred vision, we
have glaucoma, that's going tomanifest as losing the vision
(05:35):
blackness moving in from theoutside. And then macular
degeneration is from the center,there are two kinds of macular
degeneration, there's dry andwet dry is the most common. And
this is where we have just agradual blockage of capillaries
by pigmented residue and wasteproducts. And it causes the
(05:56):
macula, which is the center ofthe retina become ischemic and
necrotic. And so this is wherethe patient starts to lose that
it's a gradual process wetprogresses quickly, the patient
has a sudden decrease in vision.
And they have some issues withbleeding, maybe underneath that
macular like a blister. And theyeventually developed scar
(06:19):
formation there.
This can occur at any age, maybein one eye, both eyes, patients
with dry, macular degenerationcan actually develop wet. That's
something that we want to try tohelp our patients avoid if we
can, the sort of things we'regoing to help our patients with
is of course, diabetes,hypertension, not smoking
because the rate of dry maculardegeneration in smokers is much
(06:41):
higher. And there's somesuggestion in the research that
there's some dietary things thatcan be added, like carotenoids,
lutein, but there isn't really acure for these things. With the
wet version, we might be able todo some laser therapy to help
stop the blood vessel fromleaking and limit the damage
(07:02):
that's happened, there isn'treally anything that can cure
it. Now audio auditory problems,patients who have problems with
hearing course, we see this inthe elderly population as well.
We have some changes that areassociated with aging, we
usually have presbycusis, whichis the loss of higher pitched.
So when we go to take care ofthese patients, we want to make
(07:24):
sure we lower our tone so thatwe can be heard better, we don't
want to get higher because thatmakes it harder for them to hear
us. There are three types ofhearing loss conductive sensory,
neural and mixed conductivehearing loss can be caused by
inflammation, obstructions ofthe external or middle ear
changes in the eardrum or autoSclerosis which is an overgrowth
(07:48):
of bone. sensory neural hearingloss is usually caused by damage
to a nerve. So damage to theinner ear or the auditory nerve,
which is cranial nerve eightprolonged exposure to loud
noises. I think we all know thatright? There are some
medications that are auto toxic.
And of course, the presbycusisthat we just talked about things
that we want to assess ourpatient for when we're
(08:08):
recognizing cues, do theyexplain or complain of any
hearing changes? What is theirage have they been exposed to
noise either at work or in theirleisure activities? Do they have
any history of ear problems likerecurrent infections do they
have struggles communicating?
Have they had any diagnostictesting done not going to cover
(08:29):
diagnostic testing because thisusually is in the realm of an
EMT or a specialist. As far asanalyzing cues and prioritizing
our hypothesis, we want torecognize that they have a
decrease in functional abilityto communicate so that we can
focus on helping them tocommunicate as best we can.
Because as nurses, that's reallyall that we can do. We need to
(08:50):
know about non surgicalmanagement hearing aids are
something that are very common,we need to understand how the
hearing aid fits in the ear, isit a behind the ear and open
fit, there's multiple differenttypes of hearing aids that you
should be aware of, and you gotto make sure that the battery is
working that is turned on, thepatient can typically help you
with that sort of thing. We justwant to make sure that we
(09:11):
maximize their communication.
Our goal is going to be for thepatient to have at least a
partial improvement in hearingor the use of appropriate
hearing compensation behavior.
We want to alleviate an anxietywe want to make sure that they
can communicate effectively inmost situations. If we need to
get an interpreter for signlanguage. That's what we should
be doing if we can help themwith closed captioning or video
(09:35):
descriptions. And of course,there's always the use of
nonverbal language. Somethingelse that is common is a writing
board. If we can get a writingboard for our patients sometimes
that really helps. I hope thatyou've enjoyed this discussion
of caring for patients withsensory issues as far as visual
and auditory and I'll see younext time on nursing with Dr.
Hobbick.
Hey and welcome to nursing with Dr. Hobbick. Today
I am thinking about patientswith sensory issues. Patients
who have visual or auditoryissues as those are our most
common. The first thing that Iwant to think about are changes
that are normal with aging.
Let's talk about eyes first. Forelderly persons. As we age, we
(00:20):
get a little bit of a sunkenappearance that's not abnormal.
We also see something called anArcus Senlis it's most
noticeable in people who havedark eyes, dark colored eyes,
and it usually shows up as ablue ring on the outside of the
iris. This is something that wesee in older folks, we also
(00:40):
might see a little bit of ayellow or blue tinge to the
sclera. Making that and not anaccurate place to look for
jaundice. Of course, we oftensee some changes in visual
function. So if this person hada stigmatism, we'd see a little
bit of worsening there, we mightsee some problems with
(01:01):
discrimination between blues andgreens and violets. We see some
structural changes. So as weage, it's harder for the eyes to
dilate. So they're more likelyto be very small pupils. It also
makes it difficult for us toperform any testing for
pupillary constriction. And ofcourse, we have this thing
(01:23):
called presbyopia, that causespeople to need reading glasses
as we get older, because it'sharder to focus on things that
are near us, especially writing.
Now, if you're recognizing cues,meaning we're doing our
assessment, we are looking forthings like age demographics,
most importantly, what thingsare putting the patient
(01:44):
potentially at risk. So what aretheir leisure activities? What
kind of occupation do they have?
Do they have any systemic healthproblems? Specifically, we think
about hypertension, or diabetes,those two problems are going to
cause issues with the retina andthe blood flow. We want to know
if the patient has anymedications that they take that
(02:04):
could be affecting their eyes,their nutrition, family history,
things that we might see headtilting might be some squinting,
we're looking for symmetry, weof course are observing the
areas around the eyes, the eyesthemselves, and maybe doing some
vision testing. Now as a nursewe don't typically do in depth
(02:25):
vision testing, we might usesome charts, but mostly this is
going to fall into the realm ofthe ophthalmologist or
optometrist, especially thediagnostic testing. Now there's
three big problems with theeyes, not big but rather more
most common that I'm going totalk about. The first one is
cataracts. Cataracts aresomething that happens usually
(02:46):
with aging or a lot of exposureto UV light, the lens itself
becomes opaque and distorts theimage, these patients will begin
to complain of cloudiness intheir vision, they could have
cataracts in both eyes, and theyprogress at different rates. You
don't necessarily have acataract in both eyes at the
(03:06):
same time, it could be just oneand you may go on for years with
the other eye until it needs tobe managed. We could also have
cataracts that are congenital,the patient can be born with
them or pathologic. There aresome diseases and other eye
disorders that can happen at thesame time as cataracts. But most
of the time they're age relatedor they're caused by trauma or
(03:29):
exposure, most Americans willhave developed a cataract by the
age of 75. The things that wecan educate our patients to do
to help them prevent gettingcataracts or things like
avoiding the sun, avoid UV lightexposure, wear sunglasses every
time you're outside, wear eyeand head protection and of
course, stop smoking, smoking.
(03:49):
As far as cataracts, we want tohelp our patient as best we can.
But really, the only thing thatcan be done is surgery. This is
where they'll go in and break upthat lens and then actually
replace it. These patients oncethey've had surgery on their
eyes, they're going to need acouple of different types of
eyedrop that they'll need togive themselves and they'll need
(04:10):
to know things like don't bendover. Don't do any heavy
lifting, avoid straining, wedon't want to do anything that's
going to increase that interocular pressure for a little
bit. The next condition we'regoing to talk about is glaucoma.
And some of the things to knowabout glaucoma is it's an
increase in intra ocularpressure. So these patients have
(04:30):
pressure on the inside of theireyes that can actually cause
damage to the optic nerve. Folkswho are at risk are African
Americans over 40 and thenanybody over 60 If you have a
family history, that patient hashypertension, Corneal thinness
or optic nerve abnormalities.
These patients will begin tothey don't normally have
(04:51):
pressure that they complain ofbut they'll start to complain of
losing the peripheral visionthey will have blackness that
comes in From the outside thingsthat we can do for them non
surgical management, there aresome eyedrops the patients can
use that will help them andotherwise maybe some surgical
management. The last condition,at least for eyes that I wanted
(05:11):
to talk about is maculardegeneration. And this usually
starts as a mild blurring andvisual distortion and it's right
in the central field, thesepatients eventually can lose
their vision to the point wherethey can't really see anything
that they're looking at thedifference between the three
conditions, we have a cataractthat causes blurred vision, we
have glaucoma, that's going tomanifest as losing the vision
(05:35):
blackness moving in from theoutside. And then macular
degeneration is from the center,there are two kinds of macular
degeneration, there's dry andwet dry is the most common. And
this is where we have just agradual blockage of capillaries
by pigmented residue and wasteproducts. And it causes the
(05:56):
macula, which is the center ofthe retina become ischemic and
necrotic. And so this is wherethe patient starts to lose that
it's a gradual process wetprogresses quickly, the patient
has a sudden decrease in vision.
And they have some issues withbleeding, maybe underneath that
macular like a blister. And theyeventually developed scar
(06:19):
formation there.
This can occur at any age, maybein one eye, both eyes, patients
with dry, macular degenerationcan actually develop wet. That's
something that we want to try tohelp our patients avoid if we
can, the sort of things we'regoing to help our patients with
is of course, diabetes,hypertension, not smoking
because the rate of dry maculardegeneration in smokers is much
(06:41):
higher. And there's somesuggestion in the research that
there's some dietary things thatcan be added, like carotenoids,
lutein, but there isn't really acure for these things. With the
wet version, we might be able todo some laser therapy to help
stop the blood vessel fromleaking and limit the damage
(07:02):
that's happened, there isn'treally anything that can cure
it. Now audio auditory problems,patients who have problems with
hearing course, we see this inthe elderly population as well.
We have some changes that areassociated with aging, we
usually have presbycusis, whichis the loss of higher pitched.
So when we go to take care ofthese patients, we want to make
(07:24):
sure we lower our tone so thatwe can be heard better, we don't
want to get higher because thatmakes it harder for them to hear
us. There are three types ofhearing loss conductive sensory,
neural and mixed conductivehearing loss can be caused by
inflammation, obstructions ofthe external or middle ear
changes in the eardrum or autoSclerosis which is an overgrowth
(07:48):
of bone. sensory neural hearingloss is usually caused by damage
to a nerve. So damage to theinner ear or the auditory nerve,
which is cranial nerve eightprolonged exposure to loud
noises. I think we all know thatright? There are some
medications that are auto toxic.
And of course, the presbycusisthat we just talked about things
that we want to assess ourpatient for when we're
(08:08):
recognizing cues, do theyexplain or complain of any
hearing changes? What is theirage have they been exposed to
noise either at work or in theirleisure activities? Do they have
any history of ear problems likerecurrent infections do they
have struggles communicating?
Have they had any diagnostictesting done not going to cover
(08:29):
diagnostic testing because thisusually is in the realm of an
EMT or a specialist. As far asanalyzing cues and prioritizing
our hypothesis, we want torecognize that they have a
decrease in functional abilityto communicate so that we can
focus on helping them tocommunicate as best we can.
Because as nurses, that's reallyall that we can do. We need to
(08:50):
know about non surgicalmanagement hearing aids are
something that are very common,we need to understand how the
hearing aid fits in the ear, isit a behind the ear and open
fit, there's multiple differenttypes of hearing aids that you
should be aware of, and you gotto make sure that the battery is
working that is turned on, thepatient can typically help you
with that sort of thing. We justwant to make sure that we
(09:11):
maximize their communication.
Our goal is going to be for thepatient to have at least a
partial improvement in hearingor the use of appropriate
hearing compensation behavior.
We want to alleviate an anxietywe want to make sure that they
can communicate effectively inmost situations. If we need to
get an interpreter for signlanguage. That's what we should
be doing if we can help themwith closed captioning or video
(09:35):
descriptions. And of course,there's always the use of
nonverbal language. Somethingelse that is common is a writing
board. If we can get a writingboard for our patients sometimes
that really helps. I hope thatyou've enjoyed this discussion
of caring for patients withsensory issues as far as visual
and auditory and I'll see younext time on nursing with Dr.
Hobbick.
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