Hearing, Speech, and Vision Problems Chapter 39 Hearing, Speech, and Vision Problems Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Hearing, Speech, and Vision Allow communication, learning, and moving about Are important for self-care, work, and most activities Are important for safety and security needs Many people have some degree of hearing or vision loss. Common causes are: Birth defects Accidents Infections Diseases Aging Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Ear Disorders Otitis media is infection of the middle ear. Viruses and bacteria are causes. Otitis media is acute or chronic. Chronic otitis media can damage the tympanic membrane (ear drum) or the ossicles. Theses structures are needed for hearing. Permanent hearing loss can occur. Signs and symptoms include: Pain (earache) and hearing loss Fever and tinnitus (a ringing, roaring, hissing, or buzzing sound in the ears or head) Treatment involves: Antibiotics Drugs for pain relief Drugs to relieve congestion Review the contents of Box 39-1 on p. 652 in the Textbook. Otitis media often begins with infections that cause sore throats, colds, or other respiratory infections that spread to the middle ear. An untreated infection can travel to the brain and other structures in the head. Review the Focus on Children and Older Persons: Otitis Media Box on p. 651 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Ear Disorders (cont’d) Ménière’s disease involves the inner ear. It is a common cause of hearing loss. Usually one ear is affected. Symptoms include: Vertigo (dizziness) Tinnitus Hearing loss Pain or pressure in the affected ear There is increased fluid in the inner ear. Symptoms are sudden. An attack can last several hours. Increased fluid causes swelling and pressure in the inner ear. Symptoms can occur daily or just once a year. Vertigo causes whirling and spinning sensations. The dizziness causes severe nausea and vomiting. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Ear Disorders (cont’d) Treatment involves: Drugs Fluid restriction A low-salt diet No alcohol or caffeine Safety is needed during vertigo. The person must lie down. Falls are prevented. The person’s head is kept still. Sudden movements are avoided. Bright or glaring lights are avoided. The person should not walk alone. Bed rails are used according to the care plan. When movement is necessary, the person moves slowly. You assist the person with walking. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Ear Disorders (cont’d) Hearing loss is not being able to hear the normal range of sounds associated with normal hearing. Losses are mild to severe. Deafness is hearing loss in which it is impossible for the person to understand speech through hearing alone. Hearing loss occurs in all age-groups. Common causes of hearing loss are damage to the: Outer, middle, or inner ear Acoustic nerve Deafness is the most severe form of hearing loss. According to the National Institute on Deafness and Other Communication Disorders (NIDCD): About one third (33%) of persons over 60 years of age have hearing problems. About half (50%) of persons age 85 years and older have hearing loss. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Ear Disorders (cont’d) Risk factors that can damage the ear structures include: Aging Exposure to very loud sounds and noises Drugs (antibiotics, too much aspirin) Infections Reduced blood flow to the ear caused by high blood pressure, heart and vascular diseases, and diabetes Stroke Head injuries Tumors Heredity Birth defects Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Ear Disorders (cont’d) Temporary hearing loss can occur from earwax (cerumen). Hearing is required for: Clear speech Responding to others Safety and awareness of surroundings A person may not notice gradual hearing loss. Others may notice obvious signs and symptoms of hearing loss (leans forward during conversations, has inappropriate answers). The person may feel left out, become suspicious, and have slurred speech Older clients tend to lose high-pitched sounds Hearing improves after the earwax is removed. Many people relate hearing loss to aging. Review the Focus on Communication: Hearing Loss Box on p. 651 in the Textbook. Review the Promoting Safety and Comfort: Hearing Loss Box on p. 651 in the Textbook. With gradual hearing loss, others may see changes in the person’s behavior or attitude. People may give wrong answers or responses. Only parts of conversations are heard. Straining and working hard to hear can cause fatigue, frustration, and irritability. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Ear Disorders (cont’d) Hearing is needed for speech. Hearing loss may result in slurred speech. Words may be pronounced wrong. Some persons have monotone speech or drop word endings. It may be hard to understand what the person says. Persons with hearing loss may: Wear hearing aids or lip-read (speech-read) Watch facial expressions, gestures, and body language Learn American Sign Language (ASL) Some people have hearing assistance dogs (hearing dogs). The dog alerts the person to sounds. Phones, doorbells, smoke detectors, alarm clocks, sirens, and on-coming cars Do not assume or pretend that you understand what the person says. Review the Focus on Children and Older Persons: Effects on the Person Box on p. 652 in the Textbook. To promote communication, practice the measures in Box 39-2 on p. 655 in the Textbook. Different sign languages are used in different countries and regions. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Ear Disorders (cont’d) Hearing aids fit inside or behind the ear. They make sounds louder. They do not correct, restore, or cure hearing problems. The person hears better because the device makes sounds louder. Background noise and speech are louder. If a hearing aid does not seem to work properly, try these measures. Check if the hearing aid is on. It has an on and off switch. Check the battery position. Insert a new battery if needed. Clean the hearing aid-the person should not use hairspray The measures in Box 39-2 on p. 655 in the Textbook apply when a person uses a hearing aid. To clean a hearing aid, follow the nurse’s directions and the manufacturer’s instructions. The person should not use hair spray or other hair care products while wearing a hearing aid. Those products can damage the device. Hearing aids are costly. Handle and care for them properly. Report lost or damaged hearings aids to the nurse at once. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Speech Disorders Speech disorders result in impaired or ineffective oral communication. Common causes include: Hearing loss Developmental disabilities Brain injury These problems are common: Aphasia-cannot understand language Apraxia-cannot use speech muscles Dysarthria-difficult or poor speech Speech is used for communication. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Speech Disorders (cont’d) The person with apraxia of speech cannot use the speech muscles for understandable speech. The person understands speech and knows what to say. The brain cannot coordinate the speech muscles to make the words. The motor speech area in the brain is damaged. Dysarthria means difficult or poor speech. It is caused by nervous system damage. Mouth and face muscles are affected. Slurred speech, speaking slowly or softly, hoarseness, and drooling can occur. To communicate with the speech-impaired person, practice the measures in Box 39-3 on p. 656 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Speech Disorders (cont’d) Some persons need speech rehabilitation. The goal is to improve the ability to communicate. A speech-language pathologist and other health team members help the person. Improve affected language skills Use remaining abilities Restore language abilities to the extent possible Learn other methods of communicating Strengthen the muscles of speech The amount of improvement possible depends on many factors. Cause, amount, and area of brain damage Age and health Willingness and ability to learn Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Speech Disorders (cont’d) Aphasia is the total or partial loss of the ability to use or understand language. Common causes are stroke, head injury, brain infections, and cancer. Expressive aphasia (motor aphasia, Broca’s aphasia) Relates to difficulty expressing or sending out thoughts Receptive aphasia (Wernicke’s aphasia) Relates to difficulty understanding language Some people have both expressive and receptive aphasia. Expressive-receptive aphasia (global aphasia, mixed aphasia) The person with aphasia has many emotional needs. Aphasia is a language disorder. Parts of the brain responsible for language are damaged. Most people who have aphasia are middle-aged adults and older. The person with expressive aphasia thinks clearly and knows what to say but has difficulty or cannot speak the words. There are problems speaking, spelling, counting, gesturing, or writing. Because of difficulty understanding speech, the person with receptive aphasia may not be aware of his or her mistakes. They do not recognize people and common objects. Frustration, depression, and anger are common. You need to be patient and kind. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders Vision loss occurs at all ages. Problems range from mild loss to complete blindness. Blindness is the absence of sight. Vision loss is sudden or gradual. One or both eyes are affected. Review the contents of Box 39-4 on p. 661 in the Textbook. See the Body Structure and Function Review: The Eye Box on p. 657 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders (cont’d) Cataract is a clouding of the lens. A cataract can occur in one or both eyes. Signs and symptoms include: Cloudy, blurry, or dimmed vision Colors seem faded Blues and purples hard to see Sensitivity to light and glares Poor vision at night Halos around lights Double vision in the affected eye Trying to see is like looking through a waterfall. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders (cont’d) Risk factors Aging (Most cataracts are caused by aging.) A family history Diabetes Smoking Alcohol use Prolonged exposure to sunlight High blood pressure Obesity Eye injuries and surgeries Surgery is the only treatment. Surgery involves removing the lens. A plastic lens is implanted. Surgery is done when the cataract starts to interfere with daily activities. Vision improves after surgery. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Cataracts Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders (cont’d) Glaucoma Glaucoma causes damage to the optic nerve. Vision loss with eventual blindness occurs. Glaucoma can occur in one or both eyes. Onset is sudden or gradual. Peripheral vision (side vision) is lost. The eye produces a fluid that nourishes the eye structures. The fluid normally drains from the eye. When it cannot drain properly, it builds up in the eye, causing pressure on the optic nerve. The optic nerve is damaged. The person sees through a tunnel, has blurred vision, and sees halos around lights. Severe eye pain, nausea, and vomiting occur with sudden onset. Glaucoma is a leading cause of vision loss in the United States. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders (cont’d) Persons at risk African-Americans over 40 years of age Everyone over 60 years of age, especially Mexican Americans Those with a family history of the disease Treatment Glaucoma has no cure. Prior damage cannot be reversed. Drugs and surgery can control glaucoma and prevent further damage to the optic nerve. Glaucoma is a leading cause of vision loss in the United States. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Glaucoma Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders (cont’d) In diabetic retinopathy, the tiny blood vessels in the retina are damaged. A complication of diabetes, it is a leading cause of blindness. Usually both eyes are affected-person sees spots Everyone with diabetes is at risk. Treatment The person needs to control diabetes, blood pressure, and blood cholesterol. Laser surgery may help. Another surgery involves removing blood from the center of the eye. The person with diabetic retinopathy may need low vision services. Vision blurs. The person may see spots “floating.” Often, there are no early warning signs. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Diabetic Retinopathy Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders (cont’d) Age-related macular degeneration (AMD) blurs central vision. The disease damages the macula in the center of the retina-blind spot in center of vision Onset is gradual and painless. AMD is the leading cause of blindness in persons 60 years of age and older. Central vision is what you see “straight ahead.” AMD causes a blind spot in the center of vision. Central vision is needed for reading, sewing, driving, and seeing faces and fine detail. The retina receives light and sends messages to the brain through the optic nerve. When the macula is damaged, normal signals are not sent to the brain. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders (cont’d) Risk factors—AMD can occur during middle age. However, the risk increases with aging. Besides age, risk factors include: Smoking Obesity Race (Whites are at greater risk than any other group.) Family history Gender (Women are at greater risk than men.) Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

AMD Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders (cont’d) The following measures can reduce the risk of AMD: Eating a healthy diet high in green, leafy vegetables and fish Not smoking Maintaining a normal blood pressure Maintaining a normal weight Exercising For advanced AMD, no treatment can prevent vision loss. Some treatments may stop or slow the disease progress. Laser surgery may save what is left of central vision. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders (cont’d) Low vision is eyesight that cannot be corrected with eyeglasses, contact lenses, drugs, or surgery. Persons at risk for low vision have: Eye diseases Glaucoma Cataracts Age-related macular degeneration (AMD) Diabetes Eye injuries Birth defects The person learns to use visual and adaptive devices. The devices used depend on the person’s needs. While wearing eyeglasses or contact lenses, the person has problems: recognizing the faces of family and friends, doing tasks that require close vision, picking out and matching the color of clothing, reading signs, or doing things because lighting seems dimmer. Review the list of devices on p. 660 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Low-vision adaptive devices Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders (cont’d) Impaired vision and blindness The many causes of impaired vision and blindness include: Birth defects Injuries Eye diseases Complications of some diseases Amount of vision loss varies. The legally blind person sees at 20 feet what a person with normal vision sees at 200 feet. Loss of sight is serious. Rehabilitation programs help the person adjust to the vision loss and learn to be independent. Always introduce yourself when entering room See Box 39-4 on p. 661 in the Textbook for signs and symptoms of vision problems. Adjustments can be hard and long. Special training is needed. When caring for blind or visually impaired persons, follow the practices in Box 39-5 on pp. 661-662 in the Textbook. The goal is for the person to be as active as possible and to have quality of life. The person learns to read Braille and use visual and adaptive devices, long canes, and dog guides. Review the Focus on Long-Term Care and Home Care: Impaired Vision and Blindness Box on p. 660 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders (cont’d) Braille is a touch reading and writing system that uses raised dots for each letter of the alphabet. The first 10 letters also represent the numbers 0 through 9. Blind and visually impaired persons learn to move about using one of the following. A long cane with a red tip or guide dog Allow independence Don’t move items around room Keep hallways clear Braille is read by moving the hands from left to right along each line of Braille. Special devices allow computer access. Braille printers allow printing computer information in Braille. Braille keyboards are available. Both long canes with a red tip and dog guides are used worldwide by persons who are blind. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders (cont’d) Eyeglasses and contact lenses can correct many vision problems. Clean eye glasses daily and as needed Store in top draw of bedside stand Review the Delegation Guidelines: Eyeglasses Box on p. 664 in the Textbook. Review the Promoting Safety and Comfort: Eyeglasses Box on p. 664 in the Textbook. Contact lenses are cleaned, removed, and stored according to the manufacturer’s instructions. Report and record eye redness or irritation, eye drainage, and complaints of eye pain, blurred or fuzzy vision, or uncomfortable lenses. Review the Promoting Safety and Comfort: Contact Lenses Box on p. 665 in the Textbook. An artificial eye does not provide vision. If an artificial eye is not inserted after removal, follow the measures on p. 665 in the Textbook. Review the Promoting Safety and Comfort: Ocular Prostheses Box on p. 666 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Eye Disorders (cont’d) Removal of an eyeball is sometimes done because of injury or disease. The person is fitted with an ocular prosthesis-unable to see out of it. Some prostheses are permanent implants. If removable, the person may be taught to remove, clean, and insert it. When removed, you need to prevent chips and scratches-always protect with soft cloth Clean with mild soap and water-store in sterile water You must also protect it from loss or damage. Wash the socket with warm water or saline Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.