1. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 37 Hearing, Speech, and Vision Problems

2. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  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 Slide 2

3. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Ear Disorders  Otitis media is infection or inflammation of the middle ear.  Otitis media is acute or chronic.  Fluid builds up in the ear.  Signs and symptoms include: Pain and hearing loss Pain and hearing loss Fever and tinnitus Fever and tinnitus  An untreated infection can travel to the brain and other structures in the head. Slide 3

4. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Ménière’s disease:  Involves the inner ear  Is a common cause of hearing loss  Usually affects one ear  Symptoms include vertigo (dizziness), tinnitus, hearing loss, and pain or pressure in the affected ear.  Treatment involves drugs, fluid restriction, a low- salt diet, no alcohol or caffeine, and safety measures during vertigo. Slide 4

5. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Hearing loss  Hearing loss is not being able to hear the normal range of sounds associated with normal hearing.  Deafness is hearing loss in which it is impossible for the person to understand speech through hearing alone.  Common causes of hearing loss are damage to the outer, middle, or inner ear and damage to the auditory nerve. Slide 5

6. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Risk factors that can damage the ear structures include: Aging Aging Exposure to very loud sounds and noises Exposure to very loud sounds and noises Drugs (antibiotics, too much aspirin) Drugs (antibiotics, too much aspirin) Infections Infections Reduced blood flow to the ear Reduced blood flow to the ear Stroke Stroke Head injuries Head injuries Tumors Tumors Heredity Heredity Birth defects Birth defects Slide 6

7. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Temporary hearing loss can occur from earwax (cerumen).  Clear speech, responding to others, safety, and awareness of surroundings require hearing.  A person may not notice gradual hearing loss.  There are some obvious signs and symptoms of hearing loss.  Psychological and social changes are less obvious.  Hearing is needed for speech. Slide 7

8. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Persons with hearing loss may wear hearing aids or lip-read (speech-read).  Some people learn sign language.  Some people have hearing assistance dogs (hearing dogs).  Hearing aids make sounds louder.  If a hearing aid does not seem to work properly: Check if the hearing aid is on. Check if the hearing aid is on. Check the battery position. Check the battery position. Insert a new battery if needed. Insert a new battery if needed. Clean the hearing aid, following the nurse’s directions and the manufacturer’s instructions. Clean the hearing aid, following the nurse’s directions and the manufacturer’s instructions. Slide 8

9. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Speech Disorders  A speech disorder results in impaired or ineffective oral communication.  Aphasia means the inability to have normal speech.  Expressive aphasia (motor aphasia, Broca’s aphasia)  Receptive aphasia (Wernicke’s aphasia)  Expressive-receptive aphasia (global aphasia, mixed aphasia)  The person with apraxia of speech cannot use the speech muscles to produce understandable speech.  Dysarthria means difficult or poor speech.  It is caused by nervous system damage. Slide 9

10. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Eye Disorders  Vision loss occurs at all ages.  Vision loss is sudden or gradual in onset.  One or both eyes are affected. Slide 10

11. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Glaucoma results from damage to the optic nerve.  Fluid builds up in the eye and causes pressure on the optic nerve.  Peripheral vision (side vision) is lost.  Other signs and symptoms vary.  Risk factors African-Americans over 40 years of age African-Americans over 40 years of age Everyone over 60 years of age Everyone over 60 years of age Those with a family history of the disease Those with a family history of the disease Those with diabetes, high blood pressure, or heart disease Those with diabetes, high blood pressure, or heart disease Those who have eye diseases or eye injuries Those who have eye diseases or eye injuries Those who have had eye surgery Those who have had eye surgery  Drugs and surgery can control glaucoma and prevent further damage to the optic nerve. Slide 11

12. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Cataract is a clouding of the lens in the eye.  Signs and symptoms include: Cloudy, blurry, or dimmed vision Cloudy, blurry, or dimmed vision Colors seem faded. Colors seem faded. Sensitivity to light and glares Sensitivity to light and glares Poor vision at night Poor vision at night Halos around lights Halos around lights Double vision in one eye Double vision in one eye  Risk factors Age Age Diabetes Diabetes Smoking and alcohol use Smoking and alcohol use Prolonged exposure to sunlight Prolonged exposure to sunlight A family history of cataracts A family history of cataracts  Surgery is the only treatment. Slide 12

13. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Age-related macular degeneration (AMD)  AMD is a disease that blurs central vision.  Painless, it is the leading cause of blindness in persons 60 years of age and older.  The two types of AMD are wet AMD and dry AMD.  Risk factors Aging Aging Smoking Smoking Obesity Obesity Whites are at greater risk than any other group. Whites are at greater risk than any other group. Family history of AMD Family history of AMD Women are at greater risk than men. Women are at greater risk than men. Light-colored eyes Light-colored eyes Exposure to sunlight Exposure to sunlight Cardiovascular disease Cardiovascular disease Slide 13

14. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  When dry AMD is advanced, no treatment can prevent vision loss.  For wet AMD, some treatments (such as laser surgery) may stop or slow the progress of the disease. Slide 14

15. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Diabetic retinopathy  The tiny blood vessels in the retina are damaged.  It is a leading cause of blindness.  Everyone with diabetes is at risk for diabetic retinopathy.  The person needs to control his or her diabetes, blood pressure, and blood cholesterol.  Advanced retinopathy is treated with laser surgery.  Low vision is eyesight that cannot be corrected with eyeglasses, contact lenses, drugs, or surgery.  The person learns how to use one or more visual and adaptive devices. Slide 15

16. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Impaired vision and blindness  Amount of vision loss varies.  Braille is a touch reading and writing system that uses raised dots for each letter of the alphabet.  Blind and visually impaired persons learn to move about using a long cane with a red tip or using a dog guide.  The legally blind person sees at 20 feet what a person with normal vision sees at 200 feet. Slide 16

17. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Eyeglasses and contact lenses can correct many vision problems.  Clean glass lenses daily and as needed with warm water. Dry them with a lens cloth or cotton cloth.  Use special solutions and cloths for plastic lenses.  Report and record the following:  Eye redness or irritation  Eye drainage  Complaints of eye pain, blurred or fuzzy vision, uncomfortable lenses  Removal of an eyeball is sometimes done because of injury or disease.  The person is fitted with an ocular prosthesis (artificial eye).  An artificial eye does not provide vision. Slide 17

18. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Quality of Life  Hearing, speech, and vision problems can interfere with quality of life.  The focus is on the person’s abilities.  Do not pity the person.  Treat the person like an adult.  Be patient, understanding, and sensitive.  The health team promotes independence to improve quality of life.  The person is allowed to control his or her life to the extent possible.  He or she is encouraged to take part in the care planning process. Slide 18