1. Chapter 32 Hearing, Speech, and Vision Problems All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

2.   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 Hearing, Speech, and Vision 2 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

3. 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 Fever and tinnitus   An untreated infection can travel to the brain and other structures in the head. 3 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

4. Ménière’s Disease   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 medications, fluid restriction, a low-salt diet, no alcohol or caffeine, and safety measures during vertigo. 4 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

5. Hearing Loss   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. 5 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

6. Risk Factors   Risk factors that can damage the ear structures include: Aging Exposure to very loud sounds and noises Medications (antibiotics, too much aspirin) Infections Reduced blood flow to the ear Stroke Head injuries Tumors Heredity Birth defects 6 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

7. Hearing Loss   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. 7 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

8. Communication   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 the battery position. Insert a new battery if needed. Clean the hearing aid, following the nurse’s directions and the manufacturer’s instructions. 8 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

9. Cochlear Implant and Other Hearing Devices   A cochlear implant is a small surgically implanted device that delivers auditory impulses directly to the auditory nerve.   The auditory nerve carries signals to the brain.   The implant does not restore normal hearing but can produce useful representation of sounds.   Cochlear implants are being used for very young children as well as the elderly.   For the implant to work, the implant package and sound processor must be aligned.   Other hearing devices   Telephone amplifying devices   TV and radio listening systems 9 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

10. 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. 10 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

11. Eye Disorders   Vision loss occurs at all ages.   Vision loss is sudden or gradual in onset.   One or both eyes are affected. 11 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

12. Glaucoma   Glaucoma causes 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 Everyone over 60 years of age Those with a family history of the disease Those with diabetes, high blood pressure, or heart disease Those who have eye diseases or eye injuries Those who have had eye surgery   Drugs and surgery can control glaucoma and prevent further damage to the optic nerve. 12 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

13. Cataract   A cataract is a clouding of the lens in the eye.   Signs and symptoms include: Cloudy, blurry, or dimmed vision Colors seem faded. Blues and purples are hard to see. Sensitivity to light and glares Poor vision at night Halos around lights Double vision in one eye 13 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

14. Cataract (Cont’d)   Risk factors Age Diabetes Smoking and alcohol use Prolonged exposure to sunlight A family history of cataracts   Surgery is the only treatment. 14 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

15. Macular Degeneration   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. 15 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

16. Macular Degeneration (Cont’d)   Risk factors Aging Smoking Obesity Whites are at greater risk than any other group. Family history of AMD Women are at greater risk than men. Light-colored eyes Exposure to sunlight Cardiovascular disease 16 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

17. AMD Treatment   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. 17 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

18. Diabetic Retinopathy   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. 18 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

19. Impaired Vision and Blindness   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. 19 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

20. Eyeglasses, Contact Lenses, and Ocular Prosthesis   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. 20 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

21. 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. 21 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.