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Understanding how to care for clients with vision and hearing problems will help in ensuring good care of older persons
organized thought processes Intact sensory organs needed Intact vision and hearing 1. To be able to respond to stimuli presented by ones environment 2. Makes possible verbal and written communication. 3. To enjoy meaningful activities and social interactions.
1. Increase risk of Injury- sensory deficits. 2. Isolation limited interactions. 3. Risk for emotional distress. 4. Prone to suffer mental health problems. Becomes a behavioral Boredom management problem. Shorter attention span. (Koplac, 1983) Difficulty in coherent thinking. Confused Needs more time and attention.
VISION PROBLEMS
Impaired Vision Decreased or is lacking in the ability to see. Brought about by MAJOR VISUAL CHANGES usually starts at age 50- leading to visual impairment Preceded by functional changes
5. Presbyopia or farsightedness
Problem of accommodation Or the ability to focus clearly and quickly on objects at various distances.
1. Cataracts - common; due to the clouding or opacity of the normally clear, crystalline lens. 2. Glaucoma - blockage in the drainage of the aqueous humor Fluid in the anterior chamber of the ye. Usually reabsorbed by the venous circulation
What happened if there is increased production and failure of reabsorption? Increased intraocular pressure leads to 1. degeneration and cupping of the optic disc 2. Atrophy of the optic nerve head 3. Narrowing of the visual field.
Glaucoma insidious, chronic condition Called thief in the night because of the sudden loss of vision ( no noticeable symptoms. Starts 1. Decreasing peripheral vision but central vision remains intact 2. Does not limit the vision of the client.
3. Senile macular degeneration - results from a. Decreased blood supply b. Accumulation of waste products. c. Tissue atrophy
Macula is on the retina. Retina is where the focusing area is found. Degeneration of the macula results in a decline in central visual acuity that makes daily tasks requiring close vision hard to perform.
Ophthalmologistmedical doctor who specializes in the care and management of eye problems
OPTICIAN fits, adjusts and dispenses eyeglasses and contact lenses prescribed by optometrists and ophthalmologists.
Independence MUST BE ALLOWED as much as possible in various levels of blindness Ebersole and Hess (2001)
1. a. b. c. d. When approaching a blind client Speak before touching so as not to startle him. Sometimes a handshake will do. Facing the client when talking for better communication. Never leave a blind client for long periods of time leads to panic and hallucination. Work out a daily routine. Work with schedule. Abrupt and unannounced changes can be disorienting. Remember they dont have dawn and dusk reminders anymore. Use other sensory stimulation such as touch, sounds and smell. Increased external stimulation is necessary especially if there are signs of apathy. (clocks and chime)
e.
BUT if the cause of visual impairment is a common disorder- additional interventions are quite necessary 1. Cataracts a. Immediate medical attention is needed. b. Surgery. Post-cataract removal management. b.1 No rubbing or pressing the eye. Limit activities. b.2 Discourage shampooing and showers. b.3 Always protective gear to the eye. b.4 Discourage reading during the first weekmovement of the eye can loosen the stitches.
c. Prevent increase intraocular pressure. c.1 Not allowed to bend or stoop. c.2 Avoid straining during bowel movement. c.3 No lifting of heavy objects.(not carry more than 5 kilos) c.4Avoid strong emotions during the early postoperative period.
2. Glaucoma
Requires continual lifelong treatment. Visual loss- is quite permanent. 2.1 Eye drops (miotics)are usually prescribed. Prevent increased IOP. Continuously given even if symptoms are relieved. Given as scheduled. 2.2 If symptoms will not be relieved by mioticssurgery is required. Post-operative care is the same with cataract extraction.
3. Diabetic Retinopathy no early and advanced symptoms 3.1 DM clients- undergo annual opthalmoscopic examination.
3.2 Control the main cause. DM- maintaining blood sugar (foremost goal) Maintaining balance between food intake and energy use.
1. Adequate lighting especially for reading, sewing, writing and similar activities. 2. Suggest use of a magnifying glass to enhance vision. 3. Avoid bright glare. 4. Soft light on at night especially in the bathroom, kitchen or areas mist visited. Or flashlight near the clients bed.
5. Special dial phones. Touch phones are easier to use. 6. Dont re-arrange things around the house without explaining. 7. Written communication- use large prints.
Behavioral Modifications
(changes in behavior that will facilitate adaptation to visual impairment)
1. Face the person when speaking. 2. Pockets in their clothing for carrying treasured things. 3. Important to have a transistor radio. 4. Provision of detailed instructions for any activity to be done. 5. If client wants to be independent/alone- advise him/her to pause in doorways when going from light to dark rooms or vice-versa. Teach him to use feet/hands as probes to feel for steps, edges of floors, and the like.
HEARING PROBLEMS
1. RECEIVES 2. INTERPRETS 3. SENSE WARNING SIGNALS
Impaired Hearing is lack of or decrease in ability to hear.
HEARING LOSS
Due to abnormality in the external ear canal, tympanic membrane and/or middle ear ossicles
CARING FOR CLIENTS WITH HEARING IMPAIRMENT 1. ELIMINATION OF RISKS FACTORS a. Cerumen Impaction due to thinner and drier skin in the ear canal and increased keratin. b. Ototoxicity due to drugs b.1 aspirins b.2 most antibiotics 2. ENVIRONMENTAL MODIFICATIONS 2.1 eliminate background noise.
2.2 a. b. c. enhance your voice No shouting Lowering pitch of voice Moderate volume.
2.3 Face clients when talking. 2.4 Use of gestures and body language. 2.5 Rephrasing messages. 2.6 Use of written communication.
3.4 Insert aid with canal portion pointing into ear; press and twist until snug. 3.5 Whistling sound- indicates incorrect ear mold insertion. 3.6 Turn aid slowly to 1/3 or volume. 3.7 Adjust volume to a level comfortable for talking at a distance of one yard. 3.8 Concentrate on conversations. 3.9 sit close to speaker. 4.0 Be observant to non-verbal cues.
4.1 Remove aid when bathing. 4.2 Dont wear aid under heat lamps or hair dryer or in very wet, cold weather. 4.3 Be patient and realize the process of adaptation is difficult but ultimately rewarding.