Tabloski ch14 lecture

Gerontological Nursing
THIRD EDITION
CHAPTER
14
Sensation:
Hearing, Vision,
Taste, Touch, and
Smell
Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.
All Rights Reserved

Learning Objectives
1. Explain normal changes associated
with the aging process on the five
senses—vision, hearing, taste, smell,
and touch.
2. List common nursing diagnoses of
older persons related to sensory
problems.
Gerontological Nursing, Third Edition
Patricia A. Tabloski

Learning Objectives
3. Recognize nursing interventions that
can be implemented to assist the
aging patient with sensory changes.
4. Identify medications that may cause or
aggravate sensory dysfunction.

Introduction
• Changes in vision, hearing, smell,
taste, and touch occur naturally
throughout the aging process.
• Impairments in sensory functioning can
greatly alter the capabilities of older
adults to complete everyday activities,
affecting quality of life and safety.

Vision
• Visual impairment is defined as visual
acuity of 20/40 or worse while wearing
corrective lenses, and legal blindness or
severe visual impairment is 20/200 or
more as measured by a Snellen wall
chart at 20 feet.

Vision
• Visual impairment and blindness in the
older person is the result of four main
causes:
– Cataracts
– Age-related macular degeneration
(ARMD)
– Glaucoma
– Diabetic retinopathy

Vision
• Older patients should be questioned
regarding adequacy of vision, recent
changes in vision, visual problems, and
the date of their last complete visual
examination.

Vision
• The gerontological nurse should inspect
the eyes for any abnormalities,
including movement of the eyelids,
abnormal discharge, excessive tearing,
abnormally colored sclera, and
abnormal or absent pupillary response.

Visual Problems
• Age-related macular degeneration is
the leading cause of blindness in adults
over the age of 65.
• Cataracts cloud the lens, decrease the
amount of light able to reach the
retina, and inhibit vision.

Visual Problems
• Glaucoma is associated with optic nerve
damage due to an increase in IOP
(intraocular pressure), which can
ultimately lead to vision loss.
• Diabetic retinopathy is a microvascular
disease of the eye occurring in both
type 1 and type 2 diabetes.

Nursing Diagnoses Associated with
Visual Impairment
• Nursing diagnoses associated with
visual impairment are diverse and
depend upon the older person’s ability
to compensate for visual problems.
• The gerontological nurse should
consider the older patient’s functional
ability and not just the results of visual
acuity testing using the Snellen chart.

Hearing
• Hearing loss can interfere with
communication, enjoyment of certain
forms of entertainment such as music
and television, safety, and ultimately,
independence.
• Hearing impairments also may
endanger individuals living alone, due
to their inability to hear a smoke
detector or security alarm.

Hearing
• A thorough history and physical
examination is important to help
determine the cause of the hearing
loss.

Hearing Aids
• Professional nurses can serve as role
models, educators, and instructors for
nursing assistants who are unfamiliar
with the care of expensive items.

Hearing Impairment
• Nursing diagnoses associated with older
patients with hearing impairment are
diverse and depend upon the ability to
compensate for hearing problems.

Taste
• Taste deficits can result in weight loss,
malnutrition, impaired immunity, and
worsening of medical illness.
• A diminished sense of taste, or
hypogeusia, is a normal sensory
change usually occurring after the age
of 70.

Nursing Assessment of the Older
Patient with Taste Disturbances
• A thorough assessment of the head and
neck should be performed to rule out
obvious deformity, injury, infection, or
obstruction. Mucous membranes should
be assessed for dryness, ulceration, or
presence of candidiasis.

Nursing Assessment of the Older
Patient with Taste Disturbances
• Hypogeusia can lead to malnutrition
because a decreased ability to sense
flavor in foods can lead to lack of
motivation and enjoyment in preparing
and consuming a well-balanced diet.

Smell
• Loss of sensation can also affect the
older adult emotionally and
psychologically because the sense of
smell triggers memories and
pleasurable experiences such as
smelling fragrant flowers.

Touch
• As people age, tactile sensation
diminishes, due to slower conduction of
nerve impulses and diminished function
of peripheral nerves. As a result, older
adults have decreased perception of
pain, vibration, touch, and temperature
extremes.

Physical Sensation
• Institutionalized older persons deprived
of caring touch and nurturing physical
contact experience a diminishing
quality of life, a lessening of their
desire to relate to others, and a
weakening of what may already be a
fragile relationship with physical reality.

Tactile Impairment
• For patients with impaired sense of
touch, nursing interventions may focus
on continuous monitoring of the
intactness of the skin, assessment of
safety risks, and the development of a
safety plan with instructions to
minimize injury.

Tabloski ch14 lecture

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