Chapter 19

Care of the Eye and Ear

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 Vision and Hearing
• Risks to a patients’ eye or ear structures
or function can alter independence,
safety, body image, and self-confidence
• Nurses can help protect the vision and
hearing of patients and assist a patient
with adaptation to artificial sensory
devices that help to replace or restore
sensory function

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 Principles for Practice
 Receiving and understanding environmental
stimuli promote healthy functioning
 Alteration in a patient’s vision and hearing
affects health literacy, independence, and
adherence to medical and pharmacological
therapies
 Artificial sensory aids can restore some vision
and hearing loss
 Understand how to clean and care for these aids

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 Patient-Centered Care
• With altered communication, the patient
may feel isolated
• Health care facilities are environments
that make hearing difficult
• Hearing impaired patients need time to
adjust to their hearing aid
• Consider cultural differences
• Identify patient’s usual practices in using
sensory assistive devices
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 Evidence-Based Practice
• Dual sensory impairment (DSI) consists of
concurrent losses in vision and hearing
• DSI has the potential to cause cognitive
function decline or to contribute to acute
confusion or depression

• DSI decreases independence,

socialization, and quality of life of
individuals and, in many cases, their
families

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 Quick Quiz!
An Italian-American female patient with severe
hearing impairment is sitting in her room,
surrounded by a dozen family members, all talking
happily. The patient appears disconnected from
the group. How can the nurse engage the patient
in communication?
A.Instruct all family members to be silent.
B.Gently touch the patient’s shoulder.

C.Speak loudly in the direction of the patient.

D.Leave the family alone; the patient is fine.

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 Safety Guidelines

1. Whenever you care for patients with sensory

alterations, safety is a priority.
2. Select interventions based on the type of sensory
loss, patient preference, and patient safety.
3. Orient patient to any new environment or
changes within an existing environment to
minimize safety hazards.
4. When patients have visual impairments, they
may have difficulty with tasks requiring visual
detail.
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 Safety Guidelines (Cont.)

5. Provide additional time for patients

with hearing loss to ask repeated
questions about their care or
upcoming procedure.
6. If a patient must sign a consent
form for a procedure or surgery, be
sure to have a method to verify that
the patient read, heard, and
understood the procedure.

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 Eye Care for Comatose Patients
Procedural Guideline 19-1
 Comatose patients do not have natural
protective mechanisms, including blinking and
lubrication of the eye, to protect the cornea
 Left unprotected, damage to the cornea can
occur
 Simple nursing measures can decrease risk and
prevent damage to the cornea

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 Delegation and Collaboration
 The task of eye care for a comatose patient can
be delegated to nursing assistive personnel
(NAP)
 The nurse directs NAP to:
 Adapt the task for specific patients
 Immediately report to the nurse any eye drainage or
irritation for further assessment

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 Taking Care of Contact Lenses
Procedural Guideline 19-2
 Contact lenses correct refractive errors of the eye
or abnormalities in the shape of the cornea that
distort vision
 Rigid gas permeable (RGP)
 Daily disposable soft lens
 All lenses must be removed periodically and
cleaned to prevent infection and corneal damage
 It is critical to determine if patient is wearing
contact lenses

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 Delegation and Collaboration
 The task of taking care of contact lenses can be
delegated to NAP. However, it is the nurse’s
responsibility to assess a patient’s eyes
 The nurse directs NAP to:
 Know a patient’s contact lenses and routine
 Report immediately to the nurse any eye pain or
discomfort, redness, swelling, tearing, or drainage
 Carefully handle lenses to prevent damage and injury

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 Quick Quiz!
The nurse inserts a contact lens into the patient’s
left eye, which comes to rest on the sclera. What
action should the nurse take next?
A.No action required; the lens is in its proper placement.
B.Remove the lens immediately and reinsert.

C.Ask the patient to slowly close the eye and look toward
the lens.
D.Irrigate the eye with normal saline solution.

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 Care of Hearing Aids
Skill 19-3
 Hearing aid components: microphone, amplifier,
receiver, power source
 Two main types: analog and digital
 Hearing impaired cannot hear alerts such as fire
alarms and overhead announcements

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 Delegation and Collaboration
 The task of caring for a hearing aid can be
delegated to NAP
 The nurse directs NAP to:
 Report ear pain, inflammation, drainage, odor, or
changes in hearing
 Identify ways to communicate with a patient while the
aid is not in use
 Learn how to carefully handle the aid to prevent
damage or injury

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 Recording and Reporting
• Record removal of hearing aid, storage location if
not reinserted after cleaning, and patient’s preferred
communication techniques. If family takes aid
home, be sure that this information is included in
the patient’s medical record. If family takes aid
home, be sure that this information is recorded.
• Document your evaluation of patient learning
• Report any signs or symptoms of infection or injury
or sudden decrease in hearing acuity

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 Special Considerations
 Teaching
 Secure hearing aids and batteries when not in use
 Advise others in helpful communication techniques

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 Special Considerations (Cont.)
 Gerontological
 Advise patient to protect hearing aid
 Consult an audiologist if hearing aid size is difficult to
handle
 Home care
 Assess caregiver for level of support
 Assess home for hazards and need for special
precautions

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