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Communication

Senses and Communication

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Vision 70% of all sensory info comes

Cortex responsible for higher


thought and function; contains all
sensory and motor information

through the eyes

Thalamus relay station

Hearing provides source of info as

Forebrain interprets information

well as interpretation of meaning

Pitch high/low
Timber quality

Touch may be substitute for sight

Smell & Taste convey meaning and

Movement allows receipt of info from

trigger feelings

environment, nonverbal
communication

Speech- primary form of

Note that disability can affect ability to

communication with environment

convey or receive info

The Role of the Brain in


Communication

Common Visual Diseases

Cataracts

sugar, which causes microaneurysms


in retinal capillaries

Painless progressive vision loss 70%


of Americans develop after age 75

Increasing lens opacity causes


spraying of light and blurriness around
edges of objects

Cause: hereditary, advancing age

Corrective cataract surgery

Accounts for 7% of blindness in US

Early detection and treatment of


diabetics to prevent substantial vision
loss

Annual eye exams

Macular Degeneration

Glaucoma

Increase of intraocular pressure which

Asymptomatic until late in disease

Early detection important

Screening identifies 90% of patients

causes damage to optic nerve which


can lead to blindness

with increased pressure

Visual complication of elevated blood

Treat with eye drops to prevent vision


loss

Prostaglandin, Betar blockers,


alpha agonist, CAI

Diabetic Retinopathy

Most common cause of legal

Never yell at a blind patient.

blindness in people over 50

Progressive degeneration of macula

Starts in one eye and moves to other

and loss of central vision

Pathological Processes Associated


with Hearing Loss

pitched tones and speech


discrimination

eye in 5 years

Early diagnosis over 50 should have


eye exam every 2 years

Special Considerations:

Presbycusis difficulty with high

Tinnitus persistent ringing,

Ototoxicity hearing loss due to

buzzing, or roaring

medications or poisons

Blindness

Special Considerations:
Position where patient might

be able to see you.

Explain procedures before

doing them.

If patient has glasses make

sure they are wearing them.

Never pull blind patient.

Walk at their side and hold

their arm.

Let them know about

obstacles.

Deafness

impaired initiation, coordination


and sequencing of muscle
movements which execute speech,
caused by damage to parietal lobe

Never assume the patient is

deaf.

If patient is wearing a

hearing aid, make sure it is on.

Verbal apraxia speech disorder,

Communicating with Aphasic


1. Keep distractions and noise down:

Determine if the patient can 2. Talk to people who have aphasia in


lip-read.
adult language.

Note writing.

3. If they can not understand you, do not


shout.
4. When you ask questions:

Hearing impairment can lead to

social isolation, perception of others


of cognitive decline and depression

Pathological Changes in Speech and


Language

Dysarthria lose ability to

Aphasia

articulate, brain lesions main cause

Expressive: unable to

produce language

Receptive: unable to

comprehend

Ask questions in a way they can


answer you with a simple "yes" or
"no."
When possible, give clear choices
for possible answers, but do not
give them too many choices.

Visual prompts are also helpful,


when you can give them.

5. When you give instructions:

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Break down instructions into small


and simple steps.

10. Begin to take the person with aphasia


out more, as they become more
confident.
11. When leaving someone with speech
problems alone, make sure they have an
ID card that:

Has information on how to contact


family members or caregivers

Allow time for the person with


aphasia to understand. If the
patient becomes frustrated,
consider changing to another
activity.

6. Encourage the person with aphasia to


use other ways to communicate. Some
are:

Pointing

Hand gestures

Drawings

7. It may help the person with aphasia


and their caregivers to make a book with
pictures or words about common topics or
people so that they can communicate
better.
8. Always try to keep the person with
aphasia involved in conversations. Check
with them to make sure they understand.
9. Do not try to correct the person with
aphasia if they remember something
incorrectly.

Explains their speech problem and

Consider joining support groups for

how best to communicate with


them

people with aphasia and their


families.

Movement Disorders in Older Adults

Activities of Daily Living basic


tasks such as eating, bathing,
toileting, grooming

Instrumental Activities of Daily


Living more complex tasks such
as handling finances, managing
meds, preparing meals

As seen in Parkinsons Disease


tremor, rigidity, stiffness, slowness
of movement, postural instability,
and/or impaired balance and
coordination

Common Pathological Cognitive and


Psychological Changes in Older
Adults

Delirium: sudden onset, lasting


days to months, reversible, recent
and remote memory impaired

Dementia: insidious onset, lasting

Psychomotor agitation or

retardation

Fatigue

Feelings of worthlessness or

inappropriate guilt

Impaired ability to think or

concentrate

Recurrent thoughts of death,

including suicide ideation or


attempts

from months to years, irreversible


but can be slowed with use of
meds, progressive loss of memory Communication Tips
with recent affected prior to remote

Depression

Very serious; Characterized by at


least 5 of the following symptoms:

Sadness
Lack of interest or pleasure in
activities they once enjoyed

Significant weight loss or gain

Marked decrease or increase

in sleep

Allow extra time

Avoid distractions

Sit face to face

Maintain eye contact

Speak slowly and clearly

Therapeutic Communication

Use simple, short words and

sentences

Stick to one topic at a time

A core skill for nurses

An exchange of information

Augmentive and alternative


communication system (AAC) = all
forms of communication that
enhance or supplement speech and
writing; can enhance or replace
conventional forms of expression

Simplify and write down your

instructions

Use charts, models and

pictures

Frequently summarize the

most important points

Hearing aids

Picture boards

Synthesized

(computer-generated) and
digitalized (recorded) speech

Summary

Nurses should be mindful of and


sensitive to these changes when
planning care and teaching.

Communication in Healthcare
Normal aging changes may result
in a decreased ability of the older
adult to communicate effectively.
These changes may affect both the
ability to receive and transmit
information.

Instrumental communication:
necessary behavior for assessing
and solving problems

Affective communication: focuses


on how the HCP is caring about the
person and his or her feelings and
emotions

Communicating with the Older Adult


Basic principles for communication
(Satir, 1976):

o Invite: Im interested, openended questions

o Arrange environment: make it

conducive to communication, eye


to eye contact

o Maximize understanding: be a good


listener

o Maximize communication:

consider the patients health


literacy level

o Follow- through: forms trust

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