Page 80 nursing.elitecme.com Complete Your CE Test Online - Click Here Nursing consideration: When assessing hearing, be sure to assess for the presence of excessive cerumen wax, which may hinder hearing. Hearing is assessed in the same ways as for other adult age groups. The use of a tuning fork and covering one ear while whispering two-syllable words toward the uncovered ear are two of the ways to assess hearing. Nursing consideration: As with all assessment evaluations, be sure to review the patient’s medications to determine if any of them may affect hearing. Examples of such medications include aminoglycoside antibiotics, loop diuretics, Baciofen, and Propranolol [9,17]. Tinnitus is a common problem in older adults. It is a ringing sound in the ear and can happen with or without accompanying hearing loss. This problem may be self-limiting or chronic. Tricyclic antidepressants may be prescribed as part of the treatment as well as relaxation techniques, biofeedback, or counseling to deal with the discomfort [9]. Touch The sense of touch or physical sensation decreases with age. This is because nerve impulses are conducted at a slower rate in the older adult. There is also a reduction in the function of peripheral nerves. Medications used to calm or sedate may also contribute to a decrease in the sense of touch [9,14]. Nursing consideration: These physiological changes lead to a decreased ability to perceive pain and temperature, which, in turn, can increase the risk for injury. For example, the older adult may not perceive the temperature of water in the bathtub or shower to be too hot, increasing the risk for burns. If the sense of pain is diminished, older adults may not be aware that they have injured themselves after falling or other types of blunt trauma. Nurses must teach older adults and their families to be especially careful to avoid injuring themselves, and to check for injuries after experiencing even slight trauma. The sense of touch is also important in conveying affection and, in some cultures, to communication in general. A loss of physical sensation may be detrimental emotionally as well as physically. Nursing consideration: Some diseases, such as diabetes mellitus, can cause peripheral neuropathies that add to the loss of the sensation of touch [9,13]. One of the simplest ways to assess touch is to use a wisp of cotton. Patients close their eyes and are asked to indicate when they feel the sensation of touch. The nurse touches parts of the body such as the face, the arms, the legs, the back, etc. Additional techniques are to touch various areas of the body with a pin alternating with a wisp of cotton. The patients are asked to say whether they feel a sharp sensation (when touched with a pin) or dull (with the cotton wisp) [9,13,14]. Some nurses find it helpful to use objects of various sensations such as sand paper, a piece of silk, or fur and then ask the patients if they feel a rough or a soft sensation. Tubes of hot and cold water may be placed against a patients’ skin as they are asked to state whether they feel a cold or a hot object [9,13]. Nursing consideration: Teach older adults to examine their skin, especially over bony prominences, the soles of their feet, and between fingers and toes for open or broken areas of skin. Because of the decrease in the sensation of touch, open areas may not be noticed until they are severe and/or infected. The integumentary system The integument or the skin is the body’s largest organ and consists of three layers: the epidermis, the dermis, and the subcutaneous layers. The epidermis is the outermost layer of the skin and has up to five layers (depending on the specific part of the body). The dermis is the second layer of the skin; it has an abundant blood supply and is made up of connective tissue, lymph, and neurosensory receptors. It supports and nourishes the epidermis. The subcutaneous layer lies below the dermis, attaches to muscles, gives shape to the body, and provides a protective cushion for bones and internal organs. There are also a number of accessory structures that are part of the integumentary system. These are the hair, nails, sebaceous glands, which produce sebum for skin lubrication, and eccrine glands that produce sweat. The skin is very important to health and wellness. It is responsible for [9,14]: ● ● Regulation of body temperature. ● ● Regulation of body fluids. ● ● A barrier to infection, and promotion of the immune system. ● ● Vitamin D synthesis. ● ● Sensory reception. Nursing consideration: There are a number of age-related changes that affect how the integumentary system functions. Nurses need to be aware of these changes, not only for their impacts on physical health, but for their impacts on self-perception and self-esteem as well. Changes in the integumentary system result from a loss of subcutaneous fat along with connective tissue which becomes less elastic. The degree of these changes is determined by the individual’s nutritional status and their exposure to ultraviolet light [9]. Changes include the following: ● ● Thickness and elasticity: Both decrease with age, which leads to the appearance of wrinkles and causes the skin to sag, especially the skin of the face, neck, and upper arms. Smoking and ultraviolet light exposure is associated with an increase in wrinkling of the skin [9,14]. ● ● The epidermis: The epidermis thins and moisture is lost. The skin begins to have a dry and rough appearance. The rate of cell growth is decreased, which leads to an increased risk of infection. This decrease, combined with a lack of moisture, makes the skin more susceptible to damage. “Liver” or “age” spots appear and the number of moles and freckles may increase. The cosmetic aspects of these changes may have a negative impact on the older adult’s self-image and self-esteem [9,14]. ● ● The dermis: The dermis begins to decrease in thickness and effectiveness. The capillaries begin to thin, which leads to bruising and creates the appearance of transparency. There is an accompanying reduction in sensation that increases the risk for injuries such as burns, infections, and pressure sores [9,14]. ● ● Subcutaneous layer of skin: This layer increases in some parts of the body and decreases in others, resulting in changes in fat distribution. It thins in the face, neck, hands, and lower legs. With age, fat distribution becomes more pronounced in the abdomen and thighs in women, and in the abdomen in men [9,14]. ● ● Hair and nails: The color of the hair becomes gray or white and becomes thin. There is a loss of axillary and pubic hair and alopecia, or baldness appears. Men generally experience more obvious loss of hair from the head than do women. Balding may have a significant impact on self-esteem. Women may also begin to experience the growth of facial hair on their faces. Nails become dull, and yellow or gray. They become thick and break or split easily [9,14]. ● ● Sebaceous glands production declines resulting in less sweating, which is an important factor needed for the body to cool itself. Oil production is also decreased contributing to drier skin. ● ● Damage from sun exposure: It is estimated that more than 90% of skin cancers are related to exposure to the sun. The cumulative effects of years of sun exposure increase the amount of age-related changes such as wrinkles and freckles, and often make people appear older than they really are. Damage done by the sun is not reversible [9,13]. Nursing consideration: Some drugs increase a person’s sensitivity to sunlight. Some examples are antibiotics, antihistamines, antidepressants, and anti-arrhythmics. As always, educate patients about the risk for sun sensitivity if they are on medications that increase this problem [9,17]. Skin cancer is a common problem among older adults. It is important that nurses recognize potentially malignant lesions and initiate appropriate follow-up and treatment. Skin cancer is the most common type of cancer