CMPA 412: SPECIAL SENSES

RECLEC WK3
THE EYE
The anatomy composed of Iris, Pupil, Sclera, Retina,
Macula, Optic nerve, muscles, Conjunctiva, Cornea,
Lens, Vitreous Gland

- Nearsightedness (myopia) is a
common vision condition in which
near objects appear clear, but
objects farther away look blurry. It
occurs when the shape of the eye or
the shape of certain parts of the eye
— causes light rays to bend (refract)
ABNORMALITY OF THE EYE inaccurately
★ Refractive errors ● Any deviation from the
● Failure of the eye to focus images sharpylon normal causes abnormality,
the retina, causing blurred vision in here the light rays bend or
○ Ideally our eyes should be 20/20 refract inaccurately, so
perfect visions inaccurate meaning there's
○ Clear and not blurry abnormality.
○ In this abnormality, the eyes cannot
focus on the specific object caution it Actual vision in Myopia:
blurriness on the vision

● EMMETROPIA
○ Medical term for the perfect vision
(20/20)
■ No halo, or any light
evolving or surrounding the
retina
■ The light are usually focused
on the iris, cornea and the
pu[il beneath
2. Hyperopia
TYPES OF REFRACTIVE ERRORS - The counterpart of myopia,
Farsightedness
1. Myopia - The lights are extending
- Nearsightedness until the end part, meaning
- Wherein in the eyes, the the light can focus on the
reflection is only on this farthest part of the object
point, causing the eyes to
focus on just near object
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 Actual vision in presbyopia:

- Farsightedness (hyperopia) is a common

vision condition in which you can see
distant objects clearly, but objects nearby
may be blurry.
- The degree of your farsightedness influences
your focusing ability.
4. Astigmatism
Actual vision in Hyperopia: - The light is scattered across the
retina

3. Presbyopia
- The light is focused behind the
retina
- Astigmatism is a common eye problem that
can make your vision blurry or distorted. It
happens when your cornea (the clear front
layer of your eye) or lens (an inner part of
your eye that helps the eye focus) has a
different shape than normal. The only way
to find out if you have astigmatism is to get
an eye exam
● Can occurs in various or diff types of
ages, so it is not age related, it
happens when the lens have
different shapes than normal
- Presbyopia is the gradual loss of your eyes'
ability to focus on nearby objects. It's a Actual vision in Astigmatism:
natural, often annoying part of aging.
Presbyopia usually becomes noticeable in
your early to mid-40s and continues to
worsen until around age 65.
● Somewhat related to age, as the
person ages, then function of the
eye becomes more used of, meaning
that there will be abnormality
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 ◆ INTACS are used to treat mild
SIGN AND SYMPTOMS
myopia (< 3 diopters) and minimal
● Squinting and frowning astigmatism (< 1 diopter).
● Headache - Diopter is used to measure
● Eye irritation, redness, itching the visual acuity
● Visual fatigue
● Frequent eye rubbing ➔ LASER ASSISTED SITU KERATOMILEUSIS
◆ a flap of corneal tissue is created
DIAGNOSTIC TEST with a femtosecond laseor
➢ Visual acuity test mechanical microkeratome. The flap
is turned back and the underlying
stromal bed is sculpted (photo
ablated)with the excimer laser. The
flap is then replaced without
suturing
■ here the problem is that the
direction of the light, the
surgeon will refocused the
line in normal placement so
that the eye can see again in
Medical term for eye- Right Ocular Dexter (ROD) normal (20/20)
and Left Ocular Sinister (LOS)
➔ PHOTOREFRACTIVE KERATECTOMY
➢ Refraction Test ◆ The corneal epithelium is removed
■ The machine will be utilized and then the excimer laser is used to
to czech what grade will be sculpt the anterior curvature of the
fitted to you corneal stromal bed. PRK is used to
➢ Comprehensive eye exam treat myopia, hyperopia, and
astigmatism.
MEDICAL SURGICAL TREATMENT
➔ Myopia- Concave Lenses ★ GLAUCOMA
➔ Hyperopia- Convex Lenses ● It is not one disease but rather a
➔ Presbyopia- Prescription Lenses group of disorder characterized by
◆ There is a small hole in the inner 1. Increased IOP and the
part of the eyeglass consequences of elevated
➔ Astigmatism- Cylindrical Lenses pressure,
2. Optic nerve atrophy
➔ INCISIONAL RADIAL KERATOTOMY ● atrophy- weakening
◆ thin arc-shaped segments of of the optic nerve
biocompatible plastic that are ● if we are not using
inserted in pairs through a small appropriately our
radial corneal incision into the eyes
peripheral corneal stroma at 3. Peripheral visual field loss
two-thirds depth. After INTACS are
inserted, the central corneal
curvature is flattened, reducing
myopia.

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 3. Mild aching in the eyes caused by
increased IOP
4. Reduced visual acuity, especially at
night, not correctable with glasses.

➔ Etiology
DIAGNOSTIC EVALUATION
◆ It is related to the consequences of
elevated IOP. ● History collection.
◆ A proper balance between the rate ● Physical examination.
of aqueous production and rate of ● Visual acuity examination .
aqueous reabsorption is essential to ● Tonometry •
maintain the IOP normal limits. In ● Ophthalmoscopy.
the case of glaucoma, it is altered ● Slit lamp microscopy.
◆ When the rate of inflow is greater ● Gonioscopy - it is performed with the head
than rate of outflow, IOP can rise positioned in the slit lamp (the special
above the normal limits. If IOP microscope used to look at the eyes). After
remains elevated, permanent vision numbing the eye with drops, a special
loss occurs. contact lens is placed directly on the eye
and a beam of light is used to illuminate the
angle
RISK FACTORS ○ Examination of both eyes typically
When we are talking about factors, there is a 2 takes a few minutes
components. Predisposing and Precipitating Factors ● Visual field perimetry.
1. Predisposing Factors ● Fundus photography.
- non-modifiable factors
■ Age
MANAGEMENT
■ Race
■ Family history of glaucoma ● Lifelong therapy is almost always necessary
■ Medical conditions- Diabetes because glaucoma cannot be cured.
mellitus, ● Drug therapy:
■ Cardiovascular disease 1. Beta blockers - timolol
■ Physical injuries - Eye trauma 2. Alpha adrenergic agonist-
■ Near sightedness brimonidine
■ Corticosteroids use 3. Cholinergic agents - pilocarpine -
■ Eye abnormalities increases A.Q outflow
○ Thin cornea 4. Carbonic anhydrase- acetazolamide
2. Precipitating Factors 5. Adrenergic agonIst - Epinephrine, to
- are the factors we can modify reduce IOP by improving aqueous
outflow
6. Prostaglandins - latanoprost, to
reduce intraocular pressure.
● Treatment for acute angle-closure glaucoma
CLINICAL MANIFESTATION is an ocular emergency requiring immediate
● chronic open-angle glaucoma : intervention to reduce high lOP including:
1. Loss of peripheral vision due to 1. IV mannitol (20%) or oral glycerin
compression of retinal rods and (50%), to reduce IOP by creating an
nerve fibers. osmotic pressure gradient between
2. Halos around lights as a result of the blood and Intraocular fluid
corneal edema.
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 ● nursing consideration is to this fluid cannot escape and
check BP just remain in a certain area,
2. Steroid drops- to reduce definitely inflammation will
inflammation occur. In order to eliminate
3. Acetazolamide, a carbonic that problem, the surgeon
anhydrase inhibitor, to reduce lOP will used a lot of ways to
by decreasing the formation and redirect the flow of the fluid
secretion of aqueous humor to escape it properly
4. Pilocarpine - to constrict the pupil, ● Drainage implants or shunts
forcing the iris away from the ○ Drainage implants or shunts are
trabeculae and allowing fluid to open tubes implanted in the anterior
escape chamber to shunt aqueous humor to
5. timolol, a beta-blocker - to decrease the episcleral plate in the
IOP. conjunctival space.
6. Narcotic analgesics, to reduce pain if ○ These implants are used when
necessary failure has occurred with one or
more trabeculectomies in which
SURGICAL THERAPY
antifibrotic agents were used. A
● Argon laser trabeculoplasty: laser burns are fibrous capsule develops around the
applied to the inner surface of the episcleral plate and filters the
trabecular meshwork to open the aqueous humor, thereby regulating
intertrabecular spaces and widen the canal the outflow and controlling IOP.
of Schlemm, thereby promoting outflow of ■ shunting, specific material is
aqueous humor and decreasing IOP. placed on the eye wherein
○ glaucoma has something to do with that serves as channel or
decreased outflow of aqueous fluid medium where the aqueous
● laser iridotomy : for pupillary block fluid can flow out of the
glaucoma, an opening is made in the iris to place in the case of
eliminate the pupillary block. glaucoma in the conjunctival
● Filtering procedures- Trabeculectomy space causing inflammation
○ Trabeculectomy is the standard and blurred vision
filtering technique used to remove ● Trabectome
part of the trabecular meshwork. ○ trabectome surgery stabilizes the
Surgeon used to create an opening optic nerve and minimizes further
or fistula in the trabecular visual field damage.
meshwork to drain aqueous humor ○ The surgery is performed through a
from the anterior chamber to the small incision and does not require
subconjunctival space into a bieb creation of a permanent hole in the
(fluid collection on the outside of eye wall or an external filtering bleb
the eye), thereby bypassing the or an implant.
usual drainage structures. This
allows the aqueous humor to flow Glaucoma complication
and exit by different routes (ie, ❖ Blindness (most common)
absorption by the conjunctival ➢ Nursing intervention
vessels or mixing with tears). 1. Encourage patient compliance
■ In this procedure the surgeon by teaching the patient about
is trying to make different medications, as ordered, to
directions, wherein the
aqueous fluid will escape. If
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 dilate the pupil and protect the process due to no
affected eye. prior experience.
2. Administer pain medication as ■ Nursing Diagnosis
ordered . ● Planning for nursing
3. Encourage the patient to be interventions needs
ambulatory immediately after to take into account
surgery. the patient's level of
■ to promote blood understanding of
circulation and prevent disease process and
pulmonary atelectasist medical regimen and
➢ Nursing process in the patient with ability to comply
Glaucoma. with the
■ assessment time-consuming
● The patient should be medication regimen.
assessed for loss of both ● The goal of nursing
central and peripheral care for the
vision, discomfort, glaucoma patient is
understanding of disease to prevent further
and compliance with visual loss and to
treatment regimen, and promote comfort if
ability to conduct the patient is
activities of daily living. experiencing pain as
■ Nursing Diagnosis in acute glaucoma.
● Nursing diagnoses may ● The patient who
include the following: needs surgical
● Acute pain related to intervention has
increased intraocular additional goals.
pressure . ■ Nursing Intervention
● Disturbed sensory ● The patient is taught
perception: visual how to administer
related to altered medications and
sensory reception. performs a return
● Self-care deficit demonstration to
related to decreased ensure that eye
vision. drops are
● Anxiety related to administered
partial or total properly.
visual loss. ● If the patient has
● Risk for injury trouble with a
related to decreased steady hand when
vision. administering to
● Impaired home steady the hand
maintenance related patient to rest his or
to decreased vision. her hand on the
● Deficient knowledge forehead
related to medical ● If the patient is
regimen, disease unable to see the
label on the eye drop

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 bottle, consider condition and
large-print labels or treatment.
audiotaped ● Goals met
directions. ● partially met
● For patients with ● not met at all
multiple ★ CATARACT
medications, cataract is a clouding of the lens or any
consider using large, opacity within the lens which leads to
multicolored dot decrease in vision
stickers placed on
medication bottle
with a corresponding
direction card with a
matching colored
dot.
● Patients are taught
the need for having
regular eye
examinations
through dilated
pupils. CAUSES
■ Nursing Intervention ● Congenital
● Patient goals are met if ○ familial
the patient does the ○ intrauterine infections
following: ○ maternal drug ingestions
1. Maintains an ● Age
acceptable level of ○ elderly
comfort ● Metabolic
2. Has no further loss ○ diabetes
of vision ○ hypocalcemia
3. Is able to care for self ○ wilson’s disease
with assistance if ○ galactosemia
needed ● Drug-induced
4. Expresses concerns ○ corticosteroids
and anxieties ○ miotics
5. Does not suffer ○ amiodarone
injury as a result of ○ phenothiazines
the visual ● traumatic and inflammatory
impairment ○ post intraocular surgery
6. Is able to manage ○ uveitis
home maintenance ● disease associated
with assistance if ○ down’s syndrome
needed ○ dystrophy myotonic
7. Demonstrates correct ○ lowe’s syndrome
instillation of eye ○ atopic dermatitis
medications
8. Is able to verbalize CLINICAL PRESENTATION
understanding of PRESENTING COMPLAINTS AND HISTORY

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 ● Decreased visual acuity is the commonest ● an IOL may then be placed inside the lens
complaint. capsule and incision is closed
o Progressive and painless it is usually done if the cataract is too large to be
o Worse in bright light destroyed by ultrasound
● There may be complain of glare and SURGERY: ICCE
monocular diplopia if the cataracts splits Intracapsular cataract extraction
the visual axis ● involves extraction of the netire lens,
● A myopic shift in the refraction with including the posterior capsule and conules
progression of cataract may also be noted ● weak and degenerated zonules are pre
● Some complain of a white reflex in the requisite for this method
pupil ● this is the surgery of choice if there is
PAST MEDICAL HISTORY markedly subluxated or dislocated lens
● May reveal risk factors such as ● this technique if surgery has largely been
o Trauma replaced by ECCE
o Intrauterine infections
o Diabetes or other metabolic PHACOEMULSIFICATION
disorders ● two small incision are made in the eye
FAMILY HISTORY where the clear front covering (cornea)
● Cataract may have occurred in other meets the white of the eye (sclera)
members of the family in the hereditary ● a circular opening is created on the lens
variants surface (capsule)
PE FINDINGS ● a small surgical instrument (phaco orbe) is
● Visual acuity is impaired for both distance inserted into the eye
and near and patient may even be blind ● sound waves (ultrasound) are used to break
● Opacity in the lens the cataract into small pieces sometimes a
● Ocular adnexia and intraocular structures laser is used too. The cataract and lens
when examined may reveal lesions that pieces are removed form the eye using
may point at suction
o The cause , type, and eventual ● an intraocular lens implant (IOL) may the
visual prognosis nbe placed inside the lens capsule
● If RAPD positive, this indicates an optic ● usually, the incision seal themselves
nerve disease or extensive macular lesions without stitches
o Visual prognosis guarded in such EAR REVIEW
cases INTRODUCTION
VISUAL ACUITY ● presbycusis refers to sensorineural hearing
TREATMENT impairment in elderly
The treatment of cataracts is: ● most common otolaryngologic problem of
1. Glasses elderly
2. Better lighting ● involves bilateral high – frequency hearing
3. Surgery associated with difficulty in speech
a. Phacoemulsification discrimination and central auditory
b. ECCE (extracapsular cataract processing of information
extraction) ● association between advanced age and
c. ICCE (not performed now) high tone deafness was first described by
Sometimes a cataract should be removed even if it zwaardemaker in 1899
doesn’t cause major problems with vision, if it is ● hearing loss may contribute to the isolation
preventing the treatment of another eye problem, of elderly people by restricting their usage
such as age-related macular degeneration, diabetic of phone, causing them to forfeit social
retinopathy or retinal detachment events such as concerts and social
SURGERY: ECCE gatherings and amplifying their sense of
Extracapsular cataract extraction disability
● An 5 mm to 6mm incision is made in the EPIDEMIOLOGY
eye where the clear front covering of the ● No race ,sex, differences. Increases with
eye (cornea) meets the white of the eye age
(sclera) ● 25-30% of people aged 65 – 76 are
● Another small incision is made into the estimated to have impaired hearing
front portion of the lens capsule. the elns is ● For people aged 75 or older incidence is
removed, along with any remaining lens thought to be 40-50%
material

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 ●Westernized countries and primitive
▪ Range from amplification of
civilization have very different patterns of
hearing loss telephone signal to sound
● Rosen et al study in Sudanese tribe called transmitters
mabaans revealed significantly less hearing o Cochlear implants
loss in elderly people than those of urban ▪ Px with cochlear changes
society
AETIOLOGY and intact spiral ganglia and
central candidate are best
● Arteriosclerosis
candidates
o Cause diminished perfusion and
● Future treatment
oxygenation of cochlear
o Researchers proposing treatments
● Diet and metabolism
that address underlying genetic
o DM accelerates process of
cause
arteriosclerosis.
o Medications that block production
o Diffuse proliferation and
of reactive oxygen metabolites
hypertrophy of intimal endothelium
(carnitine) may treat presbycusis at
which may also interfere with
molecular level
perfusion of cochlea
o Sterm cell transplant into the
o Brainstem neuropathy in DM
cochlea to attempt to regenerate
● Accumulated exposure to noise sensory cells
● Drug and environmental chemical exposure MENIERE’S DISEASE
● Genetics ● First described by prosper meniere in 1861
● Stress ● Meniere disease is a balance disorder
OTHER CAUSES DEFINITION
● Nutritional and anatomic ● Is an abnormal inner ear fluid balance
o Berner et al investigated the relation caused by a malabsorption in the
between vitamin B12 and folate – endolymphatic sac or a blockage in the
not significant relationship endolymphatic duct
o Martin Villares et al found positive ● It is also called endolymphatic hydrops
ship between high cholesterol ● It occurs bilaterally in about 20% px
levels and hearing loss
o Statin users has no improvement in ETIOLOGY
rate of presbycusis ● Unknown
WORKUP
● Common in adults
● Blood test for autoimmune
● Age: between 40-60 years of age
● Audiology with PTA speech discrimination
● Equally common in men and women
o Need for additional testing can be
determined from the audiometric ● Family history: 50% of the px have a
plus physical examination of the px positive family history
TREATMENT ● Hypersecretion or hypo absorption of
● Presbycusis is not curable endolymph or both
o Effects disease on px lives can be ● Deficit membrane permeability
managed ● Allergy
o Amplification devices – properly ● Viral infection
fitted hearing aids ● Hormonal imbalance
o Older patients with arthritis and ● Mental stress
visual difficulties need extra help on CLINICAL MANIFESTATION
learning to use hearing aids ● Fluctuating, progressive sensorineural
o Patients using hearing aids may still hearing loss
experience difficulties with speech ● Tinnitus
discrimination in noisy situations ● Vertigo
● Lip reading o Accompanied by nausea and
o May help patients with diminished vomiting and nystagmus
speech discrimination and hearing o Vertigo lasts 2-4 hours
aid users who have difficulty in o And followed by dizziness and
noisy events unsteadiness
o Assistive listening devices ● Warning signs
o Headache

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 A feeling of pressure or fullness in
o o Limit alcohol intake. Alcohol may
the ear change the volume and
● Behavioral changes concentration of the inner ear fluid
o Irritability and may worsen symptoms
o Depression o Avoid monosodium glutamate
o withdrawal (MSG), Which may increase
DIAGNOSTIC MEASURES symptoms
● history collection SURGICAL MANAGEMENT
● physical examination ● The surgical TX for menieres disease is
● audiogram: identify the type and magnitude aimed at eliminating the attacks of vertigo,
of the hearing loss hearing loss, tinnitus and aural fullness may
● CT or MRI continue.
1. Endolymphatic sac procedure
● Electronystagmogram: to evaluate the
o First line surgical approach to treat
oculomotor and vestibular system to
differentiate the cause of vertigo, tinnitus, the vertigo of menières disease as it
and hearing loss of unknow origin is simple safe and can performed on
MEDICAL MANAGEMENT an outpatient bases
o Through a postauricular incision, a
● Pharmacologic therapy
shunt or drain is inserted in the
o Antihistamine: to suppress the
endolymphatic sac and fluid is
vestibular system. Eg: meclizine
drained into subarachnoid space.
o Tranquilizers: to control vertigo. Eg:
Thus release of pressure on the
diazepam endolymphatic system in the
o Antiemetic: eg: promethazine labyrinth
(Phenergan). To control the nausea 2. Vestibular nerve section
and vomiting and the vertigo o Performed by a translabyrintine
because of their antihistamine effect approach or in a manner that can
o Diuretic: relieve symptoms by conserve hearing (ie, suboccipital or
lowering the pressure in the middle cranial fossa) depending on
endolymphatic system the degree of hearing loss. Cutting
Eg: hydrochlorothiazide, triamterene the nerve prevents the brain from
o Vasodilators: eg: papaverine receiving input from the
hydrochloride semicircular canals
● Avoid aspirin and aspirin containing NURSING MANAGEMENT
medications. Aspirin may increase tinnitus ● Assess the severity and frequency of attack,
and dizziness any associated ear sx (hear loss, tinnitus)
● If not responding to drugs; ● Acute vertigo: provide bed rest, sedation
o Ablation therapy antiemetics
▪ Intratympanic injection of ● Encourage patient to lie down during attack
gentamicin is being used to in safe place
cause ablation of the ● Advise px to avoid food that cause allergy
vestibular hair cells ● Maintain to prescribed low salt diet
● Dietary management ● Impaired comfort related to impairment in
o Low sodium (1000 to 1500 mg/day auditory function or vestibular function
or less diet) ● Impaired auditory sensory perception
o The amount of sodium is a factor related to altered state of the ear
that regulate the balance of fluid ● Risk for deficient fluid volume related to
within the body. Sodium and fluid increase fluid output, altered intake
retention disrupts the delicate ● Risk for injury related to impaired
balance between endolymph and equilibrium
perilymph in the inner ear ● Anxiety related to threat to changes health
o Limit foods high in salt or sugar status
o Eat meals and snacks at regular OTOSCLEROSIS
intervals to stay hydrated. Missing ● Otosclerosis or “hardening of the ear” result
meals or snacks may alter the fluid from the formation of an abnormal spongy
level in the inner ear bone like bone growth along the stapes in
o Limit intake of coffee, tea and soft the middle ear
drinks. Avoid caffeine because of its ● With the new bone growth the stapes
diuretic effect become immobile prevents transmission as

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 sound biration into the ear, leading the o IBUFROFEN
conductive hearing loss o OXYCODONE
● Otosclerosis usually affect the both ears o ACETAMINOPHEN (PCM)
CLASSIFICATION ● Hearing aid may be used to treat the
1. Histological otosclerosis hearing loss
● This type of otosclerosis does not ● General measures
produce any symptoms during life o Avoidance of noise full environment
but is revealed only at post mortem o Side lying position
2. Clinical otosclerosis o Continuous application of
1. Stapedial otosclerosis medication
● The otosclerosis focus may produce o High protein diet
ankylosis of the membranous SURGICAL MANAGEMENT
labyrinth STAPEDECTOMY
2. Cochlear otosclerosis ● The removal of portion of the sclerotic
● The otosclerosis process stepes footplate of stapes or complete
encroached upon the membranous removal of the stapes and the implant with
labyrinth producing sensorineural prosthesis to maintain suitable conduction
deafness ● Modern surgery called stapedotomy is
3. Mixed otosclerosis performed by drilling a small hole in the
● Otosclerosis causes both fixation of stapes footplate with micro drill or laser,
the stapes as well as in involvement and the insertion of piston like prosthesis
of the labyrinth so that there are NURSING ASSESSMENT
mixed hearing loss ● History of onset and progression of
CAUSES symptoms
1. Genetic factors ● Extend of hearing loss via auditory
2. Viral infection ● Rinnes test – to evaluate loss of air
3. Measles conduction
4. Other ear conditions
● Webers test
CLINICAL MANIFESTATION
COMPLICATIONS
● Hearing loss
● Complete deafness
● Dizziness
● Nerve damage
● Tinnitus
● Infection, dizziness, pain or blood clot in the
● Roaring ear after surgery
● Buzzing the ear DYSGEUSIA
● Vertigo What is dysgeusia
● Headache & earache ● An impairment of the sense of taste
DIAGNOSTIC EVALUATION TASTE
● History ● Perceiving flavors
● Physical examination o Tongue primary organ
● Tuning fork test
● Audiometry test ▪ Nerve cells
● Tympanocentesis – fluid for middle ear ▪ Taste buds
send for culture
● CT scan – collection of fluid in ear and ● Type I – salty taste
mastoid region, abscess formation ● Type II – sweet,
● MRI – evaluation of tumor and soft tissue bitter and umami
● AUDIOGRAPHY – to assess hearing loss taste
MANAGEMENT What cause it?
● Otosclerosis may slowly get worse. The ● Autoimmune diseases
condition may not require treatment until o Sjogren syndrome
you having severe hearing problems ▪ sx
● Medication such as fluoride, calcium or
● Nerve related damage
vitamin D may help to slow the hearing
o Glossopharyngeal
loss, but the benefits have not yet been
proved ▪ Detect bad taste
● No know medical tx exist for this form of ● Medication therapy
deafness but amplification with a hearing o Chemotherapy
air may be helpful
● Administer analgesic such as ▪ Taste aversions
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 ● Upper Respiratory Infections Loss of
▪ Change in sensory receptors
olfaction after a URI is one of the most
● Psychological disorders common causes of smell disorders, and
o Depression occurs more commonly in women and the
elderly. Olfactory dysfunction during a URI
▪ Can lead to eating disorder
can initially be conductive, but persistence
STATISTICS of loss of smell after resolution of other
● Both men and female affected equally symptoms indicates sensorineural injury to
● Medication therapy px the olfactory epithelium.
● Aging ● In patients with post-viral olfactory
DIAGNOSIS dysfunction, the presence of rhinovirus,
● Taste test coronavirus, parainfluenza virus, and
o Salty, bitter, sour, umami Epstein-Barr virus have been detected in
● Smell test the nasal discharge.
o Common smells ● Other infectious causes that have been
● MRI reported include hepatitis, herpes simplex
o Check structural changes encephalitis, pneumonia and variant
TREATMENT Creutzfeld-Jacob disease.
● Zinc intake HEAD TRAUMA
● Improving food flavors Often results in smell loss, particularly where rapid
RISK acceleration/deceleration of the brain occurs (i.e.
● Malnutrition coup/contrecoup injury).
o Death ● The prevalence of olfactory loss following
SMELL head trauma is around 15 percent and is
● Dysosmia (sometimes termed cacosmia or proportional to tte severity of the injury.
parosmia) is distorted or perverted smell ● Blunt trauma to the occiput has been found
perception to odour stimulation. to produce greater olfactory loss than
● Phantosmia is a dysosmic sensation trauma to the front of the head.
perceived in the absenc odour stimulus ● Following head trauma, the loss of smell is
(also known as olfactory hallucination). usually, but not always, immediate.
● Olfactory agnosia refers to an inability to However, it may take a while for the patient
recognize an odour sensation, even though to recognize the presence of the
olfactory processing, language and general dysfunction.
intellectual functions are essentially intact, ● Fracturing of the cribriform plate is not a
as in some stroke patients. prerequisite for smell loss.
● Presbyosmnia - a decline in smell sense TUMORS AND MASS LESIONS
with age. ● A number of tumours in and around the
● Osmophobia - a dislike or fear of certain olfactory bulbs or tracts can cause
smells. olfactory disturbance. Examples include
olfactory groove meningiomas, frontal lobe
CONDUCTIVE OLFACTORY DISORDERS gliomas and
● The conditions which can decrease the ● suprasellar ridge meningiomas arising from
nasal airflow and block the access of the dura of the cribriform plate.
odorants to the olfactory epithelium; ● mesial temporal lobe tumours.
however, patients may still have some CONGENITAL LOSS
retronasal airflow, allowing the ability to ● Accounts for about 3% of anosmia.
detect the flavor of food. ● Usually an isolated finding.
● Causes of decreased nasal airflow include ● Patients often present during their preteen
nasal septal deformities, nasal polyposis, or teenage years with an inability to smell,
tracheostomy. or nasal cavity tumors. post often discovered by family members.
op adhesions. Patients with a congenital lack of olfactory
● Although rhinosinusitis may cause a ability may not recognize their olfactory
conductive loss, and a change in the sense dysfunction and haye no recollection of
of smell is one of the most predictive detecting odors. They, may have distinct
symptoms of true rhinosinusitis, evidence food preferences due to their inability to
also points to a sensorineural olfactory loss appreciate the flavor of food while retaining
especially with long-standing the ability to detect the fundamental taste
inflammątory disease. sensations from the taste buds.
SENSORINEURAL OIFACTORY DISORDERS

12 | Page CA 2 Annotated By: B.B.B.

 reduced smell identification scores,
RISK FACTORS pointing to genetic predisposition in the
Toxins development of the disease.
- Olfactory dysfunction attributed to toxin
exposure is relatively low (2%), but a large
number of toxins are associated with Epilepsy and migraine
olfactory loss. ● Olfactory auras, also described as
hallucinations, are rare.
These include: ● When present, they are often associated
● Environmental pollutants. with seizures and headaches. Olfactory
● Specific metal fumes (Cadmium, auras consist of sudden unexplained
Chromium, Nickel, Mercury, Lead etc). sensations of smell that are usually, but
● Gas exposure from industrial plants not always, unpleasant and are rarely
(formaldehyde, methyl bromide). isolated events.
● Solvents including toluene and paint ● In epilepsy, mesial temporal lobe
solvents. structures are involved in the usual
● Tobacco smoke. processing of odor information such as the
amygdala and hippocampus have been
implicated as the generators of ictal
Age olfactory sensations (simple or complex
● Under the age of 65 years, approximately partial seizures) that often evolve into
1% of the population has major difficulty in secondarily generalized seizures.
smelling.
● Between 65 and 80 years, this increases Common etiologies include mesial temporal
remarkably, with about half of the sclerosis and tumors.
population experiencing a demonstrable
CLINICAL EVALUATION OF SMELL FUNCTION:
decrement in the ability to smell.
Proper assessment of a patient's smell function
● Over the age of 80, this figure rises to
requires
nearly 75%.
(1) a detailed clinical history.
(2) quantitative olfactory testing, and
There is accumulation of damage over the years,
(3) a thorough physical examination emphasizing
and a single event, such as a bad cold, can be
the head and neck with appropriate brain and
the precipitating factor.
rhinosinus imaging.
Neurodegenerative disorders

HISTORY TAKING:
● In patients with Alzheimer and Parkinson
● Does the patient have a problem with
diseases, 90% exhibit olfactory
smell, taste or both?
dysfunction in the early stages of the
● Mode of onset, duration of impairment and
diseases.
pattern of occurrence?
● Olfactory loss may be the first clinical sign
Sudden olfactory loss can be consistent with
of these neurodegenerative diseases,
possible head trauma, ischaemia, infection or a
preceding signs of dementia in Alzheimer
psychiatric condition.
disease (AD) or motor symptoms in
Gradual loss may indicate a progressive and
Parkinson disease (PD) by several years.
obstructive lesion in or around the naso sinus
● Neurofibrillary tangles and neuritic plaques
region, particularly if the loss is unilateral.
appear in the olfactory bulb, anterior
Intermittent loss may suggest an inflammatory
olfactory nucleus, and olfactory cortex in
process in association with nasal and sinus
patients with AD.
disease.
● First degree family members of patients
with AD were found to have significantly
13 | Page CA 2 Annotated By: B.B.B.
Seasonal variation? (Allergic rhinitis) Proper allergy management is essential and may
require the use of an antihistamine.

Personal History: When a bacterial infection is suspected (for

Appetite may decrease owing to example, infectious rhinosinusitis), a course of
decreased/altered flavor. Addiction to alcohol, antibiotics should be used.
cigarette smoking, ● Nursing Responsibility: To educate the
drug abuse- intranasal cocaine. patient to adhere to antibiotic
management.
Menstrual history: Delayed puberty in ○ If prescribed for 7 days, the patient
association with anosmia (with or without midline must complete the 7 days to avoid
craniofacial abnormalities, deafness and renal resistance to the antibiotics
anomalies) suggests the possibility of Kallmann's ■ since the patient tends to
syndrome or some variant thereof. stop taking antibiotics on
the 3rd day due to absence
Physical examination and evaluation: of s/sx or manifestation of
Patients complaining of smell disturbance illness.
typically require a general assessment of the
head and neck and more detailed Surgery should be considered for:
otolaryngological and neurological examinations. (1) very large and medically refractory polyps, or
(2) situations where a malignant neoplasm is
Any signs of trauma such as healing wounds, suspected.
scarring or distorted nasal or skull architecture?

Inspection of the nasal passages to view the When epilepsy or migraine is suspected, a course
peripheral nasal cavity for signs of polyps, of antiepileptic or antimigraine medications may
congestion, deviation of septum or inflammation. prove beneficial.
Nasal endoscopy, employing both flexible and
rigid scopes, is needed to ensure thorough Medically refractory epilepsy resulting in olfactory
assessment of the olfactory meatal area. disturbance can be successfully treated with
surgery.
TREATMENT OF SMELL DISORDERS
In patients with multiple sclerosis,
The most effective treatments available are those immunomodulatory therapies, including
for conductive anosmia, where there is an interferon-beta and occasional steroids, is the
obstruction of airflow through the nose to the mainstay of treatment.
olfactory neuroepithelium.
When depression or psychosis is suspected, a
After diagnosis is confirmed using tools such as course of an antidepressant
nasal endoscopy and CT scanning of the sinuses, and appropriate psychiatric referral may be
the next appropriate course of action may include necessary.
topical or systemic steroids.
In patients with complete anosmia, supportive
Conductive and sensorineural olfactory losses are measures are necessary to protect them from
often distinguishable using a brief course of further harm. Thus,
systemic steroid therapy, since patients with 1. Smoke and carbon monoxide detectors
conductive impairment frequency respond need to be installed and properly working.
positively to the treatment, although long-term 2. When possible, electrical appliances
systemic steroid therapy is not advised. should be used instead of gas appliances.
3. Expiration dates for food products should
be scrutinized and old food items checked
14 | Page CA 2 Annotated By: B.B.B.
 by someone with normal smell function or II. Deep second degree: injury through the
discarded. epidermis and deep upto reticular dermis.
4. A balanced diet, particularly in the elderly, (c) Third degree:
must be kept to prevent weight loss and full-thickness injury through the epidermis and
malnutrition. dermis into subcutaneous fat.
SKIN (d) Fourth degree:
injury through the skin and subcutaneous fat into
underlying muscle or bone.

- Burns is defined as a wound caused by an

exogenous agent leading to coagulative
necrosis of the tissue.
CAUSES
● Thermal Burns Dry heat
○ Contact burn
○ Flame burn
○ Moist heat- Scald burn
○ Smoke and inhalation injury
CLINICAL FEATURES
○ Chemical Burns- acids & alkali
● Electrical burns- High & low voltage
i) First degree burns:
● Cold Burns- frostbite
● Reddened skin
● Radiation
● Pain at burn site (most painful among all
● Sun Burns
degrees)
CLASSIFICATIONS
1. Depending on the Percentage of Burns: ● Involves only epidermis
(a) Mild: Partial thickness burns less than 15% in ● Blanch to touch
adults or less than 10% in children or full ● Have an in-tact epidermal barrier
thickness less than 2%. ● Do not result in scarring
● Examples: Sun-burn, minor scald from a
(b) Moderate: Second degree 15-25% burns in kitchen accident
adults or 10-20% in children or third degree
2-10% burns. ii) Superficial 2nd Degree Burns:
● Intense pain
(c) Major: Second degree >25% burns in adults ● White to red skin
or >20% burns in children or third degree >10% ● Blisters
burns or burns involving eyes, ears, feet, hand, ● Second Degree Burns
perineum. All inhalational and electrical burns. ● Involves epidermis & papillary layer of
dermis
● Spares hair follicles, sweat glands etc
2. Depending on Thickness of Skin Involved: ● Erythematous & blanch to touch
(a) First degree: injury localized to the epidermis. ● Very painful/sensitive
(b) Second Degree: ● No or minimal scarring.
I. Superficial second degree: injury to the ● Spontaneously re-epithelialization from
epidermis and superficial papillary dermis. retained epidermal structures in 7-14 days

15 | Page CA 2 Annotated By: B.B.B.

 ○ Increase in core body temperature.
iii) Deep second degree burns: ● Immunologic:
● Injury to deeper layers of dermis, i.e, ○ Loss of protective barrier.
reticular dermis. ○ Increased risk of infection.
● Appears pale & mottled. ● Suppression of humoral and cell-mediated
● Do not blanch to touch. immune responses.
● Capillary returns sluggish or absent. MANAGEMENT
● Less painful, remain painful to pinprick. First Aid:
● Takes 14 to 35 days to heal by 1. Stop the burning process.
re-epithelialization from hair follicles & 2. Cool the area with tap water with continuous
sweat glands, keratinocytes often with irrigation for 20 minutes.
severe scarring.
● Contractures possible. Indications Of Admission in Burns:
1. Moderate and severe burns.
iv) 3rd Degree Burn: 2. Airway burns of any type.
● Dry, leathery skin (white, dark brown, or 3.Burns in extremes of age.
charred). 4. All electrical or deep chemical burns.
● Loss of sensation (little pain).
● All dermal layers/tissue may be involved. Definitive Treatment:
1. Maintain airway, breathing, circulation
v) Fourth degree burn: (ABC).
● Involves structures beneath the skin- 2. Sedation and analgesia.
muscle,bone. 3. Assessment of percentage, degree and
ASSESSMENT OF BURNS type of burn and accordingly fluid
management.
4. Chemoprophylaxis: tetanus toxoid
antibiotics and local antiseptics.
5. Ryle's tube insertion initially for aspiration
and later for feeding.

Fluid Resuscitation:
● Formulas to calculate fluid replacement;

1.Parkland Regimen:
● Total Fluid replacement in 24 hours = 4 ml
1. Wallace Rule of Nine per % of burn per kg body weight.
SYSTEMIC CHANGES
● Half of the volume is given in the first 8
● Cardiac:
hours, rest is given in the next 16 hours.
○ Decreased cardiac output.
● Pulmonary:
2. Muir and Burclay Regimen:
○ Respiratory insufficiency as a
● For colloids after 12-24 hours.
secondary process. Can progress
● 1 Ration = % burns × body weight in kg/ 2.
to respiratory failure.
3 Rations given in the 1st 12 hours. >2
● Gastrointestinal:
Rations given in the next 12 hours. >1
○ Decreased or absent GI motility.
Ration given in next 12 hours.
Curling's ulcer formation.
3. Galveston Regimen (Paediatric):
● Metabolic:
● 5000ml/m2 burn area + 1500ml/m2 total
○ Hypermetabolic state.
BSA.
○ Increased oxygen and calorie
requirements.
Fluids used:
16 | Page CA 2 Annotated By: B.B.B.
 ● Ringer lactate is the fluid of choice. 1. Mild: Inability to see ceiling.
● Blood is transfused after 48 hours. 2. Moderate: Flexion possible but not extension.
● In the 1st 24 hours only crystalloids should 3. Severe: Fully contracted in flexed position with
be given. pull on lower lip.
● After 24 hours colloids like plasma, 4. Extensive: Mentosternal adhesions.
gelatin, dextran, hetastarch are used at
the rate of 0.35-0.5 ml/kg/% of burns. Complications of contracture:
● Urine output should be 30-50 ml/hr. 1. Ectropion
● Hourly TPR charting. 2. Disfigurement of face.
3. Microstomia.
Local Management: 4. Hypertrophic scar and keloid formation.
1.Open Method: 5. Marjolin's ulcer.
Application of silver sulphadiazine without any
dressings commonly used in burns of face and Treatment:
neck. cutaneous flap, microvascular free flap,
Mafenide acetate & silver nitrate can be used. 1. Z- Plasty
2. Random fasciocutaneous flap. 3.
2. Closed Method: Physiotherapy.
With dressings done to soothe and protect 4. Pressure garments.
wounds, to reduce pain and as an absorbent.

3.Tangential excision: Acids:

Skin grafting can be done within 48 hours with Protein injury by hydrolysis.
less than 25% burns. ● Thermal injury is made with skin contact.
Alkali
Wound coverage: ● Saponification of fat.
● In 3 weeks the area granulate well & split ● Hygroscopic effect- dehydrates cells.
skin grafting is done (SSG, Thiersch graft). ● Dissolves proteins by creation of alkaline
● For wider area Mesh split skin graft is proteinates (hydroxide ions).
used. Treatment:
● In case of eschar, escharotomy is done to ● Late neutralization with antidote done by
prevent compression of vessels. 0.2% acetic acid in alkali burns, sodium
● Cultured skin graft. bicarbonate or calcium gluconate for acid
burns.
COMPLICATIONS OF BURNS
Eschar: It is a charred, denatured, full thickness, Electrical Burns:
deep burns with contracted dermis. ● Greatest heat occurs at the points of
● Escharotomy: resistance, i.e, at Entrance and Exit
○ Incise along medial and/or lateral wounds. Dry skin = Greater resistance-
surfaces. Wet Skin = Less resistance
○ Avoid bony prominences. ● Longer the contact, the greater the
○ Avoid tendons, nerves, major potential of injury Smaller the point of
vessels. contact, the more concentrated the
energy, the greater the injury.
Contracture: Treatment:
- Disorganized over formation of compact ● Assess Entrance & Exit wounds.
collagen (three times than normal) causes ● Remove clothing, jewelry, and leather
hypertrophic scar finally leading to items.
contracture. ● Treat any visible injuries.
○ Classification of Contracture in
Neck (BM Achauer) Radiation Burns:
17 | Page CA 2 Annotated By: B.B.B.
 ● Local burns causing ulceration need ● However, as these are also present in less
excision and vascularised flap cover - serious conditions such as cellulitis, the
usually with free flaps. degree of pain relative to the skin
● Systemic overdose needs supportive condition might provide the physician with
treatment The damage is more difficult to clues-NF typically presents with pain out
define and slower to develop than burns. of proportion to the degree of skin
● Acute frostbite needs rapid rewarming, inflammation.
then observation. ● Necrotizing fasciitis typically presents with
● Delay surgery until demarcation is clear. patchy discolouration of the skin with pain
and swelling, but without a defined margin
Cold Burns: ● Progression of NF is marked with the
● The damage is more difficult to define and development of tense edema, a
slower to develop than burns. grayish-brown discharge, vesicles, bullae,
● Acute frostbite needs rapid rewarming, necrosis, and crepitus
then observation. WORKUP
● Delay surgery until demarcation is clear. 1. Laboratory studies
NECROTIZING FASCIITIS 2. Cultures
● Necrotizing fasciitis is a necrotizing soft ● Blood cultures
tissue infection spreading along fascial ● Intraoperative Tissue cultures
planes with or without overlying cellulitis. 3. Imaging
RISK FACTORS ●
● Diabetes ● The common plain radiographic
● Chronic disease findings nonspecific with increased
● Immunosuppressive drugs (eg, soft- tissue thickness and opacity.
prednisolone) Radiographs can be normal until
● Malnutrition the advanced stages of infection
● Age > 60 years and necrosis. The characteristic
● Intravenous drug misuse finding of gas in the soft tissues is
● Peripheral vascular disease seen in only a minority of cases
● bacterial introduction ● Imaging plays a very limited role in
● IV drug use diagnosis and management of
● hypodermic therapeutic injections necrotising fasciitis.
● insect bites
● skin abrasions Laboratory risk indicator for NF (LRINEC)
● abdominal and perineal surgery score:
● Renal failure - score > 6 has PPV of 92% of having
● Underlying malignancy necrotizing fasciitis
● Obesity
● CRP (mg/L)
Bacterial introduction: ○ ≥150: 4 points
● IV drug use ● WBC count (×103/mm3)
● hypodermic therapeutic injections ○ <15: 0 points
● insect bites ○ 15-25: 1 point >25: 2 points
● skin abrasions ● Hemoglobin (g/dL)
● abdominal and perineal surgery ○ >13.5: 0 points
CLINICAL PRESENTATION ○ 11-13.5:1 point
● Patients with NF can present with ○ <11: 2 points
constitutional symptoms of sepsis (eg, ● Sodium (mmol/L)
fever, tachycardia, altered mental state) ○ <135: 2 points
● signs of skin inflammation (ie, pain, skin ● Creatinine (umol/L)
edema, and erythema) ○ >141: 2 points
18 | Page CA 2 Annotated By: B.B.B.
 ● Glucose (mmol/L) Communication can also be hindered by the
○ >10: 1 point normal aging process, which may involve sensory
TREATMENT loss, decline in memory, slower processing of
1. Antibiotics information, lessening of power and influence
● initial antibiotics over their own lives, retirement from work, and
○ start empirically with penicillin, separation from family and friends.
clindamycin, metronidazole, and
an aminoglycoside Definition:
● definitive antibiotics Is the activity of conveying meaningful
○ penicillin G information.
■ for strep or clostridium
○ imipenem or doripenem or Communication requires a sender, a message,
meropenem and an intended recipient, although the receiver
■ for polymicrobial need not be present or aware of the sender's
○ add vancomycin or daptomycin intent to communicate at the time of
■ if MRSA suspected communication.
The communication process is complete once the
2. Operative receiver has understood the message of the
- emergency radical debridement with sender.
broad-spectrum IV antibiotics operative
findings ELEMENTS OF COMMUNICATION PROCESS
SENDER:
● liquefied subcutaneous fat - Is the communicator who has the
● dishwater pus responsibility to convey actions, words
● muscle necrosis and feelings. Facial expression and body
● venous thrombosis language convey the same message.
● non contracting muscle
● a positive "probe test" result, which ● Massage :
is characterized by lack of ○ The information conveyed by the
resistance to finger dissection in sender. the receiver changes the
normally adherent tissues. massage back into feeling and
mental image, massage should be
SPECIAL GERIATRIC CONSIDERATIONS clear and in familiar terms to the
Outline: receiver and being understood.
● Definition of communication ● Receiver:
● Types of communication Ways of ○ Is the individual who listens and
communication interprets the message. The
● Factors affecting communication receiver's understanding depends
● Barriers of communication on mental function and
● How to communicate with elderly person interpretation ability.
● How to communicate with elderly person ● Feedback:
with sensory deficit ○ Enable the sender to determine
whether the massage was
Introduction: correctly interpreted simply by the
The communication process in general is receiver. Restating the message is
complex and can be further complicated by age. a type of feedback, the sender
One of the biggest problems when dealing with asks a question that allows the
older patients is that they are actually more receiver for clarification.
heterogeneous than younger people. WAYS OF COMMUNICATIONS
● Two way communication:

19 | Page CA 2 Annotated By: B.B.B.

 ○ Is a dynamic process in which - The two type of communication are verbal
exchange ideas and thoughts and non verbal. 10% of all communication
occurs as a continuous process, is verbal and 90% is nonverbal.
requires actively involved receivers
and provides feedback. Verbal communication :
○ Used when communicating with It is the use of words to express thoughts,
peers, significant others,etc. feelings , and attitude. When communicating with
older adults, feedback is essential to explore
● One way communication: thoughts of the older adults and ask for more
○ Allows the sender to remain in explanations.
control and the receiver remains
passive. Is not the most effective ● Informing: Use direct statements
type of communication. regarding facts, a good information
○ Used in therapeutic statement is clear, concise,and expresses
communication, e.g., psychiatrist & in words that elderly can understand.
psychologist to patients. ● Direct questioning: Are helpful when the
nurse needs to obtain specific information,
FACTORS INFLUENCING COMMUNICATION and appropriate when information must be
Personal factors: obtained quickly.
● Perception: A person's perception is an ● Open ended technique: Allows the
essential element in communication. person to express more about their feeling
People can see the same object and see and perception also allow the nurse to
different things. verify that the information exchanged is
● Values: values influence the process of accurate
communication because people values, ● Active listening: The nurse pays
like their perception. attention to verbal and nonverbal
● Culture: Each culture provides its communication using eye contact and
members a notion about how the world is facial expression
structured and teaches people how to use
language, space to communicate certain Nonverbal communication :
messages and techniques that differ from The most accurate form of communication
culture to culture. is the way of communication without the use of
● Attitude : A nurse's attitude toward the words. People use their facial expression, eye
elderly plays a major role as elderly need contact, gestures and body language.
to be respected and feeling valued so the ● Nurses should be more sensitive to
nurse should convey trust and empathy nonverbal communication
through verbal and non verbal especially when the patient is
communication. experiencing pain.
● Trust: Trust is central to a therapeutic
nurse – relationship. without a sense of BARRIERS OF COMMUNICATIONS
trust the interaction is superficial, trust ● Inappropriate reassurances.
implies confidence, dependability and ● Making judgments.
credibility in a relationship. ● Giving advice, telling the person what
should be avoided.
Environmental factors: ● Challenging.
● Seating arrangement, room comfort, ● Improper questioning
movement of chairs,object that facilitate or EFFECTIVE COMMUNICATIONS
distract, noise, lack of privacy. ● Be aware of the person's health issues.
● Allow the elderly person to reminisce, and
TYPES OF COMMUNICATION to grieve.

20 | Page CA 2 Annotated By: B.B.B.

 ● Respect the elderly person's background, ● Call out the person's name before
knowledge, and values. touching. Touching lets a person know
● Be attentive to the environment in which that you are listening.
you are communicating COMMUNICATING WITH PERSONS WITH
● Speak clearly and articulately, and make ALZHEIMER’S DISEASE
eye contact. ● Always approach the person from the
● Adjust your volume appropriately front, or within his/her line of vision.
● Use clear and precise questions and ● Speak in a normal tone of voice.
sentences ● Face the person as you talk to him/her.
● Employ visual aids, if possible. Take it ● Avoid a setting with a lot of sensory
slow, be patient, and smile. stimulation, like a big room where many
people may be sitting or talking, a
COMMUNICATING WITH THE HEARING IMPAIRED high-traffic area or a very noisy place.
● Check to see if the hearing aid is in the
person's ear. Also check to see that it is NUTRITION
turned on. - The study of food, its composition, the
● Wait until you are directly in front of the amounts needed by the body and its
person, you have that individual's attention effects on the body
and you are close enough to the person
before you begin speaking. There are 6 nutrients:
● Be sure that the individual sees you ● Proteins
approach ○ Sources
● Face the hard-of-hearing person directly ■ Animal protein: meat,
and be on the same level with him/her poultry, fish, eggs, cheese,
whenever possible. yogurt, milk.
● Keep your hands away from your face ■ Plant protein: Lentils,
while talking. Beans, Peas, nuts, cereals
■ Plant protein foods contain:
COMMUNICATING WITH THE DEAF ■ Less saturated fat
● Write messages if the person can read. ■ More fiber
● Use a pictogram grid or other device with ■ Cheaper to produce
illustrations to facilitate communication. ○ Functions
● Be concise with your statements and ■ The growth of all body cells
questions. ■ For repair of worn or
● Utilize as many other methods of damaged cells
communication as possible to convey your ■ To make hormones,
message (i.e. body language). Spend time enzymes and antibodies in
with the person, so you are not rushed or the body
under pressure. ● Fats / Lipids
COMMUNICATING WITH THE VISUALLY IMPAIRED ○ There are 2 classes of lipids
● Describe the room layout, other people ■ Saturated lipids: animal
who are in the room, and what is fats, solid at room
happening. temperature.
● Tell the person if you are leaving. ■ Unsaturated lipids: plant
● Let him/her know if others will remain in and fish oils, liquid at room
the room or if he/she will be alone. temperature
● Allow the person to take your arm for ○ Sources
guidance. ■ Saturated fats are found in:
● Ask how you may help: increasing the butter, suet, lard, meat,
light, reading the menu, describing where cheese, eggs, milk, yogurt.
things are, or in some other way.

21 | Page CA 2 Annotated By: B.B.B.

 ■ Unsaturated fats are found
in: fish, nuts, seeds,
cereals, soya beans, olives,
avocado pears, some
margarines, cooking oils.
● Carbohydrates
○ Sources
■ Sugars are found in: fruit,
honey, table sugar, cakes,
biscuits, sweets, fizzy
drinks, jam
■ Starches are found in:
bread, potato, pasta, rice
■ Cellulose is found in: Fruit,
vegetables, whole- cereals,
seeds, nuts, beans, brown
bread, brown rice, high
fiber breakfast cereals
○ Functions
■ To supply the body with
energy
■ Extra carbohydrate is
changed to body fat and
stored
■ Cellulose is needed to keep
the digestive system
healthy and lower
cholesterol
● Mineral elements
● Vitamins
● Water

■ Macronutrients: needed in large amounts by the

body i.e. protein, fat and carbohydrate.
■ Micronutrients: Needed in small amounts by the
body i.e. vitamins, minerals

■ Composition: the elements that make up the

nutrients.
■ Classification: dividing things into groups or
classes.
■ Sources: foods that supply a large amount of a
nutrient.
■ Functions: Uses of nutrients in the body

22 | Page CA 2 Annotated By: B.B.B.

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