Hygiene, Sensory Deficits and Comfort Measures

In depth

The one-page summary above is what the PDF prints. These sections go further.

Hearing loss and hearing aids in more depth

Age-related hearing loss (presbycusis) comes on gradually: speech is hardest to follow against background noise. Wax in the canal causes a temporary conductive loss, and high-dose aspirin and loop diuretics can damage the inner ear and cause tinnitus. Ear disorders can also cause dizziness and vertigo, so a hearing complaint may be a fall risk too.

Hearing aids sit behind the ear with an earmold, in the outer ear, or in the canal. The smallest ones are the hardest to handle and to clean. NIDCD lists the care points: keep the aid away from heat and moisture, clean it as the audiologist taught because wax and drainage damage it, keep hairspray off it, switch it off when it is out, and replace a dead battery straight away. Batteries and small aids are kept away from children and pets.

Troubleshooting in the order an exam expects: is it switched on and in the right ear, is the battery live, is the earmold blocked with wax, is it seated properly. Whistling usually means a poor fit or wax. Only then is it sent for repair.

Communication on the unit: knock and catch the client’s eye before speaking, stand 2 to 3 feet away in good light, keep gum and hands away from the mouth, lower the pitch rather than raise the volume, use short plain sentences and gestures, and check understanding.

Interpreters and effective communication: the rules

Under the ADA (28 CFR 36.303) and Section 1557 (45 CFR 92.202), a health care entity must make communication with a person with a disability as effective as with anyone else and must provide the aids needed, at no charge. A qualified interpreter interprets accurately, impartially and effectively in both directions.

• The hospital may not require the client to bring an interpreter
• An accompanying adult may interpret only in an emergency with no interpreter available, or when the client asks, the adult agrees and it is appropriate
• A minor child may interpret only in an emergency involving an imminent threat to safety, with no interpreter available
• Video remote interpreting must give a clear, real-time, full-motion picture of the interpreter’s face, arms, hands and fingers, and staff must know how to set it up; an on-site interpreter is needed if the client cannot see the screen
• Other aids: captioning, written materials, assistive listening devices, captioned or video phones, and relay calls treated like any other call

For the exam: the qualified interpreter is the answer for consent, preoperative teaching and any serious discussion; a relative or the client’s child is the distractor. Written English may be the client’s second language, so a stack of handouts does not replace the interpreter.

Vision loss, guiding and eye care

Common causes in older adults are macular degeneration (central vision loss), cataract (cloudy lens), glaucoma (gradual loss of peripheral vision from optic nerve damage) and diabetic retinopathy. Care aims at safety and independence: identify yourself, describe the room, keep things where the client put them, remove clutter and tubing from the path, provide bright light without glare, large print and high-contrast labels on items such as medication bottles.

Sighted guide: offer your arm by touching the back of the client’s hand with yours. The client holds just above your elbow and stands half a step behind, so they feel your movements. In a narrow space move your guiding arm behind you so the client follows single file. Approach steps straight on, name them, and let the client take the rail. To sit, place the client’s hand on the chair back and let them seat themselves. Never leave without saying so.

Clock method: the edge nearest the client is 6 o’clock and the far edge 12. Name each food by its position (the RNIB example puts meat at 6 and potatoes at 12) and keep items in the same place at every meal. Feeding a client who can feed themselves takes away independence.

Contact lenses: CDC advice is hand washing and drying before handling, no water on lenses or in the case, no sleeping in lenses unless the eye doctor says so, fresh solution rather than topping off old solution, and a new case at least every 3 months. The AAO reports that sleeping in lenses raises infection risk six- to eightfold. Pain, redness, discharge or blurred vision means the lens comes out and the provider is told.

Unconscious or sedated clients cannot blink or close their eyes fully. Exposure keratopathy is common in intensive care; combined lid closure support, lubrication and moisture chambers cut corneal injury in the review by Ni and Jiao (2025). Contact lenses are removed and stored in labeled cases with the client’s solution or saline, and the removal is documented.

Artificial eye: the NHS Lothian service now advises leaving a comfortable prosthesis in place, with professional polishing about every 6 months. When it is removed, handle it carefully with clean hands, wash it in warm water with mild unscented soap (never alcohol or disinfectant), store it in water, and report redness, pain or heavy discharge from the socket.

Ear irrigation step by step

1. Check the order and that the eardrum is intact: no drainage, ear tubes, recent ear surgery or history of a perforation
2. Soften the wax first with ordered drops if prescribed
3. Sit the client upright with a basin under the ear and a towel on the shoulder
4. Warm the solution to body temperature
5. Adult: pull the outer ear up and back to straighten the canal
6. Direct a gentle stream along the upper canal wall beside the wax, not at the eardrum; let it drain and repeat as ordered
7. Stop for pain, dizziness or nausea; dry the outer ear; document the return and the client’s hearing and response

Oral care in more depth

Routine care: brush the inner, outer and chewing surfaces with a soft brush and fluoride toothpaste, clean the tongue gently without causing gagging, let the client rinse and spit, and report any sores, bleeding or other change in the mouth. Clients who are NPO or have an NG tube make less saliva and collect more bacteria, so they need more frequent care, moist lips and a check of the nostril under the tube for pressure.

Unconscious clients: turn them on the side with the head down or to the side so fluid drains out, use a barely moist brush or swab, keep oral suction ready, and protect your fingers from reflex biting. Lemon-glycerin swabs dry and irritate the mucosa.

Dentures: remove them with gloves, brush them over a sink lined with a washcloth or paper towel so a drop does not break them, rinse in cool water, clean the gums and tongue, and store them in a labeled denture cup covered with cool water at night. Dentures on a meal tray or in a napkin are thrown away; dentures in hot water warp.

Mucositis from chemotherapy or head and neck radiation: NCI patient guidance is a soft brush 2 to 3 times a day, cleaning the mouth every 4 hours and at bedtime once sores appear, and a bland rinse of 1/4 teaspoon each of salt and baking soda in 1 quart of water every 2 hours. Avoid alcohol-based rinses, and spicy, acidic, rough or hot foods. Keep removable dentures out until the sores heal. Water-soluble lubricant keeps the mouth moist; topical medicines and then ordered analgesics control pain, and NCI warns that NSAIDs raise bleeding risk in chemotherapy. Burning pain or taste change can mean thrush, which is reported.

Bathing, perineal care and skin in more depth

Choose the bath by need and preference: partial bath (face, hands, underarms, perineum), shower with a chair, tub, or complete bed bath. Older adults make less oil and sweat, so daily full baths dry the skin; a daily partial bath with a full bath about weekly is often enough. Keep the client covered and warm, and prevent falls on wet floors.

Work from clean to dirty: face and neck, arms and chest, back, legs, then the perineum last; change gloves and clean your hands after perineal care. For a female client, separate the labia and wipe front to back with a clean part of the cloth each stroke, rinse the same way, then clean the buttocks and anal area wiping away from the vagina, and pat dry. Report redness, open areas, rashes, bruises, odor, discharge, or signs of pain during care.

Dry skin (xerosis): limit bathing, use warm water for 5 to 10 minutes, choose a gentle cleanser without dyes or perfume, pat dry rather than rubbing, and apply a cream or ointment while the skin is still damp. A humidifier helps. Persistent itching can have causes such as diabetes, thyroid disease or some drugs and is reported.

Diabetic feet (NIDDK): check the feet every evening, including between the toes, with a mirror or helper. Wash daily in warm water, 90 to 95 °F tested with a thermometer or elbow, and do not soak. Dry well, keep lotion off the skin between the toes, and cut nails straight across after washing. Do not cut corns or calluses or use medicated corn pads. Wear shoes and socks at all times and check inside shoes. Never use heating pads or hot water bottles on the feet. Call the provider for a sore that is not healing after a few days, a red, warm or painful area, or blood in a callus.

Heat and cold in more depth

Before any application, check the order, the skin and the client’s ability to feel temperature and report pain. Very young, older, confused, sedated and neuropathic clients burn or freeze most easily. Cover the device with a towel or sleeve, time it, check the skin during the treatment, and document the response.

Heat (hot packs, warm compresses, heat lamps, sitz baths, warm soaks) dilates vessels and relaxes muscle. Merck lists heat for subacute and chronic sprains, strains, spasm, back pain and arthritis, and gives about 20 minutes a day under an infrared lamp, with impaired sensation and implanted metal as contraindications. Open RN gives 5 to 20 minutes by tolerance. Classic teaching also avoids heat over a fresh injury (it increases swelling), active bleeding, and areas of poor circulation.

Cold (ice bags, cold packs, cool compresses) constricts vessels and numbs. Merck: packs (a commercial pack in a thin moist towel is one option) for 10 to 20 minutes, at least 1 hour of rewarming between sessions, 3 to 5 times a day in the first 24 to 72 hours, stopped when swelling settles or for excess numbness; never over poorly perfused tissue. Open RN: no longer than 20 minutes. Raynaud phenomenon and cold intolerance are classic contraindications.

Stroke communication, neglect and self-care

Broca (nonfluent, expressive) aphasia follows frontal damage and often comes with right-sided weakness: speech is short and effortful, understanding is better, and the client knows and is frustrated. Wernicke (fluent, receptive) aphasia follows temporal damage: speech flows but makes little sense and the client may not notice. Global aphasia limits both. Speech-language therapy is central; many clients improve over the first months.

For any aphasia: quiet room, adult tone, eye contact, one idea at a time, yes-or-no questions or a few clear choices, show objects, accept gestures, pointing and drawing, give plenty of time, do not correct or pretend to understand, and keep the client in the conversation. Note that yes-or-no answers can be automatic and wrong, so confirm important answers another way.

Dysarthria is weakness or poor control of the muscles of speech; language is intact. The listener reduces noise, sits close in good light to see the face, lets the client finish, says back what was heard, and asks the client to slow down or rephrase. The client speaks slowly in short sentences and can write, type or point to an alphabet board.

Unilateral neglect after right-hemisphere damage: the client ignores the left side of the body and space. Safety comes first (call light and essentials where the client attends; check the left arm for injury and position). As rehabilitation proceeds, staff approach and place items on the neglected side, cue the client to turn the head and scan, and have the client look at and touch the affected limb. Klinke and colleagues (2015) found ward-usable options such as scanning training, limb activation and family involvement, all on weak evidence.

Dressing with one-sided weakness: the client sits, the weak arm and leg go in first, and the strong side comes out first when undressing. Loose clothes with front openings, elastic waists and hook-and-loop closures help; occupational therapy teaches aids such as button hooks. At meals, adaptive utensils, a plate guard, a non-slip mat and extra time keep the client feeding themselves.

Sensory overload, deprivation and delirium

Overload happens when stimuli are too many or cannot be filtered: monitors, alarms, talk and repeated waking. Signs are irritability, restlessness, covering the eyes or ears and sensitivity to touch; in hospital it can tip into delirium. Plan care so rest is not broken, silence unneeded alarms, close the door and cut noise.

Deprivation is too little meaningful input: isolation, a quiet side room, missing glasses or hearing aids. It can cause perceptual disturbances such as hallucinations and can look like delirium, so a new perceptual change is assessed, not assumed. Meaningful stimuli help: the client’s own devices, a clock and calendar, chosen radio or TV, photos and visitors.

Who does what (PN and UAP)