disease affecting vision and hearing and communication

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  1. Vision
    • visual impairment has a negative impact on the quality of life
    • visual impairments common in elders are:
    • - age-related macular degeneration
    • - glaucoma
    • - diabetic retinopathy
    • Racial and cultural disparities in vision impairment are significant
  2. Implications of vision change
    • impact on safety-
    • - not able to read meds label
    • - difficulty nagivating stairs or curbs
    • - crossing streets
    • impact on quality of life
    • - reduces ability to remain independent
    • - difficulty or unable to read
    • falls
  3. Diseases of the eye
    • glaucoma
    • cataracts
    • diabetic retinopathy
    • macular degeneration
    • detached retina
    • dry eye
  4. Glaucoma
    • A group of diseases that can damage the eye's optic nerve and result in vision loss and blindness due to IOP
    • - greatest risk people over 60
    • - the fluid drains to slowly out of the eye
    • - as the fluid builds up, the pressure inside the eye rises
    • - IOP is the fluid (aqueous humor) pressure within the eye (normal IOP 10-21 mm Hg)
    • There is no cure glaucoma
    • - vision lost from the disease cannot be restored
    • - however there are treatments that may save the remaining vision
    • - early diagnosis is important
  5. Warning signs of glaucoma
    • trouble adjusting sight to dark rooms
    • difficult focusing near or distant objects
    • squinting or constant blinking to light or glare
    • change in the color of the iris
    • dark spots in the center of vision
    • dry eyes itching and burning
    • excessive tearing and watery eyes seeing spots and ghost like images
  6. Glaucoma types
    • Types are:
    • -low tension or normal tension glaucoma
    • - primary open-angle glaucoma
    • - acute acute closure glaucoma (medical emergency)
    • Causes of glaucoma are variable and often unknown
    • natural fluids of the eye are block cillary muscle rigidity; pressure builds, and damage to the optic nerve occurs
    • bilateral glaucoma occurs, but it is more common in only one eye
  7. Low tension or Normal tension glaucoma
    • IOP is within normal range but there is damage to the optic nerve and narrowing of visual fields.
    • causes unknown
    • management consists of the same medications and surgery used for chronic glaucoma
  8. Open angle and angle closure glaucoma
    • Primary open- angle (wide angle)
    • - 90% of pts with glaucoma, often hereditary, bilateral no early signs
    • - results from obstruction to outflow of aqueous humor due to blockage of eye's drainage system
    • Acute Primary Angel- closure (narrow)
    • - results in aqueous humor blocked. unable to reach trabecular meshwork
    • - sudden onset
    • - it considered an emergency
  9. Screening
    • eye examination
    • - annual adults over 65 and fhx of glaucoma
    • - every 6 months- those with medication controlled glaucoma
    • - 18-60 q 2yrs at risk, fhx, dm, htn
  10. Management
    • Management:
    • - oral or topical eye drops lower eye pressure
    • - medical- goal is to incre outflow through channels and lower IOP.
    • Medications:
    • 1. topical miotics (pilocarpine) constricts pupil
    • 2. beta adrenergic blocker (timoptic)- decrease production of aqueous humor and IOP
    • 3. oral carbonic anhydrase inhibitors (diamox)- decrease production of aqueous humor
    • 4. alpha-adrinergic agonist (alphagan) lowers IOP
    • 5. for angle closure- IV osmotics may be used (manitol)- osmostic diurectic
    • Surgery
    • - open angle- laser tabeculoplasty
    • - narrow closed angle- iridectomy
  11. Cataracts
    • an opacity of the lens usually associated with aging
    • red reflex may be absent or blocked
    • most common side effects are hereditary or advance aging
    • Risk factor
    • - heredity and advance age
    • - excessive sun light
    • - poor dietary habits
    • - DM
    • - HTN- kidney disease
    • - eye trauma
    • - Hx of alcohol and tobacco use
    • an increase of yellow and dark, leafy vegetables in the diet and vit E from foods and supplements may lower the risk in women
  12. Assessment cataracts
    • blurred vision
    • decreased color preception
    • diplopia
    • reduce visual acuity
    • absence of red reflex
    • presence of white pupil
    • pain or eye redness is associated with age related cataract formation
    • loss of vision gradual
    • cardinal sign: halos around lights
  13. medical management cataracts
    • Medical:
    • - no non-surgical treatment cures cataracts or prevents age related cataracts
    • - studies have been done to say vitamins may help but that is mixed results
    • - early stages- glasses or contact lenses, strong bifocals or magnifying lenese may be helpful
  14. Cataracts surgical management
    • Surgical
    • - surgery is the most common procedure
    • - reccommended when
    • * visual acuity decre 20/50
    • * cataracts affects safety or quality of life
    • - Removal of lens
    • * intracapsular- removal of lens and the lens capsule
    • * aphakia- absence of natural lens
    • * extracapsular- (most common) removal of lens and anterior portion of lens capsule. the posterior portion is left in tact to allow for the prostatic lens with less post op complication
  15. Nursing management cataracts
    • Post op
    • preventing infection
    • administratering ophthalmic meds
    • providing pain relief
    • teaching the client about self care at home and fall prevention
    • avoid heavy lifting or straining or bending at the waist
    • keep eye patch in place
    • limit activity for 24 hr
    • do not rub eye
    • do not lift more than 5lbs
    • do not strain- need for laxative
    • avoid sleeping on surgical side
    • tylenol should be enough to relieve pain
    • do not use asprin or drugs containing aspirin
    • report s/s of infection, incre IOP, N/V
    • teach instillation of drops- ABX and corticosteriod medication
  16. Diabetic retinopathy
    • is a complication of DM
    • is the leading cause of blindness
    • chronic and progressive impairment of the retinal circulation that eventually causes hemorrhage
    • inadequate blood supply deteriorates the retina and vision is permantently lost
    • no symptoms occur in the early stages
  17. Dm retinopathy detection
    • a visual acquity test
    • in a dilated eye exam
    • - annual dilated funduscopic examination of the eye is recommended 5 yrs after the initial diagnosis of DM
    • tonometry- measure pressure in eye for glaucoma
    • constant, strict control of blood glucose and cholesterol levels and BP can reduce disease progression
  18. Treatment of dm retinopathy
    • laser surgery:
    • - photocoagulation (laser therapy) to remove hemorrhagic tissue to decrease scarring and prevent progression of the disease process
    • Vitrectomy
    • - to remove the vitreous hemorrhage and thus decrease tension on the retina, preventing detachment
  19. Macular degeneration
    • Macular degeneration, often called age-related macular degeneration (amd) is the central loss of vision that affects the macula of the eye
    • leading cause of vision loss in americans who are 60 yrs of age of older
    • its prevalence increases with age
    • - progressive loss of central vision
    • - leaving on perpheral vision intact
  20. Macular degeneration risk factors
    • it is deterioation of the macula, the area of central vision
    • risk factors
    • - genetic predisposition
    • - smoking
    • - obesity
    • - a family hx
    • - excessive sun light
  21. two types of macular degeneration
    • dry from age related
    • - it is caused by gradual blocking of retinal capillaries leading to an ischemic and necrotic macula; rods and cones photoreceptor dies
    • wet-form exudate
    • - it is caused by a new growth of blood vessels that have thin walls and allow blood and fluid to leak from them
    • - serious detachment of pigment epithelium in the macula occurs; fluid and blood collect under the macula resulting in scar formation and visual distortion
  22. Macular degeneration early signs
    • blurred vision
    • need for bright light
    • colors that appear dim and gray
    • blurry spot in the middle of vision
    • difficulty reading and writing increase
  23. amsler grid
    amsler grid is used to determine the clarity of vision
  24. Medical management
    • Photodymanic therapy (PDT)= two steps dye, laser used to treat
    • laser photocoagulation (LDC)= laser used to destroy leaky vessels= wet
    • Anti- VEGF therapy= injection monthly helps slows vision loss
    • dark glasses and avoid exposure to light
  25. Dry eye
    • not a disease but a frequent compliant among older adults
    • causes can include meds such as, antihistamine, diurectics, beta blockers and sleeping pills
    • common treatment is artificial tears and management includes using a home humidifier and avoiding wind and hair dryers
  26. interventions to enhance vision
    • use warm incandenscant lighting
    • increase the intensity of lighting
    • control glare by using shades or blinds
    • use yellow to amber lenses to decrease glare
    • wear sun glasses to block out UV light
    • recommend reading material in large dark print
    • avoid low contrast colors like orange and red
  27. Low vision assisted devices
    • financial and social government programs
    • insulin delivery systems
    • talking clocks and watches
    • large print books
    • magnifers
    • telescopes with hand help devices or attached to eye glasses
    • electronic magnification
  28. things we can do for vision
    • speak normally continue to use gestures
    • place things in eye sight
    • screening vision
  29. Implication of geron nursing and healthy aging
    • vision impairment is common in older adults
    • vision decrepencies affects communication, functional abilty, safety and quality of life
    • nursing concerns:
    • - approriate assessment
    • - environmental adaption to enhance vision and safety
    • - communicating appropriately
    • - providing appropriate health teaching
    • - providing approriate referrals for prevention and treatment
    • of those 80 yrs of age and older 90% have hearing loss
  30. Hearing impairment
    • is the third most chronic condition in american older adults
    • dimenishes the quality of life
    • increa feelings of isolation
    • is under diagnosed and under treated in the older adult
  31. types of hearing loss
    • conductive loss-
    • - involves abnormalities of the external and middle ear, which reduces the ability of sound to be transmitted to the middle ear
    • - is caused by otosclerosis, infection, perforated eardrum, fluid in the middle ear, or cerumen accumulation
    • sensorineural loss
    • - is the result to damage to any part of the inner ear or the neural pathways to the brain. prebycusis is an ex of age related sensorineural hearing loss
  32. Tinnitus
    • is the perception of sound in one or both ears or the head with no external sound is present
    • described as ringing in the ear
    • high pitched tinnitus with sensorineural loss is most common
    • low pitched tinnitus with conduction loss is reported in meniere disease
    • exposure to loud noises is the leading cause
  33. Assessment of client with tinnitus
    • is described as pulsating or nonpulsatile
    • cause can be unknown
    • maintain a dairy of times when noise is heard
    • evidence indicates caffeine, alcohol, cigarettes, stress, and fatigue exacerbate the problem
    • client medication history is assessed
  34. intervention to enhance hearing
    • hearing aids to implify sound
    • cochlear implants to bypass damaged portions of the ear and stimulate the auditory nerve in those with sensorineural hearing loss
    • assisted listening and adaptive devices
  35. Implications for gerontology nurses and healthy aging hearing
    • hearing impairment is common in older folks and affects quality of life
    • inadequate communication with the older adult can lead to misdiagoses and affect his or her medical regimen
  36. Application of maslow's heirach of needs
    • hearing and vision impairments affect the biological intergrity of needs, security and sense of belonging, as well as feeling of self esteem and self actualization
    • consequences of these impairments decreas the functional level of the older adult population
Card Set
disease affecting vision and hearing and communication
now u see me now u don't
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