SPECIAL SENSES PROBLEMS - GERIA

Visual Problems

1. Age-Related Macular Degeneration (ARMD)

2. Cataract

3. Glaucoma

4. Retinopathy

5. Presbyopia

AGE-RELATED MACULAR DEGENERATION (ARMD)

• A degenerative disorder of the macula, which affects both central vision (SCOTOMA) and visual acuity

• MACULA situated in the posterior region of the retina, surrounding the fovea and is dense with photoreceptor cells (cones for color and rods for black / white )

cones

• color

rods

• black and white

macula situated in the?

• posterior region of retina

Cataract

• Opacities or yellowing of the lenses

  • → cloud the lens

  • → dec light reaching the retina

  • → inhibit vision

• NORMAL: usually clear lens which light passes to reach the retina

• Leading cause of blindness in the world

• Slow progression

• painless

• may be unilateral or bilateral

• contributing factor : UVL exposure

Glaucoma

• Associated w/ optic nerve damage due to an increase in IOP → vision loss

• Intra Ocular Pressure

  • > 21 mmHg → optic nerve potential for atrophy → loss of vision

Retinopathy

• Microvascular disease of the eye occurring in both type I and type 2 DM

• Damage to microvascular system → impairs transport of O2 and nutrients to the eye

Presbyopia

• gradual loss of your eyes' ability to focus on nearby objects

• normal part of aging

Auditory Problems

1. Tinnitus

2. Cerumen Impaction

Tinnitus

• ringing in the ears

Tinnitus Common Causes

• damage to the cilia in the inner air

• injuries or trauma

• earwax blockage

• ear infections

Taste Problems

1. Hypogeusia

2. Xerostomia

HYPOGEUSIA

• Dec taste sensation

• Poor dentition

• Oral infection

• Olfactory dysfunction

XEROSTOMIA

• salivary gland dysfunction

A common sign of an adverse reaction to a medication in the older client is a?

• sudden change in mental status

Pain

1. Pain can occur from numerous causes and most often occurs from degenerative changes in the musculoskeletal system.

2. The nurse needs to monitor the older client closely for signs of pain

   • failure to alleviate pain in the older client can lead to functional limitations affecting his or her ability to function independently.

Pain Assessment`

1. Restlessness

2. Verbal reporting pain

3. Agitation

4. Moaning

5. Crying

Pain Intervention

1. Monitor the client for signs of pain.

2. Identify the pattern of pain.

3. Identify the precipitating factor(s) for the pain.

4. Monitor the impact of the pain on activities of daily living.

5. Provide pain relief through measures such as distraction, relaxation, massage, and biofeedback.

6. Administer pain medication as prescribed, and instruct the client in its use.

7. Evaluate the effects of pain-reducing measures.

A 79 year old man with dementia , DMII, CAD, COPD and acute renal failure but no other psychiatric history was admitted for pneumonia. After a 3 week hospital o=course complicated by delirium, hyponatremia and UTI, he has been less agitated, more cooperative and more oriented for 2 days in association with decreased wbc and lessened O2 requirements. You are consulted for acute suicidal ideation. What initial plan would be best?

• Evaluate for a sitter (1:1), check urinalysis, do a chest x-ray, discuss with primary team

Delirium

• Disturbance of consciousness with reduced ability to focus, sustain or shift attention

• A change in COGNITION

  • Memory deficit

  • Disorientation

  • Language disturbance

• Development of a perceptual disturbance

  • Auditory

  • Visual hallucinations

• No accounted preexisting dementia

• Reversible if diagnosed early

Delirium : Clinical Presentation - Cognitive Symptoms

• Inattention

• Memory Impairment

• Disorientation

Delirium : Clinical Presentation - Behavioral Symptoms

• Agitation or Hypoactivity

• Resistance to care

• Sleep-wake disturbance

Delirium : Clinical Presentation - Psychiatric Symptoms

• Paranoia, delusions

• Hallucinations (often visual), illusions

• Affective lability

Delirium : Differential Diagnosis

• Dementia with Behavioral Disturbance

• Mood disorder (Depression, Mania)

• Psychotic Disorder (Schizophrenia)

• Catatonia

• Others

Delirium : Management

• Monitor VS and I/O

• Ensure good oxygenation

• D/C nonessential medications

  • Minimize opioids, benzodiazepines etc.

• Repeat PE, further lab, radiologic studies if cause not yet identified

Behavioral Environmental Strategies - Delirium : Management

• Reorientation, calendars, clocks

• Room near nursing station

• lights on/off during day/night

• Windows

• Family / familiarity

• Hearing aids, glasses

• Avoid restraints

Pharmacological Therapy - Delirium : Management

• Nothing FDA-approved

• Antipsychotics

  • = tx of choice for agitation compromising care or safety

• Haloperidol

  • = best studied, widely used

  • = virtually no anticholinergic effects

  • = virtually no hypotensive effects

  • Risk of EPS (akathisia), rare with IV route

Delirium

• Acute

• Inattention

• Abnormal LOC

• Fluctuations / minutes

• Reversible

• Hallucinations common

Dementia

• Gradual

• Memory disturbance

• Normal LOC

• None / days

• Irreversible

• Hallucinations common only in advanced disease