Gero Chapter 23 Vision and Hearing & Chapter 36 End of Life Care Lecture Notes

Flashcards for Gero Chapter 23 Vision and Hearing

What is a cataract?

Clouding of the crystalline lens of the eye.

What is glaucoma?

Eye disease involving increased intraocular pressure.

What is macular degeneration?

Loss of central vision due to the development of drusen deposits in the retinal pigmented epithelium.

What is presbycusis?

Age-related high frequency sensorineural hearing loss.

What is presbyopia?

Age-related decrease in eyes ability to change the shape of lens to focus on near objects.

What are some effects of aging on vision?

Reduced elasticity and stiffening of the muscle fibers of the lens, visual acuity declines, light perception threshold decreases, increased sensitivity to glare, distortion in depth perception, peripheral vison reduced, produce fewer tears.

What nutrients are beneficial to vision?

Essential fatty acids, flavonoid, Vitamin A, Vitamin B complex, Vitamin C, Vitamin E, Selenium, Zinc.

How can nurses promote vision?

Routine examinations by ophthalmologist, early detection and treatment of problems, consideration of financial ability to receive treatment, prompt evaluation of symptoms that may indicate a visual problem.

How can hearing be promoted?

Good care of ears throughout lifetime, Prompt/ complete treatment of infections, Prevention of trauma to ear, Regular audiometric examinations, Assessment for impacted cerumen, Education.

What are some nursing problems related to visual or hearing deficits?

Reduced social engagement; reduced activity, Anxiety; risk of injury; risk of social isolation, Pain, Communication deficit, Self-care deficits; anxiety; potential negative self-concept, Sleep disturbances; anxiety.

What are some measures to compensate for visual deficits in older adults?

Face person when speaking, Use several soft indirect lights not a single glaring one, Avoid glares from windows with sheer curtains or stained windows, Use large print reading material, Place frequently used items within visual field, Avoid use of low-tone colors; use brighter ones, Use contrasting colors on doorways and stairs and for changes in levels.

S/Sx of Cataracts

Visual acuity not affected at first; as opacification continues, vision distorted, decreased night vision, blurred objects, glare from sunlight and bright lights extremely bothersome

Risk factors for cataracts

Exposure to ultraviolet B (from sunlight), diabetes, cigarette smoking, high alcohol consumption, eye injury

Causes of glaucoma

Exact cause unknown; associated with increased size of lens, iritis, allergy, endocrine imbalance, emotional instability, family history; drugs with anticholinergic properties

S/Sx of acute glaucoma

Severe eye pain, headache, nausea, and vomiting, Rapid increase in tension and edema of ciliary body, dilation of pupil; vision becomes blurred, blindness with result if not corrected within a day

S/Sx of chronic glaucoma

peripheral vision becomes slowly impaired, frequent changing of eyeglasses; as progresses, central vision affected, tired feelings in eyes, headaches, misty vision, seeing halos around lights, cloudy appearance to cornea, iris fixed and dilated

Define detached retina

Forward displacement of the retina

S/Sx of detached retina

gradual or sudden: perception of spots moving across eye, blurred vision, flashes of light, feeling that a coating is developing over eye; blank areas of vision progress to complete loss of vision

Define corneal ulcer

Inflammation of the cornea accompanied by a loss of substance

Predisposition factors for corneal ulcer

febrile states, irritation, dietary deficiencies, lowered resistance, cerebrovascular accident

What are common causes of hearing deficits?

exposure to loud noise, recurrent otitis media, trauma, ototoxic medications, diabetes, tumors of nasopharynx, hypothyroidism, syphilis, psychogenic factors

What kind of support can you provide those w/ hearing deficits

alert neighbor to help in emergencies, locate individuals close to nursing station, provide written information

What are some difficulties with using a hearing aid?

All sounds amplified, Start by wearing hearing aid for short periods of time each day, gradually increase time used; avoid use in noisy environments, Turn aid off or remove battery when not being worn. Store in safe, padded container, Clean least weekly. Wipe if off and use toothpick, pipe cleaner, or pick to clean channel. Do not use alcohol, can cause drying and cracking. Avoid having hairspray, gels, or other chemicals come in contact with aid, Protect the aid from exposure to extreme heat (e.g hair dryers), cold weather, or moisture

General Nursing Considerations for visual and Hearing Deficits

Attention to stimulation of all senses on a daily basis, Interventions to compensate for visual changes and limitations, Interventions for those with a hearing issue, Touch as a means of sensory stimulation as well as expressions of warmth and caring

Define delirium

Acute confusion, usually reversible

Define dementia

Irreversible; progressive impairment in cognitive function

Define mild cognitive impairment

Transitional stage between normal cognitive aging and dementia in which the person has short-term memory impairment and challenges with complex cognitive functions

Define sundowner syndrome

Nocturnal confusion

Causes of delirium

Disruption in brain function due to medication side effect, circulatory disturbance, dehydration, malnutrition, hyper- or hypotension, hyper- or hypothyroidism, hyper- or hypoglycemia, infection, surgery and/or anesthesia, stress, exacerbation of chronic health condition, etc

Give some interventions during the initial acute stage of delirium

Establishing medical stability, Minimizing stimulation, Consistency in care, Prevention of harm to self and others, Support and realistic expectation

Impacts of dementia (irreversible)

Memory, orientation, reasoning, attention, language and problem solving

Alzheimer's Disease brain changes

Presence of neuritic plaques, Neurofibrillary tangles in cortex

Treatments for Alzheimer's

No current tx to prevent/ cure AD, Clinical trials in place to improve function and slow disease progression, Research on estrogen- conflicting results, Antioxidants, anti-inflammatory agents, folic acid, vitamins B6 and B12, Medications that slow acetylcholinesterase

What are some examples of other dementias?

Vascular dementia, Frontotemporal dementia, Lewy body dementia, Creutzfeldt- Jakob disease, Wernicke’s encephalopathy, Parkinson’s disease, AIDS, Trauma and toxins

Care for People living with dementia considerations

Ensuring patient safety, Promoting therapy and activity, Providing physical care, Using complementary and alternative therapies, Respecting the individual, Supporting the patients family

How to promote safety for a patient with dementia

Consistent, structured environment, Items to trigger memory, Controlled environment, Wandering behavior, Sundowner syndrome, Prevention of abuse, Respite care and support for caregivers

What communication modifications should be made w/ dementia patients?

Use simple sentences with only one idea or instruction, Speak in calm manner using adult tone, Avoid words or phrases that may be misinterpreted, Offer opportunities for simple decisions, Avoid arguments, Provide distractions, Recognize efforts with positive feedback, Observe nonverbal expressions and behaviors, act on any needs

Define assisted suicide

Suicide committed with the help of another individual

Define do not resuscitate (DNR)

Medical order advising providers not to initiate cardiopulmonary resuscitation in the event of cardiac or respiratory arrest

Define end of life

Period when recovery from illness is not expected, death is anticipated, and focus is on comfort

Define hospice care

Program that delivers palliative care to dying individual and support to dying person and that person’s family and caregivers

Define palliative care

Care that relieves suffering and provides comfort when cure is not possible

Define rational suicide

Decision by competent terminally ill person to end his or her life

How did death change over time?

Higher mortality rates, Death in the home viewed as natural process, Fewer hospitals and other institutions VERSUS Limited experience with death, Change in the site and circumstance of death, Most people have minimal direct involvement with dying individuals, Death has become more impersonal and unusual event.

What steps should a nurse caring for a dying individual take?

Assess Particular experiences, attitudes, beliefs, values of each individual to be able to give the most therapeutic and individualized support

Name 5 nursing problems related to death and dying

Reduced activity level, Anxiety, depression, Constipation, Diarrhea, Risk for cardiac complications, Pain, Difficulty communicating, Risk of infection, Fear, Risk of dehydration ,Risk of pneumonia, Potential for injury, Need for education, Poor oral health, Risk of skin breakdown, Disturbed thinking, Family stress, Sleep disturbances, Limited socialization, Unmet spiritual needs, Unmet sexual needs

List Kubler ross's 5 stages of coping mechanisms with dying

Denial, Anger, Bargaining, Depression, Acceptance

What could nursing interventions be for a patient in denial

Accept dying individual’s reactions; provide open door for honest dialogue

What could nursing interventions be for a patient in anger

Do not respond to anger, be accepting to individual

What could nursing interventions be for a patient in bargaining

Explore individual’s feelings with him or her

What could nursing interventions be for a patient in depression

Be with the individual, Facilitate clergy–patient relationship, Help family understand

What could nursing interventions be for a patient in acceptance

Nonverbal versus verbal communication, Simplify environment

Physical Care Challenges for the dying include

Pain, Respiratory distress, Constipation, Poor nutritional intake, Spiritual Care Needs

What is the goal for pain management in a dying patient?

Prevent pain form developing

Causes of respiratory distress in a dying patient

Pleural effusion to deteriorating blood gas levels

Nurse interventions for respiratory distress in a dying patient

Elevate head of bed, pacing activities, relaxation exercises, administer oxygen; atropine or furosemide; narcotics

Causes of constipation in a dying patient

Reduced food and fluid intake, inactivity, effects of medications

Name four signs of imminent death

decline in blood pressure; rapid, weak pulse; dyspnea and periods of apnea; slower or no pupil response to light; profuse perspiration; cold extremities; bladder and bowel incontinence; pallor and mottling of skin; loss of hearing and vision

What is an advanced directive?

Legal document that allows patients to express their desires regarding terminal care and life-sustaining measures

What should a nurse do regarding advanced directives?

Determine if patients have advance directives, review the patients wishes, and place the document in the medical record

List family needs requiring therapeutic interventions

Offering appropriate support, May provide immense comfort, Supporting through the stages of dying process, Helping family and friends after a death

Staff working with dying patients need _

Support

Glomerulonephritis

inflammation of the tiny filters (glomeruli) in the kidneys