November 14, 2022

After studying Module 5: Lecture Materials & Resources, discuss the following: Define presbycusis, name signs and symptoms, etiology and differential diagnosis. Create 3 interventions-ed

After studying Module 5: Lecture Materials & Resources, discuss the following:

Define presbycusis, name signs and symptoms, etiology and differential diagnosis.
Create 3 interventions-education measures with a patient with Presbycusis.
List, define and elaborate on three different retinal and macular diseases age-related.

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

Read and watch the lecture resources & materials below early in the week to help you respond to the discussion questions and to complete your assignment(s).

Read

Meiner, S. E., & Yeager, J. J. (2019).
- Chapter 17
  Chapter_017.pptx Download Chapter_017.pptx
- Chapter 18
  Chapter_018.pptx Download Chapter_018.pptx
- Chapter 19
  Chapter_019.pptx Download Chapter_019.pptx
- Chapter 20
  Chapter_020.pptx

Chapter 18

Sensory Function

Eyelids lose tone and become lax.

Conjunctiva thins and yellows in appearance.

Sclera may develop brown spots; cornea yellows and develops noticeable surrounding ring.

Pupil decreases in size and loses some ability to constrict.

Lens increases in density and rigidity.

Age-Related Changes in Structure and Function: Vision (1 of 2)

Peripheral vision decreases, night vision diminishes, and sensitivity to glare increases.

Gradual reduction in the ability to see colors in aging along with color

Examination of retina: blood vessels narrow and straighten; arteries seem opaque and gray; and drusen, localized areas of hyaline degeneration, may be noted as gray or yellow spots near macula.

Age-Related Changes in Structure and Function: Vision (2 of 2)

Floaters appear as dots, wiggly lines, or clouds moving in field of vision, more pronounced when looking at plain background.

Caused by degeneration of vitreous gel

Normal and harmless

Flashers—illusion of flashing lights or lightning streaks, last 10–20 minutes

Occur when the vitreous fluid inside the eye rubs or pulls on the retina

Likely to be caused by a spasm of blood vessels in the brain called a migraine

Floaters and Flashers

Quantity and quality of tear production diminish with aging.

Symptoms: stinging, burning, scratchiness

Treatment: OTC artificial tears, closing the lacrimal drainage system, use of humidifier

Dry Eyes

After age 40—diminished ability to focus clearly on close objects

Accommodation is impaired when lens thickens and loses elasticity.

Ciliary muscles weaken the lens’ ability to contract.

Treatment involves wearing reading glasses or bifocals.

Presbyopia

Chronic inflammation of eyelid margins

Caused by seborrheic dermatitis or infection

Symptoms: red, swollen eyelids, matting and crusting along base of eyelash at margins, small ulcerations along lid margins, irritation, itching, burning, tearing, and photophobia

Treatment: remove bacteria and heal affected areas; teach scrupulous eye hygiene.

Blepharitis

Second leading cause of blindness

At risk adults older than age 60, Mexican Americans

Results from blockage in drainage of aqueous humor in anterior chamber

If fluid formed in eye faster than it can be eliminated, IOP increases; pressure is transferred to optic nerve, where irreparable damage, possibly even total blindness, can result.

Glaucoma

Most common type, develops slowly.

Degenerative changes in Schlemm’s canal obstruct escape of aqueous humor raising IOP.

Damages vision gradually and painlessly, unaware of problem until optic nerve is badly damaged

Visual loss begins with deteriorating peripheral vision, intolerance to glare, loss of contrast perception, and difficulty adapting to the dark.

Chronic Open-Angle Glaucoma

Occurs suddenly as result of complete blockage

Symptoms: severe eye pain, redness in eye, clouded or blurred vision, nausea and vomiting, bradycardia, rainbow halos surrounding lights, pupil dilation, steamy appearance of cornea

Medical emergency to avoid severe vision loss or blindness

Closed-Angle Glaucoma

Visual field testing reveals a loss of peripheral vision, and increased IOP seen on ophthalmologic examination.

Can you name four nursing diagnoses for glaucoma?

Glaucoma: Assessment and Diagnosis

Need for patient teaching, resulting from lack of exposure and inexperience regarding glaucoma causes and treatments

Pain, resulting from increased IOP

Potential for infection, resulting from eye drop instillation

Decreased ability to dress self, resulting from visual impairment

The patient will do the following:

Have no further loss of vision

Follow prescribed glaucoma care guidelines daily

State that eye pain is decreased

Be free from eye infection

Be able to perform activities of daily living (ADLs) safely and independently

Glaucoma: Planning and Expected Outcomes

Teach that condition is chronic, requiring lifelong medical treatment

Surgical intervention if medication is unable to control rising IOP:

Trabeculoplasty—outpatient

Trabeculectomy—overnight hospitalization

Glaucoma: Intervention

Post-op care: Trabeculectomy

Routine postanesthesia care

Protect operative eye with an eye patch or a shield

Proper positioning of patient

Pain medications and cold eye compresses

Monitor for increased IOP, bleeding, or infection

Assist with and teach safe, independent performance of ADLs

Glaucoma: Interventions Post-op

Documentation of achievement of expected outcomes, no further vision loss, and independent performance of ADLs

Patient must be able to state the name and dosage of the prescribed eye medications and describe their daily use.

Patient must also be able to identify significant signs and symptoms to be reported to the ophthalmologist.

Glaucoma: Evaluation

Most common eye disorder

Proteins clump behind lens causing clouding.

Vision becomes more difficult including reduced sharpness of images reaching the retina. Over time the lens becomes discolored with a yellow/brown tint.

Symptoms: dimmed, blurred, or misty vision; need for brighter light to read; glare and light sensitivity; loss of color perception; Halo that appears around lights.

Cataracts

Subjective complaints: having trouble reading and necessity of cleaning glasses

Lens opacity may be visible on external or internal eye examination.

Can you name four nursing diagnoses for cataracts?

Cataracts: Assessment and Diagnosis

Anxiety, resulting from uncertain surgical outcome

Need for patient teaching, cataracts resulting from lack of exposure

Potential for injury, resulting from changes in visual acuity

Decreased ability to dress self, resulting from inability to see body and face clearly enough to maintain appearance of clothes and cosmetics

The patient will do the following:

Have cataract surgery when it is recommended by an ophthalmologist.

Ask questions about preoperative and postoperative care and report satisfaction with information.

Recognize that the affected eye is free from increased IOP, stress on the suture line, hemorrhaging, and infection.

Verbalize appropriate home care activities to avoid and activities to do after cataract surgery.

Demonstrate correct administration of eye drops.

Remain free from injury.

Cataracts: Planning and Expected Outcomes

Focuses on pre- and postoperative surgical care

Preoperative care—administering eye drops and sedative as ordered

Postoperative care—requires teaching patient and family home care procedures

Documentation of achievement of expected outcomes

Patients had successful will be free from complications and will have improved vision able to perform usual ADL

Cataracts: Intervention and Evaluation

Age-related macular degeneration (AMD)

Leading cause of blindness among older adults

Decline in central visual acuity, making daily tasks requiring close vision nearly impossible

Peripheral vision is retained.

Dry macular degeneration: caused by breakdown or thinning of macular tissue related to aging process; vision loss gradual

Macular Degeneration

Dry macular degeneration: caused by breakdown or thinning of macular tissue resulting from the aging process. Vision loss is gradual.

Wet macular degeneration: abnormal blood vessels form and hemorrhage on retina; vision loss may be rapid and severe

Symptoms: difficulty with tasks requiring close central vision, decreased color vision, dark or empty area in the center of vision, straight lines appearing wavy or crooked, words appear blurred

Types of Macular Degeneration

Altered circulation to eye may result in retinal edema, degeneration, or detachment.

Ballooning of tiny vessels leads to hemorrhaging, scarring, and blindness.

No symptoms may be apparent even when retinopathy advanced.

Early detection—complete ophthalmoscopic examination yearly

Diabetic Retinopathy

Occurs when the sensory layer of the retina separates from the pigmented layer

Tears or holes occur in retina as result of trauma, aging, hemorrhaging, or presence of tumor.

Symptoms: light flashes; a shower of floaters that resembles spots, bugs, or spider webs; loss of vision; veil or curtain obstructing vision

Retinal Detachment

Involves monitoring patient’s subjective statements about changes in vision and observing for signs of anxiety

Words look blurred

Flashes of light with progressive vision loss

All three retinal disorders are diagnosed by ophthalmoscopic examination.

What are at least four nursing diagnoses for retinal disorders?

Retinal Disorders: Assessment and Diagnosis

Need for patient teaching, resulting from lack of exposure to accurate information about the effect of diabetes on eyes

Need for patient teaching, resulting from retinal detachment condition, surgery, preoperative and postoperative care, and home care after surgery

Anxiety, resulting from fear of blindness

The patient will do the following:

Adjust to vision loss by using low-vision aids

State the effect of diabetes on the eyes

See an ophthalmologist yearly

Ask questions about preoperative and postoperative retinal surgery care

Recognize that the affected eye is free from further retinal detachment, infection, or hemorrhaging

Verbalize appropriate post-op home care activities

Demonstrate correct administration of eye drops

Report reduced anxiety

Retinal Disorders: Planning and Expected Outcomes

Teach patient how to obtain and use low-vision aids, self monitor central vision—Amsler chart.

Teach about condition and encourage yearly follow-up visits with an ophthalmologist.

Retinal detachment: pre-op: bed rest in proper position and eye patches until surgery

Post-op: administer eye medication, pain medication, antiemetics, and cough medication prn.

Provide assistance with ADLs and walking prn to promote comfort and safety.

Provide home care instructions.

Retinal Disorders: Intervention

Documentation of achievement of expected outcomes

Patients with macular degeneration and diabetic retinopathy will describe the condition and report use of low-vision aids.

Patients will follow-up with annual visits to ophthalmologist.

Post-op will experience no complications.

Patients with macular degeneration will monitor their central vision with an Amsler chart and report changes.

Retinal Disorders: Evaluation

The nurse is assessing the vision of an older adult. The patient has not had an eye exam in several years and has a current complaint of dimmed, blurred vision and sensitivity to light. The nurse suspects the patient has which common visual problem?

Glaucoma

Macular degeneration

Cataracts

Presbyopia

Quick Quiz!

ANS: C

Answer to Quick Quiz

Low vision: 20/50 to 20/200

Legally blind: visual acuity of 20/200 or worse in better eye with aid of best possible spectacle or contact lens correction

Blindness in older adults results from diabetic retinopathy, glaucoma, cataracts, and macular degeneration.

Visual Impairment

Requires understanding of patient’s response to vision loss

Can you name six nursing diagnoses for visual impairments?

Visual Impairment: Assessment and Diagnosis

Decreased self-esteem, resulting from sudden loss of vision

Social disengagement, resulting from impaired communication

Inadequate coping, resulting from sudden loss of vision

Decreased ability to feed/bathe/dress/toilet self, resulting from visual impairment

Decreased mobility, resulting from visual impairment

Potential for injury, resulting from impaired vision

The patient will do the following:

Perceive himself or herself positively by making positive statements about self.

Participate successfully in activities with others.

Demonstrate increased objectivity and ability to solve problems, make decisions, and communicate needs.

Provide self-care safely by using low-vision aids and environmental strategies.

Demonstrate the safe and correct use of adaptive devices.

Visual Impairment: Planning and Expected Outcomes

Provide opportunity for persons who have become visually impaired to talk about feelings, concerns, and anxieties.

Use various techniques and methods when communicating with patients.

Use of color-contrast and color-coding schemes helps the patient locate items.

Referral local, state, and federal services available

Documentation of achievement of expected outcomes, demonstrated by patient actively participating in self-care and social activities

Visual Impairment: Intervention and Evaluation

Auricle appears larger; lobule of auricle becomes elongated, wrinkled; periphery of auricle-covered with coarse, wirelike hairs.

Auditory canal narrows; hairs lining canal become coarser and stiffer.

Cerumen glands atrophy.

Tympanic membrane develops dull, retracted, and gray appearance.

Changes within the inner ear result in decreased vestibular sensitivity.

Age-Related Changes in Hearing and Balance

Atrophic changes in sebaceous and apocrine glands lead to drier cerumen.

Cerumen interferes with passage of sound vibrations affecting ability to hear and communicate.

Leads to social isolation and depression

Symptoms: hearing loss, feeling of fullness in ear, itching, and tinnitus

Removal of impaction restores hearing acuity and relieves symptoms.

Cerumen Impaction

Otoscopic examination will show whether external ear canal is obstructed by cerumen, if tympanic membrane is visible.

Can you name a nursing diagnosis for cerumen impaction?

Cerumen Impaction: Assessment and Diagnosis

Social disengagement, resulting from difficulty communicating with family and friends

The patient will do the following:

Be free from cerumen impaction

Follow proper instillation of softening agents

Report a satisfactory level of involvement with family and friends

Cerumen Impaction: Planning and Expected Outcomes

Assess patients for signs of hearing impairment.

If otoscopic examination reveals impaction, follow protocol for cerumen removal.

Teach patient and family how to instill softening agent.

Patient free from cerumen impaction and verbalizes decrease in ear fullness and increase in hearing

Document cerumen removal, noting method of irrigation, amount and type of debris removed, and patient’s response.

Cerumen Impaction: Intervention and Evaluation

Assess patients for signs of hearing impairment

Difficulty understanding the spoken word

Loud radio and television volume

Withdrawal from social activities and accompanying depression

Possible confusion and paranoia

Chronic combination of both conductive and sensorineural hearing loss

Subjective sensation of noise in ear, defined as ringing, buzzing, or hissing

Causes: noise or toxin damage to hair receptors of cochlear nerve and age-related changes in organs of hearing and balance

This symptom is associated with many diseases, conditions, and medical treatments.

Tinnitus

Tinnitus Screener can be used to assess the patient for the presence and level of tinnitus.

Question the patient on impact of the tinnitus on daily living.

Can you name two nursing diagnoses?

Tinnitus: Assessment and Diagnosis

Inadequate health maintenance, resulting from a lack of knowledge about tinnitus prevention practices

Anxiety, resulting from coping with the chronic condition of ringing in the ears

The patient will do the following:

Follow tinnitus prevention practices.

Use home masking measures and a hearing aid or tinnitus masker to relieve tinnitus.

Cope with anxiety independently by using relaxation techniques.

Tinnitus: Planning and Expected Outcomes

Teach prevention practices.

Teach patients about following home masking measures that produce a variety of distracting sounds.

Teach coping strategies to relieve anxiety and stress.

Achievement of expected outcomes is evidenced by patients following recommended tinnitus interventions and strategies to cope with chronic ringing in ears.

Tinnitus: Intervention and Evaluation

Not a normal part of the aging process

Conductive: interruption of transmission of sound through external auditory canal and middle ear

Sensorineural: inner ear, auditory nerve, brain stem, or cortical auditory pathways do not function properly so sound waves are not interpreted correctly.

Mixed: conductive hearing loss superimposed on sensorineural hearing loss

Hearing Loss

Sensorineural hearing loss is the most common form of hearing loss in older adults.

Loss is bilateral, resulting in difficulty hearing high-pitched tones and conversational speech.

Cause remains unclear.

Signs and symptoms: increasing the volume on the television or the radio, tilting the head toward the person speaking, cupping the hand around one ear, watching the speaker’s lips, speaking loudly, not responding when spoken to

Presbycusis

Subjective: onset, type, and progression of hearing loss

Objective: behavioral symptoms of hearing loss

Can you name two nursing diagnoses for presbycusis?

Presbycusis: Assessment and Diagnosis

Social disengagement, resulting from difficulty with communication

Potential for chronic low self-esteem, resulting from hearing loss

The patient will do the following:

Effectively use aural rehabilitative techniques

Maintain satisfactory social contacts and activities with others

Perceive himself or herself positively, as evidenced by positive self-talk and behaviors

Presbycusis: Planning and Expected Outcomes

Focus on aural rehabilitation and facilitation of communication.

Provide information on hearing loss and where to obtain assisted listening devices.

Documentation of achievement of expected patient outcomes, as evidenced by patient using aural rehabilitation techniques and devices to enhance communication

Presbycusis: Intervention and Evaluation

The nurse is assisting an older adult patient with his meal tray. The nurse notices the TV is very loud. The patient's wife states that he had been having increased difficulty with his hearing lately. What is the nurse's best response?

“I’ll arrange for a hearing test.”

“Hearing loss is a normal part of aging.”

“I'll check his ears for cerumen.”

“It could be from his medication.”

Quick Quiz!

ANS: C

Answer to Quick Quiz

Benign paroxysmal positional vertigo

Ampullary dysequilibrium

Macular dysequilibrium

Vestibular ataxia of aging

Meniere’s disease

Vestibular system of inner ear most common source of dizziness and balance disorders, but need to rule out other medical causes

Signs and symptom

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After studying Module 5: Lecture Materials & Resources, discuss the following: Define presbycusis, name signs and symptoms, etiology and differential diagnosis. Create 3 interventions-ed

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