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N352: Practice of Nursing I > Module 5 - Geriatric Sensory Changes > Flashcards

Module 5 - Geriatric Sensory Changes Flashcards

1
Q

Intact senses facilitate …

A

accurate perception of the environment

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2
Q

How do sensory changes occur in the geriatric population and how does it impact people?

A

The sensory changes are not noticed abruptly and the declines are individualized on a person by person basis

These impaired sensory affect everyday experiences

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3
Q

Sensation is essential for …

A

communication (sharing experiences, joys, burdens, etc)

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4
Q

Sensory decline is ___!

A

individualized!

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5
Q

Sensory changes do what to problems?

A

They compound problems that can threaten health, well being, and independence

ex: Can they read discharge instructions? Hear your education? Act and know what to do at home?

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6
Q

What sort of factors contribute to sensory issues?

A

intrinsic and extrinsic factors!

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7
Q

What is one of the most significant sensory changes with age?

A

Vision

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8
Q

Presbyopia

A

reduced elasticity of the lens with age leading to farsightedness

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9
Q

Around what age do you start to notice vision changes and reduced elasticity?

A

40-70

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10
Q

What sort of eye changes effect vision with aging?

A

Presbyopia

Decreased pupil size

Opacification of the lens and vitreous

Decreased tear production

Headaches

Loss of photoreceptors cells in the retina

Sensitivity to glare (ex: may be from cataract)

Depth perception becomes distorted

Peripheral vision reduced

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11
Q

How does decreased pupil size impact sight?

A

It makes it so we have differing light and dark adaption

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12
Q

How does opacification of the lens and vitreous impact vision?

A

It decreases visual acuity

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13
Q

How does decreased tear production impact vision?

A

Leads to dryness

This dryness can lead to infection

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14
Q

What may be causing headaches with age?

A

Muscle strain

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15
Q

How does loss of photoreceptors in the retina impact vision?

A
  1. Light perception decreases
  2. Dark and light adaption takes longer (compound with pupil decrease)

*This can lead to difficulty driving at night

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16
Q

More ___ is needed for reading with age

A

light

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17
Q

How can depth perception distortion have major impacts on elders?

A

It makes their position difficult and could lead to falls or accidents

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18
Q

Effects of blindness increases after what age?

A

65

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19
Q

Half of all individuals diagnosed as legally blind are …

A

65 y/o or older

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20
Q

How can vision changes impact communication?

A

It could make it harder to recognize gestures or facial expressions which are important to interpretation of words

Or, if there was hearing loss it could be hard to hear inflection, tone, and the vision loss makes it more difficult to lip read.

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21
Q

How to promote vision sensory health?

A
  1. Routine self care
  2. Eye examinations - including a glaucoma test
  3. Early detection and treatment
  4. Evaluation of financial ability for exam and treatments
  5. Prompt evaluation of symptoms
  6. Use bright light
  7. Avoid fluorescent light
  8. UV filter coating on lenses and sunglasses
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22
Q

What are some symptoms requiring prompt evaluation to mitigate vision loss?

A

Blurred or double vision

Redness of conjunctiva (from entropion or ectropion lids)

Spots/Many Floaters

Headaches

Infection

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23
Q

What sort of colors can aid in elder vision?

A

Red, Yellow Black - avoid purples and blues because they are harder to discriminate from each other with the loss of acuity

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24
Q

Arcus Senilis

A

A hazy gray, white, or blue opaque ring appearing in the peripheral cornea

Should be looked for as it indicates potential high cholesterol or cardiac disease

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25
Q

Ways to Compensate for Visual Deficits?

A

Face the person when speaking

Use several indirect lights instead of single glaring one

Avoid glare from windows

Use Large Print

Put frequently used items in the visual field - anything they may need when alone

Avoid low tone colors

Use contrasting colors (even on stairs)

Provide safe environment

Identify personal belongings via a design on them

Remove mats, rugs and cords and anything that may be a tripping hazards

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26
Q

Older adults may have detachment of the ___

A

retina

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27
Q

Retinal Detachment

A

Retina detaches from the back of the eye - either with symptoms being gradual or sudden - and prompt treatment is needed to prevent further damage or blindness

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28
Q

Tell Tale Sign of Retinal Detachment

A

Perception of spots that move across the field of vision

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29
Q

S/S of Retinal Detachment

A

Perception of movement of spots across the eye

Blurred vision

Feeling like there is a cloud developing over the eye

Feeling like they see flashes of light

Potential blindness/Decrease in vision

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30
Q

Individuals after treatment for retinal detachment may be given an eye patch, why may this lead to problems?

A

While needed, this can be frightening to them and the eye patch and loss of vision can lead to confusion d/t sensory loss.

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31
Q

Corneal Ulcer

A

Inflammation of the cornea accompanied by some loss of the corneum

Can be hard to treat and can cause corneal scarring and perforation

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32
Q

Corneal ulcers can be difficult to ___

A

treat

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33
Q

Risk Factors for corneal ulcers?

A

Febrile States

Irritation

Dietary Deficiencies

Lowered Resistance

CVA

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34
Q

Treatment and early care is particularly important with corneal ulcers, what are some ways to treat this condition?

A

Give sunglasses for photosensitivity

May have to give sedatives

Provide antibiotics to deal with the aftermath for the cornea in terms of abrasion

Treat the underlying cause!

Cycloplegics, Sedatives, Antibiotics, and Heat

Potentially a corneal transplant may be done in more advanced corneal ulcers

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35
Q

S/S of Corneal Ulcers

A

Eye may appear bloodshot or you may see the inflammation/sore

Increased tearing

Pain

Photophobia

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36
Q

What is the leading cause of vision loss in the eldery?

A

Cataracts

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37
Q

Cataracts

A

Dense cloudy area forming on the lens leading to loss of transparency and thus vision loss

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38
Q

What is one of the biggest cause for Cataracts?

A

Ultraviolet light exposure (while not using protection like sunglasses)

While everyone has exposure, this is more so for people with excessive exposure

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39
Q

S/S of Cataracts

A

Visual acuity is not affected much! But many patients have decreased night vision

Seeing Halos around lights/Diplopia

Lens becomes opaque

Glare from sunlight and bright light are bothersome

Night vision and night driving difficult

No Pain associated, but further opacity leads to visual acuity affects

Red reflex is reduced

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40
Q

Cataracts generally occur in what eyes?

A

Generally affects both eyes simultaneously

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41
Q

Types of Cataracts

A
  1. Secondary Cataracts
  2. Traumatic Cataracts
  3. Congenital Cataracts
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42
Q

Secondary Cataract

A

Most common in the elderly

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43
Q

Traumatic Cataract

A

Most common after an eye injury

44
Q

Congenital Cataract

A

Often noted right after birth, and most likely occurring in both eyes

45
Q

What might be seen on examination of a cataract”?

A

Decreased red reflex

46
Q

Factors that contribute to cataract formation?

A
  1. Age
  2. DM
  3. Smoking
  4. HTN
  5. Kidney Disease
  6. Physical or Chemical Injury
  7. UV/Sunlight
  8. Prolonged corticosteroid use
47
Q

What is the number 1 contributing factor to cataracts?

A

Age

48
Q

How is the decision for cataract surgery decided?

A

It is NOT based on age

Rather it is based on opacity that leads to limitations

You need to monitor and evaluate for what treatment is necessary

49
Q

Cataract surgery complications increase in occurrence with ___

A

age

50
Q

Potential cataract surgery/implant complications

A

active bleeding

loss of vision

infection

loss of vitreous humor

slipping of the implant

51
Q

How long is a cataract surgery?

A

it is a one day procedure done outpatient (they go home same day), but they are given meds that may impacts other parts of the body (like urinary retention)

52
Q

Methods of Care for Patients Post Cataract Surgery

A

Assess the older adult environment! - Remove obstacles like scattered Rugs

Prevent squeezing of the eyelids

Avoid vigorous laughing, bending over, lifting, sneezing, coughing, straining for BM/constipation

Use eye shield or patch

53
Q

When should a post cataract surgery patient contact their provider?

A

Severe pain

Pressure in the eye

Loss of vision

Any unusual symptoms

54
Q

What is the second leading cause of blindness in older adults?

A

Glaucoma

55
Q

Glaucoma

A

Degenerative eye disease where the optic nerve is damaged from increased intraocular pressure

It is irreversible

56
Q

What are the symptoms of Glaucoma?

A

There are none until it is already occurring and vision is loss

57
Q

What is the cause/etiology of Glaucoma?

A

There is no exact cause, just increased IOP causing damage

58
Q

Risk Factors for Glaucoma include…

A

Size of the Lens

Iritis

Allergy

Endocrine Imbalance

Emotional Stability

Family History

59
Q

Why should medications with cholinergic activity not be given to a patient with glaucoma?

A

It can exacerbate glaucoma, because the meds dilate the pupil - so they should not be used

60
Q

What is the general cause for ACUTE glaucoma

A

rapid increase in intraocular pressure

61
Q

What is the general cause for CHRONIC glaucoma

A

Gradual intraocular pressure with increased pressure on the optic nerve

This type tends to be irreversible

62
Q

2 Types of Glaucoma

A
  1. Acute (Angle-Closure) Glaucoma - EMERGENCY
  2. Chronic (Open Angle) Glaucoma
63
Q

Acute Angle Closure Glaucoma requires treatment how fast?

A

Within 24 hours, it is an emergency, in order to prevent vision loss

64
Q

Acute Angle Closure Glaucoma

A

Rare

Often seen Unilaterally (only in one eye)

Seen in those who are farsighted and have a family history of glaucoma

5%

65
Q

Symptoms of Acute Angle Closure Glaucoma

A

Acute Pain

H/A

N/V

Loss of Vision

Pupils unreactive and partially dilated

all occur within 24 hours of onset

66
Q

What reading does a tonometer get indicating potential acute glaucoma?

A

20-25 mmHg

67
Q

What is a normal eye pressure reading with a tonometer?

A

10-20/21 mmHg

68
Q

Chronic (Open Angle) Glaucoma

A

Chronic and progressive - 90% of glaucoma cases

Increase in IOP from accumulation of aqueous humor over time leads to this

Aqueous humor is NOT stagnant - it flows at a very slow rate

69
Q

What type of glaucoma is more common

A

Chronic Open Angle Glaucoma

70
Q

S/S of Chronic (open angle) Glaucoma

A

More acute in the morning

Tunnel vision

Seeing halos around lights

Blurred vision

Decreased peripheral vision

Difficulty adjusting to darkness

Frequent change in prescription

Cupping of the optic disk

Atrophy of the optic nerve

IOP > 22 mmHg

Cornea may appear cloudy and iris may be fixed or dilated

71
Q

Which eyes tend to get chronic open angle glaucoma?

A

It tends to be unilateral

It is also so gradual that people tend not to notice until the problem exists

72
Q

Mydriasis

A

dilation of the pupil of the eye

73
Q

Why should Anticholinergic medications be avoided with Chronic (Open Angle) Glaucoma?

A

It may cause mydriasis that exacerbates glaucoma

74
Q

How is Chronic Open Angle Glaucoma Diagnosed?

A

A fundoscopic exam showing that the optic disk is cupping and there is atrophy of the optic nerve from IOP greater than 22 mmHg

75
Q

Acute Angle Closure Glaucoma is a…

A

medical emergency!

76
Q

What kind of physician should see an Acute Angle Closure Glaucoma patient?

A

Ophthalmologist (refer to them)

77
Q

How do we treat glaucoma?

A

Medications

Surgery and or Lasers

78
Q

What kind of medications are used for Glaucoma?

A

Beta blockers - to reduce aqueous humor (ex: Diamax/Timolol)

Pilocarpine - Prevent papillary constriction/mydriasis

79
Q

What is the end result of glaucoma that is caught early?

A

If it is caught early there will be a good outcome but they will be on lifelong medications

There is some lifelong vision impairment

80
Q

Why is it so important to make sure patients continue to take their lifelong glaucoma medication?

A

Visual loss from glaucoma can never be replenished or restored, so it is important to continue medications - they may not see a visual increase from meds or eye drops, but it prevents further loss

81
Q

What kind of medication side effects or medications do we avoid with Glaucoma?

A
  1. Anticholinergics
  2. Anything that raises blood pressure like mydriatics or stimulants
82
Q

Macular Degeneration

A

Breakdown or degeneration of the macula which causes CENTRAL VISION TO DECREASE

83
Q

What causes macular degeneration?

A

Systemic changes in circulation, accumulation of cellular waste products, tissue atrophy, and growth of abnormal blood vessels in the choroid layer beneath the retina

84
Q

The most common cause of blindness in older adults is?

A

Macular Degeneration

85
Q

Forms of Macular Degeneration

A
  1. Dry ARMD (80-90%)
  2. Wet ARMD (10%)
86
Q

Dry ARMD

A

Dry Age Related Macular Degeneration

Layers of the macula become thinner and function less and less, the color changes, and providers can note yellow deposits (called Drusen) accumulating under the retina which cause the degeneration

87
Q

Drusen

A

yellow deposits/waste piles that develop under the retina and cause dry age related macular degeneration

88
Q

Wet ARMD

A

Wet Age Related Macular Degeneration

Abnormal, leaky blood vessels exist behind the retina

New blood vessels end up growing between the retinal layers and blood gets trapped in the layers of the retina and macula leading to scar tissue and preventing retinal cell function

89
Q

What is the main symptom of macular degeneration/ARMD

A

Loss of Central Vision

90
Q

S/S of ARMD

A
  1. Difficulty reading, sewing, and performing central vision tasks
  2. Decreased color vision
  3. Wavy appearance of straight lines on paper or in the environment
91
Q

Amsler Grid

A

A diagnostic test where people with ARMD will have the straight lines in the center of the grid be perceived as bent or missing

92
Q

What is another test for macular degeneration to use other than the Amsler grid?

A

Color vision test

93
Q

Risk Factors for ARMD

A

Age

Smoking

More common in Caucasians

Family history of ARMD

94
Q

Ways to mitigate ARMD

A

Avoid smoking

Regular exercise

Checking and maintaining cholesterol levels

Healthy diet rich in fish and green leafy vegetables

Eye exams regularly - since early and intermediate ARMD has no symptoms!

95
Q

Tests that can help diagnose ARMD

A

Amsler Grid

Color Vision Test

Fluorescent Angiogram

Optical Tomography

96
Q

Fluorescent Angiogram

A

can pass through the blood vessels in the eye and look for concerns (good for wet ARMD)

However, can cause N/V or an allergic reaction to the dye

97
Q

Optical Tomography

A

Sound waves getting images of living tissues (can diagnose ARMD)

98
Q

Treatments for ARMD

A

Laser Treatments - not all responsive to this procedure though

Vision Rehabilitation - link the pt with a variety of services (PT, occupational therapy, etc) - individual training occurs then also on adaptive devices

99
Q

Low Vision Optical Aids

A

Magnifying device

Telescopic lenses for distance

Microscopic for close

Large print (books, newspapers, magazines, telephones, clocks, playing cards)

High intensity reading lamps

100
Q

S/S of Hearing Loss

A

Need for increased volume

Tilting head toward the person speaking

Cupping hand around one ear

Watching the speaker’s lips

Speaking loudly

Not responding when spoken to

101
Q

Causes for Hearing Loss (Aside from Age)

A

Exposure to noise

Recurrent Otitis Media

Trauma

Medications

Chronic Illness like:
DM
Tumors
Hypothyroidism
Vascular Problems
Viral Infections

102
Q

Presbycusis

A

Age related hearing loss - gradual hearing loss in both ears related to age

103
Q

How does Smell Perception relate to age?

A

Declines after 60 with rapid decline after age 80 due to cell loss in the olfactory bulb and sensory cells

104
Q

Smell often correlates to ____. What does this cause?

A

Smell often correlates with appetite, this can cause a decrease in appetite alongside a decrease in smell

105
Q

How does Taste Perception relate to age?

A

Gradual decline occurs due to age related changes and some environmental/lifestyle factors

106
Q

What causes taste perception’s gradual decline?

A
  1. Taste Bud Atrophy with age
  2. Amylase decreases in saliva (decreased digestive ability)
  3. Perception decline accelerated with dental problems, smoking, and medicines that alter taste perception.
107
Q

Sensory deficits can …

A

impact the quality of life!

N352: Practice of Nursing I (14 decks)

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