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n3 gero > Exam 3 - Lecture 1 (communication, vision & hearing impairments, intimacy & sexuality) > Flashcards

Exam 3 - Lecture 1 (communication, vision & hearing impairments, intimacy & sexuality) Flashcards

1
Q

what are the techniques (4) for therapeutic communication?

A
  • allow more time
  • face the client
  • seek clarification
  • paying attention to non-verbal communication
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2
Q

what are the effects of using elderspeak?

A

delivers the implicit message of incompetence, beginning a negative feedback loop

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3
Q

when is asking close-ended questions more appropriate?

A

to get specific answers

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4
Q

why do close-ended questions sometimes feel intimidating?

A

it makes the client feel put on the spot

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5
Q

when is asking open-ended questions more appropriate?

A

to allow for elaboration

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6
Q

why can open-ended questions be difficult to answer?

A
  • some clients do not know exactly what is being asked
  • will have the tendency to give the “right” answer
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7
Q

communication issues

what are the causes of issues with reception?

how does the client acquire the message?

A
  • neurological disorders
  • anxiety
  • hearing deficits
  • changes in cognition
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8
Q

communication issues

what are the causes of issues with perception?

how does the client interpret stimuli?

A
  • neurological disorders
  • dementia
  • delirium
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9
Q

communication issues

what are the causes of issues with articulation?

how does the client express themselves?

A
  • mechanical difficulties
  • respiratory disease
  • larynx disorders
  • neurological disorders
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10
Q

what are the different types of communication disorders?

A
  • anomia
  • aphasia
  • dysarthria
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11
Q

communication disorders

what is anomia?

A

difficulty finding the appropriate words

“word-searching”

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12
Q

communication disorders

what is aphasia?

A
  • impairment in processing language
  • inability to speak or understand
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13
Q

communication disorders

what causes aphasia?

A

CVA / TBI on the left side

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14
Q

communication disorders

what is dysarthria?

A

impaired ability to articulate speech due to weakened speech muscles

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15
Q

communication disorders

what are the different types of aphasia?

A
  • fluent
  • nonfluent
  • verbal apraxia
  • anomic
  • global

apraxia is different from aphasia

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16
Q

verbal apraxia occurs with aphasia

A

true

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17
Q

characteristics of fluent aphasia

receptive aphasia

A
  • inablity to understand speech
  • impaired reading & writing skills
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18
Q

characteristics of nonfluent aphasia

expressive aphasia

A
  • impaired speaking
  • effortful speech
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19
Q

characteristics of verbal apraxia

A
  • difficulty brain signaling to speech muscles (jaw, lip, tongue)
  • usually occurs with aphasia
  • client cannot properly pronounce words

apraxia is different from aphasia

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20
Q

what are other causes of dysarthria?

A
  • head injury
  • brain tumor
  • PD
  • MS
  • CVA
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21
Q

what are the manifestations of dysarthria?

A
  • slurred / mumbled speech
  • varied speaking rate
  • being unable to move tongue, lips, and jaw very well
  • sounds robotic or choppy (cannot pronounce consonants)
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22
Q

what are the parameters for visual impairment?

A

20/40 to 20/200

low vision to legal blindness

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23
Q

what are the leading causes of vision impairment?

A
  • age-related macular degeneration
  • cataract
  • glaucoma
  • diabetic neuropathy
  • optic nerve atrophy
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24
Q

what is good communication the basis for?

A
  • accurate assessment
  • care planning
  • therapeutic relationships
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25
Q

best practice for communicating with adults with visual impairment

Box 11-5

A
  • be on the same level
  • use large, dark, and evenly spaced printing
  • use night lights
  • use rich-intensity colors
  • use clock face in referring to location of objects
  • facilitate access to assistive devices (magnifiers, talking books, talking watches)
  • do not rearrange objects in the room
  • provide clear instructions
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26
Q

how can you assist a blind person?

A
  • do not push nor pull them
  • let them take your arm while walking
  • give directions with details
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27
Q

what are the screening recommendations for visually impaired clients?

A

dilated eye exams & screening for vision loss annually

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28
Q

what are the implications of visual impairment?

A
  • negative effects on ADLs
  • increased risk for falls
  • increased risk of cognitive decline
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29
Q

what is presbyopia?

A

age related vision changes that start in the 40s

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30
Q

manifestations of presbyopia

A
  • difficulty focusing on near objects (due to loss of lens elasticity)
  • use of readers & bi-focals
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31
Q

what is the leading cause of blindness?

A

glaucoma

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32
Q

what is the etiology of glaucoma?

A

an increase of intraoccular pressure caused by imbalanced flow of aqueous humor

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33
Q

what is a major complication of glaucoma?

A

blindness

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34
Q

manifestations of glaucoma

A
  • reduced peripheral vision
  • tunnel vision
  • blurred vision
  • halos around lights
  • eye / brow pain
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35
Q

early diagnosis of glaucoma involves no s/s

A

true

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36
Q

closed-angle glaucoma

A

the angle of the iris obstructs drainage of the aqueous humor

acute & emergent

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37
Q

open-angle glaucoma

A

increased pressure on the eye presses on the optic nerve

non-acute & most common

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38
Q

which diagnostic tests are performed to assess for glaucoma?

A
  • vision exam
  • Tonometry (tests IOP)
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39
Q

what are the treatments for glaucoma?

A
  • reduce IOP
  • surgery
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40
Q

what type of surgery is indicated for glaucoma?

A

Argon laser trabeculoplasty

opens outflow channels to relieve pressure

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41
Q

what are the medications for glaucoma?

A
  • ß blocker (first line gtt)
  • oral medications

to increased drainage of AH or reduce AH production

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42
Q

proper administration of eye drops

A
  1. assist patient to high fowler’s position (head tilted back)
  2. expose conjunctival sac by pulling down on the lower lid
  3. administer medication
  4. gently press lacrimal ducts
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43
Q

which population is at higher risk for glaucoma?

A

African-Americans

younger African-Americans need yearly exams

44
Q

preventions for glaucoma

A
  • 65 years & older need annual eye exams
  • immediately reports s/s
45
Q

how do cataracts occur?

A

protein & fat deposits accumulate in the lens causing oxidative damage

46
Q

cataracts occur bilaterally (usually)

A

true

47
Q

manifestations of cataract

A
  • clouding of lens
  • absent red reflex
  • appearance of halos around objects
  • yellow vision
  • sensitivity to glare
  • blurred vision
48
Q

how is cataract treated?

A

surgical replacement of lens (made from plastic)

49
Q

when is surgical replacement of lens indicated?

A

vision is 20/50 or worse

needs to be done 1 eye at a time

50
Q

nursing care for patients post-op lens replacement

A
  • equip patient in preparation for vision changes
  • educate to avoid heavy lifiting & bending
  • eye drops
  • eye shields
51
Q

what is the leading cause of vision loss for older adults ≥ 60 years old

A

macular degeneration

52
Q

what are the types macular degeneration?

A
  • dry (non-exudative; more common)
  • wet (exudative; more severe)
53
Q

what are the risk factors for macular degeneration?

A
  • UV light
  • cigarette smoking
  • light-colored eyes
54
Q

which groups of people have a higher risk for macular degeneration?

A
  • Asians
  • Caucasians
55
Q

what is the etiology of macular degeneration?

A

drusen (lipids & proteins) deposits in retinal epithelium cause degeneration of macular cells

56
Q

what are the manifestations of macular degeneration?

A
  • blurred / dark vision
  • scotomas (blind spots)
  • metamorphopsia (vision distortion)
57
Q

how is macular degeneration diagnosed?

A
  • Drusen deposits seen on opthalmoscopy
  • fundus photography
  • IV angiography & fluorescein
58
Q

what are some interventions to enhance vision?

A
  • use contrasting colors (red & orange)
  • image magnification
  • text-to-speech scanners
  • tablets
  • bring objects closer
  • large type
59
Q

hearing impairment mostly affects men

A

true

60
Q

what are the types of hearing impairment?

A
  • sensorineural
  • conductive
61
Q

what is sensorineural related hearing loss?

A

damage to inner ear or neural pathways of hearing

62
Q

presbycusis is a true sensorineural hearing loss

A

true

63
Q

characteristics of presbycusis

A
  • bilateral
  • progressive & permanent
  • intolerant to loud noises
  • difficulty in distinguishing between consonants
  • difficulty filtering background noises
64
Q

what are the treatments for presbycusis?

A
  • hearing aids
  • cochlear implants
65
Q

how do cochlear implants improve hearing?

A

by directly stimulating the auditory nerve

66
Q

what is conductive hearing loss?

A

vibrations cannot get to T/M or it is impaired

67
Q

what are the causes of conductive hearing loss?

A
  • infections
  • otosclerosis
  • perforated TM
  • fluid in middle ear
  • cerumen impaction (most common)
68
Q

cerumen gets thicker with age

A

true

69
Q

which group of people have a higher risk for conductive hearing loss?

A
  • African Americans
  • those who use hearing aids
  • men with more ear hair
70
Q

how is cerumen impaction diagnosed?

A

accumulation of cerumen prevents proper assessment of ear using otoscope

71
Q

what are the factors that modify cerumen management?

A
  • anticoagulant therapy
  • immunocompromise
  • diabetes
  • radiation therapy of head & neck
  • ear canal stenosis
  • nonintact tympanic membrane
72
Q

what are the treatments for cerumen impaction?

A
  • cerumenolytic agents
  • irrigation
  • manual removal w/ instruments
73
Q

what is tinnitus?

A

constant & intermittent abnormal sounds (ringing, humming, buzzing, roaring)

74
Q

what are the risk factors for tinnitus?

A
  • presbycusis
  • loud noises
  • head & neck trauma
  • tumors
  • cerumen impaction
  • CV disease
  • ototoxic medications (Aspirin)
75
Q

how do hearing aids help with tinnitus?

A

drowns the abnormal sounds by amplification

76
Q

nursing interventions for a client with tinnitus

A
  • identify when sounds are most irritating
  • keep log / diary
  • reduce EtOH, caffeine, cigarettes, stress, & fatigue
  • refer client to American Tinnitus Association
77
Q

what is anomic aphasia?

A

severe word-finding difficulties

78
Q

what is global aphasia?

A

the inablity to understand or express language, resulting to saying meaningless things

79
Q

why do men with presbycusis not hear women & children well?

A

low-pitched & low-tone voices

80
Q

what are the characteristics of elderspeak?

A
  • simplistic vocab & grammar
  • short sentences
  • royal “we”
  • elevated pitch & volume
  • inappropriate terms of endearment
  • speaking as if the person is not present
  • slowed speech
81
Q

touch is the most fundamental means of contact

also 10x more impactful than verbal / emotional contact

A

true

82
Q

what are some things to keep in mind when touching a patient?

A
  • procedural vs. nonprocedural touch
  • appropriate handshakes
  • boundaries (not everyone wants to be touched)
83
Q

name the 4 touch zones

A
  • social
  • consent
  • vulnerable
  • intimate
84
Q

what is included in the social zone?

A
  • heads
  • arms
  • shoulders
  • back
85
Q

what is included in the consent zone?

A
  • mouth
  • wrists
  • feet
86
Q

what is included in the vulnerable zone?

A
  • face
  • neck
  • front of body
87
Q

what is in the intimate zone?

A

genitalia

88
Q

touching a patient is a form of tactile support and a way to show care

A

true

89
Q

how does an older adult adapt to touch deprivation?

A
  • rocking
  • stroking an animal’s fur
  • sensory stimulation by clothing
  • music
  • dancing
90
Q

how does touch deprivation develop?

A
  • other sensual experiences are diminished
  • sexual expression has been inhibited or limited
91
Q

what are forms of intimacy?

A
  • holding
  • touching
  • being present
  • commitment
92
Q

sexuality is redefined in older adulthood from procreation to

A
  • companionship
  • physical proximity
  • intimate communication
  • physical pleasure
93
Q

never assume anyone’s sexuality–what do you ask in assessing this of an older patient?

A

“Do you have a romantic partner? How do you identify?”

94
Q

sexual changes in women

A

dyspareunia (painful intercourse) from dryness & thinning

95
Q

sexual changes in men

A

erectile dysfunction

96
Q

how can you treat ED?

A

Phosphodiesterase (PDE) inhibitors

medications end in -fil (Viagra, Levitra, Cialis)

97
Q

why do Nitrates / Nitroglycerin contraindicate with PDE inhibitors?

A

sudden decrease in BP

due to vasodilation of both types of meds

98
Q

urinary incontinence in women can affect sexual activity

A

true

99
Q

what can help with vaginal lubrication?

A
  • low-dose estrogen
  • water-soluble lubricants
100
Q

why are older adults more likely to contract HIV?

A

compromised immune system

101
Q

Medicare covers HIV screening for high-risk individuals

A

true

102
Q

why are older women at higher risk for infection?

A

normal changes in vaginal tissue (dryness & thinning)

103
Q

PLISSIT Model

sexuality

A
  • Permission
  • Limited Information
  • Specific Suggestions
  • Intensive Therapy
104
Q

what is the appropriate diet for enhancing vision?

A
  • vitamin C
  • vitamin E
  • Beta-Carotene
  • Zinc
  • dark green leafy vegetables (collard, mustard, spinach, kale)
105
Q

how far away do you need to be from the snellen eye chart?

A

20 feet

106
Q

what is the most important capacity in humans?

A

the ability to communicate

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