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
2
Q
what are the effects of using elderspeak?
A
delivers the implicit message of incompetence, beginning a negative feedback loop
3
Q
when is asking close-ended questions more appropriate?
A
to get specific answers
4
Q
why do close-ended questions sometimes feel intimidating?
A
it makes the client feel put on the spot
5
Q
when is asking open-ended questions more appropriate?
A
to allow for elaboration
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
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
8
Q
communication issues
what are the causes of issues with perception?
how does the client interpret stimuli?
A
- neurological disorders
- dementia
- delirium
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
10
Q
what are the different types of communication disorders?
A
- anomia
- aphasia
- dysarthria
11
Q
communication disorders
what is anomia?
A
difficulty finding the appropriate words
“word-searching”
12
Q
communication disorders
what is aphasia?
A
- impairment in processing language
- inability to speak or understand
13
Q
communication disorders
what causes aphasia?
A
CVA / TBI on the left side
14
Q
communication disorders
what is dysarthria?
A
impaired ability to articulate speech due to weakened speech muscles
15
Q
communication disorders
what are the different types of aphasia?
A
- fluent
- nonfluent
- verbal apraxia
- anomic
- global
apraxia is different from aphasia
16
Q
verbal apraxia occurs with aphasia
A
true
17
Q
characteristics of fluent aphasia
receptive aphasia
A
- inablity to understand speech
- impaired reading & writing skills
18
Q
characteristics of nonfluent aphasia
expressive aphasia
A
- impaired speaking
- effortful speech
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
20
Q
what are other causes of dysarthria?
A
- head injury
- brain tumor
- PD
- MS
- CVA
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)
22
Q
what are the parameters for visual impairment?
A
20/40 to 20/200
low vision to legal blindness
23
Q
what are the leading causes of vision impairment?
A
- age-related macular degeneration
- cataract
- glaucoma
- diabetic neuropathy
- optic nerve atrophy
24
Q
what is good communication the basis for?
A
- accurate assessment
- care planning
- therapeutic relationships
25
best practice for communicating with adults with visual impairment
| Box 11-5
- 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
26
how can you assist a blind person?
- do not push nor pull them
- let them take your arm while walking
- give directions with details
27
what are the screening recommendations for visually impaired clients?
dilated eye exams & screening for vision loss ***annually***
28
what are the implications of visual impairment?
- negative effects on ADLs
- increased risk for falls
- increased risk of cognitive decline
29
what is *presbyopia*?
age related vision changes that start in the 40s
30
manifestations of *presbyopia*
- difficulty focusing on near objects *(due to loss of lens elasticity)*
- use of readers & bi-focals
31
what is the leading cause of blindness?
glaucoma
32
what is the etiology of glaucoma?
an increase of intraoccular pressure caused by imbalanced flow of aqueous humor
33
what is a major complication of *glaucoma*?
blindness
34
manifestations of *glaucoma*
- reduced peripheral vision
- tunnel vision
- blurred vision
- halos around lights
- eye / brow pain
35
early diagnosis of glaucoma involves no s/s
true
36
closed-angle glaucoma
the angle of the iris obstructs drainage of the aqueous humor
| acute & emergent
37
open-angle glaucoma
increased pressure on the eye presses on the optic nerve
| non-acute & most common
38
which diagnostic tests are performed to assess for glaucoma?
- vision exam
- Tonometry *(tests IOP)*
39
what are the treatments for glaucoma?
- reduce IOP
- surgery
40
what type of surgery is indicated for glaucoma?
Argon laser trabeculoplasty
| opens outflow channels to relieve pressure
41
what are the medications for glaucoma?
- ß blocker (***first line*** gtt)
- oral medications
| to increased drainage of AH or reduce AH production
42
proper administration of eye drops
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
43
which population is at higher risk for *glaucoma*?
African-Americans
| younger African-Americans need yearly exams
44
preventions for *glaucoma*
- 65 years & older need annual eye exams
- immediately reports s/s
45
how do *cataracts* occur?
protein & fat deposits accumulate in the lens causing oxidative damage
46
cataracts occur bilaterally *(usually)*
true
47
manifestations of *cataract*
- clouding of lens
- absent red reflex
- appearance of halos around objects
- yellow vision
- sensitivity to glare
- blurred vision
48
how is *cataract* treated?
surgical replacement of lens *(made from plastic)*
49
when is surgical replacement of lens indicated?
vision is 20/50 or worse
| needs to be done 1 eye at a time
50
nursing care for patients post-op lens replacement
- equip patient in preparation for vision changes
- educate to avoid heavy lifiting & bending
- eye drops
- eye shields
51
what is the leading cause of *vision loss* for older adults ≥ 60 years old
macular degeneration
52
what are the types *macular degeneration*?
- dry (non-exudative; more common)
- wet (exudative; more severe)
53
what are the risk factors for *macular degeneration*?
- UV light
- cigarette smoking
- light-colored eyes
54
which groups of people have a higher risk for *macular degeneration*?
- Asians
- Caucasians
55
what is the etiology of *macular degeneration*?
drusen *(lipids & proteins)* deposits in retinal epithelium cause degeneration of macular cells
56
what are the manifestations of *macular degeneration*?
- blurred / dark vision
- scotomas *(blind spots)*
- metamorphopsia *(vision distortion)*
57
how is *macular degeneration* diagnosed?
- Drusen deposits seen on opthalmoscopy
- fundus photography
- IV angiography & fluorescein
58
what are some interventions to enhance vision?
- use contrasting colors *(red & orange)*
- image magnification
- text-to-speech scanners
- tablets
- bring objects closer
- large type
59
hearing impairment mostly affects men
true
60
what are the types of hearing impairment?
- sensorineural
- conductive
61
what is *sensorineural* related hearing loss?
damage to inner ear or neural pathways of hearing
62
*presbycusis* is a true sensorineural hearing loss
true
63
characteristics of *presbycusis*
- bilateral
- progressive & permanent
- intolerant to loud noises
- difficulty in distinguishing between consonants
- difficulty filtering background noises
64
what are the treatments for *presbycusis*?
- hearing aids
- cochlear implants
65
how do cochlear implants improve hearing?
by directly stimulating the auditory nerve
66
what is *conductive* hearing loss?
vibrations cannot get to T/M or it is impaired
67
what are the causes of *conductive* hearing loss?
- infections
- otosclerosis
- perforated TM
- fluid in middle ear
- *cerumen impaction* **(most common)**
68
cerumen gets thicker with age
true
69
which group of people have a higher risk for *conductive* hearing loss?
- African Americans
- those who use hearing aids
- men with more ear hair
70
how is cerumen impaction diagnosed?
accumulation of cerumen prevents proper assessment of ear using otoscope
71
what are the factors that modify cerumen management?
- anticoagulant therapy
- immunocompromise
- diabetes
- radiation therapy of head & neck
- ear canal stenosis
- nonintact tympanic membrane
72
what are the treatments for cerumen impaction?
- cerumenolytic agents
- irrigation
- manual removal w/ instruments
73
what is *tinnitus*?
constant & intermittent abnormal sounds *(ringing, humming, buzzing, roaring)*
74
what are the risk factors for *tinnitus*?
- presbycusis
- loud noises
- head & neck trauma
- tumors
- cerumen impaction
- CV disease
- ototoxic medications *(Aspirin)*
75
how do hearing aids help with *tinnitus*?
drowns the abnormal sounds by amplification
76
nursing interventions for a client with *tinnitus*
- identify when sounds are most irritating
- keep log / diary
- reduce EtOH, caffeine, cigarettes, stress, & fatigue
- refer client to *American Tinnitus Association*
77
what is *anomic aphasia*?
severe word-finding difficulties
78
what is *global aphasia*?
the inablity to understand or express language, resulting to ***saying meaningless things***
79
why do men with presbycusis not hear women & children well?
low-pitched & low-tone voices
80
what are the characteristics of *elderspeak*?
- 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
touch is the most *fundamental* means of contact
| also 10x more impactful than verbal / emotional contact
true
82
what are some things to keep in mind when touching a patient?
- procedural vs. nonprocedural touch
- appropriate handshakes
- boundaries *(not everyone wants to be touched)*
83
name the 4 touch zones
- social
- consent
- vulnerable
- intimate
84
what is included in the *social zone*?
- heads
- arms
- shoulders
- back
85
what is included in the *consent zone*?
- mouth
- wrists
- feet
86
what is included in the *vulnerable zone*?
- face
- neck
- front of body
87
what is in the *intimate zone*?
genitalia
88
touching a patient is a form of *tactile support* and a way to show care
true
89
how does an older adult adapt to touch deprivation?
- rocking
- stroking an animal's fur
- sensory stimulation by clothing
- music
- dancing
90
how does *touch deprivation* develop?
- other sensual experiences are diminished
- sexual expression has been inhibited or limited
91
what are forms of *intimacy*?
- holding
- touching
- being present
- commitment
92
sexuality is redefined in older adulthood from procreation to
- companionship
- physical proximity
- intimate communication
- physical pleasure
93
never assume anyone's sexuality–what do you ask in assessing this of an older patient?
"Do you have a romantic partner? How do you identify?"
94
sexual changes in women
dyspareunia *(painful intercourse)* from dryness & thinning
95
sexual changes in men
erectile dysfunction
96
how can you treat ED?
Phosphodiesterase *(PDE)* inhibitors
| medications end in -fil (Viagra, Levitra, Cialis)
97
why do Nitrates / Nitroglycerin contraindicate with PDE inhibitors?
sudden decrease in BP
| due to vasodilation of both types of meds
98
urinary incontinence in women can affect sexual activity
true
99
what can help with vaginal lubrication?
- low-dose estrogen
- water-soluble lubricants
100
why are older adults more likely to contract HIV?
compromised immune system
101
Medicare covers HIV screening for high-risk individuals
true
102
why are older women at higher risk for infection?
normal changes in vaginal tissue *(dryness & thinning)*
103
PLISSIT Model
| sexuality
- Permission
- Limited Information
- Specific Suggestions
- Intensive Therapy
104
what is the appropriate diet for enhancing vision?
- vitamin C
- vitamin E
- Beta-Carotene
- Zinc
- dark green leafy vegetables *(collard, mustard, spinach, kale)*
105
how far away do you need to be from the snellen eye chart?
20 feet
106
what is the most important capacity in humans?
the ability to communicate
