Week 9: Vision and Hearing Flashcards
(49 cards)
1
Q
What does vision change with age?
A
- Changes in eye structure begin early, are progressive and affect both function and structure.
- Presbyopia (decreased near vision) is a common change of aging.
2
Q
What are extraocular changes with age?
A
- Eyelids lose elasticity contributing to drooping.
- Entropin
- Ectropion
- Xerophthalmia
3
Q
Entropin
A
Inward turning of the lower lid
4
Q
Ectropion
A
Outward turning of the lower lid
5
Q
Xeropthalmia
A
Excessively dry eyes
6
Q
What changes occur to the cornea with aging?
A
Cornea becomes flatter, less smooth, thicker and loses luster.
7
Q
What are ocular changes that occur with aging?
A
- Increased astigmatism
- Chambers that control movement of aqueous fluid decrease in size and volume capacity, leading to development of glaucoma.
- Glare is a major problem.
- Decrease ability of the lens to accommodate.
- Development of cataracts from ultraviolet exposure.
8
Q
What are intraocular changes that occur with age?
A
- Deterioration of vitreous humor may lead to development of “floaters” (lines, webs, spots, dots)
- Retinal changes affect color, with red, orange, and yellow seen more easily
- Color clarity diminishes by 59% in the eighth decade, secondary to yellowing of the lens
- Drusen spots may appear on the macula
9
Q
What are changes in vision that occur with age?
A
- Vision loss is NOT an inevitable part of aging, but age-related changes contribute to decreased vision
- Even older persons with good visual acuity need accommodations to enhance vision and safety.
10
Q
Visual impairment in older adults are associated with
A
- Cognitive and functional decline
- Decreased quality of life
- Depression
- Increased risk for injury and falls
11
Q
How can visual impairment be prevented?
A
- Have yearly dilated eye examination
- Get routine eye examinations
12
Q
Types of Glaucoma
A
- Primary Open Angle Glaucoma
- Acute Angle Closure Glaucoma
13
Q
Primary Open Angle Glaucoma
A
- Progressive, asymptomatic with visual field loss.
- Increased intraocular pressure damages optic nerve.
- Vision loss can be prevented if detected early.
14
Q
Those with primary open angle glaucoma may complain of what?
A
- Headache
- Poor vision in dim lighting
- Tired eyes
15
Q
Acute Angle Closure Glaucoma
A
- Emergency
- Angle of iris obstruct flow of aqueous humor.
- May be related to infection or trauma.
- Intraocular pressure rises rapidly.
16
Q
What are signs and symptoms of acute angle closure glaucoma?
A
- Eye is red and painful
- Severe H/A
- N/V
17
Q
What should be avoided in patients with acute angle closure glaucoma?
A
Anticholinergics
18
Q
Screening of Glaucoma
A
-Adults over the age of 65 or those at risk should have an annual eye examination with dilation.
19
Q
What is the treatment for glaucoma?
A
- Oral or topical eyedrops to decrease intraorific pressure (beta blockers are first line therapy)
- Trabeculoplasty
- Filtration surgery
20
Q
Cataracts
A
- Opacity of the lens causing the lens to lose transparency and scatter light.
- Often caused by oxidative damage.
21
Q
What is a cardinal sign for cataracts?
A
Appearance of halos around objects as light is diffused.
22
Q
How is cataracts treated?
A
Requires surgery under local anesthesia.
95% return to excellent vision.
23
Q
What should you teach patients about cataracts?
A
- Education regarding vision and adaptation to light changes.
- Post-surgery: avoid heavy lifting, straining and bending at the waist.
24
Q
What is diabetic retinopathy?
A
…
25
Diabetic retinopathy incidence
- Most diabetic patients will develop retinopathy within 20 years of diagnosis
- Leading cause of new blindness between ages 20-74
26
What are the four stages of diabetic retinopathy?
1. Mild nonproliferative retinopathy
2. Moderate nonproliferative retinopathy
3. Severe nonproliferative retinopathy
4. Proliferative retinopathy
27
Screening for retinopathy
- Early detection is essential
| - Annual fundoscopic dilated eye examination
28
Retinopathy Screening: Fundoscopic evaluation includes
- Flame shape hemorrhages
- Cotton wool spots
- Hard exudates
- Dilated capillaries
- Microaneurysms
29
What is the treatment for retinopathy?
-Maintain strict control of blood sugar, cholesterol and blood pressure.
30
Age-Related Macular Degeneration
-Progressive loss of central vision.
31
What causes age-related macular degeneration?
- Systemic changes in circulation
- Accumulation of cellular waste
- Tissue atrophy
- Growth of abnormal vessels in choroid layer beneath the retina
- Fibrous scarring affects nourishment of photoreceptor cells.
32
Age-related macular degeneration screening
- Early diagnosis is key
| - Amsler grid to determine clarity of vision helps identify central vision problems
33
What is the treatment for age-related macular degeneration?
- Photodynamic therapy
- Laser photocoagulation
- Anti-vascular endothelial growth factor therapy
34
Detached retina
- Emergency medical treatment (surgery) required to save vision
- Actual areas of the retina are torn that lead to retinal detachment.
- May have gradual increase in floaters and/or light flashes in the eye.
35
Dry eye (keratoconjunctivitis sicca)
- A common complaint rather than a disease.
| - D/t decreased tear production with age.
36
Dry eye can be related to
- Medications
| - Sjogren’s syndrome
37
Treatment for Dry Eyes
- Artificial tears
| - Consider Vitamin A deficiency
38
What are signs and behaviors that may indicated vision problems?
- Pain in eyes
- Difficulty seeing in the dark
- Double vision/distorted vision
- Migraine headaches with blurred vision
- Flashes of light
- Halos surrounding lights
- Difficulty driving at night
- Falls or injuries
39
Special considerations in long-term care in relation to vision
- Cognitive impairment interfere with ability to communicate visual disturbances.
- If a person has glasses, he or she should wear them.
- Routine eye care is a gap in care that can lead to functional decline, decreased quality of life and depression.
- 1/3 of vision problems in LTC settings are reversible.
40
Consequences of Hearing Impairment include
- Diminishes quality of life
- Decline in function
- Increased hospitalizations
- Miscommunication
- Depression
- Falls
- Loss of self-esteem
- Safety risks
- Cognitive decline
- Increases feelings of isolation
- May be diagnosed with dementia inappropriately
41
Types of Hearing Loss: Sensorineural
-Damage to inner ear or neural pathways
42
Types of sensorineural hearing loss
- Presbycusis
| - Noise induced
43
Presbycusis Hearing Loss
- Most common form of hearing loss that worsens with age.
| - First sign is difficulty hearing in noisy environments, affects high frequency.
44
Noise Induced Hearing Loss
- Second most common cause of hearing loss
- Mechanical injury to the sensory hair cells of the cochlea, continuous noise exposure.
- Expected to rise
- Consider better ear protection devices.
45
Types of Hearing Loss: Conductive
-Abnormalities of external and middle ear that reduce transmission of sound.
46
What are causes of conductive hearing loss?
- Otosclerosis
- Infection
- Perforated eardrum
- Fluid in middle ear
- Tumor
- Cerumen accumulation
47
Cochlear implants
- Increased use for sensorineural hearing loss where hearing aids aren’t effective.
- Bypasses damaged portions of the ear and directly stimulates auditory nerve.
48
For those with cochlear implants, what should be avoided?
MRI’s
49
Promoting Healthy Aging: Hearing
- Screening for hearing impairment is essential primary care for older adults
- Assessment includes focused history and physical examination and screening assessment
- Self-assessment instruments may be helpful (Box 12-5)
- May require referral to an audiologist
- Removal of cerumen impaction (Box 12-3)
- Follow best practices for communicating with older adults
