Exam 3 Flashcards
Cataracts
common cause of adult curable blindness
-clouding or opacity of lens due to structural changes in proteins= gradual loss of vision
-Development= slow and painless
Very reversible
Normal-age related vision changes
Diminished visual acuity, light sensitivity, brightness contrast, dark adaptation, recovery from glare. Lenses thicken, harden, appear yellowish and opaque
abnormal eye changes
Cataracts, glaucoma, macular degeneration, diabetic retinopathy, detached retina, floaters
Risk factors for cataracts
Over 50, DM, familial history, smoking and alcohol, obesity, hyperlipidemia, HTN, trauma to eye or Hx of eye surgery, exposure to sun and UVB rays, long-term corticosteroid meds, Caucasian race
Vision changes with cataracts
Lens clouding=decreased light to retina= limited vision
CATS
Cloudy/blurred vision
Acquiring frequent eyeglass Rx
Tones down colors
Sensitivity to glare and light
Cataract S/S
Painless and slow onset of blurring vision, sensitive to glare, halos around objects, loss of acuity from dimness to distortion, reading and night driving difficult, decreased color perception
Cataract assessment signs
Haziness of lens, inability to see fundus, no red reflex
Pre-op cataract surgery care
NPO, void, measures to decrease IOP, eye drops to dilate pupil, all consents signed, may clip eyelashes
Outpatient surgery types for cataracts
Intracapsular and extracapsular
Intracapsular cataracts surgery
Removal of lens and its capsule through wide incision in cornea
extracapsular cataract surgery
Contents of lens aspirated by large-bore needle through small incision in cornea, leaving posterior portion of lens capsule behind
Post-op cataract surgery care
HOB up, semi-fowlers position, lying on back or unoperated side, monitor for N/V, eye drops to constrict pupil, antibiotics, anti-inflammatory, minimum light
Cataract prevention
Wearing hats and sunglasses (UVA and UVB protective coating) when in sun
-smoking cessation
-eat low-fat diet rich in antioxidants and vitamins E and C
-avoid ocular injury (wear goggles when using power tools)
Complications following cataract surgery that requires physician to be notified
Pain, conjunctival injection, vision loss, sparks, flashes, floaters, N/V, excessive coughing
Complications of cataract surgery
Infection, wound dehiscence, hemorrhage, severe pain, uncontrolled elevated intraocular pressure
Post-op and D/C teaching
Infection, bleeding, elevated IOP major complications
- report any drainage, excessive tearing or decline in visual acuity or acute unrelieved pain
-wear eye shield at night for 2-3 weeks
-usually resume normal self-care activities: no heavy lifting, straining at stool, bending at waist for few days
-eye drops will be ordered postop
Glaucoma
Leading irreversible blindness in adults esp >40, no cure, group of ocular conditions, no cure
-Damaged optic nerve due to increased IOP resulting in vision loss
-open angle most common
Dx of glaucoma/recommended screening schedule
Measure IOP(tonometer) and visual acuity (snellen)
normal IOP= 10-21 mmHg
Screening should start at 40!
glaucoma risk factors
SAVE
Sixty or older(esp family Hx), African American, Asian, Hispanic, vascular problems (HTN, DM,migraines,myopia), elevated IOP (greater than 21mmHg)
What happens when glaucoma is left untreated
Progressive vision loss and damage that cannot be reversed- permanent blindness
Ophthalmic agents used to treat glaucoma
“ABCC’s”
Alpha agonists(Bromionidine)
Beta blockers (Timolol)
Cholinergics(Pilocarpine), carbonic anhydrase inhibitors (CAIs, acetazolamide,Diamox)
Glaucoma med s/e
bradycardia, bronchoconstriction, orthostatic hypotension, tremors,
Nursing interventions to prevent glaucoma med s/e
Prevent systemic absorption by lacrimal pressure- punctal occlusion
-strictly adhere to med schedule
-if >1 med, give 5 min apart to prevent washout
Detached retina
Tissue at the back of the eye pulls away from a layer of blood vessels that provide necessary oxygen and nourishment. Emergency!
S/s detached retina
Sudden appearance of many floaters, flashes of light in one or both eyes, blurred vision, gradually reduced side vision, curtain-like shadow over your visual field
Nursing care for detached retina
NPO-surgery
Limit activity, avoid pressure on eye.
Educate postop to wear eye patch, especially at night. Position to reduce swelling and pressure on eye. Use eye drops as prescribed.
Teaching for pt with gas bubble
Avoid rubbing eyes and traveling to high altitudes or riding in plane. Lasts 6-8 weeks or 10 days-1month. Vision slowly improves as bubble dissipates.
Avoid straining or causing an increase in pressure of eye. Some pain and blurry vision for few days=normal. Swollen, tender, red for several weeks. May have to keep head in certain position for few days
Gas bubble-detached retina
Inserted to float over detached area and pushes it back against back of eye.
Macular degeneration
Two forms: wet and dry (more common) forms
Deterioration of the macula (part of the retina at back of eye)= central loss of vision
Macular degeneration S/S
S/s:
-blurred vision
-center of vision dark
-develop central loss of vision->impaired reading and recognition of objects but side vision and mobility remain intact
-glasses dont help
-need low-vision aids
-laser surgery may help by sealing off damaged blood vessels to prevent bleeding and scar tissue
Dry form-macular degeneration
Atrophy, retinal pigment degeneration, drusen accumulations, other s/s, slow progression of visual loss
-light sensitive cells in eye begin to breakdown=blurry central vision in eye;both eyes
Slower onset than wet form
Wet (neovascular exudates)-macular degeneration
Blood or serum leak from newly formed vessels beneath retina moving macula(quick deterioration and damage to macula)=scar formation and visual problems
Client education for macular degeneration
Nurses should encourage:
-wearing UV protective lenses in sun
-smoking cessation
-exercising regularly
-eating a healthy diet consisting of fruits and veggies to inc consumption of antioxidants
-taking vitamins in divided doses twice a day to delay progression
Diet and supplements-macular degernation
Zinc oxide 80 mgm
Cupric oxide 2 mg
Beta carotene 15 mgm
Vitamin C 500 mgm
Vitamin E 400 IU
Drugs that risk hearing loss
Aminoglycoside antibiotics (Mycin)- ototoxic
Antineoplastics (ICS platinum)- ototoxic
Loop diuretics (furosemide)-ototoxic
Propranolol (inderal)-tinnitus and hearing loss
ASA and NSAIDs-tinnitus
Communication with elder adult with hearing loss
Speak clearly and at a normal pace without over exaggerating lip movements. Eye contact, face them head on
Care of hearing aids
Remove and clean at bedtime
- NO alcohol or harsh soaps
-use damp cotton pad/cloth with either water/saline
-carefully remove cerumen
- disengage battery
-store in safe place
Asthma
Narrowing/constriction of the bronchioles; alveoli not effected; “reactive airway”
Asthma causes
Allergic reactions- modifiable and nonmodifiable
Modifiable asthma causes
Smoking, exercise, occupational dust and chemicals, indoor and outdoor pollution
Nonmodifiable asthma causes
Allergies, genes, age, Aa deficiency
Pink puffer
Emphysema
Blue bloater
Chronic bronchitis
COPD is
Both emphysema and chronic bronchitis
Chronic bronchitis is AKA
Blue bloaters
Emphysema is AKA
Pink puffer
Chronic bronchitis
Entire respiratory tract is covered in mucous which is a barrier to gas exchange
Emphysema
Enlarged alveoli and CO2 retention
S/s chronic bronchitis
Wheezing, JVD, edema, weight gain (abdominal,trunk), ascites, productive cough, decreased activity tolerance, cyanosis, O2 sats~ middle 80s
Increased mucous production that worsens in the morning
Cardiac dysrhythmias
S/s emphysema
O2 sats read “normal” ~95/96
Enlarged alveoli with CO2 retention
-AMS, confusion,barrel chested, pink/ruddy red color, inc WOB, inc caloric needs, activity intolerance, agitation, anxiety, clubbed fingers, old and skinny, quiet chest, leans forward when breathing, purse-lipped breathing, anxious
Pulmonary rehabilitation
Improves exercise intolerance and overall QOL
-breathing
-relaxation techniques
-smoking cessation
-energy conservation
-exercise
-group support
Management of exacerbations-asthma
Rescue inhaler/ nebulizer (albuterol), oxygen administration, anti-inflammatory- ICS
Management of exacerbations-COPD
SABA, ICS, oxygen therapy
Oxygen therapy considerations and safety
Hyperoxygenation- can lead to respiratory acidosis
-only tx shown to alter course of advanced COPD
-start on 2L, never more than 4L
-can suppress drive to breathe or cause oxygen toxicity: VENTIDC
Vision, ears, nausea, twitching, irritability, dizzy, convulsions
Client education-COPD
report sputum color and amt change, report s/s infection and fever
Inhale bronchodilator FIRST then ICS, rinse mouth following ICS
-proper hydration
-proper use of oxygen
-flu and pneumococcal vaccines
-climate, avoid high temp and humidity
Client education-emphysema
Purse lipped breathing to blow off CO2, increased caloric needs, high calorie and high protein diet, oxygen use, CPAP use
Client education-asthma
Take ICS daily, albuterol=rescue drug. Rinse mouth after ICS. Report white tongue and oral mucous membranes
Rescue inhalers vs maintenance therapy
Rescue inhalers=SABA-albuterol
Maintenance-LABA and ICS inhalers
Rescue inhalers
SABA-albuterol, should be used less than twice a week
Maintenance therapy-inhalers
LABA- long acting beta agonists
Inhaled corticosteroid inhalers, anti-inflammatory ex
Assessment criteria-elder abuse
Repeated injuries, bruises and grip marks, repeat ER visits, refusal to go to same ER, fractures/breaks, hygiene deficit
Interventions-elder abuse
Types of elder abuse
Physical, emotional, financial, neglect
Usual victim and abuser in elder abuse
Usual victim: elder parent, white Caucasian elder woman, elder with dementia/confusion, elder unable to take care of self
What increases the risks for elder abuse?
Caregiver stress, family situations, caregiver personal situations, financial strain, sandwich generation
Role of nurse in elder abuse
REPORT-MANDATED!
Interview elder and caregiver SEPARATELY
-provide resources for caregiver respite care, support
Normal aging changes-memory
Forget where you put things(keys, wallet, phone, etc)
S/s dementia
Two cognate functions significantly impaired:
- memory
-communication and language
-attention span limited
-reasoning and judgement
-visual perception
Mini-cog
Screening tool with three item recall and clock drawing test. Unsuccessful recall of three items after clock drawing distractor=probable dementia
BCAT
Brief cognitive assessment tool- determines level of cognitive impairment not dementia severity (delirium/confusion)
S/s depression
Differences in s/s of dementia vs depression
FAST score-Alzheimer’s disease
NOT stroke FAST assessment- 7 stages
1=normal adult
2=normal older adult
3=early dementia
4=mild dementia
5=moderate dementia
6=moderatly severe dementia
7=severe dementia
Alzheimer’s stages
Early-mid, moderate, late
Early stages-Alzheimer’s
Subtle memory changes
Difficulty remembering names and events; mild forgetfulness- short term memory loss; go over with pt about progression of disease and future plan if aware of Alzheimer’s
Moderate stages- Alzheimer’s
Forgets names of family members, requires more assistance with ADL’s, experiences delusions, hallucinations, increased anxiety. Can become more violent, sleeps more during day. Safety and self care=major concern
-wandering
-longest stage
-Sundowning
Late stages-Alzheimer’s
All speech is lost, lose urinary and bowel control, cannot walk, bedridden, cannot swallow or speak-need constant care
7M’s of Alzheimer’s disease
Middle stage:
Memory, movement, mental health,maintain safety
Interventions for early stage Alzheimer’s
Interventions for moderate state Alzheimer’s-memory
-Reorient and remind, remain patient, keep simple, do not scold
Interventions for moderate state Alzheimer’s-movement
-Independent as allowed, routines, exercise, fun games
Interventions for moderate state Alzheimer’s- mental health
-calm, distract, no hurry, hallucinations, limit outside noise, well-lit room, remove reflective times
Interventions for moderate Alzheimer’s stage-maintain safety
-beware of driving, hide keys, supervise cooking, beware of wandering
WANDER:
W=wear ID bracelet/GPS
A= Avoid stressful, unfamiliar places/crowds
N= Needs met
D= Display signs providing cues
E= exercise is important
R= remove access to doors, windows(locks/alrams)
Interventions for late stage Alzheimer’s
Alzheimer’s drugs
When Alzheimer’s drugs are used in the progression of the disease
Management of behavioral problems with Dementia
How do you best communicate with someone with dementia
Management strategies for aggression/agitation- dementia
Redirect/refocus
Identify what they are communicating with you-hungry, bathroom, tired, etc
Physical problems/medications that can make dementia symptoms worse
Anticholinergics, HTN/cardiac drugs, chemotherapeutics,
Vascular dementia
Caused by block/interruption of bloodflow to brain
Sundowning
Worsening progression of confusion, behavior issues at night, wandering, hallucinations, agitation
Triggers: exhaustion, sickness, new med, low exposure to sunlight
Sundowning interventions
Redirect/refocus
Plan activities around pt cognition- do ADL’s and hygiene at morning, take walks during day, have established routine
-avoid caffeine at night
-low noise, calm, relaxing environment
-avoid taking long late naps
-remain calm, reassure pt you are there and they are safe
-nothing in room creating shadows,well-lit, remove reflective items, maintain safety
Respite care
Someone else takes care of elder for a few hours a couple days a week to allow caregiver a break, temporary LTC placement
Stress and impact on the lay caregivers
Can lead to neglect/abuse
Interventions to help lay caregivers
Respite care, support groups
Paperwork needed to be a caregiver
Tool for care giver strain
How to use/administer tool for care giver strain
“Test” for depression
Geriatric depression scale (short=15, long=30). Score of five or higher indicates high risk for depression, needs further evaluation.
Is depression ever normal
No. More common in older adults. Risk increases when functional ability decreases
Medications used to treat depression
SSRI
Apraxia
Inability to perform certain motor movements (brush teeth)
Aphasia
Can’t understand speech or create it (pictures help)
Agnosia
Can’t recognize objects, ppl, interpret senses(may not recognize spoon or ppl they normally see. Sensation to pee, but incontinent. Given food but do not recognize what they are eating)
Amnesia
Memory loss-cannot recall memories, who they are, birthday, address, etc
Anomia
Cannot recall name of objects. Know what it is, but can’t name it
