Exam 3: Gero Lecture 8 Flashcards

Question

what are the causes of dysarthria?

Answer 1

Injury to brain CVA, head injury, brain tumor, Parkinson’s, multiple sclerosis

Answer 2

Have "slurred" or "mumbled" speech that can be hard to understand Speak slowly Talk too fast Speak softly Not be able to move your tongue, lips, and jaw very well Sound robotic or choppy

Answer 3

Collaboration with SLPs for speech therapy

Answer 4

2/3 with impairment > 65 Among top 10 causes of disability in US Lower QOL and life expectancy Low vision to legal-blindness 20/40 to 20/200 Nurses screen vision how? Eye Snellen chart, designated in certain areas and the floor SHOULD BE makered

Answer 5

Age-related macular degeneration Cataract Glaucoma Diabetic Retinopathy Optic Nerve atrophy

Answer 6

Affects nearly all ADLs ↑ risk of Falls ↑ risk of cognitive decline

Answer 7

Age related vision changes (may start in 40s) Lens loses elasticity Difficulty focusing on near objects Readers, bi-focals

Answer 8

Leading cause of blindness Open and Closed angle Angle controls outflow Open angle most common and non-acute Increase in intraoccular pressure (IOP)

Answer 9

Imbalance between inflow and outflow of aqueous humor>pressure increases>vision impaired>possible blindness if not treated

Answer 10

Initially none (early dz) Reduced peripheral vision (subtle at initially) Tunnel vision Blurred vision Halos around lights Eye or brow pain

Answer 11

Vision exam Tonometry - Tests IOP (intra-ocular pressure) Other advanced exams

Answer 12

Reduce IOP Surgery --> can tell when they have surgery - Argon laser trabeculoplasty (ALT) - Opens outflow channels

Answer 13

PO or eye gtts Lower IOP by increasing drainage of AH or reducing AH production Beta blocker gtt first line treatments Nursing considerations for eye drop instillation? Check their heart rate, still works on their beta cells just as the HR medications. MUST MONITOR HR (-lol drugs). Make sure they are holding their eyes open and that the dropper isn’t touching the eye. Report ANY eye problems that they are having.

Answer 14

Prevention Yearly eye exam for 65 and over Report any eye s/sx immediately African Americans at higher risk (yearly exams younger) Intervention Eye provider follow up Ongoing questions and vision testing Care surrounding medication mgmt

Answer 15

Oxidative damage to lens - Protein and fat deposits By age 80, more than half have a cataract Usually bilateral

Answer 16

Clouding of lens Absent red reflex or appear black Appearance of halos around objects * they are just seeing the outer parts of their eye, not the actual halo Blurred vision Yellow tint to vision Sensitivity to glare

Answer 17

Eye exam History

Answer 18

Surgical replacement of lens (plastic) -When vision 20/50 or worse -QOL or safety an issue -Outpatient -One eye at a time -Nursing care pre-op -- Prepare for changes in vision post-op -- Avoid heavy lifting, straining, and bending -- Eye drops -- Eye shield -- Need help at home until they get out of their peri-op/post-op phases.

Answer 19

Leading cause of vision loss in 60 and over Caucasians and Asians with highest risk Dry (non-exudative) -- 90% of cases Wet (exudative) -- More severe

Answer 20

UV light Cigarette smoking Light-colored eyes

Answer 21

Drusen deposits in retinal epithelium>atrophy and degeneration of macular cells>vision impairment

Answer 22

Blurred and dark vision Scotomas -- Blind spots Metamorphopsia Vision distortio

Answer 23

Drusen seen on opthalmoscopy Fundus photography IV angiography and fluorescein

Answer 24

Promotion After age 40 – dilated eye exam q2yr After age 65 - eye exam yearly Supplements/Diet Vit C & E, beta-carotene, Zinc Dark green leafy veggies Smoking cessation: quit smoking Manage HTN and DM Sunglasses: even if it is cloudy Hats Safety eye wear: whenever doing outdoor activities Interventions to utilize remaining vision -- Vision won’t return* once it is lost, it WILL NOT RETURN

Answer 25

Use contrasting colors Black and white Reds and oranges easiest to see Assistive devices Image magnification Text-to-speech scanners Tablets General Closer to objects Large type

Answer 26

reds and oranges

Answer 27

Hearing Impairment -- Worst to lose – as described by older people Most common communication disorder 3rd most common chronic condition in older Men more affected Under-diagnosed and under-treated QOL diminished

Answer 28

Decreased function Miscommunication Depression Falls Low self-esteem Cognitive decline

Answer 29

Damage to inner ear or neural pathways Presbycusis (age-related hearing loss) High frequency sounds lost first Difficulty filtering background noises (hospital) Can’t hear women and children …WHY? Most women and children speak in a low pitch frequency tone Treatment: hearing aids and cochlear implants

Answer 30

Most common hearing loss Progressive and often permanent Bilateral 1st Sign is difficulty hearing in noisy environment (restaurant) Intolerant to loud noises Difficulty in distinguishing between consonants -- Z, S, Sh, F, P, K, T, G -- Raised (louder) voices – make it worse

Answer 31

Vibrations can’t get to tympanic membrane or TM impaired

Answer 32

Infection, otosclerosis, perforated TM, fluid in middle ear Cerumen impaction most common cause -- Cerumen thicker with age -- Higher risk: African American, hearing aids, men with increased ear hair

Answer 33

Eliminate underlying cause

Answer 34

Abnormal sounds Constant or intermittent Worsens with age Ringing, humming, buzzing, roaring, hissing, etc. More common in men

Answer 35

Presbycusis Loud noises Head and neck trauma Tumors Cerumen impaction CV disease Ototoxic meds Med SEs ASA most common

Answer 36

Hearing aids -- Amplify sounds to drown tinnitus Electrostimulation, biofeedback, cochlear implants Hypnosis, acupuncture, chiropractic, medication tx

Answer 37

Identify when sounds are most irritating Keep log/diary: things that are going on, what they are eating/taking, etc. Reduce/eliminate: might need to be eliminated to help with the ringing in their ears -- ETOH, caffeine, cigarettes, stress, and fatigue Refer to American Tinnitus Association

Answer 38

10 times stronger than verbal or emotional contact Most neglected of the senses

Answer 39

Procedural vs. non-procedural touch Boundaries of touch is often cultural Don’t assume one wants to be touched A handshake (if appropriate) gives a lot of info -- Firm or soft, fast or hold on, warm or cold, sweaty or dry

Answer 40

Desire for touch more powerful in old age as other sensual experiences are diminished and direct sexual expression is not possible or available Cause of illness may be greatly influenced by quality of tactile support received Higher death rates more related to quality of human relationships than to degree of cleanliness, nutrition, physical disabilities on which we focus

Answer 41

Touch does not have to be performed by a person or other living thing For the old, may be gained from self-contained stimulation of rocking or slowly stroking an animal’s fur or wearing something that provides sensory stimulation Music and dancing seem to be two important mechanisms of enjoyment for older people

Answer 42

Encompasses more than just sexuality: Commitment Affective intimacy Cognitive intimacy Physical intimacy Love and affection Examples: Touch, holding, cuddling, being present

Answer 43

Specific type of intimate activity: Sexual acts Sexual desire Activity Attitudes Body image Gender-role activity Acceptance and Companionship

Answer 44

Cultural, biological, psychosocial, environmental factors influence sexual behavior of older adults Factors affecting attitudes on intimacy and sexuality include family dynamics and upbringing, cultural and religious beliefs

Answer 45

Sexuality in older person not about procreation Emphasis shifts companionship physical nearness intimate communication physical pleasure-seeking relationship

Answer 46

Older LGBTQIA people: Less likely to seek out health services Less likely to identify themselves as LGBT to health care providers Often have differing or augmented healthcare needs Older LGBT more likely to have kept their relationships hidden than younger people

Answer 47

National Gay and Lesbian Task Force Aging Initiative estimates that about 3 million Americans over the age of 65 are lesbian, gay, bisexual, and transgender, and likely to double by 2030 May face real or perceived discrimination in senior centers or long term care facilities

Answer 48

“Do you have a romantic partner?” not “Do you have a boyfriend/girlfriend or married?” “How do you identify with regard to your sexuality?” Don’t assume heterosexuality

Answer 49

Menopause Dyspareunia (painful intercourse) from vaginal dryness and thinning of the vaginal tissue

Answer 50

Erectile dysfunction Refractory period extended between episodes of intercourse

Answer 51

Impotence (erectile dysfunction, or ED) - most prevalent sexual problem in men Inability to achieve or sustain an erection sufficient for satisfactory sexual intercourse in at least 50% of attempts

Answer 52

interaction among hormonal, vascular, and nervous systems problem with any of these can cause ED

Answer 53

Endocrine problems CV problems Depression Neurological problems

Answer 54

Revolutionized treatment for ED ABSOLUTE – CONTRAINDICATION with nitrates/nitroglycerin – LIFE-THREATENING

Answer 55

Considered persistent impediment to person’s normal pattern of sexual interest, response, or both Influenced by culture, ethnicity, emotional state, age, previous sexual experiences, as well as changes in sexual response with normal aging

Answer 56

Physiologic changes - Menopause/hormonal changes - lower estrogen levels can make sexual activity less pleasurable Women can experience arousal and orgasmic disorders resulting from drugs Urinary incontinence may affect sexual activity Water soluble lubricants, low-dose estrogens introduced into the vagina may also help restore tissues and restore lubrication

Answer 57

Compromised immune system makes older adults more susceptible to HIV or AIDS than are younger persons Contrary to popular belief, HIV/AIDS in elderly population is not result of blood transfusions alone nor is it confined to gay population Older women at high risk for infection due to normal changes in vaginal tissue Decreased immune response also makes older adults more susceptible to infection Many symptoms mimic other disease conditions Virus may be in late stages by time of diagnosis Medicare in 2010 began covering HIV screening for high risk individuals -- All adults should have an HIV test at least once Educational materials need to be developed for older adults

Answer 58

Guide for discussion of sexuality in older adults: Permission Limited Information Specific Suggestions Intensive Therapy

Answer 59

Educator Facilitator Consultant Counselor Advocate: you are there to teach and help them; make sure they are responsible way Assessment of any medical conditions or medications associated with poor sexual health Counseling for older adult to adapt to natural physiological changes or body-image alterations from surgical procedures