Exam 3 - Lecture 1 (communication, vision & hearing impairments, intimacy & sexuality) Flashcards
what are the techniques (4) for therapeutic communication?
- allow more time
- face the client
- seek clarification
- paying attention to non-verbal communication
what are the effects of using elderspeak?
delivers the implicit message of incompetence, beginning a negative feedback loop
when is asking close-ended questions more appropriate?
to get specific answers
why do close-ended questions sometimes feel intimidating?
it makes the client feel put on the spot
when is asking open-ended questions more appropriate?
to allow for elaboration
why can open-ended questions be difficult to answer?
- some clients do not know exactly what is being asked
- will have the tendency to give the “right” answer
communication issues
what are the causes of issues with reception?
how does the client acquire the message?
- neurological disorders
- anxiety
- hearing deficits
- changes in cognition
communication issues
what are the causes of issues with perception?
how does the client interpret stimuli?
- neurological disorders
- dementia
- delirium
communication issues
what are the causes of issues with articulation?
how does the client express themselves?
- mechanical difficulties
- respiratory disease
- larynx disorders
- neurological disorders
what are the different types of communication disorders?
- anomia
- aphasia
- dysarthria
communication disorders
what is anomia?
difficulty finding the appropriate words
“word-searching”
communication disorders
what is aphasia?
- impairment in processing language
- inability to speak or understand
communication disorders
what causes aphasia?
CVA / TBI on the left side
communication disorders
what is dysarthria?
impaired ability to articulate speech due to weakened speech muscles
communication disorders
what are the different types of aphasia?
- fluent
- nonfluent
- verbal apraxia
- anomic
- global
apraxia is different from aphasia
verbal apraxia occurs with aphasia
true
characteristics of fluent aphasia
receptive aphasia
- inablity to understand speech
- impaired reading & writing skills
characteristics of nonfluent aphasia
expressive aphasia
- impaired speaking
- effortful speech
characteristics of verbal apraxia
- difficulty brain signaling to speech muscles (jaw, lip, tongue)
- usually occurs with aphasia
- client cannot properly pronounce words
apraxia is different from aphasia
what are other causes of dysarthria?
- head injury
- brain tumor
- PD
- MS
- CVA
what are the manifestations of dysarthria?
- slurred / mumbled speech
- varied speaking rate
- being unable to move tongue, lips, and jaw very well
- sounds robotic or choppy (cannot pronounce consonants)
what are the parameters for visual impairment?
20/40 to 20/200
low vision to legal blindness
what are the leading causes of vision impairment?
- age-related macular degeneration
- cataract
- glaucoma
- diabetic neuropathy
- optic nerve atrophy
what is good communication the basis for?
- accurate assessment
- care planning
- therapeutic relationships
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
how can you assist a blind person?
- do not push nor pull them
- let them take your arm while walking
- give directions with details
what are the screening recommendations for visually impaired clients?
dilated eye exams & screening for vision loss annually
what are the implications of visual impairment?
- negative effects on ADLs
- increased risk for falls
- increased risk of cognitive decline
what is presbyopia?
age related vision changes that start in the 40s
manifestations of presbyopia
- difficulty focusing on near objects (due to loss of lens elasticity)
- use of readers & bi-focals
what is the leading cause of blindness?
glaucoma
what is the etiology of glaucoma?
an increase of intraoccular pressure caused by imbalanced flow of aqueous humor
what is a major complication of glaucoma?
blindness
manifestations of glaucoma
- reduced peripheral vision
- tunnel vision
- blurred vision
- halos around lights
- eye / brow pain
early diagnosis of glaucoma involves no s/s
true
closed-angle glaucoma
the angle of the iris obstructs drainage of the aqueous humor
acute & emergent
open-angle glaucoma
increased pressure on the eye presses on the optic nerve
non-acute & most common
which diagnostic tests are performed to assess for glaucoma?
- vision exam
- Tonometry (tests IOP)
what are the treatments for glaucoma?
- reduce IOP
- surgery
what type of surgery is indicated for glaucoma?
Argon laser trabeculoplasty
opens outflow channels to relieve pressure
what are the medications for glaucoma?
- ß blocker (first line gtt)
- oral medications
to increased drainage of AH or reduce AH production
proper administration of eye drops
- assist patient to high fowler’s position (head tilted back)
- expose conjunctival sac by pulling down on the lower lid
- administer medication
- gently press lacrimal ducts
which population is at higher risk for glaucoma?
African-Americans
younger African-Americans need yearly exams
preventions for glaucoma
- 65 years & older need annual eye exams
- immediately reports s/s
how do cataracts occur?
protein & fat deposits accumulate in the lens causing oxidative damage
cataracts occur bilaterally (usually)
true
manifestations of cataract
- clouding of lens
- absent red reflex
- appearance of halos around objects
- yellow vision
- sensitivity to glare
- blurred vision
how is cataract treated?
surgical replacement of lens (made from plastic)
when is surgical replacement of lens indicated?
vision is 20/50 or worse
needs to be done 1 eye at a time
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
what is the leading cause of vision loss for older adults ≥ 60 years old
macular degeneration
what are the types macular degeneration?
- dry (non-exudative; more common)
- wet (exudative; more severe)
what are the risk factors for macular degeneration?
- UV light
- cigarette smoking
- light-colored eyes
which groups of people have a higher risk for macular degeneration?
- Asians
- Caucasians
what is the etiology of macular degeneration?
drusen (lipids & proteins) deposits in retinal epithelium cause degeneration of macular cells
what are the manifestations of macular degeneration?
- blurred / dark vision
- scotomas (blind spots)
- metamorphopsia (vision distortion)
how is macular degeneration diagnosed?
- Drusen deposits seen on opthalmoscopy
- fundus photography
- IV angiography & fluorescein
what are some interventions to enhance vision?
- use contrasting colors (red & orange)
- image magnification
- text-to-speech scanners
- tablets
- bring objects closer
- large type
hearing impairment mostly affects men
true
what are the types of hearing impairment?
- sensorineural
- conductive
what is sensorineural related hearing loss?
damage to inner ear or neural pathways of hearing
presbycusis is a true sensorineural hearing loss
true
characteristics of presbycusis
- bilateral
- progressive & permanent
- intolerant to loud noises
- difficulty in distinguishing between consonants
- difficulty filtering background noises
what are the treatments for presbycusis?
- hearing aids
- cochlear implants
how do cochlear implants improve hearing?
by directly stimulating the auditory nerve
what is conductive hearing loss?
vibrations cannot get to T/M or it is impaired
what are the causes of conductive hearing loss?
- infections
- otosclerosis
- perforated TM
- fluid in middle ear
- cerumen impaction (most common)
cerumen gets thicker with age
true
which group of people have a higher risk for conductive hearing loss?
- African Americans
- those who use hearing aids
- men with more ear hair
how is cerumen impaction diagnosed?
accumulation of cerumen prevents proper assessment of ear using otoscope
what are the factors that modify cerumen management?
- anticoagulant therapy
- immunocompromise
- diabetes
- radiation therapy of head & neck
- ear canal stenosis
- nonintact tympanic membrane
what are the treatments for cerumen impaction?
- cerumenolytic agents
- irrigation
- manual removal w/ instruments
what is tinnitus?
constant & intermittent abnormal sounds (ringing, humming, buzzing, roaring)
what are the risk factors for tinnitus?
- presbycusis
- loud noises
- head & neck trauma
- tumors
- cerumen impaction
- CV disease
- ototoxic medications (Aspirin)
how do hearing aids help with tinnitus?
drowns the abnormal sounds by amplification
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
what is anomic aphasia?
severe word-finding difficulties
what is global aphasia?
the inablity to understand or express language, resulting to saying meaningless things
why do men with presbycusis not hear women & children well?
low-pitched & low-tone voices
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
touch is the most fundamental means of contact
also 10x more impactful than verbal / emotional contact
true
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)
name the 4 touch zones
- social
- consent
- vulnerable
- intimate
what is included in the social zone?
- heads
- arms
- shoulders
- back
what is included in the consent zone?
- mouth
- wrists
- feet
what is included in the vulnerable zone?
- face
- neck
- front of body
what is in the intimate zone?
genitalia
touching a patient is a form of tactile support and a way to show care
true
how does an older adult adapt to touch deprivation?
- rocking
- stroking an animal’s fur
- sensory stimulation by clothing
- music
- dancing
how does touch deprivation develop?
- other sensual experiences are diminished
- sexual expression has been inhibited or limited
what are forms of intimacy?
- holding
- touching
- being present
- commitment
sexuality is redefined in older adulthood from procreation to
- companionship
- physical proximity
- intimate communication
- physical pleasure
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?”
sexual changes in women
dyspareunia (painful intercourse) from dryness & thinning
sexual changes in men
erectile dysfunction
how can you treat ED?
Phosphodiesterase (PDE) inhibitors
medications end in -fil (Viagra, Levitra, Cialis)
why do Nitrates / Nitroglycerin contraindicate with PDE inhibitors?
sudden decrease in BP
due to vasodilation of both types of meds
urinary incontinence in women can affect sexual activity
true
what can help with vaginal lubrication?
- low-dose estrogen
- water-soluble lubricants
why are older adults more likely to contract HIV?
compromised immune system
Medicare covers HIV screening for high-risk individuals
true
why are older women at higher risk for infection?
normal changes in vaginal tissue (dryness & thinning)
PLISSIT Model
sexuality
- Permission
- Limited Information
- Specific Suggestions
- Intensive Therapy
what is the appropriate diet for enhancing vision?
- vitamin C
- vitamin E
- Beta-Carotene
- Zinc
- dark green leafy vegetables (collard, mustard, spinach, kale)
how far away do you need to be from the snellen eye chart?
20 feet
what is the most important capacity in humans?
the ability to communicate
