Unit 3 Flashcards
The leading causes of visual
impairment are diseases that are common in older adults:
age-related macular degeneration
(AMD), cataract, glaucoma, and diabetic retinopathy
●Period of inability to keep symptoms under control or reactivation of illness;
difficulty in carrying out everyday life activities
Unstable Phase
ACUTE ILLNESS Characteristics
● Usually self-limiting
● Responds readily to treatment
● Complications are infrequent
● After illness person returns to previous
level of functioning
compounds found in
yellow or dark leafy vegetables, as well as intake of vitamin E
from food and supplements, appears to lower the risk of cataracts
in women.
lutein and zeaxanthin
●Characterized by an exacerbation of illness symptoms, development of complications,
or reactivation of an illness in remission
Unstable Phase
s a disease of the retinal microvasculature characterized by increased
vessel permeability. Blood and lipid leakage leads to macular edema and
hard exudates (composed of lipids). In advanced disease, new fragile
blood vessels form that hemorrhage easily. Because of the vascular and
cellular changes accompanying diabetes, there is often rapid worsening of
other pathologic vision conditions as well.
Diabetic Retinopathy
Pharmacological mgt of delirium
antipsychotic drugs
Benzodiazepines
defines Disability as a multifaceted, complex experience that is
integrated into the lives of people with disabilities. The degree of the integration is influenced by
three disability-related factors:
(1) the effects of the disabling condition,
(2) others’ perceptions of disability, and
(3) the need for and use of resources by the person with a disability
Lutz and Bowers (2005)
Gradual recovery after an acute period and learning to live with or to overcome
disabilities and return to an acceptable way of life within the limitations imposed by the chronic condition or disability; involves physical healing,
limitations stretching through rehabilitative procedures, psychosocial coming-to-terms,
and biographical reengagement with adjustments in everyday life activities
Comeback Phase
recommended beginning 5 years
after diagnosis of diabetes type 1 and at the time of diagnosis of diabetes type 2.
Annual dilated funduscopic examination of the eye
Treatment Goals for dementia
- Slow the progressive deterioration
- Maintain current capabilities
- Delay nursing home placement or total dependence
diabeteic retinopathy Management:
- Constant, strict control of blood glucose, cholesterol, and blood pressure and laser
photocoagulation treatments can halt progression of the disease. - Laser treatmen
- Annual dilated funduscopic examination of the eye
When lens opacity reduces visual acuity to 20/30 or less in the central axis of
vision, it is considered a
cataract.
Focus of Nursing Care: Provide direct care, collaborate with other health care
team members to stabilize patient’s condition
Crisis Phase
●Illness course and symptoms are under control as symptoms, resulting disability and
everyday life activities are being managed within limitations of illness; illness
management centered in the home
Stable Phase
Psychomotor activity of delirum dementia
Increased, decreased, or mixed
Sometimes increased, other
times decreased
Normal, may have apraxia or
agnosia
chronic confusion also called
dementia
refers to actions aimed at early detection of disease that can
lead to interventions to prevent disease progression
Secondary prevention-
acute confusion also
called
delirium
refers to those measures such as proper diet, exercise and
immunization that prevent the occurrence of a specific disease.
Primary Prevention
Disease that have a rapid onset and short duration
Examples: colds, influenza, gastroenteririts
ACUTE ILLNESS
Types of Hearing Loss
conductive and sensorineural.
The Americans With Disabilities Act of 1990 (ADA) defines a person with a disability as
one who:
(1) has a physical or mental impairment that substantially limits one or more major life
activities,
(2) has a record of such an impairment, or
(3) is regarded as having such an impairment.
Characteristics of Chronic Conditions
- Managing chronic illness involves more than treating medical problems.
- Chronic conditions usually involve many different phases over the course of a person’s
lifetime. - Keeping chronic conditions under control requires persistent adherence to therapeutic
regimens. - One chronic disease can lead to the development of other chronic conditions.
- Chronic illness affects the entire family.
- The day-to-day management of illness is largely the responsibility of people with
chronic disorders and their families. - The management of chronic conditions is expensive.
- Chronic conditions raise difficult ethical issues for patients, families, health care
professionals, and society. - Living with chronic illness means living with uncertainty.
Seven Tasks of Persons with Chronic Illness
- Preventing and Managing a Crisis
- Carrying out prescribed treatment regimen
- Controlling symptoms
- Reordering time
- Adjusting to changes in course of disease
- Preventing social isolation
- Attempting to normalize interactions with others
50 -80% of all dementias
!Memory problem is the earliest sign
!Other cognitive functions are affected as the disease progresses
!Brain scans may be normal or show atrophy
!Diagnosis is made in the absence of any other disease that may explain the
dementia
Alzheimer’s disease
confusion that has often has an abrupt onset, over hours or days
and is associated with an identifiable risk factor or cause.
Acute confusion
Pharmacologic mgt of dementia
- Acetylcholinesterase Inhibitors
a. Tacrine (Cognex)
b. Donepezil (Aricept)
c. Rivastigmine (Exelon)
d. Galantamine (Reminyl) - NMDA receptor antagonist
a. Memantine (Abixa)
Focus of Nursing Care:Provide guidance and support; reinforce previous teaching
Unstable Phase
Applying the Nursing Process Using the Phases of the Chronic Illness System
Step 1: Identifying Specific Problems and the Trajectory Phase
Step 2: Establishing and Prioritizing Goals
Step 3: Defining the Plan of Action to Achieve Desired Outcomes
Step 4: Implementing the Plan and Interventions
Step 5: Following Up and Evaluating Outcomes
occur in the elderly population and are thought to be due to the aging process. Examples of
age-related disabilities include osteoarthritis, osteoporosis, and hearing loss.
Age-related Disabilities
Focus of Nursing Care: Provide direct care and emotional support to the patient
and family
Acute Phase
y involves abnormalities of the external and middle ear that reduce the
ability of sound to be transmitted to the middle ear. Otosclerosis, infection,
perforated eardrum, fluid in the middle ear, or cerumen accumulations cause
conductive hearing loss.
Conductive hearing loss
Types of Disability
Sensory Disabilities
Disabilities that affect the ability to speak or communicate
Diseases that are prolonged, do not resolve
spontaneously and are rarely cured completely
CHRONIC ILLNESS
reduces the risk of advanced
AMD and associated vision loss
high-dose formulation of antioxidants and zinc
is a term that describes a range of disturbances in cognitive functioning,
including disturbances in memory, orientation, attention, and concentration.
Other disturbances of cognition may affect intelligence, judgment, learning
ability, perception, problem solving, psychomotor ability, reaction time, and
social intactness.
Cognitive impairment
Glaucoma Treatment:
Beta blockers
laser surgery treatments (trabeculoplasty)
may be recommended for some types of
glaucoma.
o Surgery is usually recommended only if necessary to
prevent further damage to the optic nerve.
laser surgery treatments (trabeculoplasty)
given many labels: acute confusional state, acute brain syndrome,
confusion, reversible dementia, metabolic encephalopathy, and toxic psychosis.
Delirium
Focus of Nursing Care:
i. Provide home care and other community-based care to help patient and family
adjust to changes and come to terms with these changes
ii. Assist patient and family to integrate new treatment and management
strategies
iii. Encourage identification of end-of-life preferences and planning
Downward Phase
Final days or weeks before death; characterized by gradual or rapid shutting down
of body processes, biographical disengagement and closure, and relinquishment of
everyday life interests and activities
Dying Phase
Speech of delirum dementia
Often incoherent, slow
or rapid, may call out
repeatedly or repeat
the same phrase
Difficulty finding word,
perseveration
Attention of delirum dementia
Disordered, fluctuates
Generally normal but may have
trouble focusing
The Corbin & Strauss Chronic Illness Trajectory Model
- Pre-trajectory Phase
- Trajectory onset
3.Stable Phase - Unstable Phase
- Acute Phase
- Crisis Phase
- Comeback Phase
- Downward Phase
- Dying Phase
ffect the ability to learn, remember, or concentrate;
Learning disabilities
are a prevalent disorder among older adults caused by oxidative damage to lens
protein and fatty deposits (lipofuscin) in the ocular lens.
▪
Cataracts are categorized according to their location within the lens and are
usually
Cataract
It is an acquired, persistent impairment of intellectual function with compromise in multiple
spheres of mental activity
- Sufficiently severe to cause social or occupational disability
Dementia
to treat agitation and hallucinations and to improve sensory problems).
- These include: Haloperidol (Haldol®), Risperidone (Risperdal®), Olanzapine
(Zyprexa®), and Quetiapine (Seroquel®).
antipsychotic drugs
Appearance or onset of noticeable symptoms associated with a chronic disorder;
includes period of diagnostic workup and announcement of diagnosis; may be
accompanied by uncertainty as patient awaits a diagnosis and begins to discover and
cope with implications of diagnosis
Trajectory onset
Vascular dementia Must be confirmed by
brain scan
●Illness course characterized by rapid or gradual worsening of a condition; physical
decline accompanied by increasing disability or difficulty in controlling symptoms; requires biographical adjustment and alterations in everyday life activities with each
major downward step
Downward Phase
a complication of diabetes and a leading cause of
blindness.
Diabetic eye disease/ Diabetic Retinopathy
Onset of delirum dementia
Sudden, abrupt
Insidious, slow, over years and
often unrecognized until
deficits are obvious
● Genetic factors or lifestyle behaviors that place a person or community at risk for a
chronic condition
Pre-trajectory Phase
Criteria for Dementia
- Cognitive loss in 2 or more domains
a. Memory
b. Language
c. Calculation
d. Orientation
e. Judgment
f. Executive functions - Sufficiently severe to cause social or occupational disability
5-10% of all dementias
! Starts with personality changes: depression, disinhibition, poor judgment
! Memory decline later
Frontotemporal dementia
●Severe and unrelieved symptoms or the development of illness complications
necessitating hospitalization, bed rest, or interruption of the person’s usual activities
to bring illness course under control
Acute Phase
is an irreversible state that progresses over years and causes memory impairment and loss of
other intellectual abilities severe enough to cause interference with daily life.
Dementia
a state of disturbed
consciousness, with disruption of thought and decision-making capacity
confusion
●May require more diagnostic testing and trial of new treatment regimens or
adjustment of current regimen, with care usually taking place at home
Unstable Phase
Lutz and Bowers (2005) The degree of the integration is influenced by
three disability-related factors:
(1) the effects of the disabling condition,
(2) others’ perceptions of disability, and
(3) the need for and use of resources by the person with a disability.
have difficulty filtering out background noise and often complain of
difficulty understanding women’s and children’s speech and conversations in
large groups.
Presbycusis
affect hearing or vision
Sensory Disabilities
used to determine clarity of central vision
Amsler grid
, is a long-term, progressive, and possibly degenerative process confusion
and occurs over months or years. Both categories can befall in any age group, gender, or clinical
problem.
Chronic confusion
diagnostic of beginning macular degeneration, and vision
loss can occur in days.
A perception of wavy lines
CHRONIC ILLNESS Characteristics
● Permanent impairments or deviations from
normal
● Non-reversible pathologic changes
● Residual disability
● Special rehabilitation required
● Need for long-term medical and/or nursing
management
defines a person with a disability as
one who:
(1) has a physical or mental impairment that substantially limits one or more major life
activities,
(2) has a record of such an impairment, or
(3) is regarded as having such an impairment.
Americans With Disabilities Act of 1990 (ADA)
result of complex interactionsamong multiple causes.
▪
results from theinteraction of predisposing factors (e.g., vulnerability onthe part of
the individual due to predisposing conditions,such as cognitive impairment,
severe illness, and sensoryimpairment) and precipitating factors/insults (e.g.,
medications,procedures, restraints, iatrogenic events).
Delirium
a degenerative eye disease that affects the macula, the central part of the eye responsible for
clear central vision. The disease causes the progressive loss of central vision, leaving only
peripheral vision intact
Macular Degeneration
s the earliest sign of alzheimers disease
Memory problem
cataract Signs and Symptoms:
- clouding of the ordinarily clear ocular lens
- the red reflex may be absent or may appear as a black area.
- The cardinal sign of cataracts is the appearance of halos around
objects as light is diffused - Blurring of vision
- Decreased perception of light and color (giving a yellow tint to
most things) - sensitivity to glare.
Critical or life-threatening situation requiring emergency treatment or care and
suspension of everyday life activities until the crisis has passed
Crisis Phase
Focus of Nursing Care: Refer for genetic testing and counseling if indicated;
provide education about prevention of modifiable risk factors and behaviors
Pre-trajectory Phase
Warning signs of dementia
- Memory loss
- Difficulty performing familiar tasks
- Problems with language
- Disorientation with time and place
- Poor or decrease judgment
- Problems with abstract thinking (balancing a checkbook/understanding new
concepts) - Misplacing things
- Changes in mood or behavior
(Useful in Assisting with Understanding of Communication)
* Identify time confusion (in what time frame is the person operating at the moment? ).
* Find the theme (what connection is there between apparently disparate topics? ). Recognize an
important theme, such as fear, loss, or happiness.
* Recognize the hidden meanings (what did the person mean to say? ).
Comprehension Strategies
most common causes of cataracts are
heredity and advancing age
Alertness of delirum dementia
Increased, decreased, or
variable
Generally normal
e third most prevalent chronic condition in older Americans and the foremost
communicative disorder of older adults.
Hearing loss
an umbrella term for impairments, activity limitations, participation restrictions,
and environmental factors.
Disability
CLINICAL SUBTYPES OF DELIRIUM
Hypoactive Hyperactive Mixed
When visual acuity decreases to 20/50 and the cataract
affects safety or quality of life, surgery is recommended.
o involves removal of the lens and placement of a plastic
intraocular lens (IOL).
o performed with local anesthesia on an outpatient basis, and
the procedure has greatly improved with advances in
surgical techniques.
Surgery
Management of Macular degeneration
Amsler grid
dilated eye examination
- high-dose formulation of antioxidants and zinc
defined as the perception of sound in one or both ears or in the head when no
external sound is present. It is often referred to as “ringing in the ears” but may also
manifest as buzzing, hissing, whistling, cricket chirping, bells, roaring, clicking, pulsating,
humming, or swishing sounds. The sounds may be constant or intermittent and are more
acute at night or in quiet surroundings.
Tinnitus
a medical condition or health problem with associated symptoms or disabilities that require
long-term management.
CHRONIC ILLNESS
15% of all dementia
! Dementia after stroke
! Must be confirmed by brain scan
! Clinical course is not the same as Alzheimer’s disease as long as there are no
further strokes
! May improve or remain the same
! Respond o medications for Alzheimer’s disease
Vascular dementia
among the 10 most common causes of disability in
the United States and are associated with shorter life expectancy and lower quality of life.
Blindness and visual impairment
(Useful in Encouraging Expression of Thoughts and Feelings)
* Establish commonalities.
* Share self.
* Allow the person to choose subjects to discuss.
* Speak as if to an equal.
* Use broad openings, such as “How are you today?”
* Employ appropriate use of humor.
* Follow the person’s lead.
Facilitation Strategies
Focus of Nursing Care:
i. Reinforce positive behaviors and offer ongoing monitoring
ii. Provide education about health promotion
iii. Encourage participation in health promoting activities and health screening
Stable Phase
related to disturbances in the neurotransmitters in the
brain that modulate the control of cognitive function, behavior, and mood.
Delirium
(Useful in Encouraging Continued Communication and Supporting
Personhood)
* Introduce yourself, and explain why you are there.
* Reach out to shake hands, and note the response to touch.
* If the person does not want to talk, go away and return later. Do not push or force.
Supportive Strategies
Focus of Nursing Care:
i. Assist in coordination of care
ii. Rehabilitative focus may require care from other health care providers
iii. Provide positive reinforcement for goals identified and accomplished
Comeback Phase
cataract Management:
Surgery
Confusion can be classified into two categories
delirium
dementia
- Quiet or pleasantly confused
- Reduced activity
- Lack of facial expression
- Passive demeanor
- Lethargy
- Inactivity
- Withdrawn and sluggish state
- Limited, slow, and wavering
vocalizations
Hypoactive
results from damage to any part of the inner ear or the neural pathways to
the brain.
Sensorineural hearing loss
Course over 24 hr of delirum dementia
Fluctuating, often worse
at night
Fairly stable, may see changes
with stress
Orientation of delirum dementia
Usually impaired, fluctuates
Often impaired, may make up
answers or answer close to the
right thing or may confabulate
but tries to answer
he leading cause of vision loss in Americans 60 years of age and older. The prevalence of
AMD increases drastically with age, with more than 15% of white women over 80 years of age
having the disease.
Macular Degeneration
Signs & Symptoms: Glaucoma
Headaches
Poor vision in dim lighting
increased sensitivity to glare
“tired eyes
impaired peripheral vision
a fixed and dilated pupil
frequent changes in prescriptions for corrective lenses.
a loss or abnormality in body structure or physiologic function, including
mental function.
Impairment
10-15% of all dementias
! Common in elderly patients with beginning Alzheimer’s disease with a sudden
stroke
Mixed Alzheimer’s disease and vascular dementia
Unpredictable
fluctuations
between
hypoactivity and
hyperactivity
Mixed
leading cause of
blindness and
visual impairment
in the United
States.
Glaucoma
Four Useful Strategies for Communicating with Individuals Experiencing Cognitive
Impairment
- Simplification Strategies
- Facilitation Strategies
- Comprehension Strategies
- Supportive Strategies
Duration of delirum dementia
Hours to weeks
Years
disease that has a prolonged course, does not resolve spontaneously, and for which a
complete cure is unlikely or rare.
CHRONIC ILLNESS
Medications lower eye pressure either by decreasing the amount of
aqueous fluid produced within the eye or by improving the flow through
the drainage angle.
Beta blockers
Affect of delirum dementia
Variable but may look
disturbed, frightened
Slowed response, may be labile
form of sensorineural hearing loss that is related to aging. It is the
most common form of hearing loss in the United States. Presbycusis is a bilateral
and symmetrical sensorineural hearing loss that also affects the ability to
understand speech.
Presbycusis
(Useful with ADLs)
* Give one-step directions.
* Speak slowly.
* Allow time for response.
* Reduce distractions.
* Interact with one person at a time.
* Give clues and cues as to what you want the person to do. Use gestures or pantomime to
demonstrate what it is you want the person to do—for example, put the chair in front of the
person, point to it, pat the seat, and say,
Simplification Strategies
Factors that Affect Adjustment to Chronic Illness
- Suddenness, extent, and duration of lifestyle changes necessitated by the illness
- Family and individual resources for dealing with stress
- Stages of individual/family life cycle
- Previous experience with illness and crises
- Underlying personality characteristics
- Unresolved anger or grief from the past
Diabetic Retinopathy Signs and Symptoms
s little to no evidence of retinopathy until 3 to 5 years or more after the onset of
diabetes.
- Early signs are seen in the funduscopic examination and include microaneurysms,
flame-shaped hemorrhages, cotton wool spots, hard exudates, and dilated capillaries
- Excessive alertness
- Easy distractibility
- Increased psychomotor activity
- Hallucinations, delusions
- Agitation and aggressive actions
- Fast or loud speech
- Wandering, nonpurposeful
repetitive movement - Verbal behaviors (yelling,
calling out) - Removing tubes
- Attempting to get out of bed
Hyperactive
Diagnostics for dementia
- Brain CT scan or MRI
- Serum electrolytes
- Hepatic, renal, thyroid function tests
- Vitamin B12 levels
- Serum VDRL/RPR (syphilis screening)
- EEG
Consciousness of delirum dementia
Reduced
Clear
Focus of Nursing Care:
i. Provide explanations of diagnostic tests and procedures
ii. Reinforce information and explanations given by primary health care
provider
iii. Provide emotional support to patient and family
Trajectory onset
first-line therapy for glaucoma
Beta blockers
Types of Dementia
- Alzheimer’s disease
- Vascular dementia
- Mixed Alzheimer’s disease and vascular dementia
- Frontotemporal dementia
