Week 2 - All 3 parts

Question 1

Falls

Answer 1

unintentionally coming to rest on a lower surface such as ground or floor

Question 2

Presbyopia

Answer 2

Structural changes in eye shape cause reduction in the eye’s accommodation.
Difficulty encountered with ascending or descending steps
or diminished ability to focus on close objects (arm’s length) such as newspaper

Instruction must be given to watch door edges & landing steps.

Question 3

Eye Glare

Answer 3

tendency of the lens to become cloudy & form cataract
Instruct the patient to wear wide-brimmed hats or sunglasses and to shade indoor windows.

Question 4

Presbycusis

Answer 4

atrophy of the ossicles in the inner ear which causes
changes in sound conduction including loss of high-tone frequency

Question 5

Age-related Changes Contributing to Falling
(Cardiovascular system)

Answer 5

Loss of tissue elasticity  which affects the arteries decrease tissue recoil, resulting in changes in blood pressure (postural hypotension).

Nursing Interventions
Educate patient to change position slowly and to dangle the legs a few minutes when arising from supine position.
Encourage older adults to wait between position changes and to hold onto the side of the bed.

Question 6

Osteoarthritis

Answer 6

occurs in weight bearing joints, causing pain, eroding joint stability and loss of supportive cartilage

Question 7

Nursing Interventions - Osteoarthritis

Answer 7

Identify the problem, encourage and assist in ambulation, and joint range of motion.
Encourage patients to use assistive device to aid mobility and avoid further joint damage.
Use of ice and hot packs.
Use of anti-inflammatory agent and
Pain killer as prescribed.

Question 8

Risk Factors for Falls
1.Intrinsic Factors

Answer 8

Normal age related changes
Disease &
Medication effects

Question 9

Risk Factors for Falls
2. Extrinsic Factors

Answer 9

Environmental hazards
& Restraint

Question 10

Restraint (cont’d)What to consider before deciding to restrain?

Answer 10

Physical examination – identify potential underlying causes of behavior

Assess environment – identify irritants that may escalate behavior

Identify patient specific problems – (forgetfulness) to determine

Question 11

Fall & Injury prevention Gerontologic nurse should

Answer 11

1. Identify the individuals who are at risk for serious injury,
   2.Educate them about the importance of
   Behavioral modification.
   Physical modification
   Environmental safety

Question 12

Principles for use of assistive devices

Answer 12

Every assistive device should be adjusted to individual height.

When using walker, step down with weak then strong leg,
Don’t climb stairs with walker.

Place your cane firmly in the ground before taking a step,
Do not place it too far ahead from you,
Put all of your weight on unaffected leg then move the cane and affected leg.
When using cane on the stairs, step up with the stronger leg and down with the weaker leg
Replace cane tips frequently and choose one with flat bottom.

Question 13

Prevention of Burn Injuries
Nurses must instruct older adults to:

Answer 13

Use thermometer and container with safety handle to check the hot water temperature.

Adjust the hot water tank accordingly , temp should not be above 120 F (480C).

When space heaters are used , an emergency shutoff must be operable & keep it at 3 m from flammable items.

The electrical cords must be intact and appropriate for the electrical outlet.

Have fire extinguisher available for use, and make sure smoke detectors are working

Question 14

Non-Burn Injuries in the Home:

Answer 14

Carbon Monoxide toxicity from use of heating oil or natural gas

Skin exposure or ingestion of household chemicals , herbicides, pesticides

Fan injuries when air conditioner is unavailable.

Use of knives in the kitchen

Food borne disease.

Question 15

Hyperthermia / Heat stroke

Answer 15

is a life threatening problem that must be treated immediately

Risk factors:
Thyrotoxicosis
CVA
Dehydration

Extensive use of occlusive clothing
Heat syncope & heat exhaustion

Malignant hyperthermia
Alcohol abuse
Delirium tremor
Salicylic acid intoxication

Question 16

Management of Hyperthermia

Answer 16

Fast and effective cooling is the corner stone of treatment for heat stroke.

Heat-related deaths and illness can be prevented by drinking plenty of fluids.

Placing a fan near the client

Decrease the room temperature

Placing ice packs on the groin & axilla together with cooling blankets

Antipyretics

Bed rest to reduce heat production

Nurses should identify older adults who are living without air conditioning to keep their homes cooled to a safe temperature zone.

Question 17

Hypothermia

Answer 17

Household temperature below 65o F (18.33o C) are associated with hypothermia in older adults.
Older adults fail to sense the cold when air temperature remains below optimum levels for even short periods.
Thermoregulatory impairment will lead to failure of the body to perform adequate constriction and shivering in response to cold.

Question 18

Risk Factor of Hypothermia

Answer 18

Accidental immersion in water
Exposure to cold temperature

Alcohol, substance abuse, Drugs
(Opioids, benzodiazipines, barbituarate…

Excessive heat loss and impaired production
Surgery & trauma
Nutritional deficiency
Sepsis
Stroke & Spinal cord injury
Anoxia &Uremia
Hypoglycemia & hypothyroidism
Adrenal insufficiency

Question 19

Clinical Manifestation
of hypothermia

Answer 19

Fatigue &Apathy (most important)
confusion & lethargy
Shivering &Numbness
Slurred speech
Impaired coordination
Coma

Question 20

A decline in an older adults ability to drive safely may be a result of

Answer 20

Presbyopia,
Decrease dark adaptation,
Decrease depth perception,
Susceptibility to glare,
General slowing reflexes.

Question 21

An example of an intrinsic factor for falls in the older adult is:
1. Having a cat as a pet
2. Weakened muscles in the lower extremity.
3. Glaring lights in the hallway
4. The use of cane

Answer 21

2

Question 22

Which nursing intervention best demonstrates the understanding that older adults are at increased risk for falls because of normal age-related changes?
1. Speaking in a loud voice when warning the client about safety hazards
2. Turning on lights so the client can see objects such as furniture in the immediate area.
3. Encouraging the client to use a walker while climbing the stairs
4. Advising the client to avoid exercising painful joints

Answer 22

2

Question 23

Ptosis

Answer 23

Eye lids lose tone

Question 24

True or false
Age-related Changes in the Structure and Function of vision -
Cornea : become yellow with a ring of fat deposit (arcus senilis)

Tears : are Diminished quality and quantity of production

Pupils : Decrease in the size and less ability to constrict

The conjunctiva thins and becomes yellow in appearance

Sclera : brown spot may develop

Answer 24

All are True

Question 25

Common Complaints of vision

Answer 25

1.Floaters:
Appears (seen by the person as dots, wiggly lines or clouds. Caused by the degeneration of the vitreous gel

2. Flashers:
   Illusion of flashing lights or streaks
   Occur when Vitreous fluid inside the eye rub on the retina or There is spasm in the blood vessels in the brain (e.g. like in migraine)
3. Dry Eyes:
   called keratoconjunctivitis: decrease tear production
   Cause:
   Age, Menopause
   Diseases: DM, Arthritis, Lupusالذئبه, thyroids, Vitamin A deficiency

Question 26

Ectropion and Entropion

Answer 26

Malposition of the lower lid
Caused by tissue laxity
lead to eye irritation (outward or inwards)
So cause tearing, redness, infection
RX ; A minor surgery can treat these conditions

Question 27

Blepharitis

Answer 27

Caused by seborrheic dermatitis or infection
Eyelid :
Red,
swollen,
with crusting along the eye lash with small ulceration

Question 28

Glaucoma

Answer 28

The second leading cause of blindness in USA
Can cause partial vision loss before it is detected
Results from:
blockage in the drainage of the aqueous humor in the anterior chamber of the eye.
If the fluid cannot flow out of the anterior chamber through the channel of schlemm >
it accumulates and pushes on the optic nerve >
where irreparable damage or total blindness can occur.

Question 29

Three types of glaucoma

Answer 29

Chronic open angle
Closed angle glaucoma
Secondary glaucoma

Question 30

Trabeculectomy

Answer 30

is a surgical procedure used in the treatment of glaucoma to relieve intraocular pressure by removing part of the eye’s trabecular meshwork and adjacent structures

Question 31

Trabeculoplasty

Answer 31

laser treatment for glaucoma

Question 32

Cataract

Answer 32

A common disorder found in the aging adult. It is clouding lens
A cataract located near the center of the lens produces more symptoms such as:
Dimmed blurred vision
The need for brighter light
Glare and light sensitivity
Loss of color perception
Recurrent eyeglass prescription changes

Question 33

Age-related Macular Degeneration (AMD)

Answer 33

Damage to the macula (the key focusing area of the retina) as a result of aging
Does not cause total blindness
Irreversible damage to the macula
Results in loss of close vision and decline in central vision

Question 34

Diabetic Retinopathy

Answer 34

Altered circulation to the eye may result in retinal edema, degeneration & detachment
Ballooning تضخم of the tiny vessels leads to hemorrhage, scarring or blindness
No early symptoms of retinal changes can be noted by the patient even if retinopathy is advanced

Question 35

Retinal detachment:

Answer 35

Occurs when the sensory layer of the retina separates from the pigmented layer
Causes: Aging, Trauma, hemorrhage, or tumor
lead to tears or holes in the retina
> fluid seepage تسرب between layers of retina
> detachment

Symptoms include :
Light flashes
Shower of floaters
Loss of vision
Veil or curtain obstructing vision

Post op. Meds :
antiemetic, مضاد للقىء
pain medication and cough medication as needed to avoid detachment of the retina after repair

Question 36

Which clinical indicators is the nurse most likely to identify when exploring the history of a client with open-angle glaucoma?
A. Constant cloudiness of vision
B. Abrupt attacks of acute pain
C. Gradual loss of vision.
D. Impairment of central vision

Answer 36

D

Question 37

What should the nurse do for a client aged 70 years who had just cataract surgery on his right eye?
A. Encourage the client to perform coughing and deep breathing exercises.

B. Advise the client to sleep on his right side

C. Instruct the client to sunglasses outdoors.

D. Inform the client to apply an Ova pad on his right eye at night.

Answer 37

C

Question 38

The nurse is performing an admission assessment for a client with a detached retina. Which of the following is associated with this disorder?
A. Light sensitivity

B. Pain in the affected eye

C. A yellow discoloration of the sclera

D. Shower of floaters.

Answer 38

D

Question 39

Describe age-related changes in hearing and balance

Answer 39

Auricle appears larger because of continued cartilage formation and loss of skin elasticity

The auditory canal narrows as a result of inward collapsing (due to aging)

Hair lining the canal becomes coarser خشونة and stiffer صلابة

Cerumen glands atrophy causing the cerumen to become drier شمع الاذن ناشف

The tympanic membrane appears retracted and gray.

Question 40

Pruritus

Answer 40

Itching within the external auditory canal
Due to age-atrophic-related changes
Itch scratch –itch cycle

Question 41

Cerumen Impaction انسداد بسبب شمع الاذن

Answer 41

Cause: Narrowed auditory canal, stiffer coarser hair, sebaceous glands atrophy
Leads to conductive hearing loss
Affect ability to hear and communicate well

Question 42

Tinnitus

Answer 42

Defined as ringing, buzzing, or hissing.
Its prevalence increases with advanced age.
Tinnitus is not a disease, but symptoms associated with many diseases.
Unilateral tinnitus is associated with serious diseases like Meniere’s, tumors, or vascular problems

Question 43

TRUE / FALSE
Hearing loss is not a part of the normal aging process and should be evaluated for further treatment

Answer 43

TRUE

Question 44

Hearing loss Is classified as

Answer 44

1. Conductive- can be due to otitis mediaالتهاب الأذن الوسطى, Cerumen impaction, and otosclerosisتصلب الأذن
2. Sensorineural-الحسية العصبية- is caused by malfunctioning of the auditory nerve, brainstem, or cortical auditory pathways
   resulting in improperly interpreted sound waves
3. Mixed

Question 45

Presbycusis

Answer 45

Sensorineural hearing loss
Most common form of hearing loss
Causes :
Noise-induced hearing loss,
Head injury,
Infection,
Vascular and heart disease,
Metabolic disorders – pancreas & kidneys
Genetic factors

Question 46

Dizziness and Disequilibrium

Answer 46

Are common complaints of older adults

Should not be considered part of normal aging and necessitate thorough investigation.

Dizziness or vertigo in the elderly can occur:
With a change in head position –
(Benign Paroxysmal positional vertigo )
With rotational head movement- Ampullary disequilibrium
When rising from bed- Macular disequilibrium
During ambulation- Vestibular ataxia
In Meniere’s disease

Question 47

Meniere’s disease

Answer 47

Caused by pressure within the labyrinth of the inner ear and swelling of the cochlea
Characterized by severe vertigo accompanied and usually preceded by tinnitus & progressive low-frequency sensory- neural hearing loss

Question 48

with aging Taste and Smell :

Answer 48

diminish with age
can lead to a decreased enjoyment of food
resulting in poor eating habits and decreased intake
Impairment of nutritional and immune status

A decreased sensitivity to odors puts the older adult at risk for noxious chemicals and poisoning (failure to detect the odor of smoke or leaking gas).

Question 49

Xerostomia جفاف الفم Risk factors

Answer 49

Disease status like Alzheimer’s and depression
Conditions like the radiation of head and neck, and mouth breathing.
Medications like antihistamines, antidepressants, diuretics, and chemotherapy.

Question 50

Dry mouth in the elderly can lead to :

Answer 50

Respiratory infection,
Impaired nutritional status, and
Reduced ability to communicate

Question 51

TRUE / FALSE
Subjective tinnitus is heard by the patient and examiner.

Answer 51

FALSE