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NURS 401 > Week 9: Vision and Hearing > Flashcards

Week 9: Vision and Hearing Flashcards

1
Q

What does vision change with age?

A
  • Changes in eye structure begin early, are progressive and affect both function and structure.
  • Presbyopia (decreased near vision) is a common change of aging.
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2
Q

What are extraocular changes with age?

A
  • Eyelids lose elasticity contributing to drooping.
  • Entropin
  • Ectropion
  • Xerophthalmia
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3
Q

Entropin

A

Inward turning of the lower lid

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4
Q

Ectropion

A

Outward turning of the lower lid

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5
Q

Xeropthalmia

A

Excessively dry eyes

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6
Q

What changes occur to the cornea with aging?

A

Cornea becomes flatter, less smooth, thicker and loses luster.

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7
Q

What are ocular changes that occur with aging?

A
  • Increased astigmatism
  • Chambers that control movement of aqueous fluid decrease in size and volume capacity, leading to development of glaucoma.
  • Glare is a major problem.
  • Decrease ability of the lens to accommodate.
  • Development of cataracts from ultraviolet exposure.
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8
Q

What are intraocular changes that occur with age?

A
  • Deterioration of vitreous humor may lead to development of “floaters” (lines, webs, spots, dots)
  • Retinal changes affect color, with red, orange, and yellow seen more easily
  • Color clarity diminishes by 59% in the eighth decade, secondary to yellowing of the lens
  • Drusen spots may appear on the macula
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9
Q

What are changes in vision that occur with age?

A
  • Vision loss is NOT an inevitable part of aging, but age-related changes contribute to decreased vision
  • Even older persons with good visual acuity need accommodations to enhance vision and safety.
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10
Q

Visual impairment in older adults are associated with

A
  • Cognitive and functional decline
  • Decreased quality of life
  • Depression
  • Increased risk for injury and falls
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11
Q

How can visual impairment be prevented?

A
  • Have yearly dilated eye examination

- Get routine eye examinations

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12
Q

Types of Glaucoma

A
  • Primary Open Angle Glaucoma

- Acute Angle Closure Glaucoma

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13
Q

Primary Open Angle Glaucoma

A
  • Progressive, asymptomatic with visual field loss.
  • Increased intraocular pressure damages optic nerve.
  • Vision loss can be prevented if detected early.
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14
Q

Those with primary open angle glaucoma may complain of what?

A
  • Headache
  • Poor vision in dim lighting
  • Tired eyes
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15
Q

Acute Angle Closure Glaucoma

A
  • Emergency
  • Angle of iris obstruct flow of aqueous humor.
  • May be related to infection or trauma.
  • Intraocular pressure rises rapidly.
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16
Q

What are signs and symptoms of acute angle closure glaucoma?

A
  • Eye is red and painful
  • Severe H/A
  • N/V
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17
Q

What should be avoided in patients with acute angle closure glaucoma?

A

Anticholinergics

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18
Q

Screening of Glaucoma

A

-Adults over the age of 65 or those at risk should have an annual eye examination with dilation.

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19
Q

What is the treatment for glaucoma?

A
  • Oral or topical eyedrops to decrease intraorific pressure (beta blockers are first line therapy)
  • Trabeculoplasty
  • Filtration surgery
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20
Q

Cataracts

A
  • Opacity of the lens causing the lens to lose transparency and scatter light.
  • Often caused by oxidative damage.
21
Q

What is a cardinal sign for cataracts?

A

Appearance of halos around objects as light is diffused.

22
Q

How is cataracts treated?

A

Requires surgery under local anesthesia.

95% return to excellent vision.

23
Q

What should you teach patients about cataracts?

A
  • Education regarding vision and adaptation to light changes.
  • Post-surgery: avoid heavy lifting, straining and bending at the waist.
24
Q

What is diabetic retinopathy?

A

…

25
Q

Diabetic retinopathy incidence

A
  • Most diabetic patients will develop retinopathy within 20 years of diagnosis
  • Leading cause of new blindness between ages 20-74
26
Q

What are the four stages of diabetic retinopathy?

A
  1. Mild nonproliferative retinopathy
  2. Moderate nonproliferative retinopathy
  3. Severe nonproliferative retinopathy
  4. Proliferative retinopathy
27
Q

Screening for retinopathy

A
  • Early detection is essential

- Annual fundoscopic dilated eye examination

28
Q

Retinopathy Screening: Fundoscopic evaluation includes

A
  • Flame shape hemorrhages
  • Cotton wool spots
  • Hard exudates
  • Dilated capillaries
  • Microaneurysms
29
Q

What is the treatment for retinopathy?

A

-Maintain strict control of blood sugar, cholesterol and blood pressure.

30
Q

Age-Related Macular Degeneration

A

-Progressive loss of central vision.

31
Q

What causes age-related macular degeneration?

A
  • Systemic changes in circulation
  • Accumulation of cellular waste
  • Tissue atrophy
  • Growth of abnormal vessels in choroid layer beneath the retina
  • Fibrous scarring affects nourishment of photoreceptor cells.
32
Q

Age-related macular degeneration screening

A
  • Early diagnosis is key

- Amsler grid to determine clarity of vision helps identify central vision problems

33
Q

What is the treatment for age-related macular degeneration?

A
  • Photodynamic therapy
  • Laser photocoagulation
  • Anti-vascular endothelial growth factor therapy
34
Q

Detached retina

A
  • Emergency medical treatment (surgery) required to save vision
  • Actual areas of the retina are torn that lead to retinal detachment.
  • May have gradual increase in floaters and/or light flashes in the eye.
35
Q

Dry eye (keratoconjunctivitis sicca)

A
  • A common complaint rather than a disease.

- D/t decreased tear production with age.

36
Q

Dry eye can be related to

A
  • Medications

- Sjogren’s syndrome

37
Q

Treatment for Dry Eyes

A
  • Artificial tears

- Consider Vitamin A deficiency

38
Q

What are signs and behaviors that may indicated vision problems?

A
  • Pain in eyes
  • Difficulty seeing in the dark
  • Double vision/distorted vision
  • Migraine headaches with blurred vision
  • Flashes of light
  • Halos surrounding lights
  • Difficulty driving at night
  • Falls or injuries
39
Q

Special considerations in long-term care in relation to vision

A
  • Cognitive impairment interfere with ability to communicate visual disturbances.
  • If a person has glasses, he or she should wear them.
  • Routine eye care is a gap in care that can lead to functional decline, decreased quality of life and depression.
  • 1/3 of vision problems in LTC settings are reversible.
40
Q

Consequences of Hearing Impairment include

A
  • Diminishes quality of life
  • Decline in function
  • Increased hospitalizations
  • Miscommunication
  • Depression
  • Falls
  • Loss of self-esteem
  • Safety risks
  • Cognitive decline
  • Increases feelings of isolation
  • May be diagnosed with dementia inappropriately
41
Q

Types of Hearing Loss: Sensorineural

A

-Damage to inner ear or neural pathways

42
Q

Types of sensorineural hearing loss

A
  • Presbycusis

- Noise induced

43
Q

Presbycusis Hearing Loss

A
  • Most common form of hearing loss that worsens with age.

- First sign is difficulty hearing in noisy environments, affects high frequency.

44
Q

Noise Induced Hearing Loss

A
  • Second most common cause of hearing loss
  • Mechanical injury to the sensory hair cells of the cochlea, continuous noise exposure.
  • Expected to rise
  • Consider better ear protection devices.
45
Q

Types of Hearing Loss: Conductive

A

-Abnormalities of external and middle ear that reduce transmission of sound.

46
Q

What are causes of conductive hearing loss?

A
  • Otosclerosis
  • Infection
  • Perforated eardrum
  • Fluid in middle ear
  • Tumor
  • Cerumen accumulation
47
Q

Cochlear implants

A
  • Increased use for sensorineural hearing loss where hearing aids aren’t effective.
  • Bypasses damaged portions of the ear and directly stimulates auditory nerve.
48
Q

For those with cochlear implants, what should be avoided?

A

MRI’s

49
Q

Promoting Healthy Aging: Hearing

A
  • Screening for hearing impairment is essential primary care for older adults
  • Assessment includes focused history and physical examination and screening assessment
  • Self-assessment instruments may be helpful (Box 12-5)
  • May require referral to an audiologist
  • Removal of cerumen impaction (Box 12-3)
  • Follow best practices for communicating with older adults

NURS 401 (26 decks)

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