Eyes, Ears and SKin.pdf

VISION: CHAPTER 11 Copyright © 2020 by Elsevier, Inc. All rights reserved. VISUAL IMPAIRMENT Blindness and visual impairment are major causes of disability in older adults Associated with cognitive and functional decline, decreased quality of life, and depression Associated with increased risk for i...

VISION: CHAPTER 11 Copyright © 2020 by Elsevier, Inc. All rights reserved. VISUAL IMPAIRMENT Blindness and visual impairment are major causes of disability in older adults Associated with cognitive and functional decline, decreased quality of life, and depression Associated with increased risk for injury and falls What are age some age related changes to the eye & vision for elderly? P.132-133 Copyright © 2020 by Elsevier, Inc. All rights reserved. 3 VISUAL IMPAIRMENT Leading causes of visual impairment: Age-related macular degeneration Cataract Glaucoma Diabetic retinopathy Detached Retina Copyright © 2020 by Elsevier, Inc. All rights reserved AGE-RELATED MACULAR DEGENERATION Copyright © 2020 by Elsevier, Inc. All rights reserved MACULAR DEGENERATION (SEE STAGES BOX11.4) Dry AMD Wet AMD 90% of cases Also called neovascular Rarely causes severe impairment Abnormal blood vessels grow under the macula, causing its displacement Can lead to wet Three stages Common early sign: Drusen bodies seen on fundoscopic Affects central vision Progression can be rapid with resultant blindness within 2 years COPYRIGHT © 2020 BY ELSEVIER, INC. ALL RIGHTS RESERVED. 6 CATARACT Copyright © 2020 by Elsevier, Inc. All rights reserve GLAUCOMA Copyright © 2020 by Elsevier, Inc. All rights reserved GLAUCOMA (SEE SAFETY ALERT P. 137) Primary Open Angle Acute Angle Closure Progressive, asymptomatic with visual field loss May complain of headache, poor vision in dim lighting, tired eyes Increased intraocular pressure damages optic nerve Vision loss can be prevented if detected early Emergency Angle of iris obstructs flow of aqueous humor May be related to infection or trauma Intraocular pressure rises rapidly Eye is red and painful, severe H/A, N/V Avoid anticholinergics Copyright © 2020 by Elsevier, Inc. All rights reserved 9 DIABETIC RETINOPATHY (SEE STAGES BOX 11.3) Copyright © 2020 by Elsevier, Inc. All rights reserved DISEASES AND DISORDERS OF THE EYE (CONT.) Detached Retina Emergency medical treatment 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 Repair requires surgery Early intervention improves vision results Copyright © 2020 by Elsevier, Inc. All rights reserved 11 DISEASES AND DISORDERS OF THE EYE (CONT.) Dry Eye (keratoconjunctivitis sicca) A common complaint rather than a disease Tear production diminishes with age More common in postmenopausal women Can be related to medications, Sjogren’s syndrome Use artificial tears, consider Vitamin A deficiency Copyright © 2020 by Elsevier, Inc. All rights reserved 12 PROMOTING HEALTHY AGING Signs and Behaviors That May Indicate Vision Problems Pain in eyes Flashes of light Difficulty seeing in the dark Halos surrounding lights Double vision/distorted vision Difficulty driving at night Migraine headaches with blurred vision Falls or injuries Copyright © 2020 by Elsevier, Inc. All rights reserved 13 PROMOTING HEALTHY AGING Interventions to enhance vision Warm incandescent lighting Glare control Sunglasses that block all ultraviolet light Use of sharp contrasting colors Use of low vision assistive devices Magnifiers even for Rx bottles Communicating with Visually Impaired Box11-5 Copyright © 2020 by Elsevier, Inc. All rights reserved CASE STUDY VISION Jeanine Jackson is a 91-year-old female who is healthy and independent, with no chronic conditions. Her only concern is her inability to read small print and complaints of dry eyes. She had a recent cataract surgery on one eye and anticipates another procedure on the other eye within a few weeks. Mrs. Jackson recently obtained her drivers’ license and continues to drive herself to church, appointments, and lunches with her friends. She has one son who lives with her, and he does not feel concerned about seeing his mother get behind the wheel of the car. Copyright © 2020 by Elsevier, Inc. All rights reserved CASE STUDY QUESTIONS: VISION 1. Discuss the causes and treatment of dry eyes in the older adult. 2. Discuss the driving requirements of the older adult. Review the safe driving guidelines on the AAA website as well as that of the National Highway Traffic Safety Administration. Also check your state Department of Motor Vehicles website for specific information. 3. List and review other resources available for individuals with impaired vision. Copyright © 2020 by Elsevier, Inc. All rights reserved VISION QUESTION 1 One of the most common visual changes associated with aging is: a.macular degeneration. b.presbyopia. c. glaucoma. d.cataract. COPYRIGHT © 2020 BY ELSEVIER, INC. ALL RIGHTS RESERVED. 17 QUESTION 2 Which of the following is considered an eye emergency? a. Cataract b. Acute angle closure glaucoma c. Age-related macular degeneration (wet) d. DME Copyright © 2020 by Elsevier, Inc. All rights reserved 18 HEARING: CHAPTER 12 Copyright © 2020 by Elsevier, Inc. All rights reserved HEARING IMPAIRMENT Most common communicative disorder of older adults Third most prevalent chronic condition in older Americans Underdiagnosed and undertreated in older adults Screening for hearing impairment is an important aspect of physical assessment in older adults Changes in Hearing related to aging Table 12.1 Promoting Healthy Hearing Box 12.1 & Healthy People 2020 Do I have a hearing problem? Box 12.3 http://www.betterhearing.org/hearing_loss/ online_hearing_test/index.cfm Copyright © 2020 by Elsevier, Inc. All rights reserved CONSEQUENECES OF HEARING IMPAIRMENT Diminishes quality of life Decline in function Increased hospitalizations Miscommunication Depression Falls Loss of self-esteem Safety risks Cognitive decline Increases feelings of isolation (suspicious, distrustful, paranoia) Inappropriate diagnosis of dementia Copyright © 2020 by Elsevier, Inc. All rights reserved Retrieved from pinterest.com HEARING LOSS Two major types of hearing loss Conductive Sensorineural Usually involves abnormalities Hearing loss from damage to inner ear or neural pathways to the brain of the exernal and middle ear Reduced ability of sound to be Presbycusis most common form of hearing loss in the United States transmitted to inner ear (aging) Causes include otosclerosis, Noise induced: second most infection, perforated eardrum, common cause, mechanical injury fluid in middle ear, tumor, to the sensory hair cells of cochlea, cerumen accumulation continuous noise exposure, Cerumen impaction occurs in expected to rise, consider better ear 33% of nursing home residents protection devices Copyright © 2020 by Elsevier, Inc. All rights reserved ed Copyright © 2020 by Elsevier, Inc. All rights reserv 25 HEARING LOSS Tinnitus: the perception of sound in one or both ears or in the head when no external sound is present “Ringing in the ears” Buzzing, hissing, whistling, cricket, chirping, bells, roaring, clicking, pulsating, humming, swishing Constant or intermittent More acute at night or in quiet surroundings Increases over time Cause is unknown Copyright © 2020 by Elsevier, Inc. All rights reserved PROMOTING HEALTHY AGING Interventions to enhance hearing: Early assessment and treatment Hearing Aids Cochlear Implants Assistive Listening and Adaptive Devices *Communication Strategies for Elders with hearing impairment Box 12-5. All vier, Inc e ls E y 20 b ht © 20 Copyrig d rve hts rese Copyright © 2020 by Elsevier, Inc. All rights reserved 28 PROMOTING HEALTHY AGING: HEARING 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 May require referral to an audiologist Removal of cerumen impaction (Box 12-2 & see safety alert) Follow best practices for communicating with older adults (Box 12-5) Copyright © 2020 by Elsevier, Inc. All rights reserved 29 CASE STUDY: HEARING Phillip Spencer is a 70-year-old male who spent 40 years of his life working as a laborer in an automotive factory. He has emphysema related to his exposure to factory chemicals. He is extremely hard of hearing but does not wear hearing aids because of the associated cost. Mr. Spencer is currently in the hospital for an exacerbation of his congestive heart failure. He is being prepared for discharge and the nurse needs to educate him on his disease process and new medications. Mr. Spencer is pleasant and cooperative with staff. He enjoys watching television in his hospital bed but tends to have the volume of his television too loud. Copyright © 2020 by Elsevier, Inc. All rights reserved CASE STUDY QUESTIONS 1. What is the most likely source of hearing loss for Mr. Spencer? Was his hearing loss preventable? 2. Compare the types of hearing aids and assistive devices. What type of intervention might be most effective for Mr. Spencer? What is the likelihood that this patient will purchase an assistive device? 3. The nurse caring for Mr. Spencer needs to provide him with discharge education on his disease process and medications. What are some communication strategies that may be helpful? Copyright © 2020 by Elsevier, Inc. All rights reserved HEARING QUESTION 1 Which of the following are best practices for communicating with older adults? a. Never assume hearing loss is from age until other causes are ruled out b. Lower your tone of voice, articulate clearly, use a moderate rate of speech c. Inappropriate responses, inattentiveness, and apathy may be signs of hearing loss d. All of the above Copyright © 2020 by Elsevier, Inc. All rights reserved 32 HEARING QUESTION 2 What is the most common type of hearing loss in the older adult ? a. Conductive b. Noise induced c. Otosclerosis d. Presbycusis Copyright © 2020 by Elsevier, Inc. All rights reserved 33 SKIN: CHAPTER 13 Copyright © 2020 by Elsevier, Inc. All rights reserved GERIATRIC SYNDROME: SKIN BREAKDOWN Healthy skin is durable, pliable, and strong enough to protect the body by absorbing, reflection, cushioning, and restriction various substances and forces; yet is sensitive enough to relay subtle messages to the brain. When the integument malfunctions or is overwhelmed, discomfort, disfigurement, or death may ensue. What are some physiological functions of skin? Box 13.1 What are some changes in the Integument Related to Aging? See Table 13.1 Copyright © 2020 by Elsevier, Inc. All rights reserved COMMON SKIN PROBLEMS IN LATE LIFE Xerosis: dry, cracked, & itchy skin Most common skin problem in older people Pruritus: itchy skin (consequence of xerosis) Threat to skin integrity d/t scratching Identify Prevention measures & Interventions: Box 13.2 Copyright © 2020 by Elsevier, Inc. All rights reserved LESS COMMON SKIN Scabies: mites – intense itching Contagious; must eliminate infestation; medication kills mites but itching may last Identify Prevention weeks measures & Interventions Copyright © 2020 by Elsevier, Inc. All rights reserved COMMON SKIN PROBLEMS IN LATE LIFE Purpura: extravasation d/t increased fragility to dermal capillaries Skin Tears: thin, fragile skin, painful, acute, accidental wounds, possibly more prevalent than pressure ulcers Adapted Payne-Martin Skin Tear Classification Tool 2 Box 13.3 Prevention & Treatment Box 13.5 Copyright © 2020 by Elsevier, Inc. All rights reserved Keratosi Seborrheic Keratosis s Benign growth Mainly see on trunk, face, scalp, and neck Waxy, raised, stuck-on appearance Flesh colored or pigmented, various sizes Actinic Keratosis Precancerous Related to exposure to UV light Risk: increased age, fair complexion Rough scaly sandpaper patches Pink to reddish brown with erythematous base Copyright © 2020 by Elsevier, Inc. All rights reserved 39 COMMON SKIN PROBLEMS Herpes zoster (shingles): viral infection occurring along a nerve pathway; very painful and pruritic *Identify prevention measures & Interventions Copyright © 2020 by Elsevier, Inc. All rights reserved COMMON SKIN PROBLEMS IN LATE LIFE (SEE BOX 13.6) Candidiasis: aka Candida Albicans or “yeast infection” Grows in warm, moist, dark areas Risk: obese, bedridden, incontinent, diaphoretic, on antibiotics &/or steroids or have diabetes Treatment: Adequate drying Prompt treatment of incontinent episodes Loose fitting clothes and Copyright © 2020 by Elsevier, Inc. All rights reserved SKIN CANCERS Basal Cell Carcinoma: most common malignant skin cancer; pearly papule with prominent telangiectasia Squamous Cell Carcinoma: second most common skin cancer; firm, irregular, fleshy, pink-colored nodule that becomes reddened and scaly, increases rapidly in size Melanoma: neoplasm of melanocytes; less that 5% but accounts for most skin cancer deaths; classic multicolor, raised appearance with asymmetrical irregular border *Risk Factors for Melanoma & ABCDE Rules for Melanoma See Box 13.8 Copyright © 2020 by Elsevier, Inc. All rights reserved SKIN CANCERS Copyright © 2020 by Elsevier, Inc. All rights reserved 44 All rights reserved Copyright © 2020 by Elsevier, Inc. COMMON SKIN PROBLEMS IN LATE LIFE Pressure Ulcers (PU) See box 13.9 Avoidable & Unavoidable injuries Highest incidence reported in Hospitalized or institutionalized older adults Vulnerable adults undergoing orthopedic procedures Risk factors Box 13.11 Co-morbid illnesses Protein malnutrition Cognitive deficits Copyright © 2020 by Elsevier, Inc. All rights reserved PRESSURE ULCERS Can develop anywhere on body but most common on bony prominences See Box 13.10 Pressure Injury Stages/categories Sacrum Heels Greater trochanter Elbows Knees Copyright © 2020 by Elsevier, Inc. All rights reserved Scapula SKIN ASSESSMENT AND INTERVENTION Assessment: Braden Scale or Norton Risk Assessment Scale Skin assessment guidelines Box 13.13 Interventions: Prevention of Pressure Ulcers, Key elements Box 13.12 Prevention of medical device pressure injuries Box 13.14 Thorough assessment of skin Nutritional evaluation Laboratory studies Positioning Incontinence care Dressings: Box 13.5 Pressure Injury Treatment 13.16 Wound specialist nursing consult when indicated Copyright © 2020 by Elsevier, Inc. All rights reserved CASE STUDY: SKIN A 73-year-old male patient is transferred to the cardiac surgery unit from the cardiac intensive care unit (ICU). He had an aortic valve replacement with a mechanical valve and a two-vessel coronary artery bypass graft (CABG) 15 days ago, which was complicated by an intraoperative left cerebrovascular accident (CVA). His postsurgical course was complicated by delirium while he was in the intensive care unit, and he is now on Ativan around the clock. His nursing admission assessment documents that he was alert and oriented to person, time, and place and independent in all activities of daily living (ADLs). He has a past medical history of hypertension, atrial fibrillation, and congestive heart failure. On admission to the cardiac surgery unit, you note that he is oriented to person only, needs maximum assistance in ADLs, and needs a two-person assist to get out of bed to the chair and to the bedside commode, which means he is incontinent because it takes too long to get to the commode. The transfer summary states that he needs to be fed and that he consumes approximately 50% of his meals. The only significant changes in his medical condition are worsened CHF, requiring an increase in his diuretic. His medications include Lasix, digoxin, captopril, and Tylenol for pain. His skin assessment reveals the following: stage III pressure ulcer on his sacrum, eschar on left heel, and a right heel that feels “boggy” to touch. His Braden Scale score is 13. Copyright © 2020 by Elsevier, Inc. All rights reserved CASE STUDY QUESTIONS 1. Identify the factors that make this patient at high risk of developing pressure ulcers. 2. How often should this patient have skin assessments? 3. List the six risk factors that are part of the Braden Scale for Predicting Pressure Sore Risk. 4. Provide at least one nursing intervention that will address nutritional status, mobility, and positioning. Copyright © 2020 by Elsevier, Inc. All rights reserved SKIN QUESTION #1 Which of the following is the most common malignant skin cancer? a. Melanoma b. Squamous cell carcinoma c. Basal cell carcinoma d. Actinic keratosis Copyright © 2020 by Elsevier, Inc. All rights reserved SKIN QUESTION #2 What is the #1 treatment of pressure ulcers? a.Prevention b.Early identification c.Thorough patient history d.Risk assessment Copyright © 2020 by Elsevier, Inc. All rights reserved REFERENC ES Touhy, T., & Jett, K. (2020). Ebersole and Hess’ Toward Healthy Aging Human Needs & Nursing Response. (9th ed.) St. Louis. MO: Elsevier. Statement of Copyright and Fair Use The author of this PowerPoint believes that the following presentation contains copyrighted materials used under the Multimedia Guidelines and Fair Use exemptions of U.S. Copyright law applicable to educators and students. Further use is prohibited. If owners of images used in this presentation feel otherwise, please contact the author and they will be taken down if other amicable resolutions cannot be agreed upon. 52