Sean Whitfield - NURS 3540 - Gerontological Nursing - Module 6 Active Learning Guide PDF

NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide Module 6 Active Learning Guide Purpose/Overview Active learning guides help students focus their study time using knowledge-level information, then concentrate on applying and analyzing knowledge to provide a context concerning the co...

NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide Module 6 Active Learning Guide Purpose/Overview Active learning guides help students focus their study time using knowledge-level information, then concentrate on applying and analyzing knowledge to provide a context concerning the course and career skills. Students should review the active learning guide before engaging with the module content, then work to complete the guide both during and after engaging with the content. An active learning guide is not the same as a study guide or a test blueprint. It serves as a guide to help the student navigate the course and content. The active learning guide is not a complete composite of the information needed for the exam but a guide to navigating the content delivery. Instructions Review the active learning guide before you begin reading and engaging with other content in the module. Looking at the questions beforehand will preview the information you will be learning, including the key concepts and takeaways. As you work through the module content, complete the active learning guide. Some questions may be reflective and require that you finish all content before responding. Students will turn in the completed learning guide on Sunday night at 1159 PM. Faculty will review, award points, and return them to students to review prior to the exam. There are a possible 5 earned points for this learning guide. Reading Focus Areas In the text, you will see essential boxes, such as Safety Alerts, which discuss issues related to the care of older adults. Research Highlights contain a summary of pertinent current research related to chapter topics. Resources for Best Practice provide suggestions for further information for chapter topics and tools for practice. Healthy People boxes refer to goals cited in Healthy People 2030. Clinical judgment and next generation NCLEX examination style questions are located at the end of every chapter. Please review these questions as they are good practice for the exam. I. Vision 1. Identify age related changes in the eye that affect vision. Review the internet to find pictures of the changes and submit with assignment. Extraocular Eyelids lose elasticity and drooping (senile ptosis) may result. Spasms of the orbicular muscle may cause the lower lid to turn inward, it is called entropion. Decreases in orbicular muscle strength may result in ectropion, or an out-turning of the lower lid. NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide Ocular - Without the integrity of the trough of the lower lid, tears run down the cheek instead of bathing the cornea leads to excessively dry eyes (xerophthalmia) and the need for use of artificial tears. A reduction of goblet cells in the conjunctiva is another cause for drying of the eyes in the older adult. Goblet cells produce mucin, which slows the evaporation of tear film and is essential for eye lubrication and movement. With aging, the cornea becomes flatter, less smooth, and thicker, with the changes noticeable by its lackluster appearance or loss of sparkling transparency. The result is the increased incidence of astigmatism. With aging, the chamber decreases slightly in size and volume capacity because of thickening of the lens. Resorption of the intraocular fluid becomes less efficient and may lead to eventual breakdown in the absorption process. If the change is greater, it can lead to increased intraocular pressure (IOP) and the development of glaucoma. With age the iris becomes paler in color as a result of pigment loss and increases in the density of collagen fibers. Age-related change in the iris is linked to other neurological changes slowed response to sensory stimuli, in this case, to light and dark. Slowness to dilate in dark environments creates moments when older adults may have difficulty seeing where they are going (e.g., moving from a well-lit area to a dark area such as in a movie theater). The effect of glare from headlights of oncoming vehicles increases safety risks with driving (night blindness). Persistent pupillary constriction is known as senile miosis. It may be noted during the physical exam but is considered a normal finding if it is bilateral. At the edges of the cornea and the iris is a small ring known as the limbus. In some older adults, a gray-white ring or partial ring, known as arcus senilis, forms 1 to 2 mm inside the limbus. It does not affect vision and is composed of deposits of calcium and cholesterol salts. Intraocular The vitreous humor, which gives the eye globe its shape and support, loses some of its water and fibrous skeletal support with age. Opacities other than cataracts can be seen by the person as lines, webs, spots, or clusters of dots moving rapidly across the visual field with each movement of the eye. These opacities are called “floaters” and are bits of coalesced vitreous humor that have broken off from the peripheral or central part of the retina. The retina, which lines the inside of the eye, has less distinct margins and is duller in appearance than in younger adults. NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide Fidelity of color is less accurate with blues, violets, and greens of the spectrum; warm colors such as reds, oranges, and yellows are more easily seen. Color clarity diminishes by 25% in the sixth decade and by 59% in the eighth decade. Some of this difficulty is linked to the yellowing of the lens and the impaired transmission of light to the retina, and the fovea may not be as bright. The average 80-year-old needs more than twice as much light as a 20year-old to see equally well. 2. Prevention of eye impairment. What visual impairment is caused by aging and at what age does it begin? Presbyopia - (decreased near vision due to aging) is first seen between 45 and 55 years of age, 80% of those older than 65 years have fair to adequate far vision past 90 years of age. Nearly 95% of adults older than 65 years wear glasses for close vision. What actions should the adult client do to promote healthy eyes? Box 12.1 Have a comprehensive eye dilated eye exam Know your family’s eye health history Eat right to protect your sight (diet rich in green leafy vegetables, fruit, and fish) Maintain a healthy weight Wear protective eyewear Quit smoking or never start Be cool and wear your shades Give your eyes a rest when doing computer work or focusing on any one thing. Every 20 minutes look away 20 feet in front of you for 20 seconds. This will help reduce eyestrain Clean your hands and your contact lenses properly Practice workplace eye safety (protective eye wear if required). 3. Complete the chart below with eye diseases, how it affects the patient and any interventions to correct. EYE Disease Cataracts Affects Opacification of normally crystalline lens. Loss of lens transparency or scatter light. 70% of people older than age 75 have cataracts. Interventions Assess the patient’s ability to see and perform activities. Encourage the patient to see an NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide EYE Disease Affects Symptom is cloudy or blurred vision, glare, halos around lights, poor night vision, a perception that colors are faded or that objects are yellowish, and the need for brighter light when reading. The red reflex may be absent or may appear as a black area. Interventions ophthalmologist at least yearly. Provide sufficient lighting for the patient to carry out activities. Prepare the patient for cataract surgery as warranted. Ensure the room environment is safe with adequate lighting and furniture moved toward the walls. Remove all rugs, and objects that could be potentially hazardous. Glaucoma Group of diseases that can damage the optic nerve. Affects as many as 2.3 million Americans ages 40 years and older and 6% of those older than age 65. Determine the type and degree of visual loss. Allow expression of feelings about loss and the possibility of Most common form of the a loss of vision. condition, primary open-angle glaucoma (POAG), affects Evaluate anxiety side vision first. level, degree of pain Individuals at higher risk for experienced or glaucoma include Blacks suddenness of onset older than age 40 years; of symptoms, and people with a family history of current knowledge of glaucoma; and everyone the condition. older than 60 years, especially Mexican Americans. damage to the optic nerve in glaucoma is irreversible, and regenerative attempts have been unsuccessful, so early diagnosis is essential. Promote a calm and soothing environment by ensuring adequate lighting, and minimizing noise and distractions in the NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide EYE Disease Affects Signs of glaucoma can include headaches, poor vision in dim lighting, increased sensitivity to glare, “tired eyes,” impaired peripheral vision, a fixed and dilated pupil, and frequent changes in prescriptions for corrective lenses. Interventions environment. Identify potential side effects and adverse reactions of treatment such as decreased appetite, nausea, and vomiting, diarrhe a, fatigue, “drugged” Angle-closure glaucoma is feeling, decreased not as common as POAG and occurs when the angle of libido, impotence, the iris causes obstruction of cardiac irregularities, the aqueous humor through syncope, and heart the trabecular network. failure (HF). Individuals with smaller eyes, Asians, and women are most susceptible. Diabetic Retinopathy DR occurs in both type 1 and type 2 diabetes mellitus. Almost all people with type 1 diabetes eventually will develop retinopathy. Bleeding from abnormal retinal blood vessels can cause the appearance of “floating” spots that sometimes clear on their own. Early signs are seen in the fundoscopic examination and include microaneurysms, flameshaped hemorrhages, cotton wool spots, hard exudates, and dilated capillaries. Stress the importance of glaucoma screening. Constant, strict control of blood glucose levels, cholesterol levels, and blood pressure measurements and laser photocoagulation (LPC) treatments can halt progression of the disease. Annual dilated fundoscopic examination of the eye is recommended beginning 5 years after diagnosis of type 1 diabetes and at the time of diagnosis of type 2 diabetes. Nurses need to provide education to diabetic patients about the risk of DR, the importance of early identification, and good control of diabetes. Fall prevention education NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide EYE Disease Detached Retina Affects A retinal detachment can occur at any age but is more common after the age of 40 years. Small areas of the retina that are torn (retinal tears or breaks) and will lead to retinal detachment. Can develop in persons with cataracts or recent cataract surgery or trauma, or it can occur spontaneously. Symptoms include a gradual increase in the number of floaters and/or light flashes in the eye. Age-related Macular Degeneration It also manifests as a curtain coming down over the person’s field of vision. Most common cause of new visual impairment among people ages 50 years and older. Prevalence of AMD increases drastically with age, with more than 15% of White women older than age 80 years having the disease. Interventions should be provided to individuals with earlystage disease. Some experts are encouraging mass screening efforts. There is good treatment that can reverse vision loss and improve vision, but individuals must have access to screenings and eye examinations. Retinal detachments are treated with surgery. More than 90% of individuals with a retinal detachment can be successfully treated, although sometimes a second treatment is needed. Visual results are best if the detachment is repaired before the macula detaches, so immediate treatment of symptoms is essential. Encourage the patient to see an ophthalmologist at least yearly. Provide sufficient lighting for the patient to carry out activities. Ensure the room NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide EYE Disease Affects Whites and Asian Americans are more likely to lose vision from AMD than are African Americans or Hispanics/Latinx. AMD is a degenerative eye disease that affects the macula, the central part of the eye responsible for clear central vision. Interventions environment is safe with adequate lighting and furniture moved toward the walls. Remove all rugs, and objects that could be potentially hazardous. Keep the patient’s glasses and call bell within easy reach. Causes the progressive loss of central vision, leaving only peripheral vision intact. AMD results from systemic changes in circulation, accumulation of cellular waste products, atrophy of tissue, and growth of abnormal blood vessels in the choroid layer beneath the retina. Fibrous scarring disrupts nourishment of photoreceptor cells, causing their death and loss of central vision. Risk factors include a family history of AMD, White race, and smoking. 4. What type of assistive devices are available for the visually impaired? The text does not provide a very good list. Google electronics for the blind and see what you can find. Magnifiers, Telescopes (mounted on eyeglasses), electronic magnification via cctv, software that converts text into a.i. voice output. AI Smart Glasses, Bone Conduction Headphones, Braille Keyboards, Braille Displays and Audio Labelers. NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide II. Hearing 1. Describe some of the negative outcomes associated with hearing impairment. Decreased function, miscommunication, depression, falls, loss of self-esteem, safety risks, poor cognitive function, and possible increased health service use secondary to unmet health care needs. Among older adults who are frail and have multiple comorbidities, hearing loss has been cited as a contributing factor in common geriatric syndromes. Failures in clinical communication are considered the leading cause of medical errors. 2. Compare the two major forms of hearing loss. Sensorineural hearing loss results from damage to any part of the inner ear or the neural pathways to the brain. Conductive hearing loss usually involves abnormalities of the external and middle ear that reduce the ability of sound to be transmitted to the middle ear. 3. How can noise-induced hearing loss be prevented? Avoid or limit exposure to excessively loud sounds. Turn down the volume of music systems. Move away from the source of loud sounds when possible. Use hearing protection devices when it is not feasible to avoid. exposure to loud sounds or reduce them to a safe level. 4. What are the signs of presbycusis? Speech sounds mumbled or slurred. Trouble hearing high-pitched sounds. Trouble understanding conversations when background noise is present. 5. Discuss some of the causes of conductive hearing loss. What is the most common method of correcting hearing loss in the older adult? Otosclerosis, infection, perforated eardrum, fluid in the middle ear, tumors, or cerumen accumulations cause conductive hearing loss. Cerumen impaction is the most common and easily corrected of all interferences in the hearing of older adults 6. Describe the steps for the removal of cerumen. Use instruments under direct visualization; insert them through the procedure head of the otoscope and speculum. Remove cerumen using suction or a curette (for soft cerumen) or a loop or hook (for firm cerumen). If needed, extract cerumen using an alligator forceps. NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide 7. Provide some communication strategies for use in working with hearingimpaired patients. Speak clearly, Eliminate background noise, Get the persons attention before speaking, Be patient, Use visual cues, Repeat or rephrase, Face the person, Maintain eye contact while communicating, Optimize the environment and Use your mouth only for talking. Healthy People 2030: Hearing- Older Adults. 8. Identify the objectives of Healthy People 2030 related to hearing impairment in older adults. Increase the proportion of adults who have had a hearing exam within the last 5 years Increase the proportion of adults with hearing loss who use a hearing aid Increase the proportion of adults with tinnitus that started in the past 5 years who have been seen by a specialist Increase the proportion of adults bothered by tinnitus who have seen a doctor or other health care professional Increase the proportion of persons with hearing loss and other sensory communication disorders who have used internet resources for health care information, guidance, or advice in the past 12 months Audio/Video Focus Areas Please watch the following videos and answer the questions provided. Video #1 How good is your eyesight? (1:45) 1. What image did you see? Albert Einstein 2. What did you see at a distance? Marilynn Monroe Why is that? At a distance only see the broad strokes of the image. Video #2 Sighted Guide Techniques (7:34) 1. How do you escort a blind person when walking? Sighted Guide Technique. Ask if they would like a guide, do not assume. If yes, touch the back of their hand with yours and allow them to trace your arm to your elbow and hold. If they need more support it is ok for them to link arms with you. The sighted guide should stay a step to a half a step ahead and maintain a pace that is good for both people. While walking maintain a conversation and use special verbal cues when needed. 2. How do you lead a blind person through a doorway? The sighted guide will move arm to their back to signal the companion to line up in single file. The companion will also move hand from elbow to wrist to allow for more room for walking. 3. How do you assist a blind person in finding a seat? Approach the bench seat squarely and allow the companion’s legs to touch the seat. Most companions will be able to seat themselves at this point. Approach the chair from behind NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide and allow the companion to follow your arm down to the back of the seat. Most companions should be able to seat themselves. Video #3 How to care for visually impaired people in the hospital (3:15) 1. When first entering their hospital room provide the most accessible room, give them a tour of the room so they get their bearings. 2. Always introduce yourself when entering room. 3. Set up meals in a clock face fashion and describe the position of each food item on the plate/tray, so that the patient can easily find what they need. 4. Never move their things or any items in the room. Video #3 How old are your ears? (1:37) 1. At what frequency did you stop hearing the sound? 15,000 Hz. 2. How old are your ears? Under 40 3. Why do we lose high frequency hearing as we age? Inner ear does not have the capacity to regenerate the hair cells. As we age, we are exposed to noise and loud sounds that bend and break these hair cells. The hairs tuned to high pitches are the first to encounter sound waves and be stressed out. Website Focus Areas Locate the website for the National Institute on Deafness and Other Communication Disorders (NIDCD). 1. Identify some of the resources available for the hearing-impaired individual. Assistive listening devices (ALDs) help amplify the sounds you want to hear, especially where there’s a lot of background noise. ALDs can be used with a hearing aid or cochlear implant to help a wearer hear certain sounds better. Augmentative and alternative communication (AAC) devices help people with communication disorders to express themselves. These devices can range from a simple picture board to a computer program that synthesizes speech from text. Alerting devices connect to a doorbell, telephone, or alarm that emits a loud sound or blinking light to let someone with hearing loss know that an event is taking place. Captions for Deaf and Hard of Hearing Viewers. Cochlear Implants Hearing Aids Telecommunications Relay Services NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide 2. Locate and discuss the statistics involving hearing loss. About 2 to 3 out of every 1,000 children in the United States are born with a detectable level of hearing loss in one or both ears. More than 90 percent of deaf children are born to hearing parents. Approximately 15% of American adults (37.5 million) aged 18 and over report some trouble hearing. Among adults aged 20-69, the overall annual prevalence of hearing loss dropped slightly from 16 percent (28.0 million) in the 1999-2004 period to 14 percent (27.7 million) in the 2011–2012 period. Age is the strongest predictor of hearing loss among adults aged 2069, with the greatest amount of hearing loss in the 60 to 69 age group. Application Questions or Case Studies The following case studies were retrieved from the textbook: Touhy, T.A., & Jett, K.F. (2020). Ebersole & Hess' toward healthy aging: Human needs & nursing response (10th ed.). Elsevier. Case Study 1 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. 1. Discuss the causes and treatment of dry eyes in the older adult. Decline in oil production by the meibomian gland. The oil has the ability to make the outer layer of the tear film. As a result the tear film evaporates to quickly. To compensate the eyes lacrimal glands try to make more of the watery tears. Treatment Avoid environmental triggers, Use a humidifier in bedroom, place warm compress over your eyes, Give your eyes a rest, Take Omega-3 fatty acid supplements. Artificial Tears, Ointments, Topical cyclosporine eye drops, Nasal spray, autologous serum drops. NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide 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. AAA Yield the right of way. Respond to other vehicles properly. Merge and change lanes safely. Stay in the lane when turning and driving straight. Slow or stop appropriately at green lights or intersections. After age 75 should retake the drivers test. In Arkansas, other common requirements the ODS may impose on drivers include: no freeway driving an additional right side mirror on a vehicle no nighttime driving time of day restrictions—for example, no driving during rush hour traffic supports to ensure a proper driving position geographic area restrictions, and wearing bioptic telescopic lens when driving. 3. List and review other resources available for individuals with impaired vision. National Braille Association American Foundation for the Blind Blinded Veterans Association Case Study 2 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. 1. What is the most likely source of hearing loss for Mr. Spencer? Working as a laborer in an automotive factory and being continuously exposed to loud noises for decades. Also, being 70 years old is a factor. Was his hearing loss preventable? Without an assessment to determine the level of damage, the loss most certainly could have been limited with the consistent use of ear plugs and NURS 3540 – Gerontological Nursing Module 6 Active Learning Guide head phones to block out most loud noises. Mr. Spencer’s choice of a different career that did not expose him to this hazard would have aided in retaining his hearing. 2. Compare the types of hearing aids and assistive devices. Behind the ear, In the ear, receiver in the ear hearing aids, hearing loop, blue tooth systems. The type of device used will be determined by the hearing loss and where the user needs communication access. What type of intervention might be most effective for Mr. Spencer? Hearing aids Cochlear implants Other assistive devices What is the likelihood that this patient will purchase an assistive device? It would depend on his motivation at the age of 70. Input from family members and finances. How much coverage does his insurance give him in retirement. 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? Re-phrase what you said. If someone doesn't understand you, repeat you said or phrase it differently, use plain language. Face the person you're speaking to. Use an interpreter. Write it down. Get their full attention. Reduce background noise. what