Week 8 - Sensory PowerPoint - STUDENT PDF

Safety: Sensory Disorders N201 Intermediate Med Surg Professor Woolery Lewis Chapters 22 & 23 (12th Edition) Objectives: Alterations in Safety Integrate nursing care Prioritize care Discuss teaching needs Collaborate with related to nutrition,...

Safety: Sensory Disorders N201 Intermediate Med Surg Professor Woolery Lewis Chapters 22 & 23 (12th Edition) Objectives: Alterations in Safety Integrate nursing care Prioritize care Discuss teaching needs Collaborate with related to nutrition, interprofessional team safety and pharmacology Gerontologic Considerations Effects of Every structure of visual aging on the systems changes visual system See Table 22.1 (12th) Effects of Structures of the auditory aging on the system change, as well auditory system See Table 23.1 (12th) Cataracts N201 Intermediate Medical Surgical Nursing, Professor Woolery Chapter 22 (12th Ed.)  Cataract Opacity within the lens May occur in one or both eyes Pathophysiology: changes lens fibers, vision changes Cataract removal is most common surgical procedure in United States Influencing factors: Age Blunt trauma Congenital factors Radiation/UV light exposure Long-term corticosteroid use or diuretic use Ocular inflammation Clinical Manifestations  Cataracts Decrease in vision Abnormal color perception Glaring of vision https://youtu.be/nGV3PD5sBgM Diagnostic Studies History and physical examination Visual acuity measurement Ophthalmoscopy Slit lamp microscope Nonsurgical therapy: temporary Visual aids Changing eyewear prescription Interprofessional Reading glasses Care Magnifiers Increased lighting  Surgical Therapy Preoperative phase History and physical assessment Eye drops Anti-inflammatory: diclofenac Dilating : atropine, tropicamide Dark glasses minimize photophobia Monitor for systemic toxicity: hallucinations, restlessness, altered mental status  Surgical Therapy  Intraoperative phase  Cataract extraction is an intraocular procedure  An operating microscope is used Phacoemulsification Most common form of cataract surgery Ultrasonic vibrations dissolve lens into fragments that are suctioned Surgical out Therapy Sutures are not usually required https://youtu.be/LIza4BiEoOk Extracapsular cataract extraction procedure Used for advanced cataracts Entire cataract is removed Sutures are required Surgical Recovery is often slower Therapy Implantation of Intraocular Lens Surgical Therapy Postoperative phase Discharged after sedation wears off Postoperative medications: antibiotic and corticosteroid drops Activity restrictions (Avoid raising intraocular pressure) Nighttime shielding Follow-up for visual acuity; may or may not need glasses/lenses Discomfort is managed with acetaminophen  Nursing Management Implementation  Ambulatory Care:  Review instructions with patient and caregiver (Table 22.11)  Most have little visual impairment  If significant visual impairment— activity and environmental modifications  How to use eye drops  Use of eye patch: altered depth perception; fall precautions Nursing Management Implementation  Health Promotion Prevention: Wear sunglasses Avoid unnecessary radiation Adequate antioxidant diet A nurse is providing discharge education to a client who has undergone surgery for cataracts. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A.You will receive a prescription for NCLEX opioids to manage the post- operative pain. Question B. Notify the surgeon if you notice an increase in redness or purulent drainage. C.Wear the shield on the affected eye at night until cleared by the surgeon to stop. D.You must stay on bedrest for the next three days. E. Wash your hands before administering the prescribed eyedrops. A nurse is providing discharge education to a client who has undergone surgery for cataracts. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A.You will receive a prescription for NCLEX opioids to manage the post- operative pain. Question B. Notify the surgeon if you notice an increase in redness or purulent drainage. C.Wear the shield on the affected eye at night until cleared by the surgeon to stop. D.You must stay on bedrest for the next three days. E. Wash your hands before administering the prescribed eyedrops. Glaucoma Chapter 22 (12th Ed.)  A group of disorders characterized by Increased IOP and consequences of elevated pressure Optic nerve atrophy Peripheral visual field loss https://youtu.be/_VtFBnexqm0 Second leading cause of permanent blindness in U.S. Leading cause of permanent blindness is age- related macular degeneration (AMD) Many people are unaware the have glaucoma Incidence increases with age Blindness is preventable with detection & treatment Two types: Primary Open-Angle Glaucoma (POAG) Primary Angle-Closure Glaucoma (PACG) Primary Open-Angle Glaucoma (POAG) Most common type of glaucoma The angle (where the iris meets the cornea): Drainage channels become clogged Outflow of aqueous humor is ↓ in trabecular meshwork Clinical Manifestations Develops slowly Initially asymptomatic Gradual loss of peripheral vision Late or untreated: tunnel vision  EMERGENCY! Angle closure ↓ the flow of aqueous humor Caused by age, pupil dilation Primary Possibly drug induced Acute angle-closure glaucoma Angle- Sudden onset Closure Excruciating pain in or around eyes Nausea and vomiting Glaucoma Seeing colored halos around lights (PACG) Blurred vision Ocular redness Diagnostic Studies Normal IOP = 10 to 21 mm Hg  Diagnostic studies  IOP measurement (tonometry)  POAG—IOP 22 to 32 mmHg  PACG —IOP > 50 mmHg  Slit lamp microscopy  Visual acuity measurements Chronic open-angle glaucoma: Goal is to keep IOP low Drug therapy- Not a cure [Table 22.15 (12th)] Beta Blocker eyedrops (timolol) Alpha Adrenergic Agonist eyedrops (latanoprost) Education on medication use Educate on side effects if systemic absorption occurs Argon laser trabeculoplasty Laser stimulates scarring and contraction of trabecular meshwork = opens outflow channels Interprofessional Care   Acute angle-closure glaucoma- EMERGENCY! NEED TO LOWER IOP IMMEDIATELY!  Miotics (Pilocarpine): Decrease IOP by increasing drainage  S/E: Decreased visual acuity in dim light, headache, blurred vision Interprofessional  Oral/IV hyperosmotic: Glycerin Care liquid (Opthalgan); Mannitol solution (Osmitrol): Increased osmolality of plasma draws fluid into the blood vessels and out of eye.  Surgery to create new opening for drainage:  Laser peripheral iridotomy  Surgical iridectomy Glaucoma Nursing management  Assessment  Ability to understand and adhere to therapy plan  Psychological reaction to sight-threatening disorder  Family support  Nursing management Glaucoma Expected goals No further progression of visual impairment Pt will understand disease process and rationale for therapy Pt will comply with all aspects of therapy No post-op complications  Tend to special needs of older adult Caution about potential drug interactions that occur with Nursing systemic illnesses and their Management treatments Gerontologic Considerations Teach that occluding puncta will limit systemic absorption of glaucoma medications  Retinopathy & Retinal Detachment Chapter 22 (12th Edition) Professor Woolery   The retina lines the back of the eye. It converts incoming images into a form that the brain can process as vision.  Retinopathy = microvascular damage to the retina; blurred vision; progressive loss of vision  Most common with HTN or diabetes mellitus  Diabetic retinopathy  Nonproliferative—loss of central vision  Proliferative—advanced disease; severe vision loss. New vessels grow but they are abnormal, fragile, and leak.  Treatment: laser photocoagulation  Hypertensive retinopathy  Treatment: lower BP to restore vision Retinopathy   Separation of retina and underlying pigment epithelium; fluid accumulation between layers  Etiology:  Classified based on cause  Breaks—holes (spontaneous) or tears (aging – as the vitreous humor (gel) shrinks and pulls at the retina)  Risk factors: Age, AMD, diabetic retinopathy, eye surgery, eye trauma, family/personal history, severe myopia, thinning of the peripheral retina  Manifestations: flashes of light, floaters, and cobweb/hairnet or ring in field of vision Retinal Detachment Retinal Detachment  Diagnostic Studies: Visual acuity measurements; ophthalmoscope or slit lamp examination; ultrasound  Interprofessional Care  Monitoring and Education  Not all breaks will progress to detachment  Seek help if vision gets worse  Retinal Specialist Retinal Detachment  Surgical therapy—seal retinal breaks (without detachment) by inflammation/adhesion or scar  Laser photocoagulation— small burns → scar  Cryopexy—freezing → scar  Scleral Buckling—silicone implant and band placed around globe   Intraocular procedures  Pneumatic retinopexy—intravitreal injection of gas to form bubble to close retinal break  Vitrectomy—removal of vitreous (replaced with saline)  Postoperative considerations  Bedrest/Activity restrictions  Special positioning (face down) to maintain proper position of bubble for several weeks  No altitude changes  Medications: analgesia and topical  Patient education Retinal Detachment Age-Related Macular Degeneration (AMD) Chapter 22 (12th Ed.) Professor Woolery Age-Related Macular Degeneration  The macula is in the central retina. It’s responsible for the central visual field.  Leading cause of irreversible central vision loss  Two forms:  Dry (nonexudative)—atrophy of macular cells  More common  Slow, progressive, painless loss of vision  Caused by accumulation of yellowish extracellular deposits called “drusen” in the retinal pigment epithelium. Eventually atrophy of the macular cells occurs.  Wet (exudative)  More severe; abnormal blood vessels develop in or near macula  Rapid onset of vision loss; AMD-related blindness  Vascular Endothelial Growth Factor (VEGF) promotes new blood vessel growth in the retinal epithelium. The new vessels leak and cause scar tissue to form. Age-Related Macular Degeneration Age-related macular degeneration  Etiology: retinal aging  Risk factors: family history, obesity, HTN, being white, smoking  Clinical manifestations: blurred and darkened vision, scotomas (blind spots) and metamorphopsia (vision distortion), acute vision loss  Diagnostic studies: visual acuity measurements; ophthalmoscopy; Amsler grid test Age-Related Macular Degeneration Amsler grid test   Interprofessional care  Medications injected every 4 to 6 weeks into vitreous cavity to stop new vessel formation and slow vision loss  Ranibizumab (Lucentis), bevacizumab (Avastin), and others inhibit vascular endothelial growth factor (VEGF)  Photodynamic therapy (PDT) uses a laser to activate Verteporfin (IV medication) to create blood clots that block abnormal blood vessels; slows central vision loss  Patients must avoid sunlight and intense light for 5 days  Nutrition: vitamin C and E; beta-carotene, zinc, lutein  Smoking cessation Age-Related Macular Degeneration Hearing Loss and Deafness Chapter 23 (12th Ed.) Hearing loss & deafness  Common cause of disability in U.S.  Nearly half of hearing impaired are >65 years of age Overview of Hearing Loss Conductive—external Decrease sound intensity and/or and middle ear distortion Distortion or faintness of sound Sensorineural—inner Alter ability to understand speech ear Complete hearing loss Hearing Loss and Deafness: Causes  Classification of hearing Loss: Hearing See Table 23.13 (12th) Loss and Clinical manifestations Deafness Inappropriate responses Straining to hear; cupping hand at ear Reading lips Increased sensitivity to increased noise Sudden hearing loss—sudden deafness; unexplained, rapid loss of hearing; usually affects just one ear Medical emergency Tinnitus—“ringing in ears”  Clinical manifestations The unseen disability Understanding should be validated in patient teaching interactions Sign language—ADA Hearing requires interpreter for consents or discharge teaching Loss and Problems with communication and interactions Deafness Patient unaware or denies impairment Irritability and frustration with speech and understanding Withdrawal, depression, cognitive decline as advances  Health Promotion Environmental noise control Noise is the most preventable cause of hearing loss Hearing loss caused by noise is not reversible Nursing/and Interprofessional Management Avoidance of continued exposure Hearing Loss and Deafness to noise levels greater than 70 dB is essential Ear protection for high risk jobs OSHA standards Noise exposure analysis Periodic screenings  Health Promotion Immunizations Fetal damage can be caused by viruses Nursing / Regularly scheduled Interprofessional Management immunizations should be Hearing Loss and promoted for children Deafness and adults Women of childbearing age need special consideration  Nursing / Interprofessional Health Promotion Management: Ototoxic substances— Hearing Loss and Deafness drugs Over 200 medications are ototoxic! Salicylates (aspirin), loop diuretics (furosemide), chemotherapy drugs, antibiotics (gentamicin) Ototoxic substances— industrial chemicals Toluene, carbon disulfide, mercury Monitoring is important (hearing tests and screening) Discontinuing drug may be indicated  Nursing and Interprofessional Management: Hearing Loss and Deafness  Hearing aids (See Table 23.15 (12th))  Assessment and fitting by an audiologist or specialist  Provide amplification, sound lateralization, speech discrimination  Goal: Improved hearing with consistent use  Require a motivated, capable user for optimum success  Determine readiness  Expensive! Don’t lose them!  MRI Prescreen: Do you have implanted hearing aids?  Nursing/Interprofessional Management Hearing Loss and Deafness Speech reading Lip reading Visual cues associated with speech facilitates understanding for 40% of spoken words Sign language For those with profound impairment Sign language is not universal American sign language (ASL) is Nursing / used in the United States and in Interprofessional English-speaking areas of Canada Management: Hearing Loss and Deafness   What are some verbal aids you can use to communicate with a hearing-impaired person? (Table 23.14 (12th)) Nursing Interventions   What are some verbal aids you can use to communicate with a hearing-impaired person? (Table 23.14 (12th))  Speak normally and slowly  Do not overexaggerate Nursing facial expressions  Do not overenunciate Interventions  Use simple sentences  Rephrase the sentence and use different words if the person is not understanding  Do not shout  Speak into the better ear   What are some nonverbal aids you can use to communicate with a hearing-impaired person? (Table 23.14 (12th)) Nursing Interventions   What are some nonverbal aids you can use to communicate with a hearing-impaired person? (Table 23.14 (12th))  Draw attention with hand movements  Use good light when Nursing speaking  Avoid covering your mouth Interventions or face  Avoid chewing while talking  Maintain eye contact  Use appropriate facial expressions  Use a whiteboard or paper for difficult words Gerontologic Considerations  Presbycusis  No OSHA laws back in the day  Degenerative changes with age  Reluctance to use a hearing aid  Cost  Appearance  Insufficient knowledge of how to use  Difficulty with inserting and removing due to decreased dexterity  Accept hearing loss as part of the aging process That’s all the content! ☺ Just a couple more things…   100-ish questions  175 points total  1.5 minutes per question  Week 8 content is included in the final exam since there is no separate quiz on this material  Covers all material from weeks 1-8  Tutoring this week will focus on week 8 content, and with the remaining time I can answer any specific questions you may have on previous content.  For GENERAL recaps of disorders, please listen to the previous tutoring recordings and/or lecture recordings on Canvas.  I will only answer content questions during tutoring (not all week long through individual messages), but you CAN send me any questions you have via Remind and I will answer them during tutoring.  You may leave after the final and celebrate!!!  There is no missed concept review after the final. Final Exam   You MUST complete the nursing evolution to sit for the final  If it is not turned in, you do not get to take the final  Due Sunday October 13th by 2359  Why?  Follow the rubric to receive full credit!  Does not need to be APA  Similarity score should be 25% or less  Do not use an evolution from previous terms  Write it in your own words  Do not use Chat GPT, etc. (there is an AI score now, as well). This is supposed to be about YOUR experience. AI cannot tell me about YOUR experience. Also, this is CHEATING. Nursing Evolution   It’s called the “Zoom Summary”  We will meet live on Zoom on Tuesday October 22nd at 0800.  Use your FIRST AND LAST NAME on Zoom. This is how I will do attendance after the meeting. If you don’t use your name on Zoom, I cannot give you attendance credit.  You MUST attend the Zoom session in order to MANDATORY receive credit for the assignment. Likewise, you must complete the assignment to get attendance credit. THE TWO MUST GO Week 10  TOGETHER. There is NO LATE SUBMISSION for this assignment. Assignment Grades and attendance are due Wednesday morning, so if this assignment is not submitted by 10/22/24 at 2359, you will receive a grade of 0 and and will not get week 10 attendance credit. Also remember that ALL assignments have to be submitted to pass the class. You will fail the class Attendance if you do not submit this assignment.  Watch 3 videos. Answer the questions provided for EACH video. If you only answer one or two of the questions, you will receive a zero.  Does not need to be APA.  Similarity score should be 25% or less. Use your own words!  IF YOU HAVE MAKE-UP CLINICAL ON 10/22/24, REACH OUT TO ME VIA REMIND.  All Assignments Must be Submitted to Pass the Course Per the syllabus, all assignments MUST be submitted in order to successfully pass the course. Go back and look through your grades. If there is any assignment that you did not submit, you MUST submit it even if it will be a zero since it will be past the late deduction window. If any assignment has not been submitted by 10/22/24 @ 2359, you will fail the course no matter what your overall grade is. From the syllabus:  No Grade Changes, Additional Points, or Extra Credit Per the syllabus, instructors are not permitted to give extra credit, adjust grades, allow students to resubmit assignments for a better grade, remove late penalty point deductions, or participate in anything else of this sort to help a student pass the class. This is called grade inflation, and it is unethical. Do not message me after the final asking if there is any way you can get extra points to pass the class. The answer is no. See the grade inflation policy from the syllabus on the next slide. Grade Inflation Policy (From the Syllabus) THANK YOU FOR A WONDERFUL TERM! I wish you all the best on your nursing journey! Keep in touch!