Chapter 20
Metabolic Disorders
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
- Up to 20% older than 65 years of age have hypothyroidism
- Thyroid disorders are difficult to diagnose in older adults
- Signs and symptoms may be nonspecific, atypical, or absent
- Changes may be incorrectly attributed to normal aging, another disorder, or side effects of medications
Thyroid Disorders
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- The most common thyroid problem in older adults
- Onset is slow
- Thought to be caused by chronic autoimmune thyroiditis or inflamed thyroid; may be iatrogenic, resulting from radioiodine treatment, subtotal thyroidectomy, or medications
- Symptoms include heart palpitations, slowed thinking, gait disturbances, fatigue, weakness, or heat intolerance
- Treatment is to slowly replace the thyroxine
Hypothyroidism
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Graves disease is the most common cause
- Can also result from
- Ingestion of iodine or iodine-containing substances
- The medication amiodarone
- The wrong dose of levothyroxine
- May have sudden onset
- Symptoms include unexplained atrial fibrillation, heart failure, constipation, anorexia, and muscle weakness
- In older adults, apathetic thyrotoxicosis may occur
Hyperthyroidism
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Complications occur
- As a result of treatment
- Because of failure to diagnose and treat in a timely manner
- Myxedema coma occurs with untreated hypothyroidism, can result in death
- Thyroxin increases myocardial oxygen consumption and increases risk of
- Atrial fibrillation
- Exacerbation of angina in persons with preexisting congestive heart disease
- Congestive heart failure
Complications of Thyroid Disease
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Pharmacologic intervention
- Surgical or chemical ablation
- Nursing role
- Work with the patient and family to understand the seriousness of the condition
- Provide teaching on the medication regimen
Implications for Gerontological Nursing and Healthy Aging
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
A nurse assessing an older adult would suspect hypothyroidism if which of the following complaints were present? (Select all that apply.)
Fatigue
Weakness
Slowed thinking
Heat intolerance
Heart palpitations
Question
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- A, B, C, E—All are symptoms of hypothyroidism except heat intolerance. The patient would experience cold intolerance with hypothyroidism.
Answer
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Syndrome of disorders of glucose metabolism resulting in hyperglycemia
- Two types
- Type I: The body is unable to produce insulin needed to move glucose into the cells
- Type II: The body does not make enough insulin to keep up with the needs of the body; insulin is available, but the cells are not able to use it
- Wide variation of the prevalence of diabetes exists among ethnic and racial groups
Diabetes
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Diagnosis requires the results of two of three possible tests on 2 different days
- Prediabetes
- Fasting plasma glucose (FPG) is 100 to 125 mg/dL
- Hemoglobin A1c of 5.7% to 6.4%
- Diabetes
- FPG of ≥126 mg/dL
- HgbA1c ≥6.5%
- Random blood glucose of ≥200 mg/dL
Diagnosing Diabetes
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Classic symptoms include thirst and polyuria
- Hyperglycemia is well tolerated in older adults
- Early warning signs include dehydration, confusion, delirium, and some incontinence
- Vague symptoms include fatigue, nausea, delayed wound healing, and paresthesias
Signs and Symptoms of Diabetes
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Can affect a person’s morbidity and mortality
- Complications include heart disease, stroke, neuropathy, and periodontal disease
- Is the leading cause of end-stage renal disease and blindness in those older than 65 years of age
- Wound hearing is delayed
- Relates to a high rate of depression
- Sexual dysfunction can occur
- Person often dies from heart disease
Complications of Diabetes
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Nursing goals
- Control the blood glucose level
- Reduce the risk of complications
- Have the patient maintain the best health that is realistically possible
- Ensure that evidence-based care is received
- Participate in early detection through screening
- Assess for risk factors and signs and symptoms of complications
Implications for Gerontological Nursing and Healthy Aging
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Promoting healthy aging in older adults with diabetes requires an array of interventions and an effective interdisciplinary team working together with the patient and significant others
- Requires expertise in medication use, diet, exercise, counseling, and finding ways to support while empowering the person
Management
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Blood glucose monitoring
- Medication self-administration
- Insulin use
- Oral medication use
- Foot care and examination
- Handling sick days
Needed Self-Care Skills
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Knowledge about the disease and its effects
- Warning signs for high and low glucose levels
- Managing hypoglycemia
- Wearing an identification bracelet
- Adequate and appropriate nutrition
- Daily exercise
Patient Education
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Nurses may be responsible for activities that would normally fall to the patient or caregiver to carry out
- Nutritional status
- Intake and output
- Exercise and activity
- Signs of hypo/hyperglycemia
- Evidence of complications
- Encourages self-care when possible
Long-Term Care and Older Adults With Diabetes
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
A major difference between type 1 and type 2 diabetes is
most older adults with diabetes have type 2 diabetes.
older adults with type 2 usually do not require insulin therapy.
an older adult with type 1 can maintain glycemia with diet and exercise.
the pancreas of an older adult with type 2 does not secret any insulin.
Question
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- A—Most older adults with diabetes have type 2 diabetes.
Answer
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
2020/3/8 Critical Review #1 - WebCOM™ 2.0
https://smc.grtep.com/index.cfm/smcc/page/1criticalreviews 1/10
Santa Monica College Democracy and Di�erence Through the Aesthetics of Film Tahvildaran
Assignment Objectives: Enhance and/or improve critical thinking and media literacy skills by: 1. Developing a clear and concise thesis statement (an argument) in response to the following question: Does the �lm have the power to transform political sensibilities? 2. Writing an outline for a �ve paragraph analytical essay building on a clear and concise thesis statement, including topic sentences and secondary supports. 3. Identifying and explaining three scenes from the �lm text in support of the thesis statement/argument. 4. Writing an introductory paragraph for the outlined analytical essay
Be sure to read thoroughly the writing conventions below before beginning this assignment. Note: You are NOT writing a full essay; rather, you are outlining an analytical essay by completing the dialogue boxes below.
Writing a Critical Review (analytical) Essay
2020/3/8 Critical Review #1 - WebCOM™ 2.0
https://smc.grtep.com/index.cfm/smcc/page/1criticalreviews 2/10
1. Every essay that you write for this course must have a clear thesis, placed (perhaps) somewhere near the end of the introductory paragraph. Simply stated, a THESIS (or ARGUMENT) expresses, preferably in a single sentence, the point you want to make about the text that is the subject of your essay. A THESIS should be an opinion or interpretation of the text, not merely a fact or observation. The best possible THESIS will answer some speci�c questions about the text. Very often the THESIS contains an outline of the major points to be covered in the essay. A possible thesis for an essay on character in Perry Henzell’s The Harder They Come might read somewhat as follows:
The protagonist of THTC is not a hero in the epic sense of the word, but a self-centered young man bred of economic oppression and cultural dependency. The characters in this �lm have no real psychological depth, but are markers for a society of consumption and momentary glory.
(You might then go on to exemplify from the text and argue in favor or against this interpretation: your essay need not hold to only one perspective.)
What single, clear QUESTION does the above THESIS attempt to answer?
2. Each essay should be organized into �ve (5) paragraphs, each based on one of two to four major ideas, which will comprise the BODY of the essay. Each paragraph must have a topic sentence, often (but not always) towards the beginning of the paragraph, which clearly states the ARGUMENT or point to be made in the paragraph. Following the thesis set forth above, the �rst paragraph might begin with a sentence like “Ivan’s desires and his destiny are signaled in the opening shots of the �lm, where the friendly, jumbled interior of the bus is contrasted with Ivan’s �rst view of the outer world: a world of shiny white cars and beautiful women.” Avoid topic sentences that fail to make an interpretative statement about the work or that merely state something any reader might observe; for example, “The �rst characters we see are country people on a bus to town.”
2020/3/8 Critical Review #1 - WebCOM™ 2.0
https://smc.grtep.com/index.cfm/smcc/page/1criticalreviews 3/10
3. Underline the THESIS and each TOPIC SENTENCE in every critical review essay you submit. This exercise will force you to make certain that you have expressed and developed the ideas in your essay clearly and logically. (In other words, do not do this exercise �ve minutes before you submit the essay but, rather, as you are working on the very �rst draft.)
4. Always use present tense verbs in your critical review essays about �lm texts. Present tense is the verb tense of analysis. Past tense, on the other hand, is the tense of narration. In each essay, you will be analyzing a particular text, not retelling or summarizing the story. If you �nd yourself slipping into past tense as you compose, you are probably narrating rather than analyzing.
5. Use speci�c passages from the text to support each point that you make in your essay. You may simply refer to an event in the text, or you may paraphrase what a character or the narrator says. But the best EVIDENCE will most often be direct quotes from the text.
The Introductory Paragraph – Some Approaches
In your essay, an opening or introductory paragraph may not always be the �rst one you write. But it will be the �rst one your readers read and you need to engage your readers’ attention and interest and present all you need to make your thesis clear and convincing.
I. Some Pitfalls to Avoid
1. Dictionary de�nitions: De�ne key terms and concepts in your opening paragraph, but don’t quote directly from the dictionary to do so. Use a dictionary – more than one dictionary – to formulate the de�nition in your own words.
2020/3/8 Critical Review #1 - WebCOM™ 2.0
https://smc.grtep.com/index.cfm/smcc/page/1criticalreviews 4/10
2. Generalizations about “life,” “society,” “people today,” etc.: You don’t want to begin your essay with the kind of statement that teeters on that �ne line between opinion (those ideas you will go on to prove) and belief (those ideas unprovable with the evidence offered by the text). Rather than a statement like, “Almost every man has a sense of pride and will go to war to prove it,” try something more speci�c to the text you are analyzing. “The character of Roland exempli�es how personal pride and personal valor do not always lead to the most fortunate conclusion.”
3. The painfully obvious: Avoid opening statements like “Dante’s Inferno is about a journey to hell,” or "Roland is the hero of The Song of Roland,” unless such statements are in some way controversial and challenging to traditional interpretations of the text. Try to avoid any kind of tautological formula – “something is something else” – in the opening sentence, especially, but also elsewhere as an “argument.”
4. Try to distinguish between historical or biographical fact: “Dante’s Inferno was written in fourteenth-century Italy,” and interpretation, especially when you are considering the intention of an author: “Dante wrote his Inferno to expose the problem of Florentine political corruption to the world.” The latter may be a part of your theory or thesis (or conclusion) but if you use it as a statement of fact (an “intentional fallacy”) you will have to prove it rather than merely argue it – a slippery and di�cult and perhaps not particularly useful task. Beware also of using vague or imprecise generalizations of terms such as “dramatic,” “realistic,” or “critical,” which differ in their literary and historical signi�cance.
II. Challenges to Meet
1. Try for a (syntactically) shapely and relevant opening sentence: be thoughtful and original and persuasive. Always look for interesting ways into your essay: an epigraph, perhaps, or an important episode
2020/3/8 Critical Review #1 - WebCOM™ 2.0
https://smc.grtep.com/index.cfm/smcc/page/1criticalreviews 5/10
CRITICAL REVIEW #1 DUE MARCH 25, 2020
that seems to set the stage for what you want to say, or a succinct comparison with another well-known work, which will help your reader understand the point you want to make.
2. Always (particularly in a comparative essay) identify your texts early on. (Usually with full title, full authors’ names, and date/period of publication.)
3. Think of your thesis statement as the logical goal of the �rst paragraph. Everything you say here should lead towards (or from) that thesis. Anything that doesn’t lead in that direction – unless you are presenting a view different from yours, which you want to argue against—doesn’t belong in your paragraph. Think of the paragraph as a funnel, where the contents are being concentrated and �ltered to one end.
Using proper MLA bibliographic formatting, cite the �lm text in the box to the right: http://www.bibme.org/citation- guide/MLA/�lm
The most basic entry for a �lm consists of the title, director, distributor, year of release, and medium. You
*
How to cite a �lm in a bibliography using MLA
2020/3/8 Critical Review #1 - WebCOM™ 2.0
https://smc.grtep.com/index.cfm/smcc/page/1criticalreviews 6/10
may also choose to include the names of the writer(s), performer(s), and the producer(s), as well as the �lm’s original release date. Film title. Dir. First Name Last Name. Distributor, Year of Release. Medium.
1. Develop a thesis sentence pertaining to the assigned �lm text and whether or not it, the �lm, in your view has the power to transform one’s political sensibilities. Your argument should express your point of view regarding the politics of difference, political sensibilities, and political transformation(s) as related to the �lm. Remember, you’re writing (developing) an analytical essay. Submit your thesis statement in the box located to the right. Be sure to proofread your work.
*
2020/3/8 Critical Review #1 - WebCOM™ 2.0
https://smc.grtep.com/index.cfm/smcc/page/1criticalreviews 7/10
2. Develop three (3) topic sentences that articulate the major ideas that will comprise the body of your essay. Remember that your topic sentences should clearly state the argument or point to be made in the respective paragraphs and must map back to your thesis statement. Submit your topic sentences in the box located to the right. Be sure to proofread your work.
*
3. Identify three (3) scenes from the �lm that support your thesis statement. Brie�y explain your choices of scenes and how the scenes speci�cally support your thesis statement. Also,
*
2020/3/8 Critical Review #1 - WebCOM™ 2.0
https://smc.grtep.com/index.cfm/smcc/page/1criticalreviews 8/10
provide the exact time the scenes begin and end within the �lm text. Submit your reply in the box located to the right. Be sure to proofread your work.
4. Lastly, fully develop your introductory paragraph. Remember that the best possible thesis will answer some speci�c question about the text. In this case a question related to the �lm’s power to transform political sensibilities regarding difference. Your thesis sentence should appear parenthetically within the paragraph you present. Submit your answer in the box located to the right. Be sure to proofread your work.
*
2020/3/8 Critical Review #1 - WebCOM™ 2.0
https://smc.grtep.com/index.cfm/smcc/page/1criticalreviews 9/10
Before submitting your Critical Review make sure you have read these questions and that you fully understand the grading rubric: 1. Did I properly cite the �lm text using MLA format? Speci�cally, did I follow the example provided to me on the Democracy and Difference website? Did I click on the link to the BibMe website and review how to cite a �lm for a bibliography? Do I understand that any errors in the citation will result in a loss of points? Students who do not properly cite the �lm will see a reduction in points for this assignment 25/50. 2. Did I answer, directly, the professor's question: "Does the �lm have the power to transform one's political sensibilities?" Is it clear to the reader (the professor in this case) that I have taken a stand/made an argument pertaining to the assignment prompt? Again, “Does the �lm have the power to transform one’s political sensibilities?” Students should be sure to address: POWER, POLITICAL SENSIBILITES, and TRANSFORMATION in their thesis sentence/statements. Did I do this? Students who do not properly address this direct question will see a reduction in points for this assignment 25/50. 3. Did I provide the start and end times for each of the three scenes I chose in support of my thesis sentence/statement? And, did I explain explicitly why I chose those scenes? It is not su�cient to list scenes only. Did I explain clearly (and brie�y) why I chose the scene that I did and how they speci�cally advance my argument/thesis? Is it clear to the reader (the professor in this case) why I chose the scene I did? For example, did I write something like: “I chose the scene because it advances my argument by ….” or “I chose the scene because it clearly makes my point that …” Students who did not provide start and end times and/or explain their scene choices will see a reduction in points for this assignment 25/50. 4. Did I fully develop an introduction paragraph? And, in that paragraph did I insert my thesis sentence/statement? Did I use parentheses (to bracket my thesis statement/sentence) within the introduction paragraph? Students who did not fully develop this introduction paragraph and use parentheses (to bracket their thesis statement/sentence) will see a reduction in points for this assignment 25/50.
*
2020/3/8 Critical Review #1 - WebCOM™ 2.0
https://smc.grtep.com/index.cfm/smcc/page/1criticalreviews 10/10
WebCOM™ 2.0 is a trademark of Great River Learning. All rights reserved. © 2002-2020.
If a student fails to address any one of these components their score will result in a 25/50 per the syllabus.
S AV ES AV E
SUBM I TSUBM I T
I acknowledge this statement
Chapter 19
Diseases Affecting Vision and Hearing
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
- Visual impairment has a negative impact on the quality of life
- More than two-thirds of those with visual impairment are older than 65 years of age
- Those older than 80 years of age account for 70% of the cases of severe visual impairment
- Significant racial and cultural disparities in vision impairment
Vision Impairments
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Glaucoma
- Cataracts
- Diabetic retinopathy
- Diabetic macular edema
- Macular degeneration
- Detached retina
- Dry eye
Diseases of the Eye
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- A clouding of the eye’s normally clear crystalline lens, causing the lens to lose transparency or scatter light
- Most common causes are heredity and advancing age
- Categorized by their location
- Nuclear cataract
Most common type
Incidence increases with age and cigarette smoking
- Cortical cataract
More common with age
Related to a lifetime exposure to ultraviolet light
- Posterior subcapsular
Cataracts
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Most common symptom is cloudy or blurred vision
- Other symptoms include glare, halos around lights, poor night vision, perceiving that colors are faded or that objects are yellowish, and the need for brighter light when reading
- Red reflex may be absent or may appear as a black area
Signs and Symptoms
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Surgery is the most common
- Involves removing the lens and placing a plastic intraocular lens (IOL)
- Usually done on an outpatient basis
- Nursing interventions include
- Teaching
Avoid heavy lifting, straining, or bending at the waist
Wear glasses during the daytime and a shield at night
- Administer eye drops to aid the healing process and to prevent infection
Treatment
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Natural fluids of the eye are blocked by ciliary muscle rigidity, pressure builds, and damage to the optic nerve occurs
- Second leading cause of blindness in the United States
- Types include congenital glaucoma, primary open-angle glaucoma, low-tension or normal-tension glaucoma, secondary glaucoma, and acute angle-closure glaucoma (medical emergency)
Glaucoma
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Most common form
- Risk varies by race and age
- Other high-risk groups include those with diabetes, hypertension, history of corticosteroid use, and family history of glaucoma
- Usually affects side vision first and may go unnoticed for years
Primary Open-Angle Glaucoma
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Headaches
- Poor vision in dim lighting
- Increased sensitivity to glare
- Complaints of “tired eyes”
- Impaired peripheral vision
- A fixed and dilated pupil
- Frequent changes in prescriptions for corrective lenses
Signs and Symptoms
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Occurs when the angle of the iris causes obstruction of the aqueous humor through the trabecular network
- Medical emergency; blindness can occur in 2 days
- Those with smaller eyes, Asians, and women are most susceptible
- May occur with infection or trauma
- Symptoms include redness and pain in and around the eye, severe headaches, nausea and vomiting, and blurred vision
Angle-Closure Glaucoma
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Adults older than 65 years of age need annual eye examinations
- Those with medication-controlled glaucoma should be examined every 6 months
- Those with a family history of glaucoma and African Americans should be screened annually after age 40 years
Glaucoma Screening
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Oral or topical eye drops that lower eye pressure
- Either decrease the amount of aqueous fluid produced within the eye or improve the flow through the drainage angle
- Beta blockers are the first-line therapy followed by prostaglandin analogs
- Second-line agents include topical carbonic anhydrase inhibitors and α2-agonist
- Laser surgery treatments may be recommended
Treatment
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Complication of diabetes
- Leading cause of blindness in the United States
- Blood and lipid leakage leads to macular edema and hard exudates
- No symptoms occur in the early stages
- Early findings observed in funduscopic examination are microaneurysms, flamed-shaped hemorrhages, cotton-wool spots, hard exudate, and dilated capillaries
Diabetic Retinopathy
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Annual dilated fundoscopic examination should begin 5 years after diagnosis of diabetes type 1 and at the time of diagnosis of diabetes type 2
- Laser treatment can reduce vision loss
- Strict control of blood glucose, cholesterol, and blood pressure
Screening and Treatment
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Thickening of the center of the retina
- Leading cause of legal blindness
- Affects 1 in 25 adults age 40 years and older with diabetes
- Incidence is higher in African Americans and Hispanics
- Treatments include medications (cortisone-type drugs), laser therapy, and anti-VEGF therapy (Lucentis)
Diabetic Macular Edema
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Leading cause of vision loss in Americans who are 60 years of age and older
- Age is the greatest risk factor
- Other risk factors include genetic predisposition, smoking, hypertension, obesity, and a family history
- Causes progressive loss of central vision, leaving only peripheral vision intact
Macular Degeneration
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Geographic atrophy (dry age-related macular degeneration [AMD])
- Rapid, severe loss of central vision
- Many will be legally blind within 2 years of diagnosis
- Neovascular AMD (wet AMD)
- Occurs when abnormal blood vessels behind the retina start to grow under the macula
- These new blood vessels often leak blood and fluid, which raise the macula from its normal place at the back of the eye
Types of Age-Related Macular Degeneration
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Causes the progressive loss of central vision, leaving only peripheral vision intact
- Awareness of a blurry spot in the middle of vision; blurred areas grow larger, and blank spots develop, leading to difficulty reading and writing
- Increased need for bright light
- Colors appear dim and gray
Signs and Symptoms
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Amsler grid is used to determine the clarity of vision
- In early AMD, exercise, avoiding smoking and a diet high in green leafy vegetables and fruits may help keep vision longer
- Treatment includes photodynamic therapy, laser photocoagulation, and anti-VEGF therapy
Screening and Treatment
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Medical emergency
- Can occur spontaneously or after recent cataract surgery or eye trauma
- Exhibits a “curtain coming down” over the line of vision and a gradual increase in floaters or light flashes
- Small holes or tears are treated with laser surgery or cryopexy
- Retinal detachments treated with surgery
Detached Retina
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Not a disease but a frequent complaint among older adults
- Causes can include medications such as antihistamines, diuretics, beta blockers, and sleeping pills
- Common treatment is artificial tears or saline gel
- Management includes using a home humidifier and avoiding wind and hair dryers
Dry Eye
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Which disorder would the nurse suspect in a patient complaining of intense headaches, bloodshot eyes, and blurred vision?
Cataracts
Detached retina
Macular degeneration
Angle-closure glaucoma
Question
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- D—Symptoms of acute angle-closure glaucoma include redness and pain in and around the eye, severe headaches, nausea and vomiting, and blurred vision.
Answer
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
*
- Use warm incandescent lighting
- Increase the intensity of lighting
- Control glare by using shades and blinds
- Use yellow-to-amber lenses to decrease glare
- Wear sunglasses to block out ultraviolet light
- Use reading materials in large, dark print
- Choose sharply contrasting colors
Interventions to Enhance Vision
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Financial and social governmental programs
- Insulin-delivery systems
- Talking clocks and watches
- Large print books
- Magnifiers
- Telescopes with handheld devices or attached to eye glasses
- Electronic magnification
Low-Vision–Assisted Devices
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Vision deficiencies affect communication, functional abilities, safety, and quality of life
- Nursing concerns
- Appropriate assessment
- Environmental adaptation to enhance vision and safety
- Communicating appropriately
- Providing appropriate health teaching
- Providing appropriate referrals for prevention and treatment
Implications for Gerontology Nurses and Healthy Aging
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Third most chronic condition in U.S. older adults
- Of those who are 80 years of age and older, 80% have hearing loss
- Racial and gender disparities exist in hearing impairment
- Risk factors include noise exposure, ear infections, smoking, and chronic disease (e.g., diabetes, chronic kidney disease, heart disease)
Hearing Impairments
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Diminishes the quality of life
- Increases social isolation
- Decreases function
- Increases likelihood of hospitalizations, miscommunication, depression, falls, loss of self-esteem, and safety risks
- Increases cognitive decline and dementia
Consequences
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Conductive loss
- Involves abnormalities of the external and middle ear, which reduces the ability of sound to be transmitted to the middle ear
- Is caused by otosclerosis, infection, perforated eardrum, fluid in the middle ear, or cerumen accumulation
- Sensorineural loss
- Result of damage to any part of the inner ear or the neural pathways to the brain
- Includes presbycusis and noise-induced hearing loss
Types of Hearing Loss
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Perception of sound in one or both ears or in the head when no external sound is present
- Described as a “ringing in the ears”
- May be described as buzzing, hissing, whistling, cricket chirping, bells, roaring, clicking, pulsating, humming, or swishing sounds
- May be constant or intermittent
Tinnitus
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Exact cause can be unknown
- Exposure to loud noises is the leading cause
- Exacerbated by caffeine, alcohol, smoking, stress, and fatigue
- High-pitched tinnitus common with sensorineural loss
- Low-pitched tinnitus reported in Meniere disease
- Maintain a diary for times when noise is heard
- Assess medication history
- Lifestyle modifications and treatments
Assessment and Treatment
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Hearing aids to amplify sound
- Cochlear implants to bypass damaged portions of the ear and stimulate the auditory nerve in those with sensorineural hearing loss
- Assisted listening and adaptive devices
Interventions to Enhance Hearing
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
What information will the nurse include when teaching a patient about using a hearing aid?
“This amplifies sound and directs it into the ear canal.”
“You will be able to hear better in noisy or crowded rooms.”
“It will assist you to interpret the incoming sounds more effectively.”
“This will bypass damaged portions of the ear and stimulate the auditory nerve.”
Question
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- A—Hearing aids amplify sound in part by directing sound into the ear canal.
Answer
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
- Hearing impairment affects communication, safety, and quality of life
- Nursing concerns
- Appropriate assessment
- Communicating appropriately
- Properly caring and maintaining hearing aids
- Providing appropriate health teaching
- Providing appropriate referrals for prevention and treatment
Implications for Gerontology Nurses and Healthy Aging
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
*

Get help from top-rated tutors in any subject.
Efficiently complete your homework and academic assignments by getting help from the experts at homeworkarchive.com