Sensory Changes in the Older Adult - PowerPoint PPT Presentation


Title: Sensory Changes in the Older Adult


1
Sensory Changes in the Older Adult
  • Kristen G. Barbee, RN, BSN
  • MSN Student
  • East Carolina University

2
Visual Changes
  • External eye
  • Loss of skin elasticity may lead to entropian
  • Lashes irritate cornea and conjuctiva
  • Or extropian
  • Lid margins turn out resulting in increased
    corneal exposure

3
Visual Changes
  • Refractive changes
  • Presbyopia-loss of accommodation
  • Arms are too short!
  • Need to hold reading materials at a distance in
    order to focus

4
Cataract
  • Defined as a lens opacity or cloudiness
  • Leading cause of blindness worldwide
  • 3rd leading cause of disability in older adults

5
Cataract
  • 3 types
  • Nuclear cataract is most common. Forms in
    nucleus, or center, of lens. Due to aging.
  • Cortical cataract forms in the cortex. Extends
    spokes from outside of lens to center. Common in
    DM.
  • Subcapsular cataract forms at back of lens. DM,
    farsightedness, retinitis pigmentosa, and
    long-term corticosteroids users develop these.

6
Cataract
  • Signs symptoms
  • Painless, blurry vision
  • Surroundings seem dimmer, as if glasses need
    cleaning
  • Light scattering
  • Glare sensitivity
  • Reduced visual acuity

7
Normal Vision
8
Vision with a Cataract
9
Cataract
  • Risk factors for development of cataracts
    include
  • Aging
  • Eye infections (herpes, uveitis)
  • Retinal detachment or surgery
  • Long-term corticosteroid use
  • Cigarette smoking
  • Obesity
  • Trauma
  • UV radiation
  • Lack of antioxidants in diet
  • DM

10
Diagnosis
  • Snellen visual acuity test
  • Ophthalmoscopy
  • Slit-lamp biomicroscopic examination
  • Degree of lens opacity does not always correlate
    with the level of function
  • Some clients function well with clinically
    significant cataracts
  • Some clients cannot function with relatively
    little opacification

11
Treatment
  • Medical management
  • Not a cure
  • Early stages may see improvement in vision with
    glasses, contacts, strong bifocals, or magnifying
    lenses
  • Reducing glare is necessary
  • Mydriatics (dilate the pupil) may be used
    short-term, although they increase glare

12
Treatment
  • Surgical management
  • Extracapsular surgery-lens removed in 1 piece
  • Posterior capsule (back membrane) left intact
  • Smaller incision
  • Usually no need for sutures
  • Phacoemulsification
  • Ultrasonic waves liquefies nucleus and cortex,
    which are suctioned out through tube
  • Rapid recovery

13
Phacoemulsification
14
Cataract
  • Lens replacement
  • Usually an intraocular lens is placed during
    cataract removal surgery
  • New lens are being used which block damaging UV
    light.
  • Multifocal and accomodating IOLs correct
    nearsightedness and farsightedness
  • Monovision lenses correct presbyopia

15
Complications
  • Infection
  • Acute bacterial endophthalmitis
  • Affects 1 in 1000 cases
  • May require intravitreal antibiotics
  • Malposition of IOL
  • Chronic endophthalmitis
  • Persistent low-grade inflammation
  • After-cataract
  • Posterior capsule becomes cloudy
  • Treat with YAG laser

16
Postoperative Care
  • Eye shield for 24 hours, then at night for 1-4
    weeks
  • Sunglasses when outside
  • Mild oral analgesic may be needed
  • Eye drops
  • Antibiotic, anti-inflammatory, corticosteroid
  • DO NOT RUB EYE!
  • Call physician if vision changes new floaters
    flashing lights increased redness, swelling or
    painamt/type of eye drainage changes any
    injury significant pain not relieved by Tylenol

17
Glaucoma
  • Optic nerve damage related to increased
    intraocular pressure
  • Leading cause of irreversible blindness in the
    world
  • Leading cause of adult blindness in the US

18
Glaucoma Risk Factors
  • Age 40
  • Men Women
  • African-American and Asian races
  • Family history of glaucoma
  • Diabetes
  • Cardiovascular disease
  • Migraine syndromes
  • Nearsightedness
  • Eye trauma
  • Prolonged use of topical/systemic steroids

19
Types of Glaucoma
  • Open-angle
  • Outflow of aqueous humor impeded anterior
    chamber angle normal
  • Normal-pressure
  • IOP normal, yet individually too high
  • Angle-closure
  • Anterior chamber angle narrowed

20
Clinical Manifestations
  • Silent thief
  • Many unaware of disease until have visual changes
    or loss of vision
  • Halos around lights
  • Blurred vision
  • Tunnel vision
  • Loss of peripheral vision
  • Difficulty focusing
  • Difficulty adjusting to low light
  • Aching/discomfort around eyes headache

21
(No Transcript)
22
Medical Management
  • Goal is prevention of optic nerve damage
  • No cure
  • Lifelong therapy
  • Lower IOP

23
Pharmacological Treatment
  • Miotics (pilocarpine)
  • Constrict pupil, increase aqueous humor outflow
  • B-blockers (timolol)
  • Decrease aqueous humor production
  • Alpha-adrenergic agonists (apraclonidine)
  • Decrease aqueous humor production
  • Carbonic anhydrase inhibitors (acetazolamide)
  • Decrease aqueous humor production

24
Surgical Treatment
  • Laser trabeculectomy
  • Make holes in the trabecular meshwork to increase
    outflow
  • Laser iridotomy
  • Opening into iris

25
Nursing Management
  • Safety, especially in unfamiliar surroundings
  • Punctal occlusion
  • Take eyedrops as directed, not when eyes feel
    irritated
  • Regular ophthalmologist visits

26
Age-related Macular Degeneration
  • Most common cause of visual loss in people 60
  • Drusen (tiny, yellowish spots) beneath the retina
  • Central vision most affected
  • Peripheral vision maintained

27
(No Transcript)
28
Types of Macular Degeneration
  • Dry, AKA nonexudative
  • 85-90 of people
  • Outer layers of retina breakdown and drusen
    appears
  • Drusen in macula-blurring of vision
  • No treatment

29
Types of Macular Degeneration
  • Wet, AKA exudative
  • Abrupt onset
  • Choroidal neovascularization
  • Abnormal blood vessels grow under retina
  • Treat with photodynamic therapy
  • IV infusion of photosensitive dye
  • Laser targets dye within abnormal vessels
  • Dye also within blood vessels near skin and may
    be activated with sunlight

30
Hearing Loss
  • 30 of people 65 years and older
  • 50 of people 75 years and older
  • May be familial
  • Presbycusis
  • Progressive hearing loss with loss of high
    frequencies first, then middle and lower
    frequencies

31
Hearing Loss
  • External ear
  • Cerumen impaction
  • Wax harder and drier
  • Otalgia-sense of fullness or pain in the ear
  • Significant cause of hearing loss in elderly
  • Removal by suction, irrigation, or instrumentation

32
(No Transcript)
33
Hearing Loss
  • Middle ear
  • Tympanic membrane atrophy or sclerose
  • Inner ear
  • Cells at base of cochlea degenerate
  • Long exposure to loud noises
  • Medications
  • Aminoglycosides, ASA, Quinine
  • Diabetes

34
Nursing Management
  • Increasing volume only increases frequency
  • Talk in a lower tone
  • Talk directly to client
  • Use gestures and facial expressions
  • May be angry, suspicious, insecure
  • Miscommunication with healthcare providers-write
    things down!
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Sensory Changes in the Older Adult

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Sensory Changes in the Older Adult. Kristen G. Barbee, RN, BSN. MSN Student ... Loss of skin elasticity may lead to entropian. Lashes irritate cornea and conjuctiva ... – PowerPoint PPT presentation

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Transcript and Presenter's Notes

Title: Sensory Changes in the Older Adult


1
Sensory Changes in the Older Adult
  • Kristen G. Barbee, RN, BSN
  • MSN Student
  • East Carolina University

2
Visual Changes
  • External eye
  • Loss of skin elasticity may lead to entropian
  • Lashes irritate cornea and conjuctiva
  • Or extropian
  • Lid margins turn out resulting in increased
    corneal exposure

3
Visual Changes
  • Refractive changes
  • Presbyopia-loss of accommodation
  • Arms are too short!
  • Need to hold reading materials at a distance in
    order to focus

4
Cataract
  • Defined as a lens opacity or cloudiness
  • Leading cause of blindness worldwide
  • 3rd leading cause of disability in older adults

5
Cataract
  • 3 types
  • Nuclear cataract is most common. Forms in
    nucleus, or center, of lens. Due to aging.
  • Cortical cataract forms in the cortex. Extends
    spokes from outside of lens to center. Common in
    DM.
  • Subcapsular cataract forms at back of lens. DM,
    farsightedness, retinitis pigmentosa, and
    long-term corticosteroids users develop these.

6
Cataract
  • Signs symptoms
  • Painless, blurry vision
  • Surroundings seem dimmer, as if glasses need
    cleaning
  • Light scattering
  • Glare sensitivity
  • Reduced visual acuity

7
Normal Vision
8
Vision with a Cataract
9
Cataract
  • Risk factors for development of cataracts
    include
  • Aging
  • Eye infections (herpes, uveitis)
  • Retinal detachment or surgery
  • Long-term corticosteroid use
  • Cigarette smoking
  • Obesity
  • Trauma
  • UV radiation
  • Lack of antioxidants in diet
  • DM

10
Diagnosis
  • Snellen visual acuity test
  • Ophthalmoscopy
  • Slit-lamp biomicroscopic examination
  • Degree of lens opacity does not always correlate
    with the level of function
  • Some clients function well with clinically
    significant cataracts
  • Some clients cannot function with relatively
    little opacification

11
Treatment
  • Medical management
  • Not a cure
  • Early stages may see improvement in vision with
    glasses, contacts, strong bifocals, or magnifying
    lenses
  • Reducing glare is necessary
  • Mydriatics (dilate the pupil) may be used
    short-term, although they increase glare

12
Treatment
  • Surgical management
  • Extracapsular surgery-lens removed in 1 piece
  • Posterior capsule (back membrane) left intact
  • Smaller incision
  • Usually no need for sutures
  • Phacoemulsification
  • Ultrasonic waves liquefies nucleus and cortex,
    which are suctioned out through tube
  • Rapid recovery

13
Phacoemulsification
14
Cataract
  • Lens replacement
  • Usually an intraocular lens is placed during
    cataract removal surgery
  • New lens are being used which block damaging UV
    light.
  • Multifocal and accomodating IOLs correct
    nearsightedness and farsightedness
  • Monovision lenses correct presbyopia

15
Complications
  • Infection
  • Acute bacterial endophthalmitis
  • Affects 1 in 1000 cases
  • May require intravitreal antibiotics
  • Malposition of IOL
  • Chronic endophthalmitis
  • Persistent low-grade inflammation
  • After-cataract
  • Posterior capsule becomes cloudy
  • Treat with YAG laser

16
Postoperative Care
  • Eye shield for 24 hours, then at night for 1-4
    weeks
  • Sunglasses when outside
  • Mild oral analgesic may be needed
  • Eye drops
  • Antibiotic, anti-inflammatory, corticosteroid
  • DO NOT RUB EYE!
  • Call physician if vision changes new floaters
    flashing lights increased redness, swelling or
    painamt/type of eye drainage changes any
    injury significant pain not relieved by Tylenol

17
Glaucoma
  • Optic nerve damage related to increased
    intraocular pressure
  • Leading cause of irreversible blindness in the
    world
  • Leading cause of adult blindness in the US

18
Glaucoma Risk Factors
  • Age 40
  • Men Women
  • African-American and Asian races
  • Family history of glaucoma
  • Diabetes
  • Cardiovascular disease
  • Migraine syndromes
  • Nearsightedness
  • Eye trauma
  • Prolonged use of topical/systemic steroids

19
Types of Glaucoma
  • Open-angle
  • Outflow of aqueous humor impeded anterior
    chamber angle normal
  • Normal-pressure
  • IOP normal, yet individually too high
  • Angle-closure
  • Anterior chamber angle narrowed

20
Clinical Manifestations
  • Silent thief
  • Many unaware of disease until have visual changes
    or loss of vision
  • Halos around lights
  • Blurred vision
  • Tunnel vision
  • Loss of peripheral vision
  • Difficulty focusing
  • Difficulty adjusting to low light
  • Aching/discomfort around eyes headache

21
(No Transcript)
22
Medical Management
  • Goal is prevention of optic nerve damage
  • No cure
  • Lifelong therapy
  • Lower IOP

23
Pharmacological Treatment
  • Miotics (pilocarpine)
  • Constrict pupil, increase aqueous humor outflow
  • B-blockers (timolol)
  • Decrease aqueous humor production
  • Alpha-adrenergic agonists (apraclonidine)
  • Decrease aqueous humor production
  • Carbonic anhydrase inhibitors (acetazolamide)
  • Decrease aqueous humor production

24
Surgical Treatment
  • Laser trabeculectomy
  • Make holes in the trabecular meshwork to increase
    outflow
  • Laser iridotomy
  • Opening into iris

25
Nursing Management
  • Safety, especially in unfamiliar surroundings
  • Punctal occlusion
  • Take eyedrops as directed, not when eyes feel
    irritated
  • Regular ophthalmologist visits

26
Age-related Macular Degeneration
  • Most common cause of visual loss in people 60
  • Drusen (tiny, yellowish spots) beneath the retina
  • Central vision most affected
  • Peripheral vision maintained

27
(No Transcript)
28
Types of Macular Degeneration
  • Dry, AKA nonexudative
  • 85-90 of people
  • Outer layers of retina breakdown and drusen
    appears
  • Drusen in macula-blurring of vision
  • No treatment

29
Types of Macular Degeneration
  • Wet, AKA exudative
  • Abrupt onset
  • Choroidal neovascularization
  • Abnormal blood vessels grow under retina
  • Treat with photodynamic therapy
  • IV infusion of photosensitive dye
  • Laser targets dye within abnormal vessels
  • Dye also within blood vessels near skin and may
    be activated with sunlight

30
Hearing Loss
  • 30 of people 65 years and older
  • 50 of people 75 years and older
  • May be familial
  • Presbycusis
  • Progressive hearing loss with loss of high
    frequencies first, then middle and lower
    frequencies

31
Hearing Loss
  • External ear
  • Cerumen impaction
  • Wax harder and drier
  • Otalgia-sense of fullness or pain in the ear
  • Significant cause of hearing loss in elderly
  • Removal by suction, irrigation, or instrumentation

32
(No Transcript)
33
Hearing Loss
  • Middle ear
  • Tympanic membrane atrophy or sclerose
  • Inner ear
  • Cells at base of cochlea degenerate
  • Long exposure to loud noises
  • Medications
  • Aminoglycosides, ASA, Quinine
  • Diabetes

34
Nursing Management
  • Increasing volume only increases frequency
  • Talk in a lower tone
  • Talk directly to client
  • Use gestures and facial expressions
  • May be angry, suspicious, insecure
  • Miscommunication with healthcare providers-write
    things down!
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