Vision and Hearing Problems in the Older Adult

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A. Purulent discharge in the affected eye B. Fever of 102 degrees Fahrenheit (38.9 degrees Centigrade) E. Pain in the eye

A client is being discharged after surgery to correct a retinal detachment. Which symptoms will the nurse teach the client to immediately report to the eye care provider? (SATA) A. Purulent discharge in the affected eye B. Fever of 102 degrees Fahrenheit (38.9 degrees Centigrade) C. Pupil that constricts in response to light D. Improved visual acuity E. Pain in the eye

C. Severe pain around eyes D. Ectropion D. Dryness of the ear canal

A nurse in an emergency unit is reviewing the medical record for a client who is being evaluated for angle-closure glaucoma. Which of the following findings are indicative of this condition? A. Insidious onset of painless loss of vision B. Gradual reduction in peripheral vision C. Severe pain around eyes D. Intraocular pressure 12 mm Hg An older person seeks medication attention for irritation of the lower eyelid. To which age-related change in the eye should the nurse attribute this person's symptom? A. Decrease eyelid muscles B. Arcus senilis C. Thin skin around the eye D. Ectropion An older person is concerned about bleeding from the ear when using a cotton swab to remove cerumen. What should the nurse explain to the person about this symptom? A. Loss of sensory hair cells B. Atrophy of the organ of Corti C. Increased production of cerumen D. Dryness of the ear canal

C. Blurred vision D. White pupils

A nurse is caring for a client who has a new diagnosis of cataracts. Which of the following manifestations should the nurse expect? (SATA) A. Eye pain B. Floating spots C. Blurred vision D. White pupils E. Bilateral red reflexes

B. Genetic predisposition C. Hypertension D. Age E. Diabetes Mellitus

A nurse is caring for an older male client who has a new diagnosis of glaucoma. Which of the following should the nurse recognize as risk factors associated with the disease? (SATA) A. Gender B. Genetic predisposition C. Hypertension D. Age E. Diabetes Mellitus

A. Increase intake of deep yellow and orange vegetables (antioxidants and carotenoids) B. Nasolacrimal duct C. "This medication can absorb into your contacts."

A nurse is providing teaching for a client who has a new diagnosis of dry macular degeneration. Which of the following instructions should the nurse include in the teaching? A. Increase intake of deep yellow and orange vegetables B. Administer eyedrops twice daily C. Avoid bending at the waist D. Wear an eyepatch at night A nurse is instructing a client who has a new prescription for timolol. She is teaching them how to insert eye drops. This nurse should instruct the client to press on which of the following areas to prevent systemic absorption of the medication? A. Bony orbit B. Nasolacrimal duct C. Conjunctival sac D. Outer canthus A nurse is teaching a client who has a new prescription for brimonidine ophthalmic drops and wears soft contact lenses. Which of the following instructions should the nurse include in the teaching? A. "This medication can stain your contacts." B. " This medication can cause your pupils to constrict. C. "This medication can absorb into your contacts." D. "This medication can slow your heart rate."

the deterioration of the macula (area of CENTRAL VISION), which results in LOSS OF CENTRAL VISION or dark spots in central vision. It can be classified as age related or exudative

Age-Related Macular Degeneration (AMD OR ARMD) · Macula or Retina is the most important part of eye (Contains Fovea where visual acuity is highest) · Macular Degeneration: _________________________________________________________________ § Leading cause of blindness in adults over age 65. (especially with comorbidities) § Decreased blood supply, waste products, tissue atrophy, nutrition, and systemic disease all contribute § It is diagnosed with Ophthalmoscopy and visual acuity tests § Deposits under the retina called drusen are a common feature of macular degeneration. Drusen alone usually do not cause vision loss, but when they increase in size or number, this generally indicates an increased risk of developing advanced AMD. People at risk for developing advanced AMD have significant drusen, prominently with dry AMD or abnormal blood vessels under the macula in one eye ("wet" form). Age-Related Macular Degeneration (AMD OR ARMD) Symptoms · Blurred vision, lack of depth perception, distorted appearance of objects, eventual blindness · Center of vision is dark · Develop central loss of vision -> impaired reading and recognition of objects but side vision and mobility remain intact · Glasses don't help

high-frequency sounds is lost at first, and older adults can have trouble hearing "f, s, sh, and pa" sounds

Age-Related Changes in the Ear and Hearing and Nursing Interventions (per IGGY) · Reassure the patient that elongated pinna is normal. Don't fold the ear under the head when laying on the side · Reassure the patient that hair in the ear canal gets coarser and longer, especially in men. More frequent ear irrigation may be needed to prevent cerumen clumping · Cerumen gets drier and impacts more easily in older adults, which can reduce hearing function. Older adults may need ear canal irrigation weekly or whenever they notice changes in hearing · Tympanic membrane loses elasticity and can appear dull or retracted in older adults. This should not be confused with a symptom of otitis media · Hearing acuity can decrease in older adults, but do not assume that all older adults have hearing loss. Assess hearing with voice tests or watch test. If a deficit is present, refer the patient to a specialist to determine hearing loss and appropriate interventions · The ability to hear ________________________________________________________________. Provide a quiet environment and face the patient (don't sit in front of bright lights or windows). Make sure the patient is wearing their glasses and speak slowly, clearly, and in a deeper voice. Emphasize beginning word sounds. Sometime patients can benefit from wearing a stethoscope while listening to you speak.

1. Zinc oxide 80 mgm 2. Cupric oxide 2 mg 3. Beta carotene 15 mgm 4. Vitamin C 500 mgm 5. Vitamin E 400 IU

Age-Related Macular Degeneration (AMD OR ARMD) · Risk Factors for Age-Related Macular Degeneration (AMD OR ARMD) 1. Age (above the age of 50) 2. Cigarette smoking (smoking increases progression rate of dry AMD) 3. Family history of ARMD 4. Diet poor in carotene and vitamin E 5. Increased exposure to ultraviolet light 6. Caucasian race and light-colored eyes 7. Hypertension, cardiovascular disease, hyperlipidemia 8. Lack of dietary intake of antioxidants and zinc 9. Female gender, short stature · Nurses Should Encourage Prevention Of ARMD: 1. Eye exam every year to detect changes 2. Wearing ultraviolet protective lenses in sun 3. Smoking cessation 4. Exercising routinely 5. Eating a healthy diet consisting of fruits and vegetables to increase consumption of antioxidants. 6. Consuming lutein and zeaxanthin: eggs, spinach, romaine lettuce, broccoli, corn, Brussel sprouts 7. Taking vitamins in divided doses twice a day to delay progression: -1 -2 -3 -4 -5 Age-Related Macular Degeneration (AMD OR ARMD) Symptoms · Blurred vision, lack of depth perception, distorted appearance of objects, eventual blindness · Center of vision is dark · Develop central loss of vision -> impaired reading and recognition of objects but side vision and mobility remain intact · Glasses don't help

1. Little more acute onset of s/s (especially with detachment of epithelium) 2. More light required for reading 3. Can have drusen, but abnormal blood vessels are more prominent 4. Blurred central vision, visual distortion (straight lines look wavy) 5. Central scotomas: scar formation from drusen bodies; blind spots in visual field 6. Metamorphopsia: images are distorted to look smaller or larger than they actually are

Age-Related Macular Degeneration (ARMD) Two types: · "Wet" Neovascular Macular Degeneration (Exudative): This form of macular degeneration results when abnormal blood vessels form underneath the retina at the back of the eye. These new blood vessels leak fluid or blood and cause scars that blur central vision. Vision loss may be rapid and severe. § Blood or serum lead from newly formed blood vessels beneath retinaà scar formation + visual problems § Symptoms of "Wet" Neovascular Macular Degeneration (Exudative): 1 2 3 4 5 6

1. Slow progression of central visual loss with blurring and image distortion 2. Atrophy 3. Retinal pigment degeneration (like plastic wrap over the eye) 4. Drusen accumulations: cellular debris that appear as yellow spots, galaxy 5. Other symptoms

Age-Related Macular Degeneration (ARMD) Two types: · Dry Age-Related Macular Degeneration (atrophic form): This macular degeneration is caused by aging and thinning of the tissues of the macula. There is gradual blockage of retinal capillaries which allows retinal cells to become ischemic and necrotic. Vision loss is usually gradual. Most people have the "dry" form of AMD. § Symptoms of Dry Age-Related Macular Degeneration (atrophic form): 1 2 3 4 5 § Has no cure, so treatment is focused on slowing progression and maximizing vision and QOL § Long-term intake of antioxidants, vitamin B12, and carotenoids (lutein and zeaxanthin) both prevent risk of dry AMD and slow progression of dry AMD

§ Stains on clothing § Too much or poorly applied makeup § Multiple bumps/bruises § Squinting or tilting the head to see § Changes in ability to read, drive (BIG SAFETY CONCERN), watch TV, or write § Holding objects closer to the face § Problems with color discrimination and using stairs Hesitation in reaching for objects or not being able to find something

An older adult comes into your clinic for a routine check-up. As you note their general appearance and signs and symptoms, what are some signs of visual impairment?

always intact, shiny, transparent, or opaque, pearly gray, without lesions, and with presence of a light reflex (left eardrum = light reflex in left lower quadrant or 7 o'clock; right eardrum = light reflex in right lower quadrant or 5 o'clock)

Assessment of Hearing Impairment · History: ear trauma/surgery, infections, excess cerumen, ear itching, using Q-tips to clean ears, ear hygiene, loud noise exposure, air travel, use of ear protection when swimming, heart disease, hypertension, diabetes, vitiligo, smoking, vitamin B12/folate deficiency, · Ask about problems that may cause hearing impairment: allergies, URI, hypothyroidism, atherosclerosis, osteogenesis imperfecta, Down syndrome, head trauma, head surgery, or ototoxic drugs · Question ototoxic hearing problems if they take: gentamycin, erythromycin, cisplatin, furosemide, baclofen, propranolol, or other ototoxic medications · Assess symptoms of Hearing Impairment/Loss: § Tilting the head to one side or leaning forward when listening to someone speak; straining to hear § Frequently asking someone to repeat statements, saying "what?" or "huh?" § Difficulty understanding speech, especially in loud rooms § Mismatched responses to questions: Asking the patient "how old are you" and they respond "No I don't have a cold" § Decreased ability to hear "f, s, sh, th, ch and pa" sounds (this often occurs early) § Ear pain or discharge § Hyperacusis: intolerance for sound levels that don't bother other people § Tinnitus: ringing in ears § Feeling of fullness in ears, dizziness, feelings of "off balance", or vertigo · Otoscopic Exam: don't use the otoscope to examine ears of anyone who can't hold their head still or who is confused. § Tilt patient's head slightly away and hold the otoscope upside down (like a large pen) § Pull the pinna up and back/out and use caution when inserting the speculum because touching the speculum to the walls of the ear canal cause pain § Observe the ear canal as your insert the speculum through the external canal to avoid the risk of perforating the eardrum § A normal eardrum is ___________________________________________________________________________________ · Voice/Whisper Test: ask the patient to block one ear canal while standing about 1-2ft away. Whisper a statement and have the patient repeat what you said. Test each ear separately. If you think the patient is reading your lips, block view of your mouth · Assess for lip reading · Weber Test: tuning fork is placed on top of head. The person without hearing loss hears sound from vibrating fork equally in both ears · Rinne Test: placing tuning fork on mastoid bone. Normally air conduction should be longer than bone conduction, so they should hear the tuning fork after it is moved alongside the person's ear · Assess And Encourage The Ability To Perform Activities Of Daily Living § Communication: use devices to type messages for those with hearing/verbal impairment; use sign language § Use closed captioning for watching TV § Driving or taking public transportation § Safety awareness including the ability to hear alarms, doorbells. Use flashing lights or vibrations to get attention instead of phone ringing or alarms. § Engaging in leisure and recreational activities · Refer to an audiologist. They will perform a very detailed hearing test/audiometry

KEEP THIS ID CARD SOMEWHERE SAFE (like a wallet, which can stay on there person at all times); MAKE A COPY for backup (electronic copy stored in cloud, storing it on paper and kept in fireproof safe)!!

Cataracts Cataract Outpatient Surgeries · Intra Capsular Cataract Surgery: Removal of lens and its capsule thru wide incision in cornea · *Extracapsular Cataract Surgery: Contents of lens aspirated by large-bore needle thru small incision in cornea, leaving posterior portion of lens capsule behind. IOL placed there § Some people do not tolerate this, and they require an additional surgery to create a hole in the posterior lens. This is determined by if they develop opacity after initial surgery. · Phacoemulsification with Lens Implant (Cataract Extraction): a probe is inserted through the capsule and sound waves break up the lens into small pieces, which are then removed. Then the replacement lens in placed in the capsule § ALL PATIENTS must tell their providers that they have a replacement lens device (you get an ID card that tells you the serial #, date of insertion, etc) because devices can get recalled! § THEY NEED TO _______________________________________________________________________________________ · REMEMBER: All patients must have some type of replacement lens when they have cataract surgery!!!!!!! § Intra ocular implanted lens especially >70 § Contact lens § Eyeglasses- Simplest and safest but have difficulty with depth perception and peripheral vision

warfarin, clopidogrel, aspirin, any drug that affects clotting

Cataracts Pre-Op Care Cataract Surgery · All consents signed; education on cataracts, their progression, and treatment · Assess how the reduced vision affects ADLs (dressing, eating, ambulating) · Reinforce care for after surgery: several different eyedrops several times/day for 2-4wk · Ask about _____________________________________________________ because the surgeon may want to discontinue them · NPO · Void before surgery! They will be there for a while and they can't get up during surgery! · Measures to decrease Intraocular Pressure (IOP) · Instill Eyedrops to DILATE pupil and cause VASOCONSTRICTION; other eyedrops are instilled to paralyze the eye and prevent lens movement · May clip eyelashes · Vitals, Labs (INR, etc) · Arrange for someone to drive them home after · Surgeon verifies that they are doing R/F eye, and they mark the side of the face that they are operating on! · After the patient is in the surgical area, a local anesthetic is injected behind the eye

· HOB in Semi-Fowlers position (because laying supine = increased ocular pressure) · Lying on back with HOB elevated or unoperated side (for the first day, it might be good to tell them to sleep in a recliner to prevent them from turning onto the operative side)

Cataracts · Antibiotic eye drops instilled · Anti-inflammatory or corticosteroid eye drops instilled · Eye drops to constrict pupil - Positioning:_________________________ - · Monitor for nausea and vomiting, which increases intraocular pressure and can cause bleeding. TREAT THEM FOR N/V EARLY, such as when they are just nauseated to prevent them from actually vomiting · Pain early after surgery can indicate intraocular pressure or bleeding, so patients should call the surgeon if this occurs with nausea or vomiting. · Minimum light exposure (bright light would be painful). Tell them to wear dark glasses outdoors or in brightly lit areas until the pupil responds to light · NORMAL: Eye itching is normal. A "blood shot" appearance is normal. The eyelid can be slightly swollen. § BUT, significant swelling or bruising is ABNORMAL · Treat discomfort with a cool compress, acetaminophen (not aspirin due to bleeding risk)

corticosteroid, phenothiazine derivatives, beta blockers, or mitotic medications

Cataracts · Cataract Prevention § Wearing hats and sunglasses (with UVA & UVB protective coating) when in the sun. § Smoking cessation § Eat a low-fat diet rich in antioxidants and vit. E & C § Avoid ocular injury (wear goggles/eye protection when using power tools or doing hazardous activities) § Encourage annual eye exams, especially in those older than 40 · Risk Factors for Cataracts: § Increased age; especially age over 50-65 § Family history of cataracts § Smoking and alcohol § Obesity § Diabetes, hyperlipidemia, hypertension, hypoparathyroidism § Intraocular disease (uveitis) § Trauma to the eye or history of eye surgery § Exposure to the sun and UVB rays or radiation exposure § Long-term use of ________________________________________________ § Caucasian race · Common Causes of Cataracts: § Age-related Cataracts: lens water loss and fiber compaction § Traumatic Cataracts: blunt injury to eye, penetrating eye injuries, ocular foreign bodies, radiation/UV exposure § Toxic Cataracts: corticosteroids, phenothiazine derivatives, mitotic agents § Associated Cataracts: diabetes, hypoparathyroidism, Down syndrome, Chronic sunlight exposure § Complicated Cataracts: retinitis pigmentosa, Glaucoma, Retinal detachment

Surgical removal of cataract as soon as possible after vision is reduced and interferes with activities (driving, reading)

Cataracts · Cataract Symptoms: NO eye redness or pain! § Painless blurring of vision (patients may think their "contacts/glasses are smudged") or double vision § Sensitive to glare/light § Decreased color perception (colors are faded or discolored) § Halos around objects § Loss of acuity from dimness to distortion § Reading and night driving difficulty (poor night vision) § With progression of disease, severe blurred and double vision occurs (creates a problem with completing ADLS); and eventually total blindness § Cataract assessment signs · Haziness/cloudy of lens · Inability to see fundus · No red reflex · Diagnostics: vision test (Snellen chart), external/internal assessment with ophthalmoscope · Treatment for Cataracts § Depends on how much difficulty the patient is having with function § Opacity does not always equate to functional status § Provide adaptive devices: magnifying lens, large print books, talking devices ("talking clocks") § Treatment of choice = _________________________________________

careful supervision for at least 24 hours after surgery to ensure they do not remove the protective eye patch and do not rub their eye

Complications of Cataract Surgery · Infection: · Wound dehiscence · Hemorrhage · Severe pain · Uncontrolled, elevated intraocular pressure · Special concerns: Patients with cognitive impairments (Alzheimer's) -> _______________________________________ Treating cloudy vision that remains after cataract surgery · Posterior part of the lens capsule becomes cloudy d/t cells growing onto the back of the capsule. · Treatment- Brief and noninvasive · Create a hole with Yag laser so light may pass freely to the back of the eye.

teach the patient to keep their head in the position prescribed by the surgeon to promote reattachment · AVOID activities that increase IOP (bending at waist, straining to defecate, heavy lifting) · AVOID reading, writing, close work, sewing, etc. in the first week after procedure because the rapid eye movements can cause detachment

Detached Retina · Retinal Detachment is the separation of the retina from the epithelium · Signs and Symptoms of Detached Retina § The sudden appearance of many floaters — tiny specks or dark spots that seem to drift through your field of vision § Photophobia: Flashes of light in one or both eyes ("shooting stars" or "lightening streaks") § Blurred vision § Gradually reduced side (peripheral) vision § A curtain-like shadow over the visual field § On ophthalmic exam, detachment is seen as gray bulges or folds in the retina · Treatment: putting a gas bubble into the eye to hold the retina up against the part of the eye that provides it with O2/blood § Pre-Op Care For Retinal Detachment Surgery · Patients are usually fearful of loss of vision, so nurses should provide information and reassurance to allay fears · Restrict activity and head movement before surgery to prevent further tearing · Eye patch is placed over the eye to reduce eye movement · Topical drugs are given to inhibit pupil constriction and accommodation § Post-Op Care For Retinal Detachment Surgery · Eye patch or shield are applied; monitor the patch for drainage · If gas/oil was instilled in the eye, ____________________________________________________________ · Report any sudden increase in pain or pain occurring with n/v · AVOID activities that increase IOP (bending at waist, straining to defecate, heavy lifting) · AVOID reading, writing, close work, sewing, etc. in the first week after procedure because the rapid eye movements can cause detachment · Monitor for infection and detachment (sudden pain, decreased vision, non-constricting pupil)

§ Tight glycemic control · Average preprandial 80 to 120 mgm/dL · Average bedtime capillary blood glucose 100 to 140 mgm/dL · HbA1c < 7 § Manage hypertension § Manage hyperlipidemia § Proper nutrition, low carb, low cholesterol diet § Exercise, weight management § Always refer older adults for eye exam after diagnosis of diabetes

Diabetic Retinopathy · Diabetic Retinopathy: Microvascular disease of the eye -> damage to the ocular microvascular system -> impairing transportation of oxygen and nutrients to the eye in diabetics § Wool Spots: appear anywhere in the eye (unlike AMD, which is in macula) · Two Forms Of Diabetic Retinopathy: Proliferative and Non-proliferative § Non-proliferative Diabetic Retinopathy: · Endothelial layers of blood vessels in eye are damaged + development of microaneurysms -> microaneurysm leakage -> edema near macula -> impaired vision § Proliferative Diabetic Retinopathy: · Damaged blood vessels -> retinal ischemia -> decreased blood supply + nutrient supply to retina -> neovascularization -> fragile blood vessels + RBC leakage -> hemorrhage + vision obscured · New blood vessels can also attach themselves to various eye areas. · Tension exertion on retinal surface + vitreous body -> retinal detachment + further damage to surrounding blood vessels -> hemorrhage · If Neovascularization of the iris occurs, -> impaired drainage of the aqueous humor -> risk for Neovascular glaucoma · Prevention of Diabetic Retinopathy - - - - - - - · Symptoms of Diabetic Retinopathy § Gradual vision loss § Generalized blurring and areas of focal vision loss · Treatment for Diabetic Retinopathy: § Laser Photocoagulation (PRP) Therapy to repair microaneurysms and reduce ocular edema § Vitrectomy surgery is indicated for those with severe retinopathy that doesn't respond to PRP. It involves removing the gelatinous contents and bleeding within the vitreous chamber that was obscuring vision, and replacing it with a salt solution

10-20 mmHg

Glaucoma · Glaucoma is the leading cause of irreversible blindness in adults especially >40 § No cure! Thus, early diagnosis and treatment is essential to prevent blindness § Described as "A thief in the night" (due to No noticeable early symptoms) · Glaucoma: a group of ocular conditions that damage optic nerve due to increased intraocular pressure (IOP) § Normal intraocular pressure (IOP) = ___________________________________________________________ § Normal IOP requires a balance between production and outflow of aqueous humor. If IOP becomes too high, the extra pressure compresses retinal blood vessels, photoreceptors, and nerve fibers. This compression results in poorly oxygenated photoreceptors/nerves. Then these sensitive tissues become ischemic and die, and when too many have died, vision is lost permanently. · Glaucoma Pathophysiology: Increase in intraocular pressure (IOP) à optic nerve damage à vision loss § Open angle glaucoma is most common § Slowed flow of aqueous humor through trabecular meshwork à build upàincreased intraocular pressure (IOP) à damage to nerve fiber à loss of vision § Painless vision loss § Midperipheral visual field loss (permanent)

PERIHPERAL

Glaucoma · Risk Factors for Glaucoma 1. Increased intraocular pressure 2. Older than 60 years of age, especially those of Mexican-American heritage (screening should start at 40!) 3. Family history of glaucoma 4. Personal history of myopia, diabetes, hypertension, or migraines 5. African American ancestry, especially those over age 40 6. Eye trauma, severe myopia, or retinal detachment · Prevention of Glaucoma: no known preventative measures, besides having eye exams: § Eye exam every 2-4 years before age 40 § Eye exam every 1-3 years between ages 40-54 § Eye exam every 1-2 years between ages 55-64 § Eye exam every 6-12 months over age 65 · Symptoms of Glaucoma: § Often they can be asymptomatic in the early phase, so we need to do eye exams yearly to detect it, diagnose it, and treat it early! § Ophthalmic exams show cupping and atrophy/degeneration of the optic disc. It gets wider and turns white/gray § High intraocular pressure (IOP) § Loss of _____________________________________ visual field

trichloroethylene

Hearing Loss · Hearing loss, or loss of auditory sensory perception, is common in: § > 30% aged 65 to 76 years § 50% >75 years § Older men > older women § Caucasian men and women > African American men and women · Risk Factors for Hearing Loss § Long-term exposure to excessive noise (men who have worked in loud environments without ear protection) § Impacted cerumen (ear wax) § Ototoxic medications § Tumors attached to ear canals or auditory nerve § Diseases that affect sensorineural hearing § Smoking § History of middle ear infection § Chemical exposure (e.g., long duration of exposure to ___________________________________________)

§ Rinne Test: air conduction less than bone conduction § Weber Test: lateralization to unaffected ear

Hearing Loss · Sensorineural Hearing Loss: this hearing loss results from a deficit in the cochlea and auditory nerve (cranial nerve VIII), resulting in sound distortion · Causes of Sensorineural Hearing Loss: § Presbycusis: Hearing impairment as a result of aging (loss of hair cells and neuron loss) · Bilateral hearing impairment · Impaired ability to hear high pitches · Risk factors: vitamin B12/folate deficiency, hypertension, atherosclerosis, infections, fever, Meniere's disease, diabetes, ear surgery § Damage as a result of excessive noise exposure § Infection § Ototoxic drugs § Diseases: Meniere's disease, acoustic neuroma, diabetes mellitus, labyrinthitis, Myxedema · Symptoms of Sensorineural Hearing Loss: § Normal appearance of ear/tympanic membrane § Tinnitus § Occasional dizziness § Speaking loudly; hearing poorly in loud environment § Rinne Test: ________________________________________ § Weber Test: __________________________________

§ Rinne Test: air conduction greater than bone conduction § Weber Test: lateralization to affected ear

Hearing Loss · Conductive Hearing Loss: a blockage/obstruction of the sound waves being able to get into the ear canal to the tympanic membrane, such as a foreign bodies, inflammation of ear, or retracted/bulging tympanic membrane. It is often reversible, unless it is caused by an unhealing perforated tympanic membrane or unremovable ear tumors. - Causes of Conductive Hearing Loss: § Otitis externa (swimmer's ear: ear canal gets very inflamed and you cannot see the tympanic membrane due to swelling) § Impacted cerumen (Most common and reversible) § Otitis media, inflammation/edema § Benign tumors § Tympanic membrane perforation § Foreign bodies § Otosclerosis (overgrowth of soft bony tissue on ossicles) § Cerumen Impaction can cause Conductive Hearing Loss -Symptoms of Conductive Hearing Loss: § Evidence of obstruction with otoscope exam § Abnormality of tympanic membrane § Speaking softly; hearing best in a noisy environment § Rinne Test: _______________________ § Weber Test: ________________________________

swimmer's ear

ruptured tympanic membrane, ear trauma/surgery, tumors, cholesteatoma, otitis externa (swimmer's ear)

Hearing Loss · Conductive Hearing Loss: a blockage/obstruction of the sound waves being able to get into the ear canal to the tympanic membrane, such as a foreign bodies, inflammation of ear, or retracted/bulging tympanic membrane. It is often reversible, unless it is caused by an unhealing perforated tympanic membrane or unremovable ear tumors. o Causes of Conductive Hearing Loss: § Otitis externa (swimmer's ear: ear canal gets very inflamed and you cannot see the tympanic membrane due to swelling) § Impacted cerumen (Most common and reversible) § Otitis media, inflammation/edema § Benign tumors § Tympanic membrane perforation § Foreign bodies § Otosclerosis (overgrowth of soft bony tissue on ossicles) § Cerumen Impaction can cause Conductive Hearing Loss: · Symptoms: feeling of fullness or itching in ear, tinnitus, pain, vertigo · Hygiene: gently cleaning auricles while bathing; DON'T clean ear canal with Q-tips · Cerumen removal: o Curette: small instrument inserted into ear for wax removal. Use both hands and sterile equipment, wear a headlamp. No water is needed so less risk of infection; but it requires more skill, and it has bigger risk of injury to ear o Lavage or irrigation: soften wax prior with mineral oil, then irrigate - Lavage/irrigation is contraindicated with history of ear surgery, ruptured tympanic membrane, or swimmers ear · Contraindications to Cerumen removal: _________________________________________________________

Hearing impairment as a result of aging (loss of hair cells and neuron loss) · Bilateral hearing impairment · Impaired ability to hear high pitches · Risk factors: vitamin B12/folate deficiency, hypertension, atherosclerosis, infections, fever, Meniere's disease, diabetes, ear surgery

Hearing Loss · Sensorineural Hearing Loss: this hearing loss results from a deficit in the cochlea and auditory nerve (cranial nerve VIII), resulting in sound distortion · Causes of Sensorineural Hearing Loss: § Presbycusis: ________________________________________________________________ § Damage as a result of excessive noise exposure § Infection § Ototoxic drugs § Diseases: Meniere's disease, acoustic neuroma, diabetes mellitus, labyrinthitis, Myxedema · Symptoms of Sensorineural Hearing Loss: § Normal appearance of ear/tympanic membrane § Tinnitus § Occasional dizziness § Speaking loudly; hearing poorly in loud environment § Rinne Test: air conduction less than bone conduction § Weber Test: lateralization to unaffected ear

effects can last 7-12 days

Medications for Cataracts · Pre-Op § 1. Mydriatics (dilators which make it easy to get into the eye for surgery) · Short acting pupillary dilation · Phenylephrine ophthalmic · Tropicamide § 2. Anticholinergic agents: atropine eye drops · Prevents pupil constriction and relaxes eye muscles · Remind patient that _________________________________________ · It can cause photosensitivity, so they need to wear sunglasses § 3. NSAID ophthalmic · Decreases pain and inflammations · Bromfenac ophthalmic · Pre-Op § 1. Corticosteroids · Reduce inflammation · Prednisolone acetate § 2. Antibiotics · Broad spectrum ABX · Prophylactic · Ciprofloxacin ophthalmic · Moxifloxacin

ability to see objects upon entering a dimly lit room after being in a bright room (or daylight). They don't see objects at first; it takes them a second to see

thicken, harden, and appear yellowish and opaque . This can cause light to scatter and poor color discrimination. Very high risk for falls and dangerous night driving

Normal Age Related Changes in Vision · Thinning of skin surrounding the eye; decrease in musculature of eyelids · Ectropion: bottom lid sags outward and is no longer in contact with eye (causes irritation) · Entropion: the lid turns inward, bringing the eyelashes in contact with the eye (irritation and abrasion to cornea) · Visual acuity (sharpness and clarity) decreases § Diminishes gradually after age 50 § Decreases rapidly after age 70 § Reading and color discrimination is decreased (they need extra light and glasses) · Light sensitivity (the ability to adapt to different degrees of light) declines with age § Brightness contrast: ability to discriminate objects in varying degrees of light § Dark adaptation: ability to see objects upon entering a dimly lit room after being in a bright room (or daylight). They don't see objects at first; it takes them a second to see § Recovery from glare takes more time with age. Glare is excessive light reflected back into the eye § Acuity tests should be done in lower lighting because they may not show visual deficits in a brightly lit exam room when they actually suffer from glare and contrast in reduced light setting · Lenses _________________________________________________________ § Increased risk for glaucoma and presbyopia § Decreased accommodation · Atrophy of lacrimal glands, results in dry eyes (saline drops can be used to relive) · Intraocular pressure can increase, and must be treated to prevent glaucoma

extra light, gradual changes from dark to bright light, and avoiding glare

Normal Age Related Changes in Vision · Thinning of skin surrounding the eye; decrease in musculature of eyelids · Ectropion: bottom lid sags outward and is no longer in contact with eye (causes irritation) · Entropion: the lid turns inward, bringing the eyelashes in contact with the eye (irritation and abrasion to cornea) · Visual acuity (sharpness and clarity) decreases § Diminishes gradually after age 50 § Decreases rapidly after age 70 § Reading and color discrimination is decreased (they need extra light and glasses) · Light sensitivity (the ability to adapt to different degrees of light) declines with age § Brightness contrast: ability to discriminate objects in varying degrees of light § Dark adaptation: ability to see objects upon entering a dimly lit room after being in a bright room (or daylight). They don't see objects at first; it takes them a second to see § Recovery from glare takes more time with age. Glare is excessive light reflected back into the eye § Acuity tests should be done in lower lighting because they may not show visual deficits in a brightly lit exam room when they actually suffer from glare and contrast in reduced light setting · Lenses thicken, harden, and appear yellowish and opaque . This can cause light to scatter and poor color discrimination. Very high risk for falls and dangerous night driving § Increased risk for glaucoma and presbyopia § Decreased accommodation · Atrophy of lacrimal glands, results in dry eyes (saline drops can be used to relive) · Intraocular pressure can increase, and must be treated to prevent glaucoma · Pupil Changes: § Decreased dilation and constriction § Delayed pupillary response -> difficulty responding to changes in light § Pupil Diameter is decreased -> decreased light reaching diameter (they need _____________________________________________________________________) · Iris Changes: § Loses color -> eyes appear gray or light blue § Lenses thicken and harden § Yellowish appearance + opacity § Light to scatter -> interference with color discrimination

pruritis

Normal Hearing Changes in the Older Adult · External ear: § Auricle wrinkles and sags § Increased cerumen production · Dry cerumen and dry ear canal -> ______________ · Hard · Decreased apocrine gland activity -> accumulation · Inner ear § Atrophy of organ of Corti and cochlear neurons § Loss of sensory hair cells § Degeneration of the stria vascularis · Hearing impairments make communication difficult and are frustrating § They can't understand conversations § Inability to participate in dialogue with family can result in lack of desire to attend functions, feeling of social isolation, and depression § Hearing impairment is also dangerous because they can't hear fire alarms and can't hear oncoming traffic when crossing the street · Encourage older adults to use ear wax softening kits, instead of Q-tips to prevent cerumen impaction. · Be sure to assess the tympanic membrane before irrigating ears. If you cannot see it do to cerumen, you need to soften the cerumen and remove it before irrigation.

offer them your arm and walk a step ahead

Nursing Care of ANY Patient with Reduced Vision · Assess ability to perform ADLs: reading labels, driving or taking public transportation, ambulate safety, shop/pay for food, prepare food safety, engage in recreation/leisure · If an older adult complains of visual problems with glasses on, make sure they are free from dirt or scratches before assuming a new visual problem is occurring · Always knock and announce your entrance into patient's room and introduce yourself. Ensure that all other team members do the same · Ensure patient's reduced vision is noted in the chart and communicated to staff, marked on call board, and identified on door of patient's room · Determine the degree of vision loss · Orient the patient to the environment, counting steps with them to the bathroom · Help the patient put objects on the bedside table or around the room and don't move them unless that patient says so · Remove clutter between the bed and bathroom · Ask the patient what type of assistance they prefer for grooming, toileting, eating, and ambulating (communicate these with staff) · Describe food placement on plate in terms of a clock face · Open milk cartoons, salt, pepper, and condiment packages; remove lids from bowls · Unless the patient also has a hearing problem, use a normal tone of voice when speaking · When walking with the patient, _______________________________________________________________________________

§ Low-vision clinics for suggestions § Telescopic lenses § Books in Braille or audible tape books § Computer scanners and readers § Tinted glasses to reduce glare, large print books and magazines § Seeing eye dogs § Canes § Bright lighting

Nursing Diagnoses/Interventions for Vision- Impaired Older Patients · Evaluate functional ability § Perform activities of daily living, including the ability to read medication labels § Drive or take public transportation § Ambulate safely in familiar and strange environments § Shop and pay for food and personal items § Prepare food while maintaining a safe and hygienic environment § Engage in recreational and leisure activities · Helpful aids for visually impaired: - - - - - - - - · Often rejected because of the stigma attached · Very expensive and not covered by Medicare · Register with Commission for the Blind § Books on tape and tape player § Telephones with large numbers § High-intensity lights

Cochlear implants

Nursing Interventions for Hearing Impairments/Loss · Assistive devices for hearing impairment: § portable amplifiers can be used while watching TV or in theaters § small portable amplifiers can be taken out of the house for communication with others § telephone amplifiers increase phone volume, and allow the caller to speak in a normal voice § Some telephones have a video display of words being spoken by the caller § Telephone device for the deaf (TDD): allows telephone communication with keyboard § For doorbells or telephone rings, use flashing lights or vibratory devices § Hearing Aids are used for conductive hearing loss (less effective with sensorineural). Patients must be reminded that hearing with a hearing aid is different from natural hearing. They should learn to use it slowly, starting with home use or use during one part of the day; progressing to full use during day § ________________________________________________________-: used for sensorineural hearing loss; it helps conduct sound through the skull to skip the malfunctioning portion of the auditory nerve. After surgery, they need follow up with a SLP to interpret new sounds. A small battery pack is worn around the waist. Patients should avoid MRI scans if they have a cochlear implant

1. Stinging discomfort, itching on instillation (don't rub eyes!) 2. Dilated pupils, blurred vision, headache, dry mouth 3. Reddened sclera 4. Hypotension, drowsiness (caution with driving) (Per ATI) 5. Palpitation 6. HYPERTENSION (per Powerpoint) 7. Tremor 8. Sweating

Ophthalmic Solutions For Glaucoma · Adrenergic Agonists: these drugs reduce IOP by limiting production of aqueous humor and dilating the pupil § Apraclonidine, Brimonidine tartrate, Dipivefrin hydrochloride (purple bottle caps) § Side effects: 1. 2. 3. 4. 5. 6. 7. 8. § Nursing Interventions: · Before giving, ask if the patient takes MAOIs (phenelzine, tranylcypromine) because if taken together these drugs can cause hypertensive crisis. · Antihypertensives potentate hypotensive effect · Wear dark sunglasses outside and when indoor light is bright because the pupil dilates · Don't use the drug with contacts in. Wait 15 minutes after using the drug to put in contacts (contacts absorb the drug and can get cloudy)

every 10 years until age 50. Then hearing test every 3 years with audiometric battery test

Nursing Interventions for Hearing Impairments/Loss · Asymptomatic adults get hearing test ________________________________ · If hearing loss is due to infection, antibiotics are prescribed · Because many hearing disorders cause vertigo, dizziness, and n/v, antiemetics, antihistamines, anti-vertigo, or benzodiazepines can be prescribed for these problems · Explain the danger of using foreign objects to clean ear canal. They can scrape skin, push cerumen against the eardrum, and puncture eardrum · SAFETY: hearing loss = fall risk. Check the patient's home for hazards and encourage family to assist with meal prep or ADLs if needed. · Provide written instructions to the patient and family on treatment and follow-up · If patients do not have family/friends, refer to home care agency. Contact case management to help with meal prep, cleaning, personal hygiene, etc. · If Cerumen Buildup Is A Problem, Suggest Ear Irrigation For Cerumen Removal · Communicating with a hearing impaired patient: § Sit/stand 2-3ft in front of patient, but not sitting in front of bright lights or windows § Ensure the room is well lit § Get the patient's attention before speaking, and move closer to the better-hearing ear § Speak clearly and slowly and pause at the end of phrases. Don't shout. Keep other objects away from your face/mouth while talking § Have conversations in quiet rooms with minimal distractions § Have the patient repeat your statements, not just indicate assent § Rephrase rather than restate when things are misunderstood § Use appropriate hand motions/gestures and write messages on paper if the patient can read § Encourage lip-reading or sign language § Manage anxiety to increase communication efforts. Help patients use resources and communication to encourage social contact

gentle but firm pressure to allow water to flow against the top of the ear canal. DO NOT use sudden bursts/blasts of pressure. AVOID getting air in the syringe (causes strange sounds and scares those who are cognitively impaired)

Nursing Interventions for Hearing Impairments/Loss · If Cerumen Buildup Is A Problem, Suggest Ear Irrigation For Cerumen Removal: § Don't attempt to remove earwax or irrigate ears if you have ear tubes or blood, pus, or drainage from the ear § Use ear syringe designed for wax removal, such as one that has a right-angle or "elbow" in the tip § Irrigating the ears in the shower is an easy method § Always use tap water that feels just barely warm to use because hot/cold water can cause dizziness and nausea § If earwax is thick/sticky, place a few warm eardrops (baby oil or mineral oil) into the ear for an hour prior to irrigation to soften the earwax § Fill the syringe with lukewarm tap water § If using a syringe with an elbow tip, place only the last part of the tip into the ear aiming to the roof of the ear canal § If using a straight syringe, insert tip ½ to ¾ inches into the canal aiming to the roof of the canal § Hold the head at a 30 degree angle to the side you are irrigating § Use one hand to hold the syringe and the other to push the plunger/squeeze bulb § Apply ____________________________________________________________________________ § The ear canal should fill and water should flow own, bringing wax/debris with it § IT SHOULD NOT BE PAINFUL. If pain occurs, decrease pressure, and if pain persists, stop irrigating. § Continue irrigation until at least a cup of solution has been washed (may have to refill syringe) § Tiling the head to a 90 degree angle should allow most, if not all, of the water to drain out of the ear § Following irrigation, swab and dry the canal to reduce infection risk § Repeat procedure on other ear § If you feel that water is still in the ear, hold a hairdryer on a low setting near the ear § Irrigate ears weekly to monthly depending on how fast earwax collects

· NO alcohol or harsh soaps. NO submerging in water · Take them out before baths, swimming · Use damp cotton pad/cloth with either water/saline to wipe the hearing aid's mold/earpiece · Carefully remove cerumen from the hole on the part of the device that goes into the ear (often this is done with a small "toothpick" device) · At night, take them out and ensure that they dry (drying container) because they can get damp from sweat, cerumen, etc.

Nursing Interventions for Hearing Impairments/Loss · Teach Care of hearing aids § Keep the hearing aid dry, and report cracking/rough areas § Avoiding dropping the hearing aid or exposing it to extreme temperatures § Adjust the volume to the lowest setting that allows you to hear to prevent feedback squeaking § Avoid hair spray, cosmetics, oils, or other beauty products from coming into contact with the hearing aid receiver § Dials should be clean, easily rotated, and volume should vary when it is moved § Remove and clean at bedtime - - - - - - § Disengage battery when you take the hearing aid out of your ear. Battery life can be short, so we conserve the battery life as much as possible. § Keep extra batteries on hand § How to tell if a battery is working: lay the hearing air in your hand and close you hand around it. If working, it should make a squealing sound § Store in safe place § If the hearing aid does not work: · Change the battery · Check the connection between the ear mold and the receiver · Check the on/off switch · Clean the sound hold · Adjust the volume · Take the hearing aid to an authorized service center for repair

use the drug if the cornea is not intact. Always check the cornea for abrasions or trauma before using

Ophthalmic Solutions For Glaucoma · Prostaglandin analogs: these drugs reduce IOP by dilating blood vessels (trabecular mesh), which drains aqueous humor § Latanoprost, Bimatoprost, Tafluprost, Travoprost, Unoprostone § Side Effects: 1. changes in eye color/pigmentation (darkens) and periorbital tissues 2. eyelashes can elongate 3. itching, stinging, burning, red conjunctiva (don't rub eyes!) 4. bulging of ocular blood vessels 5. blurred vision 6. migraine (report) § Nursing Interventions: · If only one eye is affected, teach patient not to put the drug in the other eye to make the eye color similar. This can reduce IOP in the good eye and reduce its vision · Do not ___________________________________________________________________

contacts in. Wait 15 minutes after using the drug to put in contacts (contacts absorb the drug and can get cloudy) * This is also true for Carbonic anhydrase inhibitors: Dorzolamide Hydrochloride, Brinzolamide, acetazolamide, methazolamide(orange bottle caps)

Ophthalmic Solutions For Glaucoma · Adrenergic Agonists: these drugs reduce IOP by limiting production of aqueous humor and dilating the pupil § Apraclonidine, Brimonidine tartrate, Dipivefrin hydrochloride (purple bottle caps) § Side effects: 1. Stinging discomfort, itching on instillation (don't rub eyes!) 2. Dilated pupils, blurred vision, headache, dry mouth 3. Reddened sclera 4. Hypotension, drowsiness (caution with driving) (Per ATI) 5. Palpitation 6. Hypertension (per Powerpoint) 7. Tremor 8. Sweating § Nursing Interventions: · Before giving, ask if the patient takes MAOIs (phenelzine, tranylcypromine) because if taken together these drugs can cause hypertensive crisis. · Antihypertensives potentate hypotensive effect · Wear dark sunglasses outside and when indoor light is bright because the pupil dilates · Don't use the drug with __________________________________________________

1. Stinging or discomfort of the eye on instillation 2. Occasional conjunctivitis, blurred vision, photophobia, dry eyes (report) 3. Bradycardia, hypotension (especially with systemic absorption or taking another beta blocker with eyedrops) 4. congestive heart failure, heart block 5. syncope 6. bronchospasm 7. depression 8. confusion 9. sexual dysfunction

Ophthalmic Solutions For Glaucoma · Beta-blockers: these drugs reduce IOP by limiting production of aqueous humor and dilating the pupil § Betaxolol hydrochloride, Carteolol, Levobunolol, Timolol, Timoptic GFS (blue or yellow bottle caps) § Side effects: 1 2 3 4 5 6 7 8 9 § Nursing Interventions: · Before giving, ask if the patient has COPD/asthma because if these drugs are absorbed systemically, they can cause bronchoconstriction · Don't give to patients with sinus bradycardia, AV heart block; caution with congestive heart failure · Warn diabetic patients to check glucose more often because they mask hypoglycemia · If the patient also takes systemic beta blockers/calcium channel blockers, they need to take pulse 2x/day and notify the provider if pulse is less than 58 (can cause hypotension)

diabetic patients to check glucose more often because they mask hypoglycemia

Ophthalmic Solutions For Glaucoma · Beta-blockers: these drugs reduce IOP by limiting production of aqueous humor and dilating the pupil § Betaxolol hydrochloride, Carteolol, Levobunolol, Timolol, Timoptic GFS (blue or yellow bottle caps) § Side effects: 1. Stinging or discomfort of the eye on instillation 2. Occasional conjunctivitis, blurred vision, photophobia, dry eyes (report) 3. Bradycardia, hypotension (especially with systemic absorption or taking another beta blocker with eyedrops) 4. congestive heart failure, heart block 5. syncope 6. bronchospasm 7. depression 8. confusion 9. sexual dysfunction § Nursing Interventions: · Before giving, ask if the patient has COPD/asthma because if these drugs are absorbed systemically, they can cause bronchoconstriction · Don't give to patients with sinus bradycardia, AV heart block; caution with congestive heart failure · Warn _________________________________________ · If the patient also takes systemic beta blockers/calcium channel blockers, they need to take pulse 2x/day and notify the provider if pulse is less than 58 (can cause hypotension)

1. flu-like symptoms (fever, headache, body aches) 2. renal failure, nephrolithiasis 3. hypokalemia, hyponatremia, dehydration, altered liver function 4. GI: nausea, diarrhea 5. depression 6. COPD exacerbation 7. Allergic reaction 8. Blood disorders, bone marrow depression (report) 9. CNS disturbance, paresthesia of extremities, fatigue, sleepiness, seizures 10. glucose disturbance

Ophthalmic Solutions For Glaucoma · Carbonic anhydrase inhibitors: these drugs directly/strongly inhibit aqueous humor production, but do not affect flow/absorption of fluid § Dorzolamide Hydrochloride, Brinzolamide, acetazolamide, methazolamide(orange bottle caps) § Side Effects: 1 2 3 4 5 6 7 8 9 10 § Interactions: high-dose aspirin, quinidine, lithium, phenytoin, sodium bicarb § Nursing Interventions: · Ask about allergies to sulfa drugs due to risk of allergic reaction · Shake the drug before applying because the drug separates with stasis · Don't use the drug with contacts in. Wait 15 minutes after using the drug to put in contacts (contacts absorb the drug and can get cloudy) · Regular electrolyte monitoring, daily weights · Increase fluid intake (2-3L/day), and monitor for orthostatic hypotension · If diabetic, monitor glucose

Shake the drug before applying because the drug separates with stasis

Ophthalmic Solutions For Glaucoma · Carbonic anhydrase inhibitors: these drugs directly/strongly inhibit aqueous humor production, but do not affect flow/absorption of fluid § Dorzolamide Hydrochloride, Brinzolamide, acetazolamide, methazolamide(orange bottle caps) § Side Effects: 1. flu-like symptoms (fever, headache, body aches) 2. renal failure, nephrolithiasis 3. hypokalemia, hyponatremia, dehydration, altered liver function 4. GI: nausea, diarrhea 5. depression 6. COPD exacerbation 7. Allergic reaction 8. Blood disorders, bone marrow depression (report) 9. CNS disturbance, paresthesia of extremities, fatigue, sleepiness, seizures 10.glucose disturbance § Interactions: high-dose aspirin, quinidine, lithium, phenytoin, sodium bicarb § Nursing Interventions: · Ask about allergies to SULFA drugs due to risk of allergic reaction · ______________________________________________ · Don't use the drug with contacts in. Wait 15 minutes after using the drug to put in contacts (contacts absorb the drug and can get cloudy) · Regular electrolyte monitoring, daily weights · Increase fluid intake (2-3L/day), and monitor for orthostatic hypotension · If diabetic, monitor glucose

1. blurred vision, miosis, decreased visual acuity, retinal detachment 2. parasympathetic effects: bradycardia, increased salivation, sweating, pupil construction, flushing 3. Hypotension 4. Bronchospasm 5. nausea, vomiting, diarrhea, abdominal pain 6. lacrimation

Ophthalmic Solutions For Glaucoma · Miotics/cholinesterase inhibitors/Cholinergic Agonists: these drugs reduce IOP by limiting production of aqueous humor and making room between the iris and lens to improve outflow § Carbachol, Echothiophate, Pilocarpine (green bottle caps) § Side Effects: 1 2 3 4 5 6 § Nursing Interventions: · Do not use more eyedrops than prescribed · Report increased salivation or drooling · If absorbed systemically, it can cause headache, flushing, increased saliva, and sweating · Use good lighting when reading and use caution in dark rooms because these drugs can cause the pupil to not respond in the dark (fall risk)

good lighting when reading and use caution in dark rooms because these drugs can cause the pupil to not respond in the dark (fall risk)

Ophthalmic Solutions For Glaucoma · Miotics/cholinesterase inhibitors/Cholinergic Agonists: these drugs reduce IOP by limiting production of aqueous humor and making room between the iris and lens to improve outflow § Carbachol, Echothiophate, Pilocarpine (green bottle caps) § Side Effects: 1. blurred vision, miosis, decreased visual acuity, retinal detachment 2. parasympathetic effects: bradycardia, increased salivation, sweating, pupil construction, flushing 3. Hypotension 4. Bronchospasm 5. nausea, vomiting, diarrhea, abdominal pain 6. lacrimation § Nursing Interventions: · Do not use more eyedrops than prescribed · Report increased salivation or drooling · If absorbed systemically, it can cause headache, flushing, increased saliva, and sweating · Use _______________________________________________________

1. changes in eye color/pigmentation (darkens) and periorbital tissues 2. eyelashes can elongate 3. itching, stinging, burning, red conjunctiva (don't rub eyes!) 4. bulging of ocular blood vessels 5. blurred vision 6. migraine (report)

Ophthalmic Solutions For Glaucoma · Prostaglandin analogs: these drugs reduce IOP by dilating blood vessels (trabecular mesh), which drains aqueous humor § Latanoprost, Bimatoprost, Tafluprost, Travoprost, Unoprostone § Side Effects: 1 2 3 4 5 6 § Nursing Interventions: · If only one eye is affected, teach patient not to put the drug in the other eye to make the eye color similar. This can reduce IOP in the good eye and reduce its vision · Do not use the drug if the cornea is not intact. Always check the cornea for abrasions or trauma before using

eye shield or patch at night for 2-3 weeks. (for 1 week it is for 24h/day, then after that week they can just wear it at night) § Patients who are not cognitively intact (confused), they need to wear the patch ALL THE TIME

Post-Op and D/C Teaching for Cataracts · Patients are usually discharged within an hour after surgery · Patients have a dramatic vision improvement within the day after surgery, but final best vision will not occur until 4-6wk after surgery · If they have difficulty instilling eyedrops, a friend, neighbor, or family member can be taught how to use them; or they can use adaptive equipment · Patients can use a cool compress for the eye to treat pain/swelling · Monitor for infection, bleeding and elevated IOP major complications. · Infection: Report any yellow/green drainage, excessive tearing, decline in visual acuity, acute unrelieved pain, photophobia, increasing eye redness, increase in tears § Remember: a creamy white, dry, crusty drainage is NORMAL. Yellow/green is NOT NORMAL · Encourage hand hygiene to prevent infection · Wear _______________________________________________________________ · Avoid getting water in the eye for 3-7 days · Eye drops will be ordered postop. They need to keep the dropper clean (no contact with fingers, eyes, tables, etc) · Encourage smoking cessation, low-fat diet, diet high in antioxidants and vitamin E/C, avoid ocular injury · Usually resume normal self-care activities · AVOID any activities that increase ocular pressure: § bending from the waist or forward flexion (vacuuming, cooking, housekeeping, driving, operating machinery) § lifting heavy objects that weight more than 10lb (heavy lifting) § sneezing, coughing, blowing the nose § straining to have a bowel movement § vomiting, or other jerky/rapid movements (sports) § sexual intercourse § keeping the head in a dependent position or head hyperflexion (tilting head back to wash hear) § wearing tight shirt collars · Instruct patient to immediately report the following to surgeon: § Pain (sharp, sudden eye pain), bleeding or increased discharge § Green, yellow, thick discharge; lid swelling § Conjunctival injection § Vision loss; reappearance of a bloodshot sclera after initial appearance has cleared § Sparks § Flashes of light or Floaters § Nausea, vomiting § Excessive coughing

1. bending from the waist or forward flexion (vacuuming, cooking, housekeeping, driving, operating machinery) 2. lifting heavy objects that weight more than 10lb (heavy lifting) 3. sneezing, coughing, blowing the nose 4. straining to have a bowel movement 5. vomiting, or other jerky/rapid movements (sports) 6. sexual intercourse 7. keeping the head in a dependent position or head hyperflexion (tilting head back to wash hear) 8. wearing tight shirt collars

Post-Op and D/C Teaching for Cataracts · Patients are usually discharged within an hour after surgery · Patients have a dramatic vision improvement within the day after surgery, but final best vision will not occur until 4-6wk after surgery · If they have difficulty instilling eyedrops, a friend, neighbor, or family member can be taught how to use them; or they can use adaptive equipment · Patients can use a cool compress for the eye to treat pain/swelling · Monitor for infection, bleeding and elevated IOP major complications. · Infection: Report any yellow/green drainage, excessive tearing, decline in visual acuity, acute unrelieved pain, photophobia, increasing eye redness, increase in tears § Remember: a creamy white, dry, crusty drainage is normal. Yellow/green is NOT normal · Encourage hand hygiene to prevent infection · Wear eye shield or patch at night for 2-3 weeks. (for 1 week it is for 24h/day, then after that week they can just wear it at night) § Patients who are not cognitively intact (confused), they need to wear the patch ALL THE TIME · Avoid getting water in the eye for 3-7 days · Eye drops will be ordered postop. They need to keep the dropper clean (no contact with fingers, eyes, tables, etc) · Encourage smoking cessation, low-fat diet, diet high in antioxidants and vitamin E/C, avoid ocular injury · Usually resume normal self-care activities · AVOID any activities that increase ocular pressure: 1 2 3 4 5 6 7 8 · Instruct patient to immediately report the following to surgeon: § Pain (sharp, sudden eye pain), bleeding or increased discharge § Green, yellow, thick discharge; lid swelling § Conjunctival injection § Vision loss; reappearance of a bloodshot sclera after initial appearance has cleared § Sparks § Flashes of light or Floaters § Nausea, vomiting § Excessive coughing

keep the eye closed for one minute

PostOp Cataract Surgery Care · Antibiotic eye drops instilled · Anti-inflammatory or corticosteroid eye drops instilled · Eye drops to constrict pupil · HOB in Semi-Fowlers position (because laying supine = increased ocular pressure) · Lying on back with HOB up or unoperated side (for the first day, it might be good to tell them to sleep in a recliner to prevent them from turning onto the operative side) · Monitor for nausea and vomiting, which increases intraocular pressure and can cause bleeding. TREAT THEM FOR N/V EARLY, such as when they are just nauseated to prevent them from actually vomiting · Pain early after surgery can indicate intraocular pressure or bleeding, so patients should call the surgeon if this occurs with nausea or vomiting. · Minimum light exposure (bright light would be painful). Tell them to wear dark glasses outdoors or in brightly lit areas until the pupil responds to light · Eye itching is normal. A "blood shot" appearance is normal. The eyelid can be slightly swollen. § BUT, significant swelling or bruising is ABNORMAL · Treat discomfort with a cool compress, acetaminophen (not aspirin due to bleeding risk) · Instilling ophthalmic ointment: § Check name, strength, and expiration date (make sure it is for eyes and not skin) § Check if only one or both eyes are to be used § If both eyes are to receive the same drug and only one eye is infected, use two separate tubes and label them "right" and "left" eye § Wash hands, put on gloves, and explain the procedure § Ask patient to tilt head backwards and look up at ceiling § Gently pull lower lid down against patient's cheek forming a small pocket § Hold the tube like a pencil with the tip down, and rest the wrist holding the tube against the patient's cheek § Without touching the tube to the eye, put a small thin strip of ointment into the pocket of the lower lid moving from the inner to outer part of the eye § Release the lower lid and tell the patient to close their eye without squeezing the eyelid § With the eye closed, wipe away any excess ointment § Remind the patient that the eye will be blurry, so don't drive/operate heavy machinery until the ointment is removed § Ask the patient to ________________________________________ § Wash the hands again. If removing the ointment, have the patient close their eye and wipe the closed lids with a tissue from the inner canthus outward

use a container of different shape (with a lid) each time. For example, if they have morning, afternoon, and evening drugs, put the morning drugs in a round container, put the afternoon drugs in a square container, and put the evening drugs in a triangular container

Promoting Independent Living in Older Patients with Impaired Vision · Drugs: Have a neighbor, friend, family member, or home nurse visit once a week to measure the proper drugs for each day § If the patient is taking more than one drug/day, _________________________________________________________________ § Place each day's drug containers in a separate box with raised letters on the side spelling out each day § "talking clocks" are available for patients with low vision § Some drug boxes have alarms that can be set for when to take the drug · Communication: telephones with large raised block numbers can be helpful. Use phones with black numbers on a white background § Telephones with programmable automatic dialing features (speed dial) are helpful, especially for 911, fire department, police, relatives, friends, neighbor's phone numbers

Microwaves

Promoting Independent Living in Older Patients with Impaired Vision · Food preparation: meals on wheels can be helpful. It brings meals at mealtimes § Grocery stores with "shop by telephone" service, where the patient completes a computer booklet with the food they want, or they call the store and tell them what they want. The grocery store delivers the groceries to the patient's door § _____________________________________ are safer than standard stoves, but a lot of older adults are scared of them. If the patient has one and will use it, other family members can make meals ahead of time, freeze them, and the older adult can heat them up to eat. § Friends/relatives can help with food prep. They can create home-made prepackaged frozen meals that the patient enjoys · Personal Care: hand grips in bathrooms, non-skid surface on bathtubs, use electric razors, choosing a hairstyle that's easy to care for ("avoiding parts" per IGGY), home-hair-care services, tinted glasses for glare · Diversional activity: large-print books, newspapers, and magazines, Braille books, audiotapes, kitting, card games, dominoes, board games (all with large print/objects) § Computer scanners or readers

reflective floors

Promoting Independent Living in Older Patients with Impaired Vision · Safety: it can be best to leave furniture the way the patient wants it (not move it) § Throw rugs are best eliminated, and cords should be short and out of walkways § Lounge-style chairs with built-in footrests are preferable to footstools § Non-breakable dishes and glasses are preferable to breakable ones § Cleaners and toxic agents should be labeled with big letters § Velcro (hook and loop) strips at hand level may help park the locations of switches and electrical outlets § Guide dogs, using canes § Bright lights, motion sensor lights that turn on when they walk into the room. Always walk into bright/dark rooms slowly to help eyes accommodate § Use good lamp shades to prevent glare § Use contrasting colors when painting home to help discriminate between floors/walls/doors; avoid ________________________________________________ § If using signs, use bright colors (red, orange, yellow), avoiding use of blues, grays, and light greens § Put red tape on the edges of stairs § Avoid complicated rug patterns that can obscure vision

A. Apply red tape to the edge of stairs C. Shouts directly into one of the person's ears A. Amiodarone B. Propranolol

The nurse is concerned that an older person may fall when using the stairs at home. What should the nurse recommend to improve safety? A. Apply red tape to the edge of stairs B. Ensure lighting in the stairway has appropriate shade C. Paint the entryway to the stairs a shade of blue D. Suggest carpeting with a geometric design The nurse observes a CNA care for an older person with a severe hearing deficit. For which action performed by the CNA should the nurse intervene? A. Pauses at the end of every phrase B. Stands next to the person's bed C. Shouts directly into one of the person's ears D. Faces the person when talking A nurse review an older person's current medications. For which medication should the nurse assess the person's vision for any changes? A. Amiodarone B. Abilify C. Furosemide D. Verapamil An older person reports progressive hearing loss of both ears. Which medication should the nurse suspect is causing this change in hearing? A. Digoxin B. Propranolol C. Baclofen D. Tamoxifen

C. "If I can't remember when to take which drops, I'll just take them all at once." B. Glaucoma D. 57 year old, 60 inches tall, with hypertension

The nurse is teaching a client who must instill multiple types of eyedrops before cataract surgery. Which client statement requires further teaching? A. "I will make a schedule for inserting the eye drops." B. "Touching the dropper to my eye could cause contamination and infection." C. "If I can't remember when to take which drops, I'll just take them all at once." D. "If I have trouble instilling the drops, I will have my spouse put them in for me." The nurse is caring for a client who reports slow onset of a gradual loss of vision in the center of the right eye. The client describes vision as "foggy" and reports concerns of ongoing headaches from "trying to concentrate to see." What condition does the nurse anticipate? A. Cataract B. Glaucoma C. Conjunctivitis D. Retinal detachment The nurse is caring for four clients. Which has the highest risk for development of macular degeneration? A. 25 year old, 70 inches tall, with fracture of the right femur B. 38 year old, 71 inches tall, who has just given birth to a healthy baby C. 45 year old, 67 inches tall, who is a vegetarian D. 57 year old, 60 inches tall, with hypertension

punctal occlusion: placing pressure on the corner of the eye near the nose immediately after eyedrop instillation

Treatment and Nursing Interventions for Glaucoma: Open Angle Glaucoma Teaching · Visual loss can be prevented with early detection, lifelong treatment, and close monitoring. · Use good hand hygiene, keep eyedrop tip clean, avoiding touching the eyedrop tup to the eye. · Don't drop the medication directly onto the eye or contaminate the dropper. Tilt the head back, pull the lower lid down, and drop the medication into the eyelid pouch · Must strictly adhere to medication schedule because the benefit of the drug only occurs with adherence to the schedule (usually eyedrops every 12 hours) · Do not skip doses. · If the patient is on more than one medication, give them 5 minutes apart to prevent "washout" (one drug diluting another drug) · Watch for drug interactions and side effects · Prevent systemic absorption by using ____________________________________________________ · If the patient cannot instill their own eyedrops, teach the caregiver the technique · Patient will usually be seen every 1-3 months for follow-ups and monitoring · USE THE ADAPTIVE DEVICE TO INSTILL DROPS IF YOU HAVE MOTOR PROBLEMS IN ONE HAND Meds: 1. Beta-blockers: Betaxolol hydrochloride, Carteolol, Levobunolol, Timolol, Timoptic GFS (blue or yellow bottle caps) 2. Adrenergic Agonists: Apraclonidine, Brimonidine tartrate, Dipivefrin hydrochloride (purple bottle caps) 3. Miotics/cholinesterase inhibitors/Cholinergic Agonists: Carbachol, Echothiophate, Pilocarpine (green bottle caps) 4. Carbonic anhydrase inhibitors: Dorzolamide Hydrochloride, Brinzolamide, acetazolamide, methazolamide(orange bottle caps) 5. Prostaglandin analogs: Latanoprost, Bimatoprost, Tafluprost, Travoprost, Unoprostone

antioxidants, carotene, and vitamins E and B12. Provider may prescribe supplements

Treatment and Nursing Interventions for Macular Degeneration · Wet Macular Degeneration: Laser surgery may help by sealing off damaged blood vessels to prevent bleeding and scar tissue (but it can also cause secondary vision loss due to destruction of healthy tissue) § Ocular injections with vascular endothelial growth inhibitors, like bevacizumab or ranibizumab may improve vision for patients with wet AMD § Phototherapy: injection of photosensitive med (verteporforin) which destroys new blood vessels. It doesn't affect healthy tissues and is painless, but you have to avoid exposure to direct light for 5 days afterwards · Need Low-vision aids · Encourage diet high in ____________________________________________________ · Because central vision loss reduced ability to read, drive, write, and recognize safety hazards, suggest the use of large print books, public transportation, and use of community services for adaptive equipment

bradycardia and bronchoconstriction!

Two Types of Glaucoma · 1. Primary Open Angle Glaucoma (POAG): this type of glaucoma develops slowly, with gradual loss of visual fields that can go unnoticed because central vision is unaffected at first. At times vision is foggy and the patient feels mild eye aching or headaches § Slow, progressive, painless bilateral obstruction of aqueous outflow system, causing increased IOP and destruction of optic nerve fibers. § Symptoms: loss of peripheral vision that progresses to a larger loss · Mild eye aching; headaches · losing peripheral vision; decreased accommodation · seeing halos around lights, · decreased vision that does not improve with glasses. · Central acuity remains intact (like looking through a toilet paper tube) · Diagnosis of Primary Open Angle Glaucoma (POAG): · measure IOP with tonometry: with POAG, it is often between 22-32mmHg · measure visual acuity · Gonioscopy: determines drainage angle of anterior chamber of eye · Treatment of Primary Open Angle Glaucoma (POAG): Ophthalmic medications § Beta-Adrenergic Blockers i.e. Timolol (Decreases production of aqueous humor) Use caution with Asthma, COPD, and CHF · May cause _______________________ § Cholinergic (Miotic) i.e. Pilocarpine (Constricts pupil -> Opens canal and increases flow of aqueous fluid) § Challenges to medication regimen: · Asthma/COPD patients can probably only use Pilocarpine · These must be taken multiple times per day (decreased adherence) · With Timolol, it can be absorbed systemically if they don't perform punctual occlusion (pressure on inner canthus) when administering, OR they use too much, then it can cause bradycardia. · If they are already on a beta blocker, then they use the BB eye drops, it can further cause bradycardia § Needs to be Diagnosed early to prevent loss of vision; Can't reverse damage that has occurred but can control IOP

systemic osmotics (IV mannitol or oral glycerin) to quickly decrease IOP

Two Types of Glaucoma · 2. Primary Angle Closure Glaucoma (PACG): this type of glaucoma has a sudden onset and is an emergency. There is a closure of the chamber angle, which suddenly prevents outflow of aqueous humor. § Rare but is an Ophthalmic Emergency, because acute closure causes a significant vision loss if not treated immediately. § Pathophysiology: Angle of the iris obstructs drainage of aqueous humor through trabecular meshwork à increased IOP à sudden visual changes § Symptoms of Primary Angle Closure Glaucoma (PACG): SUDDEN · Sudden severe pain around eyes radiating over face · Unilateral headache or brow pain · Visual blurring · Nausea and vomiting · Photophobia, seeing colored halos around lights · Sclera can appear reddened. The cornea is foggy · Ophthalmic exam shows shallow anterior chamber, cloudy aqueous humor, and moderately dilated/nonreactive pupil § Diagnosis of Primary Angle Closure Glaucoma (PACG): · Measure IOP via tonometry: with PACG it may be 30mmHg or higher · Gonioscopy: determines drainage angle of anterior chamber of eye · measure visual acuity § Treatment of Primary Angle Closure Glaucoma (PACG): · Give oral or IV Diamox (Carbonic Anhydrase Inhibitor) plus topical beta blockers and miotics (ie Timolol gtts) Preoperatively · Give ______________________________________________ · Requires surgical iridectomy or laser iridotomy with YAG. Passage through iris permanently connects anterior and posterior chambers of eye. (If have filtering procedure must keep from healing)

Primary Open Angle Glaucoma (POAG)

Two Types of Glaucoma · ________________________________________: this type of glaucoma develops slowly, with gradual loss of visual fields that can go unnoticed because central vision is unaffected at first. At times vision is foggy and the patient feels mild eye aching or headaches § Slow, progressive, painless bilateral obstruction of aqueous outflow system, causing increased IOP and destruction of optic nerve fibers. § Symptoms: loss of peripheral vision that progresses to a larger loss · Mild eye aching; headaches · losing peripheral vision; decreased accommodation · seeing halos around lights, · decreased vision that does not improve with glasses. · Central acuity remains intact (like looking through a toilet paper tube) -Diagnosis -measure IOP with tonometry: with POAG, it is often between 22-32mmHg · measure visual acuity · Gonioscopy: determines drainage angle of anterior chamber of eye

Primary Angle Closure Glaucoma (PACG)

Two Types of Glaucoma ·_________________________________________: this type of glaucoma has a sudden onset and is an emergency. There is a closure of the chamber angle, which suddenly prevents outflow of aqueous humor. § Rare but is an Ophthalmic Emergency, because acute closure causes a significant vision loss if not treated immediately. § Pathophysiology: Angle of the iris obstructs drainage of aqueous humor through trabecular meshwork à increased IOP à sudden visual changes § Symptoms: SUDDEN · Sudden severe pain around eyes radiating over face · Unilateral headache or brow pain · Visual blurring · Nausea and vomiting · Photophobia, seeing colored halos around lights · Sclera can appear reddened. The cornea is foggy · Ophthalmic exam shows shallow anterior chamber, cloudy aqueous humor, and moderately dilated/nonreactive pupil § Diagnosis: · Measure IOP via tonometry: with PACG it may be 30mmHg or higher · Gonioscopy: determines drainage angle of anterior chamber of eye · measure visual acuity

visual acuity, intraocular pressure, and examination of the retina.

Vision · Sensory Changes Occur Naturally as Persons Age · Visual Impairment in the older adult can lead to a loss of independence, social isolation, depression, decreased quality of life, increased fall risk (and risk of fractures, disability, and premature death). · All older adults should have yearly eye exams consisting of ___________________

Choroidal detachment, bleeding (which can occur after coughing, sneezing, straining with stools, Valsalva maneuver, sexual intercourse, head hyperflexion, tight-collared shirts, bending over at the waist)

What Happens If Medications for Glaucoma Don't Work? ...SURGERY! : · Surgical intervention with Laser Trabeculoplasty produces a thermal burn in the trabecular meshwork that increases outflow of aqueous humor or new opening is created in the meshwork. · Fibrosis of this opening must be prevented with antimetabolites (5FU and mitomycin C) · Trabeculectomy is a surgical procedure that creates a new channel for fluid outflow · This is often combined with medications to control pressure and visual loss · Complications of Glaucoma Surgery: ____________________________________________________________________________________ · Patients must wear sunglasses after surgery to protect eyes · Teach patients not to lie on the operative side and report severe pain or nausea · Report: lid swelling, decreased vision, bleeding, discharge, sharp/sudden pain, flashes of light, floaters, yellow/green drainage · Limit activities: tilting head back to wash hair, cooking, housekeeping, rapid/jerky movements, vacuuming, driving, operative machinery, playing sports

C. Being very specific with descriptions and directions B. Mild itching and bloodshot appearance C. Avoiding straining to have a bowel movement.

Which action by a nurse is most likely to increase accurate communication with a client who has low vision? A. Speaking slowly and loudly B. Enhancing the talk using hand gestures C. Being very specific with descriptions and directions D. Marking the door of the client's room to indicate his or her vision status Which postoperative outcome would the nurse anticipate for a patient who has undergone surgery for cataract removal? A. Yellowish drainage and photophobia B. Mild itching and bloodshot appearance C. Pain early after surgery accompanied by nausea and vomiting D. Change in visual acuity accompanied by tearing and redness What priority teaching will the nurse provide to a patient who has received a corneal transplant? A. Keep the eye moist. B. Watch the eye for signs of infection. C. Avoiding straining to have a bowel movement. D. Keep the eye covered for the first 24 hours postoperatively.

A. 52-year-old Asian female B. Open angle glaucoma D. " you need to limit your housekeeping activities"

Which patient is at greatest risk of developing primary angle-closure glaucoma? A. 52-year-old Asian female B. 32-year-old Caucasian female C. 42-year-old Hispanic male D. 64-year-old African-American male A nurse is caring for a client who has diabetes mellitus and reports a gradual loss of peripheral vision. The nurse should recognize this as a manifestation of which of the following diseases? A. Cataracts B. Open angle glaucoma C. Macular degeneration D. Angle closure glaucoma A nurse is providing postoperative teaching to a client following cataract surgery. Which of the following statements should the nurse include in the teaching? A. " you can resume playing golf in two days." B. " you need to tell your head back when washing your hair." C. " you can get water in your eyes in 1 day" D. " you need to limit your housekeeping activities"

Abnormal

_________________ Eye Changes that Need to Be Reported by Older Adults: · Cataracts · Glaucoma · Macular Degeneration · Diabetic Retinopathy · Detached Retina · Floaters · Excessive tearing/discharge, red eye · Headaches or eyestrain when reading · Feeling like something is in the eye · New onset double vision or deterioration of vision, haziness, flashing lights, eye trauma

retinopathy, blurred vision, and difficulty focusing, photophobia

· Medications with Side Effects of Visual Disturbance § Hydroxychloroquine: ________________________________ § Tamoxifen: retinopathy, decreased visual acuity and blurred vision § Thioridazine: blurred vision, impaired night vision, and color discrimination problems, dry eyes, glaucoma § Levodopa: blurred vision, diplopia, dilated pupils § Propranolol and thiazides: dry eyes, visual disturbances § Sildenafil: abnormal vision, vision loss § Anticholinergics (asthma meds, decongestants): blurred vision § Bisphosphonates: ocular pain, red eye, blurred vision § Corticosteroids: cataracts § Digoxin: yellow-orange vision, flickering images

1. Aminoglycoside antibiotics ( gentamicin, erythromycin, mycin drugs):ototoxic 2. Antineoplastics (cisplastin): ototoxic 3. Loop diuretics (Furosemide): ototoxic 4. Baclofen: tinnitus 5. Propranolol : tinnitus and hearing loss 6. ASA and NSAIDs (ibuprofen): tinnitus

· Drugs with Risk of Hearing Changes: 1 2 3 4 5 6

Detached Retina: the separation of the retina from the epithelium

· Signs and Symptoms of _______________________ § The sudden appearance of many floaters — tiny specks or dark spots that seem to drift through your field of vision § Photophobia: Flashes of light in one or both eyes ("shooting stars" or "lightening streaks") § Blurred vision § Gradually reduced side (peripheral) vision § A curtain-like shadow over the visual field § On ophthalmic exam, detachment is seen as gray bulges or folds in the retina

Cataract

· _______________ Symptoms: NO eye redness or pain! § Painless blurring of vision (patients may think their "contacts/glasses are smudged") or double vision § Sensitive to glare/light § Decreased color perception (colors are faded or discolored) § Halos around objects § Loss of acuity from dimness to distortion § Reading and night driving difficulty (poor night vision) § With progression of disease, severe blurred and double vision occurs (creates a problem with completing ADLS); and eventually total blindness § ______________ assessment signs: · Haziness/cloudy of lens · Inability to see fundus · No red reflex

Cataract

· ___________________: a lens opacity/clouding due to structural changes in proteins that distorts the image and results in gradual loss of vision. It is often VERY reversible. § Pathophysiology: Lens clouding à decreased light to retina à limited vision · With aging, then lens gradually loses water and increases in density · Lens density increases with drying and compression of older lens fibers and production of new fibers and lens crystals · With time, as lens density increases and transparency is lost, visual perception is reduced. Both eyes can have cataracts, but the rate of progression is different for each eye. § Common cause of adult curable blindness § Often bilateral § Development is slow and painless § Leading cause of blindness in the world

Vision and Hearing Problems in the Older Adult

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