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2011-11-14 05:42:42

Chapter 14
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  1. Sensory Overload
    • Neuroexcitability and secretion of stimulating
    • neurotransmitters decrease as one ages.

    • from abrupt, unexpected environmental change such as
    • accident or hospitalization.

    factor to the development of delirium
  2. 3 types of Sensosory Deprivation
    • reduced sensory capacities,
    • eIimination of patterns and meaning from input, and
    • restricti ve, monotonous environments.
  3. Symptoms of Sensory Deprivation
    • Somatic distress
    • Vivid imaginings
    • Psychotic delusions
    • Hallucinations
    • Boredom, withdrawal
    • Spatial
    • distortions
    • Cognitive impairment
  4. Sensory Overload
    • Withdrawal
    • Perseveration
    • Anxiety
    • Fear
    • Panic
    • Psychosis
    • Irritability
    • Short attention span
  5. Visual impairment is
    • loss that cannot be corrected by glasses or contact lenses
    • 20/40 or worse with corrective lenses
    • 20/200 legal blindnes­ or severe visual impairment
  6. Presbyopia
    • lens' gradually loses elasticity
    • affecting refractive ability of the eye
    • inability to accommodate to close details
    • occur earlier than for the nearsighted (myopia) not hyperopic (farsighted)
  7. Why do some individuals at 60 or 70 years of age develop better vision
    As lens opacity increases, refractive power increases at the same time that accommodation, or lens resilience, decreases. The result is a temporary shift toward myopia and improved close vision.
  8. keratoconjunctivitis sicca
    • diminished tear product
    • com­mon in women after menopause
    • may be described a dry, scratchy feeling in mild cases (xerophthalmia)
    • Other cause od dry eyes include:
    • antihistamines, beta-blockers, and some sleeping pill
    • Vit A def.
    • Sjogren's syndrome is a cell-mediated autoimmune
  9. Major diseases affecting vision
    • glaucoma,
    • cataracts,
    • macular degeneration,
    • diabetic retinopathy
    • 40% of blindness and visual impairment is treatable or preventable
  10. Glaucoma
    • chronic pro­gressive disease
    • fluids bloocked by ciliary muscle rigidity or an overproduc­tion of aqueous humor
    • buildup of pressure damages optic nerve

    • Primary-open angle - 2/3 of cases assymtomatic till late noticeable loss of peripheral vision
    • Normal pressure -
    • Acute angle-closure - rapid rise in intraocular pressure (IOP)

    • Beta-blockers are the first-line therapy for
    • glaucoma, surgery if needed, Medications lower eye pressure either by de­crease amount produced or improving drainage

    • Screening: adults older than 65 years be evaluated 1:yr
    • Medication controlled glaucoma be examined every 6mth
  11. Normal IOP is
    • 11 - 20 mm Hg.
    • Glaucoma is pressure > 20 mm Hg
  12. Cataracts
    • oxidative damage to lens protein
    • fatty deposits (lipofuscin) in the ocular lens
    • When lens opacityeduces visual acuity to 20/30 or less
    • categorized according to loca­tion within the lens
  13. Diabeic Retinopaty
    • effects of elevated blood sugar
    • vascular and cellular changes accompanying
    • third leading cause of blind­ness
    • evidence of retinopathy until 3 to 5yrs of diabetes
  14. Age related Macular Degeneration (AMD)
    • Progressive loss of central vision
    • affects macula central part of eye for central
    • leading cause of blindness >65yrs
    • systemic changes in circula­tion
    • accumulation of cellular waste products
    • tissue atrophy
    • Gowth of abnormal blood vessels in the choroid
    • layer under retina
  15. The two forms of macular degeneration
    Dry AMD accounts for the majority of cases, rarely causes severe visual impairment, but can lead to the more aggressive wet AMD

    wet AMD, the severe loss of central vision can be rapid and many people will be legally blind within 2 years of diagnosis.

    Peripheral vision is normal, difficulty seeing at a distance or doing detailed work
  16. Assessment of Vision
    • Color vision is evaluated with Ishihara chart sensitive
    • for red/green blindness but not blue, which is more common in older adults

    Near vision can be evaluated using a book or newspaper

    Rosenbaum chart about 12 to 14 inches away

    Snellen chart is commonly used by nurses to test for distance vision.
  17. Signs of Vision Problems

    • pain in eyes
    • difficulty seeing in darkened area
    • double vision/distorted vision
    • headaches coupled with blurredvision
    • flash of light surrounding lights
    • difficulty driving at night
    • fall or injuries


    • getting lost
    • bumping into objects
    • straining to read or no reading
    • stumblling/falling
    • spilling food on clothing
    • social withdrawal
    • mismatched clothes
    • less eye contact
    • placid facial expression
    • viewing tv at close range
  18. caring for elder with visual impairment
    • warm incandescent lighting;
    • increase intensity of lighting;
    • control glare with shades and blinds
    • yellow or amber lenses to decrease glare
    • sunglasses that block all ultraviolet light
    • colors with good contrast and intensity
    • read­ing materials large, dark, evenly spaced printing.
  19. Interventions to Enhance Vision
    use warm and intense colors such as reds and oranges rather than blues and beiges.

    Color contrasts are used to facilitate location of items
  20. Low-Vision Assistive Devices
    • cosmetically appealing glasses
    • magnifying glasss
  21. Orientation Strategies for the Nonsighted
    • the clock method
    • the sighted guide, guides the visually impaired
    • the cane sweep, which encounters obstacle
    • varied textured surfaces
    • sound signals
    • guide dogs.
  22. Presbycusis
    • age related sensorineural hearing loss
    • treated with hearing aids
    • bilateral and symmetrical
    • genetics, noise exposure, car­diovascular
    • status, central processing capacity, certain medi­cations, smoking, diet, personality, and stress
    • affects the ability to understand speech.
    • intolerant of loud noises
    • incapable of distinguishing among con­sonants
    • such as z, s, sh, f, p, k, t, and g
  23. Conductive hearing loss usually involves
    • ab­normalities of the external and middle ear, such as otoscle­rosis, perforated eardrum, fluid in
    • the middle ear, or cerurnen accumulations.
  24. Tinnitus
    ringing in the ear, may also manifest as buzzing, hissing, whistling, crickets, bells, roaring, clicking, pulsating, humming, or swishing sounds.

    • most common type is high-pitched
    • tinnitus with sensorineural loss; less common is low-pitched tinnitus with conduction loss such as is seen in Meniere's disease

    • Tinnitus can be caused by loud noises, excessive cerumen or auditory canal
    • obstruction, disorders of the cervical verte­brae or the temporomandibular joint, allergies, an underac­tive thyroid, cardiovascular disease, tumors, conductive hearing loss, anxiety, depression, degeneration of the bones in the middle ear, infections, or trauma to the head or ear.
  25. Choclear implants
    surgically im­planted in the mastoid bone behind the ear and electrically stimulates the primary hearing organ,
    • senses of taste and smell play an important role
    • in eating behaviors and health
    • may be the result of medicatic disease processes,
    • or, in rare situations, hallucination.
  27. Tastes
    • two thirds dependent on the olfactory sense
    • VII [facial] and IX [glossopharyngeal])
    • most affected by aging- sweet and salty at tongue tip
    • >70 increased sensitivity to bitter
  28. Olfaction
    • fail to detect the odor of leaking gas, a smoldering cigarette, or tainted food
    • nasal sinus disease that results in obstruction of pas­sages
    • injury to olfactory receptors through viral infections
    • trauma results bleeding into the nasal mucous membrane
    • Olfactory nerve cells capable of regeneration
    • anosmia >6mths permanent damage
    • Dysosmia (the sensation of unpleasant smell)
  29. confusion vs disorientation
    • "confusion"is a catchall diagnosis of unexplained symptoms
    • whereas "disorientation" can be highly specifi
  30. Disorientation (time)
    • Perception of Time.first to emerge distorted by stressful circumstances
    • monotonous environments that lack contrasting events
  31. Perception of Place.
    • second level of orientation interrupted when a person is uncertain of territory
    • the older person slips into the security of the
    • familiar past;
  32. Perception of Person
    • third level of disorientation
    • A patient who believes he or she is at home may expect a family member to enter the room
    • Disorientation regarding one's identity is the most pro­found insecurity
  33. Perception of Space
    • changes occur in total body awareness (proprioception) in elder
    • Psychomotor slowing related to four cns system processing factors:
    • ( 1 )neuron loss reduces signal strength and processing capacity,
    • (2) an increase in random neural activity creates "noise"
    • interference in processing,
    • (3) reconstitution after neural activity takes longer
    • (4) arousal levels are di­minished.

    movement integration stimulate vestibular function
  34. Touch Sensitivity
    • visual and hearing impairments compensate by intesified touch sense
    • Touch is lacking in elder environment contributes to < sensorium
    • disease ex. diabetes mellitus causes peripheral neuropathy and < light touch in extremities
    • < thermal sensitivity (hot , cold)
    • <sensitivity on hands and foot (degenerative meissner's corpuscles)
    • < pain reaction reflex time