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Gerontological Nursing, 132574859-young-nurse-helping-and-supporting…

- - - - Asthma
        
        Intermittent disease with reversible airflow obstruction causing wheezing
        
        Can cause complications of bronchiectasis or cardiac problems
        
        Can be caused by allergens, poor air quality, pet hair, or fragnances
        
        Patient might need bronchodilators, fluids and humidification, or C-Pap or Bi-Pap
      - Chronic Bronchitis
        
        Chronic cough with sputum for minimum of 3 months in each of 2 consecutive years
        
        Increase mucus and bronchial wall thickness, chronic hypoxemia occurs
        
        Assessment of patient will be general cyanosis, right heart failure, distended jugular veins, productive cough, white tenacious cloudy sputum, and shortness of breath
        
        Interventions include low FiO2, fluid overload signs, remove bronchial secretions, prevent obstruction of airway, assess nail beds, and maintain adequate fluid intake
      - Emphysema
        
        Causes: chronic bronchitis, chronic irritation, cigarette smoking and morphologic changes in the lung
        
        Assessment of patient will be barrel-chested, dyspneic, prolonged expiration, hunched-over position, pursed lip breathing
        
        Treatment includes postural drainage, bronchodilators, avoid stress, and breathing exercises
      - Pneumonia
        
        Inflammation of the lower respiratory tract caused by aspiration or inhalation
        
        Causative agents include bacterial, viral, fungal and chemical (classifications)
        
        Community acquired and medical care associated are common
        
        Risk factors include cigarette smokers, immobile, immunosuppressed, depressed gag or cough, sedated, neuromuscular disorder, and NG
        
        Assessment of patient will be tachypnea, rapid bounding pulse, fever, productive cough, confusion, lethargy, anorexia, rapid respiratory rate, tachycardia, bronchial breath sounds, crackles, tactile fremitus, chest x-ray will show infiltrates with consolidation, elevated WBC, and decrease O2 saturation
        
        Interventions include assessing sputum, deep breathing, humidification, chest physiotherapy, 3L of fluid daily, assess lung sounds before/after coughing, monitor ABGs, and use anti-infectives if prescribed
      - COVID-19
        
        Caused by SARS-CoV-2 respiratory virus
        
        Symptoms include cold symptoms, red watery eyes, cough, heart palpitations, loss of sense of smell and taste, and extreme fatigue
        
        80% get mild symptoms, 14% are severe, 5% are critical and causes lead to damage to walls
      - Lung Cancer
        
        More likely to occur in men
        
        More likely to occur in people who smoke
        
        Symptoms include dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, and respiratory infections
        
        Treatment includes surgery, radiotherapy, and chemotherapy
      - Lung Abscess
        
        Causes: pneumonia, tuberculosis, malignancy, trauma, aspiration
        
        Symptoms: anorexia, weight loss, elevated temperature, and chronic cough
        
        Diagnosis: chest x-ray and CT scan of the chest
        
        Treatment: postural drainage, high protein and high calorie diet
        
        Postural drainage is used to remove bronchial secretions, aerosol medications used before the procedure, consider positioning based on individual patient's abilities, discontinue if dyspnea or signs of distress occurs, and do oral hygiene and rest after procedure
- - - - Hypertension
        
        Occurs with aging because of high peripheral resistance
        
        Evaluation of blood pressure to be done more than once
        
        Systolic blood pressure greater than 140, Diastolic greater than 90
        
        Symptoms: dull headache, confusion, disorientation, impaired memory when blood pressure is high
        
        Lots of treatment methods: medications, diet and exercise changes
        
        Sometimes no symptoms occur
      - Congestive Heart Failure
        
        Leading cause of hospitalization in older adults
        
        Complication of arteriosclerotic disease which could be followed by hypertension, diabetes, sleep apnea, stress, sedentary lifestyle
        
        Can be caused by coronary artery disease
        
        Symptoms: crackles, dyspnea, shortness of breath, fatigue, cough, weight gain, orthopnea, depression, wheezing, bilateral ankle edema
        
        Classes of CHF
        
        Class 1: no physical limitations
        
        Class 2: symptoms with ordinary activities, slight limitation
        
        Class 3: symptoms with less activities, more limitation
        
        Class 4: symptoms with any activity, most limitation
        
        Educate patients to monitor weight, avoid salt, organize activities with rest in between, watch heart rate and rhythm, watch for skin breakdown and mental status changes
      - Orthostatic Hypotension
        
        Drop in systolic blood pressure by 20mmHg or more after position changes
        
        Can be caused by vasoactive medications or issues with baroreceptors
        
        Can lead to falls, syncope, or stroke
        
        Educate patient to take their time with position changes
      - Coronary Artery Disease
        
        Ischemic heart disease
        
        Angina
        
        Discomfort under the sternum, coughing, confusion, sweating
        
        Nitroglycerin sublingual tablets or patches used as treatment
      - Thrombus
        
        Cancer can cause thrombus formation
      - Diabetes
        
        Microvascular disease
        
        Hurts kidneys, retina of eye, and tiny capillaries/arterioles
      - Myocardial Infarction
        
        Confusion, shortness of breath, high temperature, low blood pressure
      - Heart Failure
        
        Heart cannot pump enough blood to meet the tissues demands for Oxygen
        
        Left sided heart failure
        
        Results in pulmonary edema leading in pulmonary congestion because the left ventricle cannot pump blood to the rest of the body
        
        Symptoms include crackle, anxiety, restlessness, confusion, anxiety, dyspnea
        
        Right sided heart failure
        
        Results in peripheral edema leading in peripheral congestion because the right ventricle cannot pump blood out of the lungs
        
        Can be caused by left sided heart failure or a disease of the pulmonary system
        
        Symptoms include weight gain, peripheral edema, jugular vein distension, ascites, hepatomegaly
      - Pulmonary Emboli
        
        Risk factors include fractures, unable to move, thrombosis history, CHF, arrhythmias
        
        Symptoms: apprehension, high temperature, shortness of breath, confusion
      - Hyperlidemia
        
        Higher risk of coronary artery disease
        
        High cholesterol levels
        
        Nurse should examine triglycerides, LDL, and HDL levels
        
        Treatment includes changing diets, exercising, and medications
      - Arrhythmias
        
        Caused by hypokalemia, hemorrhage, digitalis toxicity, acute infections
        
        Symptoms include bradycardia, hypotension, dizziness, fatigue, weakness, palpitations
        
        Treatment includes using potassium supplements, cardioversion, anti-arrhythmic drugs and digitalis
        
        Educate the patient to increase activity, decrease/stop smoking and alcohol and to change their diet
      - Peripheral Vascular Disease
        
        Arteriosclerosis
        
        Common in patients with diabetes
        
        Mainly affects the small vessels furthest from the heart
        
        Venous vascular disease
        
        Brown pigmented ankles, normal pulses, warm skin, aching dull pain but relieved when horizontal, superficial ulcers, cyanotic when dependent
        
        Arterial vascular disease
        
        Smooth and shiny skin, sharp pain and claudication relieved with rest, circular ulcers, dry skin, loss of hair, thick nails, ruby when dependent and pallor on elevation
      - Varicose Veins
        
        Causes dull, cramping pain and makes the veins look dilated.
        
        Treatment is to reduce venous stasis
      - Venous Thromboembolism
        
        At higher risk for development if on bed rest, recent surgery or fractures
        
        Edema, pain in foot, engorged superficial veins, cyanosis, aching, warm area
        
        Prevent with anticoagulants, elastic stockings, and elevation of extremities, not Homan's sign!
        
        CROSS LINK: Immobile patients are at risk for issues in many body systems such as developing a DVT, pneumonia, constipation, pressure injuries, musculoskeletal weakness and atrophy, urinary tract infections, orthostatic hypotension, pulmonary emboli, sarcopenia, and urinary/bowel incontinence
      - Aneurysms
        
        Can be caused by arteriosclerosis
        
        Some can be seen with the naked eye, some detected with radiography
        
        Abdominal aortic aneurysms most common with older adults, can rupture
- - - - Dry Mouth (Xerostomia)
        
        Results from decreased salvia, medications, mouth breathing, and decreased cognition
        
        Patient will need salvia substitutes, sipping water, and sugarless candy/gum
      - Dysphagia
        
        Swallowing difficulties increases with age
        
        Watch them eat and assess the patient's swallowing
        
        Can be caused by GERD, stroke, or anatomical/structural disorders
        
        Interventions include prevention of aspiration, promote adequate nutritional status, and a nutritional assessment with the dietician
        
        CROSS LINK: Dysphagia can be caused by a cerebrovascular accident due to neurological muscle damage, stroke patients will need to be evaluated before returning to a normal diet.
      - Hiatal Hernia
        
        Herniation of the esophagogastric junction meaning a portion of the stomach is in the chest
        
        Can be caused by obesity or eating a large amount of food
        
        Types: Sliding (axial, top) and Rolling (paraesophageal)
        
        Symptoms include heartburn, belching, abdominal discomfort
        
        Treatment includes small meals, avoid eating at bedtime, bland diet, and sleeping in a partial recumbent position
      - Esophageal Cancer
        
        Happens with increased age, smoking and alcohol
        
        Types include squamous cell and adenocarcinoma
        
        Caused by poor oral hygiene, irritation, GERD
        
        Symptoms include dysphagia, weight loss, excessive salivation, thirst, hiccups, anemia
        
        Diagnosis includes Barium swallow, esophagoscope and biopsy
        
        Treatment includes surgical resection, radiation, chemotherapy, laser and photodynamic therapy
      - Stomach Cancer
        
        Not very common
        
        Symptoms include anorexia, epigastric pain, weight loss, indigestion, and anemia
        
        Diagnosis includes gastroscopy and barium swallow
        
        Treatment includes surgical-partial gastrectomy
        
        Prevention includes diet low in red meats and high in antioxidents
      - Diverticular Disease
        
        Types: diverticulosis and diverticulitis
        
        Common, presents in 50% of older adults
        
        Causes: chronic constipation, obesity, atrophy of the intestinal wall muscles
        
        Symptoms of Diverticulitis include LLQ pain, more flatus, and increased rectal bleeding
        
        Symptoms of Obstruction: fever, anorexia, abdominal distension, constipation, and diarrhea
        
        Diagnosis includes colonoscopy and barium enema
        
        Nutrition treatment includes acute phase- NPO, recovery phase, no fiber or foods that irritate the bowel
        
        Maintenance phase treatment includes high-fiber diet with bulk forming laxatives to prevent pooling of foods, and avoid small foods such as popcorn, nuts or seeds
      - Colorectal Cancer
        
        Second leading cause of cancer death, fourth most common malignancy in the U.S.
        
        More common in the rectal or sigmoid
        
        Symptoms include change in bowel habits, sense of incomplete bowel movements, abdominal pain, nausea, vomiting, weight loss, cachexia, abdominal distension, family hx, and hx of polyps
        
        Diagnosis includes fecal occult blood tests, Cologuard, CBC, and colonoscopy
        
        Treatment includes colon resection
        
        Avoid processed, high sugar diets
      - Chronic Constipation
        
        Can be caused by poor diet with a lack of fiber and physical activity or medications
        
        Interventions include increased dietary fiber, exercising, assessing bowel sounds
        
        Diagnosis includes blood tests, x-rays, sigmoidoscopy, colonoscopy, and assess bowel movements
        
        Make sure the patient understands safe use of laxatives
        
        Use an elimination chart to evaluate frequency of bowel movements
      - Flatulence
        
        Caused by changes in digestion
        
        Treatment include chewing food well, anti-gas medications, changing diet to be healthier
      - Intestinal Obstruction
        
        Can be caused by tumor, intersession, and stool impaction
        
        Types: Partial or complete, large intestine (cancer), and small intestine (adhesions and hernias)
        
        Symptoms depend on location and cause. Harsh and acute abdominal pain
        
        Assess by listening to bowel sounds carefully
        
        Treatment includes timely intervention, medical and surgical management
      - Fecal Impaction
        
        Best way to prevent is to avoid constipation
        
        Obtain a bowel elimination record is essential
        
        Symptoms include liquid stools oozing around impaction and guarding of the abdomen
        
        Diagnosis includes flat plate of the abdomen
      - Bowel Incontinence
        
        Not a normal part of aging, can be caused by neuromuscular issues or dementia
        
        Involuntary defecation and inability to voluntarily control the passage of stool
        
        Most often associated with fecal impaction, assess!
        
        Treatment/Management: medications, regular routine for bowels, digital stimulation if spinal cord compromised
      - Acute Appendicitis
        
        Not very common in older adults
        
        Pain all over the body, not usually specific to one location
        
        Potential for a delay in diagnosis and greater complications/mortality
        
        Treatment includes appendectomy, antibiotics, laparoscopy
      - Pancreatic Cancer
        
        Difficult to detect and diagnosed at an advanced stage
        
        Symptoms include epigastric pain, anorexia, wasting, changes in blood sugar
        
        Diagnosis: scans of the pancreas
        
        Treatment includes resection of the pancreas
        
        Generally causes a poor prognosis, life altering if removing pancreas because losing pancreatic enzymes
      - Biliary Tract Disease
        
        Cholelithiasis (gallstones)
        
        Incidence increases with age
        
        Symptoms include acute, harsh right sided pain under the ribcage to left shoulder (referred pain)
        
        Treatment includes removing fatty foods (low-fat diet), surgical procedure to remove, endoscopy and laparoscopy
        
        Cancer of the gallbladder
        
        Symptoms are similar to gallbladder disease
        
        Poor prognosis but very rare
- - - - Urinary incontinence
        
        Identify cause as initial goal
        
        Types: stress (laughing, coughing, runs incontinence), urgency, overflow (prostatic hypertrophy), neurogenic, functional, mixed
        
        Treat underlying cause and type
        
        Assess urinary pattern, pain, fullness, symptoms, fecal impaction, diet, reactions, medications, functional status, other conditions
        
        Encourage 2-3L a day, educate on signs of dehydration, always complete antibiotics
      - Urinary Tract Infections
        
        Infection/inflammation at any site in the urinary tract
        
        Usually caused by E. coli
        
        High risk population includes diabetes, pregnancy, immunosuppressed, catheterized, urinary retention
        
        Symptoms include sudden onset incontinence, hematuria, confusion, urgency, dysuria, pain at costovertebral angle, fever, chills
        
        Antibiotics, fluids, I&O, encourage voiding, analgesics, remove catheters, perineal hygiene
      - Bladder Cancer
        
        Symptoms include dysuria, frequency, blood
        
        Diagnosis includes cystoscopy
        
        Treatment includes surgery, radiation, immunotherapy, chemo
        
        Risk factors include irritation and smoking
      - Renal Calculi
        
        Can be formed through diet
        
        Common in older adults
        
        Hematuria, severe pain, fever
        
        Ultrasounds for diagnostics
        
        Treat with lithotripsy, hydration
      - Glomerulonephritis
        
        Blood or protein in urine, high blood pressure, swelling of ankles/face, lack of appetite, nausea, vomiting, tiredness, difficulty sleeping, itchy skin, muscle cramps at night
        
        Late stage can be cerebral edema with confusion and convulsions
        
        Diagnosis with labs and biopsy
        
        Treat with low sodium and low protein diets
- - - - Dementia
        
        Irreversible, progressive impairment of cognitive functions
        
        Causes issues with memory, reasoning, attention, problem solving, and orientation
        
        Stems from injury or damage to the brain
        
        Qigong therapeutic exercise can help Dementia patients
        
        Can be caused by genetics, environmental factors, free radicals, slow-acting virus, inactivity, chromosomal abnormalities, hypoxia, dehydration, hyper/hyponatremia, new medications, and pain
        
        Types: vascular, frontotemporal, lewy body, creutzfeldt-jackob disease, wernicke encephalopathy, parkinson's disease, AIDs, toxins and trauma
        
        Nursing interventions include helping make a structured environment, items to trigger memory, wandering behavior, prevention of abuse, promote therapy and activity, respect the uniqueness of individual, promote independence, support the patient's family, minimize stimulation, consistent care, and prevent harm to self and others
        
        CAM therapies include vitamins, minerals and herbs
        
        Provide close attention to eating, drinking, skin care, needs and discomforts, and bathing
        
        Symptoms include rapid and altered level of consciousness, personality changes, confusion, disorientation, loss of memory, decline in ADLs, or change in mood
      - Alzheimer's Disease
        
        Form of dementia, gradually develops
        
        Extremely common causing plaques and neurofibrillary tangles to form while losing neurons
        
        Can be caused by genetics, free radicals, environment
        
        Progress varies between persons
        
        Stage by using the Global Deterioration Scale/Functional Assessment Staging (GDS/FAST)
        
        No cure but treatment might include antioxidants, medications to slow acetylcholinesterase, anti-inflammatories, folic acid, vitamins B6 and B12
        
        Patient safety is key for nurses to implement because of wandering, abuse, poor judgement, misperceptions, help with bathing and feeding, communicating needs, promoting activity and orientation
      - Delirium
        
        Can be caused by chronic illness, changes in electrolytes, isolation in hospital, infection, or alcohol/drug withdrawal
        
        Nurse should closely monitor vital signs, reduce noise, promote sleep, limit distractions, keep the atmosphere relaxing, and reorient the patient as needed
        
        Proper and prompt treatment can reverse the condition and avoid further damage
        
        Treatment varies upon the cause of the delirium although mainly medications and fluids are used
        
        At the beginning of diagnosis or symptoms, help minimize stimulation, be consistent with care, and establish medical stability
      - Depression
        
        Most prevalent mental health disorder among older adults
        
        Symptoms include insomnia, fatigue, anorexia, and weight loss
        
        Diagnosis includes the geriatric depression scale: mild is generalized sadness and issues concentrating, moderate is decreased sleep and slurred speech, and severe is the whole body is closed and less eye contact
        
        Assessment includes looking for hopelessness, coping, open ended questions, and suicidal thoughts
        
        Analysis includes decreased serotonin and norepinephrine
        
        Nursing interventions include monitor sleep, nutrition, ADLs, be present and express feelings
      - Anxiety
        
        Unexplained discomfort, tension, apprehension, or uneasiness, which occurs when a person feels a threat to self. The threat may be real or imagined.
        
        Identified by unrealistic, excessive, or persistent (lasting 6 months or longer) anxiety and worry about two or more life circumstances. Previously learned coping mechanisms are inadequate to deal with this level of anxiety
        
        Older adult women are twice as likely as older men to have an anxiety disorder
        
        Symptoms include restlessness, SOB, shakiness, uneasiness, and heart palpitations
        
        Diagnose with subjective assessments and vital signs
        
        Nursing interventions include active listening, meditation, guided imagery, and communication
      - Substance Use Disorder
        
        Abuse refers to the habitual use of psychoactive substances that is not socially acceptable or a medical necessity. The substance is purposely used to alter the individual’s emotion, mood, or state of consciousness.
        
        Most commonly used illicit psychoactive substance is marijuana
        
        Other substances include:
        
        ecstasy, gamma-hydroxybutyric (GHB) acid, lysergic acid diethylamide (LSD), and methamphetamine.
        
        Anabolic-androgenic steroids
        
        Nonmedical use of prescription drugs: painkillers such as oxydodone, sedatives, stimulants.
        
        Psychoactive substances: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, stimulants, and tobacco.
        
        Can cause impairment and distress with problematic behaviors
        
        Analysis includes risk for injury, ineffective family coping, imbalance nutrition, and situational low self-esteem
        
        Interventions include reinforce reality, assist with identification of stressors, encourage exploration of alternative coping strategies, and help patient identify appropriate support systems
        
        Alcohol abuse assessment:
        
        Episodic drinking (binges)
        
        Continuous drinking
        
        Morning drinking
        
        Increase in family disruption
        
        Blackouts
        
        Hiding drinking patterns
        
        Legal problems, such as drinking under the influence (DUI)
        
        Withdrawal syndrome (DTs) hallucinations, convulsions, gross tremors,
        
        Continued drinking despite medical advice.
        
        Health problems ie gastritis, cirrhosis, hepatitis, pancreatitis, malnutrition, dehydration, peripheral neuropathy, cardiac disorders; hypertension, irregular heartbeat, and heart failure due to cardiomyopathy. Cognition impairment by loss of brain cells and enlargement of the ventricles, Wernicke syndrome (encephalopathy) in chronic alcoholics due to deficiency of Vitamin B1 (thiamine)
      - Behavior Problems
        
        actions that are disruptive, harmful or deviate from the normal and tend to be recurrent in nature, such as physical or verbal abuse, resistance to care, repetitive actions, wandering, restlessness, suspiciousness or inappropriateness.
        
        These problems can occur in persons with altered cognitive status who are unable to think rationally and make good judgements.
      - Suicide Risk
        
        Older adult males over the age of 85 have the highest rate of suicide
        
        Warning signs include giving away possessions, previously depressed patient has a change in affect
        
        Risk factors include loneliness, isolation, and coping with chronic disease
        
        Treatment includes proper nutrition, regular exercise, socialization, psychotherapy, and antidepressants, electroconvulsive therapy might be considered
- - - - We have not talked about musculoskeletal pathologies yet in class but some examples are arthritis, osteoporosis, rheumatoid arthritis, carpal tunnel syndrome
- - - - Pruritus (itching), caused by dry skin
      - Seborrheic Keratosis, non cancerous lesions called age spots and raised lesions
      - Skin cancers
        
        Basal Cell Carcinoma, least aggressive and unlikely to metastasize, looks like papules with pus
        
        Squamous Cell Carcinoma, thick rough patches that can bleed, dangerous and need to be caught early
        
        Melanoma, black to brown irregular surface
      - Pressure Injuries
        
        Level 1: Non-Blanchable Erythema
        
        Level 2: Partial Thickness Injury
        
        Level 3: Full Thickness Skin Loss
        
        Level 4: Full Thickness Tissue Loss
      - CROSS LINK: Watch for skin breakdown in older adults with conditions such as hypothyroidism, dementia since they might not be able to care for their own skin, CHF, arterial vascular disease, malnutrition and immobile patients
- - - - Vulva, cervix, uterus, and fallopian tubes atrophy, less subcutaneous fat and hair
      - Less lubrication of vaginal canal (intercourse uncomfortable) and can cause dyspareunia (painful sex)
      - More alkaline vaginal pH
      - Breasts are sagging and slight retraction of the nipples
      - Uterus and ovaries are smaller in size
      - Cervix decreases in size, Nabothian cysts can occur
    - - Testes atrophy and reduce in mass
      - Ejaculation contains less live sperm
      - Slower erection arrival time
      - Prostate gland enlarges
      - Less capacity to retain fluids
      - More connective tissue replacing muscle tissue
    - - Females:
        
        Endometrial Cancer
        
        Symptoms/Signs: Post menopausal bleeding/spotting
        
        Common in older women
        
        Diagnose with a biopsy
        
        Treatment: Hysterectomy
        
        Ovarian Cancer
        
        Leading cause of death from gynecologic malignancies
        
        Symptoms/Signs: bloating, large abdomen, constipation, frequent urination
        
        Diagnosis: ultrasounds and blood tests
        
        Treatment: surgery and/or chemotherapy
        
        Perineal Herniation
        
        Types include rectocele (rectum slips to vaginal canal), cystocele (bladder slips down), and prolapsed uterus (uterus slips down to vaginal canal).
        
        Can be caused by pregnancy
        
        Symptoms/Signs: visible/non-visible bulging, constipation, swelling near the vaginal canal or rectum
        
        Treatment: surgical repair
        
        Breast Cancer
        
        Second leading cause of cancer deaths
        
        Importance of regular breast examinations by self and health care professional
        
        Treatment usually includes chemotherapy and radiation
      - Males:
        
        Erectile Dysfunction
        
        Not a part of normal aging
        
        Can be caused by medications such as antidepressants, muscle relaxers, and antihistamines. Or an underlying disease such as DM, smoking, obesity, and hypertension.
        
        Treatment: oral medications or surgery
        
        CROSS LINK: Male patients diagnosed with hypertension might complain of difficulty performing during intercourse, antihypertensives can cause erectile dysfunction
        
        Benign Prostatic Hyperplasia
        
        Occurs in all men to a certain degree
        
        Causes hesitancy of urine, less force of the urine stream, and nocturia
        
        Treatment: Medications or surgery (Transurethral Resections)
        
        Prostate Cancer
        
        Increased risk with age
        
        Symptoms: issues with urinating, nocturia, urinary retention, dribbling of urine
        
        Diagnosis by digital rectal examination
        
        Treatment includes surgery, monitoring PSA levels, and medications
        
        Scrotal Masses
        
        Causes: varicocele, inguinal hernia, hydrocele
        
        Diagnosis by ultrasound
        
        Treatment can include education and using surgical patches
        
        Typically are benign
- - - - Muscle fibers of the lens become stiffer and less elasticity
      - Vision Pathologies
        
        Cataracts
        
        Clouding of the lens, no transparency
        
        Diminished vision
        
        Treat with cataract surgery
        
        Symptoms include sensitivity to light, difficulty seeing at night, increased glare, and halos around lights
        
        Glaucoma
        
        Damage occurs to optic nerve due to high IOP
        
        Causes blindness (very common)
        
        Symptoms include headache, eye pain, blurred vision, and loss of peripheral or all vision
        
        Treatment includes oral medications such as beta blockers, surgery, or eye drops
        
        Type: Acute (closed/narrow angle) Glaucoma
        
        Causes eye pain, nausea, headache, edema, and vomiting
        
        Treat early to avoid blindness, diagnosis with tonometry to determine IOP
        
        Type: Chronic open angle Glaucoma
        
        Most common, early prevention to avoid blindness
        
        Symptoms include loss of peripheral and tunnel vision
        
        Treat with medications and surgery
        
        Macular Degeneration
        
        Most common cause of blindness
        
        Damage of macula causing loss of central vision
        
        Treatment includes medications such as VEGFR inhibitors, surgery, or corrective lens
        
        Detached Retina
        
        Forward displacement of retina
        
        Symptoms include seeing floaters, blurred vision, seeing spots, and sensitivity to light
        
        Early treatment to avoid damage and blindness
        
        Corneal Ulcer
        
        Inflammation of cornea, loss of substance
        
        Can be caused by contact lenses, injuries, or nutritional deficiencies
        
        Symptoms include eye redness, tearing, pain, sensitivity to light, or vision loss
        
        Treatment includes antibiotics or antifungals
      - Dark and light adaptation takes longer, harder to see at night
      - Arcus senilis (white ring encircles cornea)
      - Depth perception changes, reduced peripheral vision and tear production
      - Blindness can occur and might be unable to read lips or facial expressions
      - Routine exams and early detection/treatment is important
      - Nutrients that help vision: zinc, selenium, vitamin C, A, E, riboflavin, gingko biloba, and flavonoid
      - Smaller pupil size, opacification of lens
    - - Presbycusis (sensorineural hearing loss)
      - Hearing Pathologies
        
        Otosclerosis
        
        Abnormal bone growth in the ear causing hearing problems
        
        Tinnitus
        
        Ringing or other noises in the ear
        
        Presbycusis
        
        Age-related sensorineural hearing loss
        
        Nursing Interventions
        
        Encourage audiometric testing
        
        Teach how to live with hearing issue
        
        Advise to wear hearing aids or discuss possibilities of getting hearing aids
      - More cerumen, becomes impacted
      - Ability to discriminate tones is diminished
      - Treatment requires prompt treatment and educate about protecting and cleaning ears
      - High pitches harder to hear
    - - Amount of taste buds that function is lower
      - Ability to taste sweet and salty flavors is diminished
    - - Unable to sense pressure as easily
      - Diminished tactile sensation
      - Hard to discriminate temperatures
    - - Less cells in olfactory bulbs so less function
- - - - Type 2 Diabetes
        
        Glucose intolerance
        
        Diagnosis occurs in older adult
        
        Oral antiglycemics or insulin dependent
        
        Seventh leading cause of death in older adults
      - Type 1 Diabetes
        
        Insulin dependent
        
        Autoimmune against pancreas, familial tendency, post viral syndrome
      - Diabetes Mellitus
        
        Need to receive fasting blood sugar every 3 years if above 45 y/o
        
        Diagnosis: random blood glucose above 200, fasting blood glucose above 126, post prandial blood glucose above 200
        
        Lots of patient education is necessary: nutrition, exercise, medications, complications, and symptoms
        
        First line medication is Metformin, other options include Sulfonylureas, Thiazolidinediones, and Insulin
        
        Monitoring includes Hemoglobin A1c test, triglyceride monitoring, and finger stick glucoses 4x daily
        
        Complications include hypoglycemia, retinopathy, neuropathies, blindness, UTIs, cerebral arteriosclerosis, cognitive impairment
        
        CROSS LINK: High blood sugar levels can damage blood vessels causing cardiovascular complications, these patients will be more likely to develop PVD, CAD and strokes. Close monitoring of the cardiovascular system is needed for these patients.
      - Hypothyroidism
        
        Hypofunction of the thyroid gland causing low thyroid hormone levels
        
        Diagnosis by low T3 and T4 or presence of T4 antibody
        
        Symptoms: fatigue, weakness, weight gain, anorexia, periorbital edema, peripheral edema, ataxia, paresthesia, dry skin and hair, husky voice, lethargy
        
        Treatment includes Thyroxine at a low dose to start and monitor side effects and symptom relief, provide bowel elimination plan by increasing fiber, fluids and activity
        
        Watch for myxedema, hypotension, hypothermia, respiratory failure with high doses of medication
      - Hyperthyroidism
        
        Excess thyroid hormone secreted
        
        Symptoms: tachycardia, anxious, agitation, mood swings, difficulty sleeping, heat intolerance, fatigue, exophthalamos, diarrhea, diaphoresis, insomnia
        
        Diagnosis: T3 levels above 220 and T4 above 12
        
        Treatment includes thyroid ablation, radioactive iodine therapy
- - - - Parkinson Disease
        
        Disease of basal ganglia causing tremor at rest, muscle rigidity, bradykinesia, and difficulty with gait and balance
        
        Low levels of dopamine that helps control movement and coordination
        
        Treatment includes anticholinergic medications and controlling symptoms (medication- levodopa)
        
        Nursing interventions include education and address psychosocial and physical needs
        
        Goal is to maximize level of independence
        
        Nursing assessment includes rigid extremities, mask-like facial expression, difficulty chewing/swallowing, drooling, shuffling gait, pill rolling movement, increased tremors at rest and stooped posture
        
        Nursing diagnosis includes impaired physical mobility, disturbed body image, self-care deficit, impaired verbal communication, imbalanced nutrition
        
        Schedule activities later in the day, exercise, decrease environmental noises, and soft diet
        
        Early symptom is constipation
      - Transient Ischemic Attacks (TIA)
        
        Temporary or intermittent reduction in cerebral perfusion
        
        Causes include smoking, high blood pressure, obesity, alcohol, and diabetes
        
        Symptoms include muscle weakness, difficulty swallowing, confusion, dizziness
        
        Treatment includes fixing underlying cause and reducing risk of cerebrovascular accident
      - Cerebrovascular Accident
        
        Types include ischemic and hemorrhagic
        
        Warning signs include face drooping, arm weakness, and difficulty speaking
        
        Drop attacks occur as sudden, spontaneous falls
        
        Symptoms include confusion, impaired vision, difficulty walking, slurred speech, or numbness
        
        Focus on acute care until stabilization and then focus on rehabilitation