Exam 1 for NUR 407 - Adult Health & Illness III ORU

what is a major risk factor for hearing loss?

occupation

____ loss affects nearly every aspect of an individual's life

hearing

presbycusis

progressive, age related hearing loss

cochlear implant

auditory prosthetic used for people with profound bilateral sensorineural hearing loss

aural rehabilitation

intervention to improve communication skills of the person who has a hearing impairment

hearing aids

much smaller and more cost effective

hearing guide dogs

For moderate to severe hearing loss assist owners in hearing things in the environment and cues owner

true or false? does repeated exposure to loud noises cause the development of conductive hearing loss?

false: noise exposure causes irreparable sensorineural hearing loss.

conductive hearing loss

hearing impairment caused by interference with sound or vibratory energy in the external canal, middle ear, or ossicles

in order to enhance communication with a pt who has moderate hearing loss the nurse should? a. speak as loudly as possible b. discuss only simply, unambiguous topics c. ensure the pt can see the nurse's mouth d. use writing as the sole means of communication

c. make sure the pt can see the nurses mouth

cerumen impaction:

buildup of ear wax blocking ear canal --> can be removed

how can cerumen be removed

irrigation, suction, or instrumentation

how are foreign bodies removed in the ear?

same way as cerumen

tympanic perforation

tear of hole in the eardrum

what causes tympanic perforation

infection or trauma

what sound does a tympanic perforation make

whistling sounds when you sneeze and blow your nose.

symptoms from tympanic perforation

pain, < hearing, purulent drainage

tympanoplasty

surgical repair of the eardrum

otosclerosis

hearing loss that results from the formation of new, abnormal spongy bone that impairs the functioning of the stapes

options to help otosclerosis

only surgical: stapedectomy or stapedotomy

vertigo

the sensation of dizziness

nystagmus

Involuntary rapid eye movements

is vertigo an issue with the middle or inner ear?

inner ear

is nystagmus a middle or inner ear issue?

inner ear

menière disease

chronic disease of the inner ear characterized by dizziness, ringing in the ear, and hearing loss

what causes meniere disease

changes in pressure within the inner ear or mixing of inner ear fluids

how can we treat pts with meniere disease

diet and medication

what meds would we prescribe someone with meniere disease?

antihistamines, tranquilizers, antiemetics, or surgery

true or false: a pt with meniere disease should be counseled to avoid high-salt foods and caffeine

TRUE: low sodium diet, NO alcohol or caffeine

is vertigo an issue with the middle or inner ear?

inner ear

tinnitus

ringing in the ears

what is tinnitus caused by

underlying disorder of the ear associated with hearing loss

benign paroxysmal positional vertigo (BPPV)

brief period of incapacitating vertigo that occurs when the position of the patient's head is changed

ototoxicity

result of medications that have adverse effects of the cochlea, vestibular apparatus, or cranial nerve VIII

acoustic neuroma

slow growing benign tumor of cranial nerve VIII

a nurse should be aware of potential ototoxicity when administering which of the following medications a. amino glycoside antibiotics b. alpha-adrenergic blockers c. anti fungal meds d. opioid analgesics

amino glycoside antibiotics gentamicin are some of the most ototoxic drugs

myopia

nearsightedness - distant vision is blurred

hyperopia

farsightedness - near vision is blurred

astigmatism

irregularity of the curve of the cornea

blindness

20/400 to no light perception

true or false: typically an individual who becomes suddenly blind adapts to his or her new circumstances more easily than someone who loses vision gradually

false: pts with progressive eye disorders develop coping and management techniques over time

glaucoma

group of ocular conditions characterized by optic nerve damage related to intraocular pressure (IOP)

open-angle glaucoma

the most common form of glaucoma, where the trabecular meshwork gradually becomes blocked, causing a buildup of pressure

angle-closure glaucoma

Rapid onset of elevated IOP

cataracts

clouding of the lens

nurse is teaching a group of older adults about cataracts what teaching point should the nurse include in this health education?

eye surgery is the most effective treatment for cataracts

retinal detachment

separation of the retinal pigment epithelium from the sensory layer

macular degeneration

tiny, yellowish spots called druse beneath the retina

two types of age-related macular degeneration

dry and wet

orbital trauma is used associated with

head injury

conjunctivitis

inflammation of the conjunctiva

major causes of conjunctivitis

infection, allergy, and irritating toxic stimuli

true or false: preventing the spread of conjunctivitis can often be accomplished by promoting hand washing

true

enucleation

removal of entire eye and part of the optic nerve

evisceration

surgical removal of the intraocular contents

exenteration

The removal of the eyelids, the eye, and various amounts of orbital contents

common meds with eyes are

topic anesthetics, mydriatics, and cycloplegia agents

when administering a topical ocular medication to a pt the nurse should

position the pt's head in a supine position

stress

non-specific response of the body to any demand for change

acute stress

results from daily life encounters: flight or fight response

chronic stress

sustained response or repeated event that eventually impedes coping

coping

process of applying thoughts and actions to deal with stressful events

problem-focused coping

deals directly with the challenge

emotion-focused coping

directed at dealing with emotions

stressor:

stimulus initiating the stress response

sociocultural stressors

family, financial, career concerns

altered coping patterns

smoking, drinking, physical illness, addictive behaviors

separation anxiety

fear/anxiety when separated from someone person is emotionally attached to

panic disorder

recurrent panic attacks

phobias

irrational fear of a specific object or situation

generalized anxiety disorder

uncontrollable excessive worry > 3 months

OCD

unrealistic obsessions

trauma and stress related disorders

- acute stress disorder - PTSD - adjustment disorder

Risk Factors for anxiety:

•Women •Trauma •Genetics •Other mental illness •Worse with substance Abuse 30-44 years old

mild anxiety symptoms

Restlessness, increased motivation, irritability

moderate anxiety symptoms

agitation, muscle tightness

severe anxiety symptoms

inability to function, ritualistic behavior, unresponsive

panic attacks

15-30 minutes palpitations SOB choking chest pain Nausea

social phobia

fear of embarrassment, dread of social situations, feels judged

agoraphobia

avoids being outside

specific phobias

fear of objects or specific situations or events

hoarding

collecting and putting things away in a guarded manner

sensory perception

ability to receive sensory input and translate it into meaningful info

sensation

the process by which our sensory receptors and nervous system receive and represent stimulus energies from our environment

perception

the process of organizing and interpreting sensory information, enabling us to recognize meaningful objects and events

presbycusis

age related hearing loss

ototoxicity

Toxicity to the ears, often drug induced and manifesting as varying degrees of hearing loss that is likely to be permanent.

paresthesia

abnormal sensation

5 senses

Sight, hearing, touch, smell, taste

what is the largest population at risk for impaired sensory perception

elderly population

what is a test we do for balance

Romberg

what is Romberg test

Tests the client's equilibrium, client stands with feet together and arms at sides eyes open and then closed. Client should be able to maintain the position for 20 secs with minimal or no swaying

monofilament testing

Testing for lower extremity sensation Diabetic neuropathy screen LEAP program

what do we use for newborn's eyes to prevent infection

erythromycin

what age do vision and hearing screenings occur

around 2-2.5 years old

how often do you check someone's vision or hearing

3-5 years

what medications can we use to treat vision

beta-adrenergic, prostaglandin analogs, adrenergic agonists, carbonic anhydrase inhibitors, antimicrobial, steroidal, analgesics

is cochlear implants a surgery or adaptive method

surgery

cornea

the transparent outer covering of the eye

lens

the transparent structure behind the pupil that changes shape to help focus images on the retina

iris

Colored part of the eye - controls light levels

ciliary body

mass of muscles

vitreous humor

jellylike substance found behind the lens in the posterior cavity of the eye that maintains its shape

retina

Light sensitive layer of the eye; contains rods and cones

rods

retinal receptors that detect black, white, and gray; necessary for peripheral and twilight vision, when cones don't respond

cones

color vision

which statement about age-related changes that affect vision is true

age-related changes affect all the structures involved in visual function

visual impairment

loss that cannot be corrected with glasses or contacts; ranges from mild to blindness

mild impairment

caused by normal age-related changes, exacerbated by environmental conditions such as glare and poor lighting

loss of accomodation

presbyopia - diminished ability to focus clearly on objects at various distances

diminished acuity

diminished ability to detect details and discern objects

delayed dark and light adaptation

slower adaptive response to changes in lighting

altered color vision:

perception so objects look darker and whites appear more yellowed

diminished critical flicker fusion

ability to perceive flashing lights

what is presbyopia

loss of accommodation

opacification and yellowing of the lens cause an altered perception of which colors

blue and green

AMD (age-related macular degeneration)

leading cause of severe vision loss

glaucoma explained

causes loss of peripheral vision leading to blindness if untreated

diabetic retinopathy

occurs when diabetes damages the tiny blood vessels in the retina, causing blood to leak into the posterior segment of the eyeball

which population is at highest risk for diabetic retinopathy

hispanics

what is the leading cause of visual impairment in older adults

cataracts

what is the leading cause of SEVERE vision loss in older adults

macular degeneration

what is the second leading cause of blindness in the U.S.

glaucoma

a client complains of a loss of peripheral vision. which condition should the client be evaluated for

glaucoma

which is not a consequence of a visual impairment while driving?

increased illumination with tinted windows --> it is actually decreased

pinna

outer ear

auditory canal

the area that sound waves pass through to reach the eardrum

tympanic membrane

separates outer and middle ear

what is the primary function of the tympanic membrane

transmit sound energy and protect middle and inner ear

What are the 3 auditory ossicles?

malleus, incus, stapes

what meds can affect or cause/contribute to hearing loss

ahminoglycosides, aspirin, loop diuretics, quinine

meningitis

inflammation of the meninges of the brain and spinal cord

which is the most prevalent risk factor for impaired hearing

exposure to noise

sensorineural hearing loss

abnormalities of sensory and neural structures of inner ear, usually age related or noise induced

mixed hearing loss

combo of conductive and sensorineural impairments

which statement about tinnitus is true

-People with tinnitus should be evaluated pathologic conditions

which letters of the alphabet become distorted as hearing loss progresses

b, d, k, p, t

what do studies of the psychosocial consequences of hearing impairment demonstrate

hearing loss is less likely to have detrimental effects for people who have few social relationships

which is not a contraindication for clearing the impacted ear canal of cerumen

chronic disease of the respiratory system