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Geri Test 3- Sensory impairment*
Terms in this set (59)
What % of older adults have significant visual or auditory dysfunction?
Many don't report it to their physicians
What are physiologic changes in the eye that lead to visual changes in the elderly?
Changes in choroid, pigment epithelium, retina
Decreased function of the rods, cones and other neural elements
Intraocular pressure slowly increases w/ age
Decreased ability to compensate for hyperopia
Increase in myopia
Decreased tear secretion in older pts, esp postmenopausal women
What is presbyopia?
Inability to focus on near objects
Why does presbyopia occur physiologically?
Lens sclerosis and atrophy of the ciliary muscle
S/sxs of decreased tear production in elderly?
Tx of dry eyes in elderly?
What are the most common causes of blindness in the elderly?
What is a senile cataract?
Opacification of the lens
Frequent complication of aging
It is painless and progressive
Starts in periphery then migrates to the pupil area
Etiology of senile cataract?
UV light may be a contributing factor
Tx of senile cataract?
Once cataract interferes w/ ADLs, surgery is indicated
What is angle closure glaucoma?
An acute and relatively infrequent type of glaucoma
It is usually bilateral
Rapid or sudden increase in intraocular pressure (IOP), the pressure within the eye.
Presentation of angle closure glaucoma?
Characterized by sudden painful attack of increased intraocular pressure accompanied by a loss in vision
Tx of angle closure glaucoma?
Normalize IOP w/ miotic eye drops or other meds like carbonic anhydrase inhibitors or osmotic agents
Definitive tx- surgical excision of iris w/ laser iridectomy
What is one of the leading causes of blindness in the US?
Open angle glaucoma
Second leading cause in the US
First leading cause among black Americans
What is open angle glaucoma?
A chronic form of glaucoma that is more common
Physiology of open angle glaucoma?
The irido-corneal angle is open, but aqueous outflow is diminshed due to degeneration/obstruction of trabecular framework
Presentation of open angle glaucoma?
Characterized by insidious onset, slow progression
Appearance of typical defects of visual fields
Tx of open angle glaucoma?
In severe cases- carbonic anhydrase inhibitors
Surgery or laser tx if dz progresses on maximal medical therapy
Where is the site of highest visual acuity in the eye?
Macula in the retina
What is the most common cause of legal blindness in older adults?
Age related macular degeneration
Epidemiology of age related macular degeneration?
28% at ages 75-85 yrs
Etiology/risk factors for developing age related macular degeneration?
Low dietary intake/plasma concentration of antioxidant vitamins and zinc
What will be markedly affected in age related macular degeneration?
Central visual acuity
Total blindness does not occur b/c peripheral vision remains
What are the two types of macular degeneration?
Dry (atrophic) degeneration
What is dry (atrophic) macular degeneration?
Depigmentation caused mainly by changes in retinal pigment epithelium
Lesions coalesce and involve the central macula
Vision progressively gets worse
What is wet macular degeneration?
Neovascularization is occurring
As new blood vessels form they are weak and leak serous fluid and blood, which scars the macula
It causes irreversible damage to the photoreceptors and leads to vision loss
Physiology of macular degeneration?
Disturbance of nutrients and oxygen from choroicapillaries to central retina leading to degeneration
Tx of age related macular degeneration?
Dry- no tx
Verteporfin photodynamic (PTD) tx- IV infusion of light sensitive dye (verteporfin) w/ low intensity laser, causing occlusion of abnormal choroidal vessels
Pathophys of diabetic retinopathy?
Visual loss is related to vascular changes in and around macula
Leads to central vision loss
Leakage of serous fluid from vessels surrounding macula leads to macular edema and deterioration of visual activity
Tx/management of diabetic retinopathy?
Blood glucose control
Retinal laser photocoagulation
PE findings of cataracts?
Loss of visual acuity
PE findings of open angle glaucoma?
Optic disc changes
Loss of peripheral vision
PE findings of angle closure glaucoma?
Sudden vision loss
PE findings of macular degeneration?
Loss of visual acuity
PE findings of temporal arteritis?
Retinal vessels changes
Optic disc changes
Sudden vision loss
PE findings of diabetic retinopathy?
Retinal vessel changes
Loss of visual acuity
T/F- all pts w/ hearing loss should be referred to an audiologist
Common cause of hearing loss in the elderly?
Does cerumen impaction affect high tones or low tones?
What type of hearing loss is most common in the elderly?
Sensorineural type- damage of hearing organ, peripheral NS and/or CNS
What are three major factors that enhance the progression of hearing loss w/ advancing age?
Previous middle ear dz
Exposure to noise
What is presbycusis?
the loss of hearing that gradually occurs in most individuals as they grow older
At which decade of life does deterioration of hearing begin?
In the third decade of life
Does high or low frequency tend to go first?
Dx of sensorineural hearing loss?
What factors make understanding speech difficult for the elderly?
Poor acoustic conditions
Speech in rooms w/ long reverberations
Auditory reaction time and frequency discrimination
Hypersensitivity to sounds of high intensity
Inability to hear soft sounds
Loss of localization of sounds
T/F- tinnitus may occur in older adults w/o hearing impairment
True. It isn't necessarily associated w/ hearing loss
What are other hearing disorders in the elderly?
Vascular or mass lesions
Which abx require special attention b/c of risk of ototoxic damage?
Irreversible hearing loss
What affect can aspirin have on hearing?
May cause reversible hearing impairment
Which pts require an ENT eval to rule out remediable dz?
Every individual w/ communication difficulties caused by permanent hearing loss
Should also have audiological eval
T/F- hearing aides are most useful in noisy group settings, and less effective in one-on-one conversations
False. More effective one-on-one, less so in noisy environments
Management of hearing loss?
Body hearing aides work well, less expensive
Surgical tx- safe and effective
What factors lead to decreased taste in the elderly?
Decreased salivary secretion- decreases solubilization of flavoring agents
Upper dentures may cover secondary taste sites
Olfactory bulbs atrophy
What is the most common risk factor for polyneuropathy?
Next are- alcoholism, nonalcoholic liver dz, malignancy
Presentation of polyneuropathy?
Sxs usually begin in the LEs
Sensory sxs usually precede motor sxs
In demyelinating polyneuropathy (Guillain-Barre) weakness is more typical than sensory loss
PE of polyneuropathy?
Focus on sensory exam- pin prick, light touch, vibration, cold, proprioception
Dx of polyneuropathy?
Serum/urine protein electrophoresis
Tx of polyneuropathy?
Tx of underlying dz
Avoidance of toxins- alcohol, drugs is the most important step
TCAs- in painful neuropathies
PT eval- pts w/ weakness,
Foot and nail care.
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