(Week # 10: March 8 to March 15 – Main post under Assignment by Wed, March 11 at 11:59 PM EST). APA FORMAT 

Chapter 19 – Diseases Affecting Vision and Hearing. 

Chapter 20 – Metabolic Disorders.

Question(s): Choose and explain one of the eye diseases / disorders discuss in you textbook. Discuss its possible treatments. 

Guidelines: The answer should be based on the knowledge obtained from reading the book, no just your opinion. If there are 3 questions in the discussion, you must answer all of them. Your grade will be an average of all answers.  

Chapter 19
Diseases Affecting Vision and Hearing
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Visual impairment has a negative impact on the quality of life
More than two-thirds of those with visual impairment are older than 65 years of age
Those older than 80 years of age account for 70% of the cases of severe visual impairment
Significant racial and cultural disparities in vision impairment
Vision Impairments
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Glaucoma
Cataracts
Diabetic retinopathy
Diabetic macular edema
Macular degeneration
Detached retina
Dry eye
Diseases of the Eye
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A clouding of the eye’s normally clear crystalline lens, causing the lens to lose transparency or scatter light
Most common causes are heredity and advancing age
Categorized by their location
Nuclear cataract
Most common type
Incidence increases with age and cigarette smoking
Cortical cataract
More common with age
Related to a lifetime exposure to ultraviolet light
Posterior subcapsular
Cataracts
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Most common symptom is cloudy or blurred vision
Other symptoms include glare, halos around lights, poor night vision, perceiving that colors are faded or that objects are yellowish, and the need for brighter light when reading
Red reflex may be absent or may appear as a black area
Signs and Symptoms
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Surgery is the most common
Involves removing the lens and placing a plastic intraocular lens (IOL)
Usually done on an outpatient basis
Nursing interventions include
Teaching
Avoid heavy lifting, straining, or bending at the waist
Wear glasses during the daytime and a shield at night
Administer eye drops to aid the healing process and to prevent infection
Treatment
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Natural fluids of the eye are blocked by ciliary muscle rigidity, pressure builds, and damage to the optic nerve occurs
Second leading cause of blindness in the United States
Types include congenital glaucoma, primary open-angle glaucoma, low-tension or normal-tension glaucoma, secondary glaucoma, and acute angle-closure glaucoma (medical emergency)
Glaucoma
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Most common form
Risk varies by race and age
Other high-risk groups include those with diabetes, hypertension, history of corticosteroid use, and family history of glaucoma
Usually affects side vision first and may go unnoticed for years
Primary Open-Angle Glaucoma
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Headaches
Poor vision in dim lighting
Increased sensitivity to glare
Complaints of “tired eyes”
Impaired peripheral vision
A fixed and dilated pupil
Frequent changes in prescriptions for corrective lenses
Signs and Symptoms
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Occurs when the angle of the iris causes obstruction of the aqueous humor through the trabecular network
Medical emergency; blindness can occur in 2 days
Those with smaller eyes, Asians, and women are most susceptible
May occur with infection or trauma
Symptoms include redness and pain in and around the eye, severe headaches, nausea and vomiting, and blurred vision
Angle-Closure Glaucoma
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Adults older than 65 years of age need annual eye examinations
Those with medication-controlled glaucoma should be examined every 6 months
Those with a family history of glaucoma and African Americans should be screened annually after age 40 years
Glaucoma Screening
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Oral or topical eye drops that lower eye pressure
Either decrease the amount of aqueous fluid produced within the eye or improve the flow through the drainage angle
Beta blockers are the first-line therapy followed by prostaglandin analogs
Second-line agents include topical carbonic anhydrase inhibitors and α2-agonist
Laser surgery treatments may be recommended
Treatment
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Complication of diabetes
Leading cause of blindness in the United States
Blood and lipid leakage leads to macular edema and hard exudates
No symptoms occur in the early stages
Early findings observed in funduscopic examination are microaneurysms, flamed-shaped hemorrhages, cotton-wool spots, hard exudate, and dilated capillaries

Diabetic Retinopathy
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Annual dilated fundoscopic examination should begin 5 years after diagnosis of diabetes type 1 and at the time of diagnosis of diabetes type 2
Laser treatment can reduce vision loss
Strict control of blood glucose, cholesterol, and blood pressure

Screening and Treatment
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Thickening of the center of the retina
Leading cause of legal blindness
Affects 1 in 25 adults age 40 years and older with diabetes
Incidence is higher in African Americans and Hispanics
Treatments include medications (cortisone-type drugs), laser therapy, and anti-VEGF therapy (Lucentis)
Diabetic Macular Edema
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Leading cause of vision loss in Americans who are 60 years of age and older
Age is the greatest risk factor
Other risk factors include genetic predisposition, smoking, hypertension, obesity, and a family history
Causes progressive loss of central vision, leaving only peripheral vision intact
Macular Degeneration
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Geographic atrophy (dry age-related macular degeneration [AMD])
Rapid, severe loss of central vision
Many will be legally blind within 2 years of diagnosis
Neovascular AMD (wet AMD)
Occurs when abnormal blood vessels behind the retina start to grow under the macula
These new blood vessels often leak blood and fluid, which raise the macula from its normal place at the back of the eye
Types of Age-Related Macular Degeneration
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Causes the progressive loss of central vision, leaving only peripheral vision intact
Awareness of a blurry spot in the middle of vision; blurred areas grow larger, and blank spots develop, leading to difficulty reading and writing
Increased need for bright light
Colors appear dim and gray
Signs and Symptoms
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Amsler grid is used to determine the clarity of vision
In early AMD, exercise, avoiding smoking and a diet high in green leafy vegetables and fruits may help keep vision longer
Treatment includes photodynamic therapy, laser photocoagulation, and anti-VEGF therapy
Screening and Treatment
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Medical emergency
Can occur spontaneously or after recent cataract surgery or eye trauma
Exhibits a “curtain coming down” over the line of vision and a gradual increase in floaters or light flashes
Small holes or tears are treated with laser surgery or cryopexy
Retinal detachments treated with surgery
Detached Retina
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Not a disease but a frequent complaint among older adults
Causes can include medications such as antihistamines, diuretics, beta blockers, and sleeping pills
Common treatment is artificial tears or saline gel
Management includes using a home humidifier and avoiding wind and hair dryers
Dry Eye
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Which disorder would the nurse suspect in a patient complaining of intense headaches, bloodshot eyes, and blurred vision?
Cataracts
Detached retina
Macular degeneration
Angle-closure glaucoma

Question
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D—Symptoms of acute angle-closure glaucoma include redness and pain in and around the eye, severe headaches, nausea and vomiting, and blurred vision.
Answer
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Use warm incandescent lighting
Increase the intensity of lighting
Control glare by using shades and blinds
Use yellow-to-amber lenses to decrease glare
Wear sunglasses to block out ultraviolet light
Use reading materials in large, dark print
Choose sharply contrasting colors
Interventions to Enhance Vision
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Financial and social governmental programs
Insulin-delivery systems
Talking clocks and watches
Large print books
Magnifiers
Telescopes with handheld devices or attached to eye glasses
Electronic magnification
Low-Vision–Assisted Devices
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Vision deficiencies affect communication, functional abilities, safety, and quality of life
Nursing concerns
Appropriate assessment
Environmental adaptation to enhance vision and safety
Communicating appropriately
Providing appropriate health teaching
Providing appropriate referrals for prevention and treatment
Implications for Gerontology Nurses and Healthy Aging
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Third most chronic condition in U.S. older adults
Of those who are 80 years of age and older, 80% have hearing loss
Racial and gender disparities exist in hearing impairment
Risk factors include noise exposure, ear infections, smoking, and chronic disease (e.g., diabetes, chronic kidney disease, heart disease)
Hearing Impairments
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Diminishes the quality of life
Increases social isolation
Decreases function
Increases likelihood of hospitalizations, miscommunication, depression, falls, loss of self-esteem, and safety risks
Increases cognitive decline and dementia
Consequences
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Conductive loss
Involves abnormalities of the external and middle ear, which reduces the ability of sound to be transmitted to the middle ear
Is caused by otosclerosis, infection, perforated eardrum, fluid in the middle ear, or cerumen accumulation
Sensorineural loss
Result of damage to any part of the inner ear or the neural pathways to the brain
Includes presbycusis and noise-induced hearing loss
Types of Hearing Loss
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Perception of sound in one or both ears or in the head when no external sound is present
Described as a “ringing in the ears”
May be described as buzzing, hissing, whistling, cricket chirping, bells, roaring, clicking, pulsating, humming, or swishing sounds
May be constant or intermittent
Tinnitus
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Exact cause can be unknown
Exposure to loud noises is the leading cause
Exacerbated by caffeine, alcohol, smoking, stress, and fatigue
High-pitched tinnitus common with sensorineural loss
Low-pitched tinnitus reported in Meniere disease
Maintain a diary for times when noise is heard
Assess medication history
Lifestyle modifications and treatments
Assessment and Treatment
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Hearing aids to amplify sound
Cochlear implants to bypass damaged portions of the ear and stimulate the auditory nerve in those with sensorineural hearing loss
Assisted listening and adaptive devices
Interventions to Enhance Hearing
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What information will the nurse include when teaching a patient about using a hearing aid?
“This amplifies sound and directs it into the ear canal.”
“You will be able to hear better in noisy or crowded rooms.”
“It will assist you to interpret the incoming sounds more effectively.”
“This will bypass damaged portions of the ear and stimulate the auditory nerve.”

Question
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A—Hearing aids amplify sound in part by directing sound into the ear canal.
Answer
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Hearing impairment affects communication, safety, and quality of life
Nursing concerns
Appropriate assessment
Communicating appropriately
Properly caring and maintaining hearing aids
Providing appropriate health teaching
Providing appropriate referrals for prevention and treatment

Implications for Gerontology Nurses and Healthy Aging
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Chapter 20
Metabolic Disorders
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Up to 20% older than 65 years of age have hypothyroidism
Thyroid disorders are difficult to diagnose in older adults
Signs and symptoms may be nonspecific, atypical, or absent
Changes may be incorrectly attributed to normal aging, another disorder, or side effects of medications
Thyroid Disorders
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The most common thyroid problem in older adults
Onset is slow
Thought to be caused by chronic autoimmune thyroiditis or inflamed thyroid; may be iatrogenic, resulting from radioiodine treatment, subtotal thyroidectomy, or medications
Symptoms include heart palpitations, slowed thinking, gait disturbances, fatigue, weakness, or heat intolerance
Treatment is to slowly replace the thyroxine
Hypothyroidism
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Graves disease is the most common cause
Can also result from
Ingestion of iodine or iodine-containing substances
The medication amiodarone
The wrong dose of levothyroxine
May have sudden onset
Symptoms include unexplained atrial fibrillation, heart failure, constipation, anorexia, and muscle weakness
In older adults, apathetic thyrotoxicosis may occur
Hyperthyroidism
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Complications occur
As a result of treatment
Because of failure to diagnose and treat in a timely manner
Myxedema coma occurs with untreated hypothyroidism, can result in death
Thyroxin increases myocardial oxygen consumption and increases risk of
Atrial fibrillation
Exacerbation of angina in persons with preexisting congestive heart disease
Congestive heart failure
Complications of Thyroid Disease
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Pharmacologic intervention
Surgical or chemical ablation
Nursing role
Work with the patient and family to understand the seriousness of the condition
Provide teaching on the medication regimen
Implications for Gerontological Nursing and Healthy Aging
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A nurse assessing an older adult would suspect hypothyroidism if which of the following complaints were present? (Select all that apply.)
Fatigue
Weakness
Slowed thinking
Heat intolerance
Heart palpitations

Question
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A, B, C, E—All are symptoms of hypothyroidism except heat intolerance. The patient would experience cold intolerance with hypothyroidism.
Answer
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Syndrome of disorders of glucose metabolism resulting in hyperglycemia
Two types
Type I: The body is unable to produce insulin needed to move glucose into the cells
Type II: The body does not make enough insulin to keep up with the needs of the body; insulin is available, but the cells are not able to use it
Wide variation of the prevalence of diabetes exists among ethnic and racial groups
Diabetes
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Diagnosis requires the results of two of three possible tests on 2 different days
Prediabetes
Fasting plasma glucose (FPG) is 100 to 125 mg/dL
Hemoglobin A1c of 5.7% to 6.4%
Diabetes
FPG of ≥126 mg/dL
HgbA1c ≥6.5%
Random blood glucose of ≥200 mg/dL
Diagnosing Diabetes
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Classic symptoms include thirst and polyuria
Hyperglycemia is well tolerated in older adults
Early warning signs include dehydration, confusion, delirium, and some incontinence
Vague symptoms include fatigue, nausea, delayed wound healing, and paresthesias
Signs and Symptoms of Diabetes
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Can affect a person’s morbidity and mortality
Complications include heart disease, stroke, neuropathy, and periodontal disease
Is the leading cause of end-stage renal disease and blindness in those older than 65 years of age
Wound hearing is delayed
Relates to a high rate of depression
Sexual dysfunction can occur
Person often dies from heart disease

Complications of Diabetes
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Nursing goals
Control the blood glucose level
Reduce the risk of complications
Have the patient maintain the best health that is realistically possible
Ensure that evidence-based care is received
Participate in early detection through screening
Assess for risk factors and signs and symptoms of complications
Implications for Gerontological Nursing and Healthy Aging
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Promoting healthy aging in older adults with diabetes requires an array of interventions and an effective interdisciplinary team working together with the patient and significant others
Requires expertise in medication use, diet, exercise, counseling, and finding ways to support while empowering the person
Management
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Blood glucose monitoring
Medication self-administration
Insulin use
Oral medication use
Foot care and examination
Handling sick days
Needed Self-Care Skills
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Knowledge about the disease and its effects
Warning signs for high and low glucose levels
Managing hypoglycemia
Wearing an identification bracelet
Adequate and appropriate nutrition
Daily exercise
Patient Education
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Nurses may be responsible for activities that would normally fall to the patient or caregiver to carry out
Nutritional status
Intake and output
Exercise and activity
Signs of hypo/hyperglycemia
Evidence of complications
Encourages self-care when possible
Long-Term Care and Older Adults With Diabetes
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A major difference between type 1 and type 2 diabetes is
most older adults with diabetes have type 2 diabetes.
older adults with type 2 usually do not require insulin therapy.
an older adult with type 1 can maintain glycemia with diet and exercise.
the pancreas of an older adult with type 2 does not secret any insulin.
Question
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A—Most older adults with diabetes have type 2 diabetes.
Answer
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