Eyes ears nose and mouth discussion post response

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I'm working on a nursing discussion question and need support to help me understand better.

Hello, the assignment is to respond to these two discussion post. The topic is about Eyes, ears, nose and mouth health assessment. Please see attached rubric for discussion response requirement. Please type discussion 1 and put your response under it as if you were replying to the writer. Be sure to include references of peer reviewed article used in theresponse. Each discussion should include 3 references. 400 words to each response.

Discussion post 1 (Allison): Eyes, ears, nose and mouth

As we age, our body and all its working parts undergo many changes. In looking at aging and the eyes, many significant changes can take place. Reduced pupil size can be attributed to a weakening of the muscles that dilate and constrict the pupils. This can cause an over sensitivity to light. The lens of the eye also begins to lose its ability to change shape which results in difficulty focusing and viewing up close items. Those aging could also experience a loss in peripheral vision and declining color vision.(Lemmens et al., 2020) Another very common change, as noted in this assessment scenario, is eye dryness and itching. As we age, our lacrimal gland, responsible for tear production, declines in function. In simple terms, less tears are produced which can lead to dry, itchy eyes.(Terry, 2001)

In assessing this patient there are a few key things I would like to ask. First, I would want a complete subjective report of her symptoms. Onset, frequency, aggravating factors, and interference in performing ADLs to name a few. In looking at the risk factors, I know that age and female sex are two, but I would also like to know if the patient is a smoker as this can lead to increased loss of lacrimal function as well. I would collect a list of medications that she is taking to see if any could contribute to her symptoms. I would also ask is she has had any recent blood work drawn checking hormone levels. A decline in systemic and sex hormones can contribute to these symptoms, and one pharmaceutical approach that could be taken is hormone replacement therapy.(Foulks, 2008) Last, I would also want to know any home and over the counter remedies being used. I would want to know what is working and what is not. This could help steer me towards a plan of care to successfully reduce and manage her symptoms.

Discussion 2 (Emanuela) Discussion 1: Eyes, Ears, Nose, and Mouth

As we begin to age, and unfortunately it happens to all of us, many changes occur. Not only to our bodies but to our overall health. In older adults one of the things that changes drastically is their eyes. The changes that occur in the eye are pupil size decrease, lacrimal glands involute, glaucoma, cataract formation, and macular degeneration. According to another source, “the most common culprits of vision loss are cataract, glaucoma, and age-related macular degeneration (AMD). However, AMD and glaucoma lead to irreversible vision loss without early diagnosis and intervention. In the U.S., cases of AMD re expected to double by 2050, reaching 17.8 million among patients age 50 or older.” (Umfress & Brantley, 2017) Knowing this information and how serious these changes are in older adults, it's important to do a thorough assessment, as well as early detection and intervention to prevent further deterioration.

While caring for an 81- year- old woman in the hospital, that seems to complain about itchy and dry eyes, I would first like to get a full medical history and assessment completed. Furthermore, I would ask her if she has noticed any sight changes recently? Does she wear glasses? Does she have eye pain? Does she ever have diplopia? Ever experience blurring? Have her eyes been red? Does she feel like they are swollen? Does she have any family history of eye issues? Has she had eye discharge? Does she notice the itching and dryness after certain time of day? What type of medication she is on? What type of activities bring these symptoms on? Does she read? Does she eye a computer, tv, tablet, etc.? Has she seen her ophthalmologist recently? Patients know themselves best, therefore the more we ask the more we will know about them. Which will help to reach a resolution to this problem and potentially any other that might arise.

Amongst of all the questions I would ask the patient, I would also perform some basic assessments to check her eyes. I would use my ophthalmoscope to check the optic disc. I would also check her periphery as “glaucoma causes gradual vision loss, with damage to the optic nerve, loss of visual fields, beginning usually at the periphery.” (Bickley et al., 2021) All of this additional information will not only help to better understand our patient but also try to find a resolution to the problem. In another article it states that:

Large epidemiological studies from the Women’s Health Study and Physician’s Health noted that dry eye prevalence increases in women and men every five years after the age of 50, with greater prevalence in women compared to men. Age and female sex have been found/ to be the greatest risk factors for dry eyes. This is supported by the clinical findings of decreased tear production in women through the 6th decade of life... The lacrimal gland (LG) suffers significantly with aging. Various histopathologic changes were observed in the human main lacrimal gland such as acinar atrophy; periacinar fibrosis; periductal fibrosis; lymphocytic infiltration; and fatty infiltration. (de Paiva, 2017)

Because this patient is over 50 years old and is a female, she is in the greatest risk factor for dry eyes. Next step in my option would be running some tests, getting a consult with an ophthalmologist, figuring out if this is normal, and getting potential medication to improve the condition. 

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