AC 2 3 Flashcards
What are some risk factors for cataracts?
Exposure to the sun and UVB rays
Long-term corticosteroid meds
Increased age
Smoking and alcohol
Obesity
DM, HLD, HTN
Trauma to the eye or hx of eye surgery
Caucasian race
What are some vision changes with cataracts?
Often bilateral, painless and slow onset of blurry vision
Sensitive to glare
Halos around objects
Loss of acuity
Reading and night driving difficulty
Decreased color perception
What’s the most common cause of adult CURABLE blindness?
Cataract
Cataract is characterized with
Clouding or opacity of lens due to structural changes in proteins, which leads to gradual loss of vision
Pre-op care for cataract surgery includes
NPO, void, measures to decrease IOP, eyedrops to dilate pupil, consents.
May clip eyelashes
Post-op care for cataract surgery includes
Measures to decrease IOP
Eyedrops to constrict pupil
Antibiotics
Anti-inflammatory
Minimum light
What’s the most important cataract post-op care?
Pressure management (IOP)
What are some complications following cataract surgery that require immediate physician notice?
Infection (drainage)
Wound dehiscence (poor IOP control)
Hemorrhage
Severe, acute, unrelieved pain
Uncontrolled, elevated IOP
Excessive tearing
Decline in visual acuity
Sparks, flashes, floaters
Excessive coughing
Why is IOP management so important following cataract surgery?
Because the incision site can burst. We don’t want that.
What are some measures to decrease IOP?
HOB at least 30, lying on back or unoperated side, monitor for N/V
How long do post-cataract surgery patients have to wear eye shield at night?
2-3 weeks
What is one medication that we need to give to eye surgery patients?
Stool softeners (no straining)
What is the leading cause of IRREVERSIBLE blindness?
Glaucoma
How are glaucoma and IOP related?
Increased IOP causes optic nerve damage, leading to glaucoma
What is the recommended schedule for glaucoma screening?
Screening should start at 40
What is glaucoma called a “thief in the night?”
Because there are no noticeable early symptoms
How is glaucoma diagnosed?
Measure IOP and visual acuity
What’s the relation between the aqueous outflow system and glaucoma?
The aqueous outflow system is obstructed, causing increased IOP, leading to optic nerve damage from all those pressure.
What are some ophthalmic medications used to treat glaucoma?
Beta blockers and cholinergics. They both control IOP.
What is the purpose of using ophthalmic agents for glaucoma?
To control IOP; we can’t treat/cure glaucoma, but can control IOP
How does beta blocker help decrease IOP in glaucoma?
It decreases production of aqueous humor, decreasing the IOP.
Patients with what condition should not use beta blockers?
Asthma and CHF. Beta blockers can also cause bradycardia
How does cholinergics help with glaucoma?
Ex. Pilocarpine; it constricts pupils, which opens canal and increases flow of aqueous fluid, decreasing IOP.
Why does glaucoma need to be diagnosed early?
Because it is irreversible. permanent blindness.
What needs to happen if a patient with glaucoma gets admitted to the hospital but forgets to bring their glaucoma medications at home?
We need to get those meds somehow to prevent them from going blind.
How long should we wait if the patient has more than one eye drop to be administered?
5 minutes
How can we prevent systemic absorption of eye drops?
Put punctal pressure
What does AMD/ARMD stand for?
Age-related macular degeneration
What causes macular degeneration?
Decreased blood supply, waste products, tissue atrophy, nutrition, and systemic disease
Why is the macula/retina the most important part of the eye?
Because it contains fovea where visual acuity is highest
What is the nutritional risk factor for ARMD?
Lack of dietary intake of antioxidants and zinc
What are some foods that are high in antioxidants?
Carrots, fruits, veggies, whole grains
What supplements should patients with ARMD take to delay progression? And how often?
Zinc oxide 80 mgm
Cupric oxide 2 mg
Beta carotene 15 mgm
Vitamin C 500 mgm
Vitamin E 400 IU
Divided doses twice a day
What are some symptoms of ARMD?
Blurred vision, center of vision dark, develop central loss of vision, glasses don’t help
What are some s/s of detached retina?
Sudden appearance of many floaters
Flashes of light in one or both eyes
Blurred vision
Gradually reduced peripheral vision
Curtain-like shadow over your visual field
What are some nursing cares for retina detachment patients?
Evaluate their functional ability; make sure they can do their ADLs and IADLs, read, drive, safety, prepare food, recreational and leisure activities, etc.
In what position should patients with gas bubble need to be in?
Face down so the bubble can hold the detached retina in place until it reattaches.
What are some drugs that can cause hearing loss?
Aminoglycoside antibiotics (-mycin)
Antineoplastics (chemo meds) (cisplatinum)
Loop diuretics (furosemide)
Propranolol (inderal)
ASA and NSAIDS
How should you communicate with an elder with hearing loss?
Speak clearly, slow, stand in front of them so they can read your lips. Make sure they have their hearing aids on if they have one.
What is the proper way to do hearing aid care?
Remove and clean at bedtime
Don’t use alcohol or harsh soaps
Use damp cotton pad/cloth with water/saline
Carefully remove cerumen
Disengage battery
Store in safe place
COPD includes what 3 diseases?
Emphysema, chronic bronchitis, asthma
What is the patho behind expiratory wheeze in asthma?
Due to inflammation and secretions, air is relatively easier to get in but hard to be out
What are the 4 categories of asthma?
Mild intermittent (symptoms < x2/week)
Mild persistent (> x2/week but not daily)
Moderate persistent (daily with exacerbations x2/week)
Severe persistent (continuous with frequent exacerbations that limit physical activity and QOL)
What is the goal of asthma symptom management in the sense of using the rescue inhaler?
Usage < 2/week
What are some nursing interventions for asthma?
Decrease risk of exposures, sit them up in high fowlers, O2 as ordered, monitor cardiac rate and rhythm during attack, maintain calm and reassuring demeanor, provide rest periods for older adult clients with dyspnea, encourage prompt medical attention for infections, encourage appropriate vaccinations
What is status asthmaticus?
A life-threatening episode of airway obstruction that is often unresponsive to common treatment
What are some s/s of status asthmaticus?
Extreme wheezing, labored breathing, use of accessory muscles, distended neck veins, risk for respiratory failure and cardiac arrest
What are some educational points for asthma patients?
Drink plenty of fluid (adequate hydration, thin secretion)
Take prednisone with food
Use anti-inflammatory med regularly to prevent asthma attacks
Use good mouth care (risk of infection and inhaled steroids)
Do not stop anti-inflammatory meds abruptly
Leukotriene receptor antagonists are used for
Preventing asthma attacks.
It’s an anti-inflammatory
What are the modifiable risk factors of COPD?
Smoking, long-term exposure to lung irritants like air pollution, chemical fumes, or dust from the environment or workplace
What is chronic bronchitis?
Chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of chronic cough have been excluded
What’s emphysema?
Abnormal and permanent enlargement of alveoli distal to the terminal bronchioles that is accompanied by destruction of the alveolar walls, without obvious fibrosis
Blue Bloaters
Chronic bronchitis.
overweight and cyanotic
elevated hgb
peripheral edema
rhonchi and wheezing
Pink Puffers
Emphysema
older and thin
severe dyspnea
quiet chest (not much air moving)
CXR: hyperinflation with flattened diaphragms (because air is trapped)
Why does COPD cause dyspnea?
COPD is an airflow limitation from irritation and inflammation which cause airway narrowing d/t swelling and mucus production; this increases work of breathing, need to push the air out, feeling sensation of dyspnea
Why is a baseline assessment essential in COPD patients?
We need to have something to compare to see if the patient is getting better or worse
What are some assessment findings that we need to watch for?
Dependent edema/JVD, enlarged or tender liver, elevated temp, tachycardia, tachypnea, diaphoresis, use of accessory muscles, tripod position, labs, sputum
What’s the first indicator of hypoxia?
Altered sensorium (restlessness or lethargy)
What is the goal of COPD treatment?
Breath better, increased/improved quality of life, improved perfusion, ability to perform ADLs & IADLs (back to baseline)
What are some important nursing interventions for COPD?
Sit them up, adequate hydration to thin secretions, coughing and suctioning, incentive spirometer use, adequate nutrition (need higher calories), teach diaphragmatic or pursed lip breathing, cardiac monitoring
What is the goal of pulmonary rehabilitation for COPD?
Improve exercise tolerance and overall QOL
What’s included in pulmonary rehabilitation?
Breathing, relaxation techniques, smoking cessation, energy conservation, exercise, group support
What are some education points for COPD patients?
S/s of infection (can lead to exacerbation)
Proper hydration
Proper use of O2
Proper use of meds; MDIs and spacers
Immunizations (up to date, flu and pneumococcal, RSV, COVID vaccines)
Avoid high temp and humidity
What’s the recommended diet for COPD patients?
Decrease carbs, moderate protein, increase fat
What medication is used as a last resort for COPD?
Theophylline
Theophylline can cause what deficiency?
Vitamin B6 deficiency
s/s: peripheral neuropathy, confusion, seizures, depression
What’s the most common causes of COPD exacerbation?
Infection and air pollution of the tracheobronchial tree
How do you manage COPD exacerbation?
Meds (bronchodilators, oral steroids, antibiotics)
Noninvasive intermittent positive pressure ventilation
What are some complications of COPD?
Pneumothorax, respiratory failure, cor pulmonale or right-sided HF, oxygen toxicity
What is the difference between the rescue inhalers vs. maintenance therapy?
Rescue inhalers are bronchodilators; they open the airway up. Maintenence meds are given after that to decrease inflammation
What are the early signs of oxygen toxicity?
Cough, substernal pain, N/V, paresthesia, nasal stuffiness, sore throat, malaise, decreased vital capacity
What are the late signs of oxygen toxicity?
Edema, sputum, lung fibrosis
What’s the desired O2 delivery level in patients with COPD?
Should start NC at no more than 2L/min and never go above 4L/min
What’s the goal of oxygen therapy in COPD patients?
Keep them hypercapnic (high CO2) and hypoxic (low O2)
What are some usual aging changes in relation to memory?
Decrease in short-term memory and increased incidence of benign process or deterioration of aging
Do depression and mood disorders become more common with aging?
Yes
What increases in normal aging that can cause daytime fatigue and instability?
Insomnia and other sleep disturbances
Does the size and weight of the brain increase or decrease as we age?
Decrease
What happens to sensation as we age that is normal?
Increased pain threshold, decreased sensation to light touch, pain, joint position
What is the care goal of elderly/dementia patients?
No restraints, safe, as independent as possible based on their disease process, and keep dignity
What’s a Mini-Cog test?
It tells if the patient has problems or not.
Screening tool; 3 item recall and a clock drawing test.
0 item recall = demented
1-2 item recall with abnormal clock = demented
1-2 item recall with normal clock = nondemented
3 items recalled = nondemented
What does a positive Mini-Cog test indicate?
The need for further assessment by a geriatrician or mental health professional
What is the FAST Scale used for?
Alzheimer’s staging
What are the stages of the FAST scale?
Stage 1 - normal; no cognitive decline
Stage 2 - normal; mild memory loss
Stage 3 - Early dementia; unable to remember names of people
Stage 4 - Mild dementia; difficulty with IADLs and memory loss of current and recent events
Stage 5 - Moderate dementia; begin to need more assistance
Stage 6 - Moderately severe dementia; forgets name of family members, more assistance with ADLs, delusions, hallucinations, can be violent, sleeps more during the day
Stage 7 - Severe dementia; all speech is lost, lose urinary and bowel control, can’t walk, bedridden
At what stage would an Alzheimer’s patient begin to need assistance?
Stage 4
What is the medication used to manage Alzheimer’s?
Cholinesterase inhibitor. This may improve symptoms but doesn’t slow the progression
What’s the difference between dementia and vascular dementia?
Dementia - associated with accumulation of proteins into plaques and tangles in the brain
Vascular dementia - reduced blood flow to the brain cells so they starve and die. Due to atelectasis
What type of dementia is associated with a loss of communication between cells, leading to the loss of specific types of neurons?
Dementia with Lewy bodies and Parkinson’s disease. This is usually rapid progression
How do you best communicate with someone with dementia?
Try to redirect, not reorient.
Keep calm voice
One thing at a time, short sentences since their focus is not good
What medication in the cholinesterase inhibitor family is most commonly used in moderate to severe dementia?
Donepezil
What’s the major side effect of cholinesterase inhibitors?
GI disturbances
What medication is used for moderate-severe dementia?
NMDA inhibitor; Memantine (Namenda)
Which medication will be used for a patient who has dementia with existing GI problems?
NMDA inhibitor
What’s depression?
A clinical syndrome characterized by low mood tone, difficulty thinking, and somatic changes precipitated by feelings of loses or guilt
What screening tool is used to assess an elderly suspecting to have depression?
Geriatric Depression Scale (GDS)
It successfully distinguishes between non-/depressed older persons
A GDS score above 5 indicates
Suggests depression
Can chronic depression decrease immune function?
Yes; depressed elderly are more at risk for development of acute illness or exacerbation of chronic illness due to depression
What’s important to consider when giving elderly any high-risk meds?
Risk vs. benefit
What should you do if a dementia patient is having hallucinations and feels threatened/paranoid?
Distract them, place your hand on theirs to calm them.
Don’t try to talk them out
What can cause anxiety and agitation in dementia patients?
Bodily discomfort or pain, constipation, or hunger
Why does the caregiver of dementia patient need to stay calm?
Because the patient will pick up on their anxiety
Why do we have to keep the environment as calm, quiet, and stress-free as possible when caring for a dementia patient?
Overstimulation can cause agitation, which will not be a fun shift
What medication is used to treat depression in elderly?
MAOIs
Why do we always have to look behind the behavior issue with dementia patients?
Behavior issues are how the person tries to communicate something to us. finding the cause is important
How long will it take for MAOIs to start showing full effect?
2-3 weeks
What can nurses do to help with sundowning?
Decrease stimulation, reduce naps during daytime, go on a walk/keep them busy during the day, limit caffeine intake, prepare a sleep environment
What are the types of abuses?
Physical, psychological/emotional, financial/material, sexual, caregiver neglect
Who is the victim of elder abuse?
Oldest elders (> 80yrs), White female, elders who are unable to care for themselves, mental impairment/confusion, depressed
What increases the risk of abuse?
Caregiver burden and stress, abuser often dependent on their victim for financial assistance, housing, etc., mental illness and alcohol or drug abuse
What is the role of the nurse if abuse is suspected?
Know s/s of abuse, report, assessment, patient education
Who is the usual abuser in elder abuse?
White males in 41-59 age group, elderly persons who care give, family members (90%) with 47% being adult children and 19% being spouses
What is respite care?
Having someone else care for the elder, a few hours each week can greatly decrease caregiver stress
Abuse assessment:
Interview the patient and caregiver SEPARATELY
Ask general screening questions
Get thorough history (finances, family dynamics, etc)
Complete physical, cognitive, emotional exam
Labs (electrolyte, albumin, drug levels)
What can you do if the patient is in immediate danger of abuse?
Consider hospital admission
What can we use to assess caregiver strain?
Care Giver Strain Index Assessment
When should you perform a caregiver strain index?
If you see a caregiver with comorbidities decline in their health
Score >7 = need respite care
Caregiver strain can lead to
Elder abuse, abandonment
What paperwork needs to be in place to be a caregiver?
Legal documentation; Power of attorney, living will, advanced directives
What is an adverse effect of leukotriene receptor antagonists?
Depression
While taking theophylline, the patient should avoid which kind of diet?
Avoid high protein diet since it decreases the duration of action
Also avoid caffeine and alcohol
