Complex Final Exam New Info Flashcards
What happens to the lens of the eye with cataracts?
clouding
What do cataracts interfere with?
the ability to see images clearly
What does glaucoma increase?
intraocular pressure (IOP)
What is normal IOP?
10-20
What type of vision is lost with glaucoma?
peripheral vision
Which type of glaucoma is most common?
open-angle
What type of vision is lost with macular degeneration?
central vision
What are the characteristics of DRY AMD?
- more common
- gradual blackage
- painless
What are the characteristics of WET AMD?
- less common
- more severe
- rapid onset
- thin blood vessels leak blood/fluid
What should you use to examine the eye with cataracts?
- snellen chart
- ophthalmoscope
Should the light be increased or decreased in the room of someone with cataracts?
increased
What adaptive devices can be used for cataracts?
- magnifying lens
- large print books
- talking clock
What should you monitor for post-cataract surgery?
nausea and severe eye pain
What should you assess with glaucoma?
visual acuity and visual fields
When talking to a patient with MD, what should you do?
- introduce yourself and say goodbye
- make eye contact
What assistive devices can be used for MD?
- braille
- audiobooks
- text-to-speech
What is atropine 1% ophthalmic solution used for?
cataracts
- prevents pupil constriction
- relaxes muscles in the eye
What is timolol used for?
open-angle glaucoma 1st line tx
- decreases IOP
What are some side effects of timolol?
- bronchoconstriction
- hypoglycemia
What is pilocarpine ophthalmic solution used for?
open-angle glaucoma
- pupil constriction
- increases circulation
What is the antidote for pilocarpine ophthalmic solution?
atropine
What is the side effect of the pilocarpine ophthalmic solution?
blurred vision
What are the “-mide’s” used for in open-angle glaucoma?
decreases IOP
What is IV/oral mannitol used for?
closed-angle glaucoma
- emergency tx to decrease IOP
What medications slows the rate of vision loss in macular degeneration?
intravitreal injectable drugs (antiangiogenic)
- bevacizumab
- ranibizumab
When should you get eye exams with cataracts?
annually
When should you avoid driving with cataracts?
at night
When should those aged 40-64 get dilated eye exams for glaucoma?
every 2-4 years
When should those over 65 y/o get dilated eye exams for glaucoma?
every 1-2 years
How long do those with glaucoma have to use eyedrops?
lifelong
How should you instill eye drops for glaucoma?
- one drop each eye 2 times/day
- wait 5-10 minutes between drops is more than one is needed per eye
- do not touch applicator to eye
- apply pressure to inner corner of eye and pinch eyelid closed after instilling
- wash hands before and after
What vitamins are important for cataracts?
C and E
What vitamins are important for MD?
C, E, B12, beta-carotene, zinc, copper, carotene (Vitamin A)
What foods are high in carotene (vitamin A)?
- orange/yellow fruits & veggies
- apricots, carrots, yams, squash, cantelope
What kind of pain is felt with peripheral neuropathy?
aching, shooting, burning
What happens to the extremities with peripheral neuropathy?
numbness, tingling
What is felt in the feet and hands with peripheral neuropathy?
pins, needles
What vitamin should you increase your intake of with peripheral neuropathy?
vitamin B12
What is important with foot care?
- test water temp with hand
- close-toed shoes
- NO lotion
- massage (UNLESS DIABETIC)
- avoid repetitive motion and prolonged pressure
- guided imagery, relaxation techniques
- look at feet daily
What forms on the myelin sheath with MS?
plaques
What is myelin replaced with in MS?
glial scar tissue
How does MS affect the eyes?
- loss of vision
- diPloPia (double vision)
- nystagmus
What is Uhtoff’s sign (MS)?
decreased motor function and worsening of vision after being in heat (hot bath/shower)
How can the Romberg test be used for MS?
to assess balance because loss of balance is a symptom of MS
How does MS affect the brain?
- fatigue/brain fog
- mild depression
- ataxia (impaired coordination)
How does MS affect the muscles?
- impairment of the trunk/limbs
- spasticity
How does MS affect the extremities?
- numbness/tingling/pain in extremities
- fine tremors of the fingers
What immunosuppressants decrease the frequency of relapse in MS?
- azathioprine
- cyclosporine
What does the steroid prednisone do in MS?
decrease inflammation
What antispasmodics can be used to treat spasticity and stiffness with MS?
- dantrolene
- baclofen
- diazepam
What is carbamazepine used for with MS?
paresthesias
How is propranolol used in MS?
to treat tremors
What does CSF show increases in for MS?
- protein
- WBC (slightly)
What does an MRI show in someone who has MS?
lesions/plaques of the brain and spine
Who should a patient with MS be referred to for problems with walking?
PT/OT
What are the classic symptoms of Parkinson’s Disease?
- tremors
-muscle rigidity - shuffling gait
- bradykinesia
- shakiness
What neurotransmitters are involved with Parkinson’s?
- increased acetylcholine (tremors)
- decreased dopamine
Why should you slowly increase Levodopa?
to avoid resistance
How does Levodopa affect bodily fluids?
turns them dark
What is a side effect of amantadine?
drowsiness
What type of food should you avoid with Parkinson’s? What should you eat more of?
- avoid high-protein foods
- increase calories
What type of chair should someone with Parkinson’s sit in?
an upright chair to facilitate standing and sitting and for eating and drinking
Who should a patient with Parkinson’s be referred to for LTC?
PT
What type of foods should someone with Parkinson’s eat if swallowing is affected?
thick foods
How should you speak to someone with Parkinson’s?
slowly with frequent pauses, using alternative communication if needed
Why should you space out meds and protein intake with Parkinson’s?
they compete for space
- LEVadopa does not LEAVE enough room for protein
What are the characteristics of normal cartilage?
smooth, white, translucent
- can withstand wear and strain
What are the characteristics of osteoarthritis cartilage?
dull, yellow, granular
How does cartilage get damaged?
by injury or use, destruction outweighs production
What happens to the bones when there is damaged/no cartilage?
they rub against each other, causing the synovium to become inflamed
When does joint pain occur with OA?
during motion/activity
When does joint stiffness occur with OA?
after rest/static positions, “early morning stiffness”
Crepitation occurs with OA. What is crepitation?
bones rubbing together
What forms osteocytes in the hands and fingers?
Heberden’s nodes and Bouchard’s nodes
What things should you assess for OA?
- pain
- functional limitation
- gait
- fatigue & pain after activity
- ROM
- anxiety/depression
What should be used to protect the joint and encourage use of larger joints?
splinting
What exercises should someone with OA participate in?
- low impact: walking
- strength training: weights
- ROM
- NO high impact: running
When should you do high-energy activities? When should you take meds (OA)?
- high energy activities in the morning
- take meds before activity
What should heat be used for (OA)?
pain
What should cold be used for (OA)?
inflammation
What assistive devices can be used for OA?
- elevated toilet seat
- shower bench
- long-handed reacher
- shoe horn
How long does acute back pain last?
4 weeks or less
How long does chronic back pain last?
greater than three months with repeated episodes of pain
How can back pain affect the hips, legs, and ankles?
paresthesias, pain, weakness
What is the leading cause of work disability?
back pain
Is acetaminophen helpful for back pain?
NO
What should be used instead of acetaminophen for back pain?
NSAIDS, mild opioids if NSAIDS do not work
Why are topical medications beneficial for back pain?
they can dull pain by using heat or cold
What are proper body mechanics for lifting?
with legs, not back
How should someone with back pain sleep?
- on a firm mattress
- semi-fowlers position
- pillow under flexed knees
- NO stomach sleeping
What medication should someone with back pain take daily?
aspirin
What causes a hemorrhagic stroke?
a ruptured artery or aneurysm
Where does bleeding occur with a hemorrhagic stroke?
inside and around brain tissue
What are the two types of ischemic stroke?
thrombotic and embolic
What causes a thrombotic stroke?
a blood clot or atherosclerotic plaque that gradually shuts off the artery
What causes an EMBolic stroke? (think EMBarking on an adventure)
an embolus travels to a cerebral artery
What is a TIA a warning sign for?
an impending stroke
How long do symptoms of a TIA last, and how many progress to a stroke?
- s/sx last more than 1 hr
- 1/3 progress to stroke
What are visual disturbances, dizziness, slurred speech, and weak extremity manifestations for?
TIA
What are common s/sx of stroke? (FAST)
F: face - drooping, uneven smile
A: arms - numbness, weakness
S: speech - slurred speech
T: time - act fast, record onset and duration of stroke
What are the 4 “A’s” of left brain damage?
- aphasia (expressive and receptive)
- agnosia
- alexia
- agraphia
What are expressive and receptive aphasia (L brain damage)?
- inability to speak
- inability to understand language
What is agnosia (L brain damage)?
inability to recognize familiar objects
What is alexia (L brain damage)?
difficulty reading
What is agraphia (L brain damage)?
difficulty writing
When LEFT brain damage occurs, which side of the body experiences hemiplegia or hemiparesis?
the RIGHT side
What is hemiplegia (stroke)?
paralysis
What is hemiparesis (stroke)?
weakness
What is hemianopsia (stroke)?
loss of visual field in one or both eyes
When the RIGHT side of the brain is damaged, the patient may experience unilateral neglect syndrome. What happens with this?
- ignoring the LEFT side of the body
- inability to see, move or feel affected extremity
- clenched fingers
- contracted extremities
When RIGHT brain damage occurs, which side of the body experiences hemiplegia or hemiparesis?
the LEFT side
Which side of the brain is damaged when the patient experiences altered perception of deficits, loss of depth perception, and poor impulse control/judgment?
the RIGHT side
What is altered perception of deficits (R brain damage)?
overestimation of abilities
To what degree should the bed be elevated for a stroke?
at least 30 degrees
How often should ROM exercises be done after a stroke, and when should they be started?
- every 2 hours
- start early
Which side of the body should use passive ROM exercises after a stroke?
the AFFECTED side
Which side of the body should use active ROM exercises after a stroke?
the UNAFFECTED side
How can the nurse help with contracture after a stroke?
- give the patient a washcloth to hold
- contracture makes it hard to clean hands
What vital sign is important to monitor after a stroke, and when should the provider be notified?
- BP
- notify if >180/110
To ensure safe feeding, what should the SLP do (stroke)?
a swallow study
What consistency should liquids be for a patient recovering from a stroke?
thickened
- apple sauce
- cream soup
- pudding
- cooked cereal
What side should be dressed first after a stroke?
the AFFECTED side
Stroke, hypoxia, and substance withdrawal are risk factors for what?
seizures
Infants under what age are at risk for seizures?
< 2 y/o
Abrupt cessation of what kind of drug is a risk factor for seizures?
anti-epileptics
What metabolic disorders put someone at risk for seizures?
HYPOglycemia and HYPOnatremia
Exposure to what toxins are a risk factor for seizures?
carbon monoxide and lead
What does the prodromal phase of a seizure look like?
signs or activity that precedes a seizure
What does the aural phase of a seizure look like?
a sensory warning, the first few seconds of a seizure
What does the ictal phase of a seizure look like?
a full seizure, 1-3 minutes
What does the postictal phase of a seizure look like?
recovery
What can generalized seizures begin with?
aura
What is an aura (seizure)?
alterations in vision, smell, hearing, emotional feelings
What is a tonic seizure characterized by?
stiffening of muscles
What is a clonic seizure characterized by?
jerky spastic movements
How long does a tonic episode last during a tonic-clonic seizure? What happens after?
a few seconds and then loss of consciousness
How long does a clonic episode last during a tonic-clonic seizure?
1-2 minutes
What is a myoclonic seizure characterized by, and how long does it last?
- brief jerking and stiffening of the extremities
- lasts a few seconds
What characterizes an atonic/akinetic seizure, and what is it followed by?
loss of muscle tone for a few seconds followed by confusion
Can you put anything in a patient’s mouth or use restraints during a seizure?
NO!!!
What position should a patient be in while having a seizure?
side lying
What should be protected during a seizure?
- the head
- privacy
- the body from injury
What needs to be documented about a seizure?
onset and duration
When is a seizure considered a medical emergency?
if it lasts longer than 5 mins
What assessments should be done after a seizure?
- injury
- neuro, PERRLA
- vitals
- trigger of seizure
How many antiepileptic meds should be used every day?
ONE
What is an adverse effect of phenytoin?
bleeding gums
What are some adverse effects of phenobarbital?
respiratory depression and hypotension
What do most meds for seizures cause at the beginning of treatment?
drowsiness
What do seizure precautions consist of?
- bed in the lowest position
- side rails up
- padded side rails
- suction and oxygen available
When does the prodromal stage of migraine with aura start?
hours to days before onset
How long does the aura stage of migraine with aura take to develop?
minutes to an hour
What symptoms occur during the aura stage of a migraine?
- numbness and tingling in the mouth, lips, face, and hands
- visual disturbances
When do a severe headache, N/V, drowsiness, and vertigo occur for migraine with aura?
the second stage
What does the headache feel like in the third stage of migraine with aura?
dull
What symptoms occur in the recovery phase of a migraine with aura?
muscle ache and contracture of the head/neck muscles
What causes a migraine without aura? How long does it last?
- pain is aggravated by physical activity
- can be caused by stress, premenstrual tension, and fluid retention
- 4-72 hours
- early in the morning
How long does an atypical migraine last?
longer than 72 hours
What does migraine pain feel like?
throbbing, unilateral
What does a cluster HA feel like, and how long does it last?
non-throbbing, intense, unilateral
- 30 mins to 2 hours
What type of environment is good for someone with a migraine?
cool, dark, quiet
What should a HA journal consist of?
patterns, auras, symptoms, triggers
How much and how long should oxygen therapy be used for cluster HA?
12 L for 15-20 mins
What foods trigger migraines?
foods with tyramine, MSG, high-preservatives
What foods trigger cluster HA?
foods with tyramine, MSG, nitrates (preservatives)
What medications induce migraines?
- ranitidine
- estrogen
- nitroglycerin
- nifedipine
What can a lack of quality rest, stress/anger/anxiety, and glare/flickering/excess light trigger?
migraines and cluster HA
What can environmental odors, changes in altitude, and menstrual cycle trigger?
migraine
What can excessive physical activity trigger?
cluster HA
What causes photophobia and phonophobia?
migraines
What causes sweating and tearing?
cluster HA
When are cluster HA most common?
spring and fall
During the spring and fall, how often does cluster HA occur?
- daily
- at about the same time everyday
- then 9-12 months of remission
What happens to H&H with anemia?
decreases
How does general anemia present?
- hypotension
- tachycardia
- cold, pale
- decreased LOC
Which kind of anemia is a blood transfusion done for?
general
What dietary deficiencies can cause iron deficiency anemia?
- vegetarian
- inadequate protein
Decreased absorption can cause ID anemia. How can this occur?
- gastrectomy
- diarrhea
- malabsorption syndrome
Increased metabolic requirements can cause ID anemia. How can this occur?
- pregnancy
- lactation
What are the early signs of ID anemia?
- fatigue
- SOB
- cold intolerance
What are the late signs of ID anemia?
- brittle, spoon-shaped nails
- cheilosis
- glossitis
- pica
What is cheilosis (ID anemia)?
cracks at the corners of the mouth
What is glossitis (ID anemia)?
smooth, sore tongue
What is pica (ID anemia)?
eating things that are not food
What does total iron-binding capacity measure (ID anemia)?
serum transferrin
What does serum ferritin indicate (ID anemia)?
the body’s total iron stores
What does serum iron measure (ID anemia)?
the amount of iron in the blood
What diagnostic results indicate ID anemia?
- decreased serum iron
- increased TIBC
What foods should someone with ID anemia eat, and how many meals?
- soft, cool, bland foods
- increased protein and vitamins
- 4-6 small meals
What type of anemia are ferrous sulfate, ferrous fumarate, and ferrous gluconate used for?
iron deficiency
What does vitamin C do to iron absorption and what can it not be given with?
- increases absorption
- no milk
What foods contain heme iron?
- beef
- chicken
- clams
- egg yolks
- turkey
- pork loin
- veal
What foods contain nonheme iron?
- bran flakes
- brown rice
- whole grain bread
- dried beans and fruit
- greens
- oatmeal
What causes pernicious anemia?
inadequate B12 (vegetarian), lack of intrinsic factor
How does pernicious anemia present?
- jaundice
- smooth/sore/beefy red tongue
- diarrhea
- problems with proprioception and balance
- weakness
What is a progressive symptom of pernicious anemia?
paresthesias
What does the Schilling test do (pernicious anemia)?
measures vitamin B12 absorption
What is cyanocobalamin used for?
B12 supplement for pernicious anemia
How would cyanocobalamin be given if B12 deficiency was due to dietary intake?
orally
How would cyanocobalamin be given if B12 deficiency is due to a lack of intrinsic factor, malabsorption, or bowel removal?
parenterally or intranasally
What foods have increased amounts of B12 (pernicious anemia)?
- meat
- eggs
- dairy
- liver
- shrimp
- cheese
What are the clinical manifestations of thrombocytopenia?
- petechiae
- ecchymosis
- bleeding gums
- nose bleeds
- blood in stools/urine/vomit
What is the neutropenic ANC level associated with thrombocytopenia?
<1,000
At what PLT level is there the greatest risk for bleeding?
<50,000
At what PLT level might spontaneous bleeding occur?
<20,000
When should PLT be administered?
<10,000
What bleeding precautions should be taken for thrombocytopenia?
- avoid IVs/injections
- apply pressure 10 mins after blood draws
- use an electric razor
- use a soft-bristled toothbrush
- avoid blowing the nose vigorously
- make sure dentures fit
- avoid restrictive clothing
- NO crossing legs
What do WBCs invade and destroy in leukemia?
bone marrow, where PLT and H&H are made (so they will decrease)
What should be monitored with filgrastim (leukemia)?
bone pain
What lab levels are decreased with leukemia?
H&H and PLT
What precautions should be used for leukemia?
neutropenic precautions
Chemotherapy causes immunosuppression and neutropenia. What should be monitored?
- temp (report >100)
- WBC
- ANC (<1000 = weak immune system)
Chemotherapy can cause N/V and anorexia. What should you assess for?
- dehydration
- fluid and electrolyte imbalances
What medication should you give before chemotherapy to prevent N/V?
ondansetron
How should you eat when going through chemotherapy?
- low fat
- high-calorie, protein, and nutrient-dense foods
- cold foods that do not need cooking
- dry foods (crackers, toast)
- no salty, acidic, or spicy foods
- bland, soft foods
- several small meals a day
- no liquids with meals
When should you select a hairpiece for chemotherapy?
before starting tx
When does hair loss begin after starting chemo?
7-10 days
What is mucositis, and when does it occur?
- during chemotherapy
- inflamed mucous lining of the upper GI tract (mouth to stomach)
What is stomatitis, and when does it occur?
- during chemotherapy
- inflamed tissues of the oral cavity (gums, tongue, roof/floor of mouth, inside lips/cheeks)
What types of mouthwash should you avoid during chemotherapy?
glycerin-based or with alcohol
What medications should be avoided with chemotherapy?
NSAIDS
During chemotherapy, what can cause loss of sensation, ortho hypo, loss of taste, and constipation?
peripheral neuropathy
What 3 things can radiation cause?
- skin changes
- hair loss
- debilitating fatigue
Where is internal radiation therapy placed?
in body orifice or cavity
What becomes radioactive with internal radiation?
waste products
What does a dosimeter film badge do during internal radiation?
records personal radiation exposure
How long can visitors stay, and where can they stand in the room of someone receiving internal radiation? Who cannot visit?
- 30 mins, 6 feet away
- no pregnant women or anyone under 18
How is external radiation therapy done?
teletherapy, small doses over several weeks
What skin injuries are associated with external radiation?
- blanching
- erythema
- desquamation (skin peeling)
- sloughing
- hemorrhage
What mouth injuries are associated with external radiation?
mucositis and dry mouth
What neck injuries are associated with external radiation?
difficulty swallowing
What abdominal injuries are associated with external radiation?
gastroenteritis
External radiation can cause dysgeusia, which affects taste. What food is unpalatable?
red meat
How should you wash the skin during external radiation?
with mild soap and water using a patting motion
What should you NOT remove/wash off from radiation?
radiation tattoos and markings
What do interleukins do during immunotherapy?
help coordinate inflammatory and immune response
What should you watch for with interleukins?
flu-like symptoms and edema
What do interferons do during immunotherapy?
exert exert an antitumor effect
What should you watch for with interferons?
lethargy and ortho hypo
What is the ABCDE evaluation for skin cancer?
A: asymmetry
B: borders
C: color
D: diameter
E: evolving
Breast changes, pain, and soreness are manifestations of what type of cancer?
breast
How many servings of veggies should someone with breast cancer eat a day?
at least 5
How often should you do a self-breast exam?
monthly
How often should a clinical breast exam be done?
- every 3 years for 20-39 y/o
- yearly for 40+ y/o
What cancer is a thoracentesis done for?
lung cancer
Where does the scope go when bronchoscopy is done for lung cancer?
through the trachea
What are the clinical manifestations of prostate cancer?
enlarged/hard prostate and urinary symptoms
What confirms prostate cancer after a digital rectal exam or prostate-specific antigen test?
biopsy
Changes in stool consistency/shape and the presence of blood in the stool are manifestations of what type of cancer?
colorectal
How often should a colonoscopy be done to screen for colorectal cancer?
every 10 years
How often should a sigmoidoscopy be done to screen for colorectal cancer?
every 5 years for ages 50-75
How often should a fecal occult blood test be done to screen for colorectal cancer?
annually for ages 50-75
What tests determine cervical cancer?
PAP test followed by a biopsy
How often should HPV screening be done?
every 5 years for women 30-65 y/o
What are the vaginal manifestations of cervical cancer?
bleeding between menses and water/blood-tinged discharge
What are the urinary manifestations of cervical cancer?
dysuria and hematura
What cancers are being childless, having your first child after 30, HRT, early menarche, and late menopause risk factors for?
breast and ovarian
What can protect against ovarian cancer?
birth control and pregnancy
What abdominal symptoms are present with ovarian cancer?
- pain/swelling/discomfort
- dyspepsia
- gas
- distention
What happens to the mouth with oropharyngeal cancer?
- lesions
- red patches
- bleeding
- difficulty chewing/swallowing
How can you tell if oropharyngeal cancer is present by doing to Toluidine Blue 1% staining test?
malignant cells stain blue
Chemotherapy can cause N/V and anorexia. What should you assess for?
- dehydration
- fluid and electrolyte imbalances