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MedSurg > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Nursing Intervention during:
Pre-trajectory health

A

Prevention, changing modifiable risks

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2
Q

Nursing Intervention during:
Trajectory onset

A

Explain testing, emotional support to pt and family

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3
Q

Nursing Intervention during:
Stable

A

Reinforce positive behaviors

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4
Q

Nursing Intervention during:
Acute

A

Direct care, emotional support

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5
Q

Nursing Intervention during:
Comeback

A

Rehab and PT to increase strength, gain lifestyle back

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6
Q

Nursing Intervention during:
Crisis

A

Direct pt care, collaborate with team members to stabilize pt

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7
Q

Nursing Intervention during:
Unstable

A

Education, emotional support

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8
Q

Nursing Intervention during:
Downward

A

Home care or community-based care, end of life planning

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9
Q

Nursing Intervention during:
Dying

A

Direct and supportive care

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10
Q

Primary prevention

A

Prevent disease before it happens;
alter unhealthy lifestyle, education, immunization

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11
Q

Secondary prevention

A

Reduce the impact of disease;
exam and screening (mammography, colonoscopy), early detection, modified work

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12
Q

Tertiary prevention

A

Soften impact of ongoing illness/disease;
chronic disease management programs, rehab programs, support groups

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13
Q

Apraxia

A

Inability to use words correctly

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14
Q

Aphasia

A

Inability to speak or understand

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15
Q

Delirium

A

A hallucination, delusions, or fear and anxiety
Causes: Infection, alcohol, medication toxicity, dehydration, impaction

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16
Q

Alzheimer’s disease

A

Chronic, progressive, and degenerative

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17
Q

Medicare

A

Health insurance for 65+ or disabled; does not cover long term care (hearing aides, glasses, dentures)

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18
Q

Medicaid

A

State-based, need-based health insurance

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19
Q

Developmental disability

A

Occurs from birth to age 22;
ex. Down Syndrome

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20
Q

Acquired disability

A

Occurs from an acute injury
ex. Stroke, TBI

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21
Q

Age-related disability

A

Progression from chronic illness
ex. Arthritis, dementia

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22
Q

Outermost parts of the eye

A

Cornea and sclera

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23
Q

Middle portion of eye contains

A

Iris, choroid, and ciliary body
Also aqueous humor, lens, and vitreous humor/body

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24
Q

Innermost layer of eye contains

A

Retina, macula, and photoreceptors (rods and cones)

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25
Q

Cranial nerves, GO!

A

1 - Olfactory
2 - Optic
3 - Oculomotor
4 - Trochlear
5 - Trigeminal
6 - Abducens
7 - Facial
8 - Vestibulocochlear
9 - Glossopharyngeal
10 - Vagus
11 - Spinal Accessory
12 - Hypoglossal

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26
Q

Aqueous humor

A

Clear liquid in front of the lens, continuously produced and replaced

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27
Q

Lens

A

Behind the iris, bends light that enters the pupil, constricts and widens light (PERRLA)

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28
Q

Vitreous humor/body

A

Contains clear gel-like plasma, helps maintain eyeball shape (along with sclera)
Shrinks with age and can develop floaters (normal aging)

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29
Q

Retina

A

Extension of optic nerve, contains photoreceptors (rods and cones)

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30
Q

Rods

A

Provide peripheral light and low light (night vision)

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31
Q

Cones

A

Provide bright light and color

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32
Q

4 Eye functions

A

Pupil constriction
Accomodation
Convergence
Refraction

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33
Q

Pupil convergence

A

adjusting to light

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34
Q

Accomodation

A

allows eye to adjust image to retina no matter where it is

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35
Q

Convergence

A

ability of eyes to turn something seen between two eyes into one object

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36
Q

Refraction

A

bending light from outside the eye to meet the retina
Refraction errors are how we get poor eyesight/acuity

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37
Q

Ectropion

A

Eyelid turns outward

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38
Q

Entropion

A

Lower eyelid turns inwards

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39
Q

Trichiasis

A

Eyelashes grow inwards

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40
Q

Nystagmus

A

Involuntary eye movements

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41
Q

Impaired vision

A

20/40 or worse

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42
Q

Blindness visual acuity

A

20/200 and worse

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43
Q

Amsler grid

A

Tests for macular degeneration
Curvy lines = macular degeneration

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44
Q

Jaeger test

A

Tests reading visual acuity

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45
Q

Ishihara

A

Tests color vision; numbers hidden in colored circle

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46
Q

Pinhole test

A

Physician looks for cataracts with shield with pinholes to eliminate glare from direct light

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47
Q

Tonometry

A

Test intraocular pressure; screening for glaucoma

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48
Q

Confrontation test

A

Tests peripheral vision; stand across and cover mirrored eyes; indicates retina health

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49
Q

Fluorescein Angiography

A

Evaluates macular edema or abnormal blood vessels/perfusion

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50
Q

Nursing consideration for Fluorescein angiography

A

Check for iodine or shellfish allergy; check labs for BUN/Creatinine (kidney function), increase hydration to excrete dye

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51
Q

Eye ultrasonography

A

Looks for tumors, retinal detachment, hemorrhage, cataracts

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52
Q

OD

A

Oculus Dexter; right eye

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53
Q

OS

A

Oculus Sinister; left eye

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54
Q

OU

A

Oculus Uterque; both eyes

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55
Q

Myopia

A

Nearsightedness
Dx with Snellen chart

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56
Q

Hyperopia

A

Farsightedness
Dx with Jaeger chart

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57
Q

Presbyopia

A

Age-related farsightedness

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58
Q

Hordeolum

A

Stye; infected sebaceous gland
Tx: Topical antibiotic and warm soak

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59
Q

Seborrheic Blepharitis

A

Inflammation of eyelid edges; reduced tear production increased risk for bacterial infections
Tx: Wash eyes with baby shampoo

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60
Q

Staphylococcal Blepharitis

A

Can develop from severe seborrheic blepharitis
Tx: Antibiotics

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61
Q

Conjunctivitis

A

“pink eye”, inflammation of the conjunctiva
Causes: allergic reaction (dander, pollen, pools), viral, or bacterial
Tx: According to cause, allergic meds or antibiotic

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62
Q

Chlamydia Trachomatis

A

Major cause of worldwide blindness, r/t STI
Tx: Antibiotics

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63
Q

Keratitis

A

Infection/inflammation of the cornea; bacterial, viral, fungal, or parasitic
Tx: (in order) IV/topical antibiotic, acyclovir, antifungal

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64
Q

Uveitis

A

Severe inflammation characterized by redness, pain, and photophobia
Tx: Steroid eye drops, dark sunglasses

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65
Q

Corneal dystrophies

A

Inherited; characterized by deposits that lead to irregular surface and blurred vision
S/sx: Edema, blisters, pain

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66
Q

Keratoconus

A

Inherited; cornea thins and protrudes, can have astigmatism (corrected with glasses)

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67
Q

Corneal ulceration

A

Tissue loss from an infection (EMERGENCY); Can develop from corneal abrasion (trauma)
S/sx: Pain, tearing, purulent/bloody drainage, loss of vision
Dx: Fluoresein dye
Tx: Antibiotic or antifungal, possible cornea transplant

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68
Q

Cataracts

A

Lens opacity that distorts the image directed onto the retina

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69
Q

Cataracts risk factors

A

Smoking, diabetes, obesity, trauma, steroid use

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70
Q

Cataracts s/sx

A

Blurred vision, decreased color perception, vision worse in bright lights (halo), possible double vision, decreased peripheral vision, H/A, arched eyebrow

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71
Q

Cataracts pathology

A

Lens proteins dry out and form crystals

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72
Q

Cataracts Tx

A

Surgery (one eye at a time)
- Steroids, antibiotics, eye patch, sunglasses, avoid increasing IOP
Without treatment it will lead to blindness

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73
Q

Cataracts surgery nursing consideration

A

Itchiness/scratching, mild blurry vision, and drainage is normal, pain is NOT normal

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74
Q

Retinopathy

A

Microvascular damage that can be slow or rapid

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75
Q

Retinal holes, tears, or detachment s/sx

A

Sudden pain, floating dark spots, curtain covering visual field, cobweb, bright flashing light

76
Q

Retinal holes, tears, or detachment dx

A

Ophthalmoscope

77
Q

Retinal holes, tears, or detachment tx

A

Emergent tx: Surgery, Cryotherapy, insert air bubble to reattach retina (positioning)
Conservative tx: Restrict activity, eye patch to reduce eye movement

78
Q

Macular degeneration pathology

A

Waste material and debris collects to create drusen - yellow plaques
- Retina may show yellow spots on exam

79
Q

Macular degeneration risk factors

A

Smoking, hypertension, female, short, long term diet poor in carotene and Vit. E

80
Q

Types of macular degeneration and tx

A

Dry macular degeneration: More common; caused by gradual blockage of retinal capillaries, retinal cells become necrotic (faster in smokers), rods and cones can dye; no cure;
- Tx: reduce progression
Wet macular degeneration: Abrupt onset
- Tx: laser surgery to stop leaking vessels

81
Q

Normal IOP range

A

10-21 mmHg (22-32 = glaucoma dx)

82
Q

Glaucoma pathology

A

IOP leads to ischemia and damage to the optic nerve; causes peripheral vision loss

83
Q

Chronic Open-Angle Glaucoma pathology

A

Most common type; blockage in trabecular mesh work impairs aqueous humor flow

84
Q

Chronic Open-Angle Glaucoma s/sx

A

None besides decreased peripheral vision/poor visual field

85
Q

Chronic Open-Angle Glaucoma tx

A

Eye drops that reduce IOP

86
Q

Acute Angle-Closure Glaucoma pathology

A

Retina bends and blocks aqueous humor flow; usually sudden onset, emergency

87
Q

Acute Angle-Closure Glaucoma s/sx

A

Sudden H/A, brow pain, N/V

88
Q

Acute Angle-Closure Glaucoma tx

A

Surgery, laser, or medication (or combination) to reduce IOP
Long term: Beta blockers or cholinergics that dilate blood vessels

89
Q

Topical anesthetics (eyes) use

A

For eye pain

90
Q

Mydriatic use for eyes

A

dilate the pupil

91
Q

Cycloplegic use for eyes

A

paralyze the iris

92
Q

Glaucoma meds do what for eyes

A

Lower IOP by decreasing aqueous production or increase aqueous outflow

93
Q

Nursing consideration for eye drops

A
  1. Use eye drops before ointments
  2. Wait 5 minutes between 2 different eye drops
94
Q

External ear is called

A

pinna/auricle

95
Q

Middle ear contains

A

Tympanic membrane and ossicles (malleus, incus, and stapes)

96
Q

Failure in outer/middle ear causes what kind of hearing loss

A

Conductive hearing loss

97
Q

Inner ear contains

A

Cochlea and cochlea nerves (facial, auditory, vestibulocochlear), eustachian tube (opens and closes with yawning and swallowing)

98
Q

Failure in inner ear leads to what kind of hearing loss

A

Sensorineural hearing loss; also disturbance of balance and orientation

99
Q

Where is cone of light located on tympanic membrane

A

Lower right

100
Q

Presbycusis

A

Age-related hearing loss

101
Q

Subjective data for hearing assessment

A

History of mumps or scarlet fever, aspirin use (ototoxic), pain, hearing changes

102
Q

Audiometry

A

Tests pitch and intensity with beeps in headphone

103
Q

Weber test

A

Tuning fork placed on top of head, sound should be heard equally in both ears
Sound is heard louder on damaged side with conductive hearing loss (outer/middle ear damage)
Sound is heard worse in effected ear with sensorineural hearing loss (inner ear damage)

104
Q

Rinne test

A

Tuning fork placed on bone behind ear until it isn’t heard, then placed beside ear until it is no longer heard
Distinguishes between air and conduction hearing loss
Air conduction is 2-3x longer than bone conduction

105
Q

What happens if there is conductive hearing loss with Rinne test

A

Sound is heard longer and louder during bone conduction

106
Q

What happens if there is sensorineural loss with Rinne test

A

Air conduction and bone conduction can be diminished

107
Q

Auditory Evoked Potential

A

Electrodes are used to test the cranial nerves

108
Q

Electronystagmography (ENG)

A

Records nystagmus (goes along with vertigo)

109
Q

Caloric testing

A

Evaluates the inner ear; warm water is infused into the ear, nystagmus is a normal response within 20-30 seconds

110
Q

Epley Maneuver

A

For vertigo; turn head towards side with vertigo then quickly lay down with head over edge; look for nystagmus, HELPS with vertigo by correcting displaced crystals in the ear

111
Q

Dix-Hallpike maneuver

A

Turn head 45 degrees and lay back; dizziness will occur on side with vertigo; use to DIAGNOSE vertigo

112
Q

Endoscopy

A

Looks for new onset hearing loss or fistulas

113
Q

CT Scan (for ears)

A

Looks at ear structures for tumors

114
Q

MRI (for ears)

A

Notes any soft tissue changes (tumors)

115
Q

External otitis

A

Irritation of the auditory canal, bacterial, fungal, allergic
Otalgia = ear pain
Tx: Topical antibiotics, antifungals, steroids, and pain control

116
Q

Cerumen impaction

A

S/sx: Otalgia or sensation of fullness, hearing loss
Tx: Irrigation with warm water, suction

116
Q

Earwick

A

Used to instill antibiotics into the external canal; can be used for edema/inflammation

116
Q

Trauma/perforation (ears)

A

Most heal in 1-2 weeks, may require aspiration of hematoma or surgery if it doesn’t heal

116
Q

Foreign body (ears)

A

Do not use irrigation - bugs and vegetables can swell and further impact ear
Can use mineral oil for bugs

116
Q

Tympanoplasty

A

Grommet (tube) inserted into tympanic membrane to release pressure and fluid
- Watch for facial nerve changes, signs of infection, vertigo, tinnitus, balance issues, educate on avoiding water in ears, avoid planes

116
Q

Malignant external otitis

A

More virulent form of external otitis
Usually caused by pseudomonas aeruginosa
Tx: Antibiotics, sometimes need an earwick if swelling is close to canal entrance

116
Q

Motion sickness tx

A

Antivert, Dramamine

116
Q

Mastoiditis

A

Infection of the mastoid air cells
S/sx: Pain not relieved by tubes, fever, malaise, hearing loss, vertigo, can lead to meningitis
Tx: IV antibiotics, mastoidectomy
Unsuccessful tx: Cranial nerve damage to 6&7 - facial drooping, inability to look sideways

116
Q

Otosclerosis

A

Hereditary; most common cause of hearing loss, abnormal bone growth in middle ear that causes progressive hearing loss
S/sx: Vascular and bony changes, good bone conduction but poor air conduction
Tx: Calcium, Tympanoplasty

116
Q

Meniere’s disease

A

Excess endolymphatic fluid in the ear,
S/sx: Tinnitus, fullness in ear, one sided hearing loss, vertigo episodes that last 3-4 hours, hearing loss is eventually irreversible
Cause: Unknown

116
Q

Malignancy (ears)

A

Most commonly basal squamous cell skin cancer due to sun exposure
S/sx: Sandpaper feeling on auricle edge

116
Q

Otitis media

A

Types: Acute, Chronic, or Serous (involves fluid w/o active infection)
Infection of middle ear that causes inflammation and build-up of fluid behind the eardrum

116
Q

Meniere’s disease tx

A

Low sodium, low sugar diet, fresh/unprocessed foods (Furstenberg/Neutral Ash diet)
Limit alcohol, Avoid aspirin -> increase dizziness
Meds: Diuretics, Antivert, Dramamine, antihistamines, N/V meds
Surgery: Endolymphatic shunt

117
Q

Benign Paroxysmal Positional Vertigo (BPPV)

A

Cause: debris particles in the ear
S/sx: Dizziness, N/V, falling, nystagmus
Tx: Meclizine, Epley maneuver

118
Q

Acoustic Neuroma

A

Benign tumor where cranial nerve 8 enters the canal
S/sx: hearing loss and vertigo
Tx: surgical removal of tumor
- Educate pt to report clear drainage from nose (may be CSF)

119
Q

Labyrinthitis

A

Infection of inner ear/labyrinth; sudden onset
Rare complication of otitis media
S/sx: Vertigo, N/V, hearing loss, tinnitus

120
Q

Ototoxicity

A

Medications can cause hearing loss
Tx: D/C drug

121
Q

Nociceptive pain pathway

A
  1. Transduction
  2. Transmission
  3. Perception
  4. Modulation
122
Q

Neuropathic pain characteristics

A

Stabbing, electric shock

123
Q

Non opioid examples

A

Acetaminophen, Aspirin, ibuprofen (NSAID’s), Salicylates

124
Q

Ceiling effect of non opioids

A

Increasing the dose above a certain level will not give more pain relief
- Opioids do not have ceiling effect
- Mixed opioids DO have ceiling effect (cannot exceed dose of non-opioid in the mix)

125
Q

Where does the opioid react to the mu agonist receptor?

A

The dorsal horn (of the vertebrae)
- Dorsal side of vertebrae brings in sensory information, ventral side sends out motor information

126
Q

NSAID AE

A

GI bleeding, peptic ulcer
- give with food
- assess for bleeding (bruising, coffee ground emesis, tarry stool)

127
Q

Adjunctive examples

A

Local anesthetic - Lidocaine
Anticonvulsants - Neurontin, Lyrica
Antidepressants - Cymbalta, Effexor
Ketamine

128
Q

Layers of the skin

A

Epidermis - no vasculature, Vit D activated here
Dermis - hair follicles, sebaceous gland, sweat gland
Subcutaneous tissue

129
Q

Skin assessment for moles/lesions

A

A: Asymmetry of shape
B: Border irregularity
C: Color variation
D: Diameter
E: Evolving or changing in any feature

130
Q

Macule

A

Flat, discolored spot on skin with sharp borders
- Ex. Freckle

131
Q

Papule

A

Solid elevations without fluid with sharp borders
- Ex. Mole

132
Q

Nodule, tumor

A

Palpable, solid, elevated mass
Nodules with distinct borders
Tumors extend deep into dermis
- Ex. Wart (nodule), large lipoma (tumor)

133
Q

Vesicle

A

Small distinct elevation with fluid
- Ex. Blister from herpes simplex

134
Q

Bulla

A

Large distinct elevation with fluid
- Ex. Friction burn or burn blister

135
Q

Pustule

A

Vesicle or bulla filled with purulent drainage
- Ex. Acne, carbuncles

136
Q

Wheal

A

Localized area of edema, irregular and variable in size and color
- Ex. Hive, insect bite

137
Q

Plaque

A

Larger, flat, elevated, solid surface
- Ex. Psoriasis

138
Q

Scale

A

Thin or thick flake, varying in color
- Ex. Dandruff

139
Q

Crust

A

Dried residue of exudates
- Ex. Residue of impetigo

140
Q

Fissure

A

Linear crack in the skin
- Ex. Athlete’s foot

141
Q

Ulcer

A

Opening in skin caused by sloughing of necrotic tissue
- Ex. Pressure ulcer, stasis ulcer

142
Q

Tzanck smear

A

Blistering condition observed under glass slide
- Used for herpes

143
Q

Wood’s light

A

UV light shows hyperpigmentation of lesions

144
Q

Actinic Keratosis

A

Rough, scaly patch from overexposure to the sun
Premalignant (turns into squamous cell carcinoma)
- Tx: Efudix cream (Fluorouracil)

145
Q

Squamous cell carcinoma

A

Rough, thick, scaly tumor
Local or metastatic
- Tx: Surgical excision, cryosurgery, Efudix cream (Fluorouracil)

146
Q

Basal cell carcinoma

A

Most common; sun exposure
Rarely metastatic
Small, waxy nodule with pearly border
- Tx: Mohs surgery or curettage (excision), cryosurgery

147
Q

Malignant melanoma

A

Variation in color, grows radially (wide) and vertically (deep)
Seen in ages 20-45
Highly metastatic to bone, liver, and spleen
- Tx: Surgical excision

148
Q

Cellulitis

A

Generalized infection
Tx: Oral or IV antibiotic

149
Q

Carbuncle

A

Cluster of boils
Usually staphylococcus
Tx: Oral or IV antibiotic

150
Q

Furuncle

A

Boil
Usually staphylococcus
Tx: Oral or IV antibiotic

151
Q

Impetigo

A

Superficial infection caused by staph. or strep.
Contagious

152
Q

Herpes 1

A

Cold sore
Flair ups and remissions, but always remains in nerve ganglia
Spread by direct contact

153
Q

Herpes 2

A

Genital warts
Flair ups and remissions, but always remains in nerve ganglia
Spread by direct contact

154
Q

Herpes zoster

A

Shingle
Dormant chicken pox

155
Q

Plantar wart

A

HPV (human papillomavirus) infection

156
Q

Tinea pedis

A

Athlete’s foot; fungal infection

157
Q

Tinea capitis

A

Fungal infection of scalp

158
Q

Tinea corporis

A

Ringworm; fungal infection

159
Q

Pediculosis capitis

A

Head lice

160
Q

Pediculosis corporis

A

Body lice

161
Q

Pediculosis pubis

A

Genital lice; crabs

162
Q

Scabies

A

Mites under skin
Severe itching, burrows, straight lines
- Tx: Scabicide left on for 12-24 hours and repeated a week later

163
Q

Atopic dermatitis

A

Eczema
- Tx: Steroid creams, light therapy (sunlight)

164
Q

Uticaria

A

Hives

165
Q

Psoriasis

A

Autoimmune disorder; epithelial cells divide too quickly
Lifelong
Exacerbation and remission
- Tx: Corticosteroid, UV light

166
Q

Koebner’s phenomenon

A

Skin that was previously damaged is at risk for further complications and even cancer

167
Q

Lentigo

A

Melanocytes related to sun exposure and aging
AKA liver spots or age spots

168
Q

Seborrheic keratosis

A

Neoplasm that occurs during middle age
Itching and scaly spot
Hereditary
Removed for cosmetic reasons; benign

169
Q

Hidradenitis suppurativa

A

Abscess in axilla from blockage or infection in sweat glands
Tx: Warm compress and antibiotics

170
Q

Seborrheic dermatosis

A

Excessive oil production
Leads to chronic inflammation
Can lead to secondary yeast infection
- Tx: (wet form) topical corticosteroid, (dry form) dandruff shampoo

171
Q

Keloid

A

Overgrowth of scar tissue

172
Q

Purpura

A

Blood spots under the skin

173
Q

Petechiae

A

Broken capillaries
Seen with venous insufficiency or liver disease

174
Q

Vitamin C role in healing

A

Promotes collagen synthesis

175
Q

Vitamin A role in healing

A

Stimulates epithelial cells, stimulates immune system

MedSurg (5 decks)

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