exam 1 Flashcards
refractive disorders:
related to lengthening or shortening of eyeball
-types: myopia, hyperopia
myopia:
-patho: nearsighted (blurry vision for distances), light focused in front of retina, eye focuses an image in front of the retina due to lens thickness, lengthened
-s/s: difficulty seeing at distances, eye fatigue and strain, headaches
-assessment: eye exam
-risks: a family history, and certain environmental conditions
hyperopia:
-patho: farsighted (blurry vision up close) , light behind the retina, focusing of an image behind the retina, which alters the transmission of light, shortened
-s/s: blurry vision close-up, eye fatigue and strain, headaches
-assessment: eye exam
-risks: a family history, diabetes, and certain medications
emmetropia:
“normal” vision
impairment and blind:
impairment: 20/40 or more
blind: 20/200
conjuntivits:
-patho: inflammation of the mucous membrane lining in the eye (pink eye)
-types: viral, bacterial, allergic, toxic
-education: cool compress, very contagious, do not share towels, makeup, hand hygiene, do not apply makeup until after infection clears, monitor discharge
bacterial conjuntivitis:
-caused by: pneumonia, flu, aureus
-s/s: acute redness, burning, discharge, drainage (mild: mucopurulent, severe: purulent)
-treatment: self-limiting (2 weeks), antibiotics
viral conjunctivitis:
-causes: adenovirus, herpes
-s/s: tearing, redness, foreign body sensation, photophobia, last longer than bacterial, discharge (watery)
-management: no medical treatment, cold compress
allergic conjunctivitis:
cause: hypersensitivity reaction
s/s: pruritus, epiphora (excessive tears), severe photophobia, drainage (stringy mucoidal)
management: cool compress, corticosteroids
toxic conjunctivitis:
-cause: toxin in eye, medication, chlorine, toxic fumes, smoke, hairsprays, acids
-irrigate eye immediately and thoroughly
cataracts:
-patho: lens opacity or cloudiness
-risk factors: aging, eye conditions, toxins, nutrition, physical trauma, systemic diseases
-management: risk reduction, no non-surgical treatment, cataract removal (very common)
-post-op (if needed): eye patch, manage discomfort, meds, no sleeping on side of effected eye, avoid rubbing, lifting, or bending
detached retina:
-patho: retina pulls away from supportive tissues of eye, ocular emergency!!
-management: surgical reattachment (scleral buckle and vitrectomy)
-s/s: shade, cobwebs, bright flashing lights, sudden onset of floaters, no pain
-causes: myopia, cataract, diabetic, trauma, AMD
-manage: surgery, post-op (face down for gas, education, emotional support)
glaucoma: 3rd most common eye disease
-patho: vision loss due to optic nerve damage, can be primary or secondary, fluid accumulation increases IOP leading to damage
-treatment: no cure can be controlled
-treatment conditions: control IOP, surgery when meds arent helping
-risk: CV diseases, diabetes, family, migraines, myopia, older age
-s/s: silent thief of sight
macular degeneration:
-risk factors: aging, smoking, caucasian, family history
-patho: age related macular degenerations (AMD), drusen beneath the retina (yellow deposits under retina) (dry AMD is most common) (wet more serious and dry more progressive over time)
-assessment: a medical history, eye exam, and a variety of tests
-management/ considerations: wet AMD can be treated with VEGF inhibitors but no treatment for dry AMD, monitor vision changes
-complications: central vision lost, blurry vision, dark spots, straight lines appear curved, variable severity
eye trauma:
-patho: blunt force causes peripheral volume displacement with increased “wedge pressure” that causes damage to area of least resistance along the lens, iris root, and trabecular meshwork
-nurse management: irrigate if chemical, can be flushed if small, or if larger cover with eye shield (DO NOT REMOVE), proper eye protection/ sporting equipment
function of ear:
hearing: sound conduction and transmission (Sound can be transmitted by air or by bone. Sound enters the ear by the external auditory canal. That sound causes the tympanic membrane to vibrate. The sound then goes to the inner ear and then to the central nervous system, where it is interpreted as noise)
balance and equilibrium: a problem in any part of the pathway can impact balance (The eyes, the body, and the ears send signals to the cerebral cortex in the brain)
hearing loss:
-patho: occurs when sound waves are disrupted as they travel from the outer ear to the brain
-causes: loud noise, trauma, ear wax, structural tissue
-assessment: speech deterioration, fatigue, indifference, social withdrawal, insecurity, indecision
-diagnostics:
-considerations: preferred communication, full pt attention, sign language, do not appear to understand, always face the person, speak slow, face visible, patient understanding
-conductive: damage to outer or middle ear (transmission to inner blocked)
-sensorineural: damage to inner ear
external otitis:
-patho: inflammation of the external ear canal
-management: reduce swelling, manage pain, ear drops, educate, no Q-tips, keep ear dry
-prevention: advise patients to avoid sticking a q-tip in the ear, which can scratch the ear canal, trauma can lead to infections, additionally, wearing ear plugs while swimming can help prevent swimmers ear
acute otitis media:
-patho: middle ear infection, infected fluid in middle ear, bacterial or viral
-treatment/ prevention: antibiotics, myringotomy (incision in the tympanic membrane, allows for drainage, equalizes pressure, tube falls out 6-18 months)
serous otitis media:
-patho: middle ear function, non-infected fluid in middle ear
-treatment: usually needs no treatment, middle ear tube can be placed, Valsalva maneuver
chronic otitis media:
-patho: recurrent AOM with irreversible pathology
-treatment: antibiotic ear drops, surgery
-complications: mastoiditis, cholesteatomas (cyst like lesion)
vertigo:
-patho: sudden internal or external spinning sensation, triggered by moving head to quickly, nausea and vomit may accompany, not cause hearing loss, dysfunction in vestibular system
-nursing management: bedrest, repositioning, meclizine 1-2 weeks, safety
-considerations: FALL RISK!!!!!
menieres:
sensory ends
-patho: abnormality in the inner ear fluid balance caused by malabsorption of the endolymphatic sac or a blockage of the endolymphatic duct
-s/s: episodic vertigo, tinnitus, fluctuating sensorineural hearing loss, nausea
-management: diet, diuretics, surgery
the epidemiology of cancer:
-most common types: lung (most common), breast, colorectal, stomach, prostate
-men: prostate, lung, colorectal
-women: breast, lung, colorectal
-risk factors (Modifiable and non-modifiable): most common is exposure to carcinogen, environmental, hormonal, lifestyle, infections, medications, immune status, nutrition, advanced age and genetic predisposition
-common causes of death in cancer patients (types/complications
of therapy):
CAUTION:
-Change in bowel or bladder habits
-A sore that does not heal
-Unusual bleeding or discharge
-Thickening or lump in the breast or any other part of body
-Indigestion or difficulty swallowing
-Obvious change in a wart or mole
-Nagging cough or hoarseness
what is cancer?
disease of mitosis where the normal checkpoints regulating mitosis are ignored by the cell
pathophysiology of cancer cells (how do cancer cells develop):
-hallmarks/characteristics of cancer cells: uncontrolled cell growth, lack contact inhibition, do not undergo apoptosis, no anchorage dependence, dysplasia (presence of abnormal cell type in tissue), neoplasia (formation or presence of new abnormal growth), anaplasia (loss of maturity)
-difference between primary and secondary cancer: primary cancer is the original cancer that starts in a specific part of the body, while secondary cancer is cancer that has spread from the primary site to another part of the body
-metastasis: cell-to-cell transfer, lymphatic, blood
staging & treatment options:
-purpose of staging: purpose is how large the tumor is and how extensive the disease process it
-how is treatment determined from staging: staging helps doctors determine the most appropriate treatment approach
malignant and benign
malignant: break away from the tumor begin to spread to surrounding tissues and start new tumors = metastasis
benign: tumor cells remain at original site- not spread
divided into 2 main cancers:
3 subcategories of hematological malignancies:
2: solid tumors and hematological malignancies
3: leukemia, lymphoma, multiple myeloma
staging:
-stage 1: small tumor without obvious spread outside organ
-stage 2: invasion of tissues or involvement of local lymph nodes
-stage 3: large or locally invasive tumors
-stage 4: cancers that have metastasized
grading:
-grade 1: cells differ slightly from normal cells and are well differiented
grade 2: more abnormal and moderately differiented
-grade 3: very abnormal and poorly differiented
-grade 4: immature and primitive and undifferiented, origin is difficult to determine
lab values associated with cancer treatments including complications related to them—CBC, BMP (Ex: low platelets relates to bleeding risks, WBC related to risks of infections, bone marrow suppression, etc., definition of nadir):
-nadir: lowest period after chemo blood counts are at their lowest
-CBC: ANC, H&H, platelets
ANC > 1800 safe to give chemo
side effects of chemotherapy:
-nursing interventions related to side effects: stopping drug, maintain airway, emergency meds if needed, mouth care
-how does chemotherapy affect normal/abnormal cells: myelosuppression suppresses bone marrow so it affects WBC, RBC, Plt
-goals of treatment
-destroys good cells as well as cancerous cells
-neutropenia: ANC <1500, risk for infection, initiate neutropenic precautions, has to be > 1800 to give chemo
-thrombocytopenia: low PLT, increase bleed, precaution
side effects of radiation:
-nursing interventions related to side effects: engaging, games, talking to loved ones on the phone
-how does radiation affect normal /abnormal cells: damaging their DNA, causing breaks in the genetic material which can lead to cell death
-goals of treatment: to kill cancer cells while minimizing damage to healthy tissue
-about: private room, limit time in room to 30 mins, position self at furthest point from source, no pregnant staff, risk for feelings isolation
side effects of adjuvant treatments:
-nursing interventions related to side effects:
-goals of treatment: treatment/therapy applied after the initial treatment, to help with the risk of cancer returning
sealed source:
mechanically positioned source of radioactive material placed in a body cavity
side effects of surgical treatment:
-nursing interventions related to side effects
-goals of treatment
prevention and education:
-types of screenings (Example: monthly breast exam/women; testicular exam/men; digital prostate exam/men, etc.): breast self-exams/ mammography, prostate screening & PSA, testicular exams
-types of lifestyle changes/teaching (health promotion): avoid tobacco, limit exposure to sun, eat diet rich in fiber, fruits, and veggies, maintain weight, protect against carcinogens, limit alcohol consumption, discuss prevention with doctor if family history could play a roll
therapeutic communication:
-things you should/should not say:
-respecting patient decisions:
-coping strategies:
-patient rights related to information on their condition:
-support systems:
nursing management:
-patient report should be believed always
-drug therapy should be used to control pain
-fear of addiction
-numerous drug options for pain
-non-pharmacological interventions: relaxation therapy, imagery
resources needed for cancer patients:
oncology ends
psychologic support
CPAP/BiPap—what they are, what would they be used for, differences
between them:
-CPAP: CONTINUOUS POSITIVE AIRWAY PRESSURE
-BiPap: BILEVEL POSITIVE AIRWAY PRESSURE
-CPAP machines provide a constant air pressure level, while BiPAP machines provide different air pressure levels for inhalation and exhalation
laryngectomy priorities of care
(permanent tracheostomy from changes in airway)
maintaining a patent airway, reduce anxiety, promote communication method
pneumonia:
-patho: inflammation of lung parenchyma from organisms (bacterial, fungal, viral)
-risk factors: smoking, recent hospitalization, intubation or mechanical ventilation, surgery, bed rest for prolonged periods, and being overweight or obese
-prevention: hydration, antipyretics, antitussives
-treatment/Interventions:
-s/s: fever, chills, malaise, loss of appetite, and myalgia
-for treatment: culture and sensitivity results
-types: community acquired, hospital acquired, ventilator assisted
laryngeal cancer:
-patho: changes in squamous cells from irritation result in cells becoming precancerous
-s/s: hoarseness, doesn’t resolve in 2 weeks, lower than normal voice pitch, raspy, persistent cough, lumps in neck
-late sign is bad breath from infection becoming an open wound
cystic fibrosis:
-patho: genetic disease of the exocrine glands causing the production of abnormally thick mucus, leading to the blockage of the pancreatic ducts, intestines, and bronchi and often resulting in respiratory infection
-education:thick, sticky mucus to build up in the lungs, pancreas, and other organs, build up leads to infection, inflammation,
-priorities of care: airway clearance (manual postural drainage, chest physiotherapy, high frequency chest wall oscillation), antibiotic therapy, reduce risks
GENE MUST BE INHERITED BY BOTH PARENTS!!!
flu
-patho: viral infection from aerosolization of small droplets from infected individuals sneezing or coughing, direct contact with fomites inhaled and deposited on upper respiratory tract epithelial cells (type A most common)
-prevention: handwashing, annual flu shot, get tested
-treatment: hydration, antipyretics, analgesics, rest
-fever is what differentiate flu with other respiratory diseases
rhinitis
-patho: inflammation, congestion, edema, irritation of mucous membranes in the nose
-differences: this does not have an infection
-s/s: runny nose, itching of nose, mouth, eye, sneezing, nasal congestion, purulent drainage, headaches
-types:
rhinosunuitis:
-patho: infection and inflammation of the paranasal sinuses
-s/s: purulent nasal drainage, fever, nasal obstruction, facial pain-pressure-fullness
trauma:
-patho: when the cehst either experiences a direct blunt force to the chest or when a foreign object penetrates the chest wall
-complications: pulmonary contusion, flail chest, tension pneumothorax, cardiac tamponade
-priorities of care: stablize, immediate surgery, ABCs
lung cancer:
-patho: uncontrolled growth of abnormal cells in the lungs, NSCLC- represents 85% of tumors, SCLC- represents other 15%
of tumors
-complications: respiratory failure, prolonged mechanical ventilation, decreased cardiopulmonary function, pulmonary fibrosis, pericarditis, myeltits, pneumonitis, pulmonary toxicity
-priorities of care: breathing, manage symtpoms
respiratory failure:
-patho: hypoxemic respiratory failure where gas exchange and oxygenation does not occur or is impaired
priorities: prevent complications, education, maintaining airway
COPD: chronic bronchitis, emphysema, and asthma
-patho: characterized by airflow limitations involving the airways, pulmonary parenchyma (areas/ tissue of lung which aids gas transfer) or both
-s/s: chronic cough, sputum production, dyspnea, emphysema pts might have barrel chest
-how diagnosed: history, pulmonary function, physical, spirometry, ruling out other diagnosis
-teaching:
-risks factors:
-treatment: smoking cessation, assess and monitor disease, reduce risk factors, manage exacerbations
asthma:
-patho: intermittent, reversible airway obstruction resulting from inflammation, tightening of muscle surrounding airways
-s/s: wheezing, cough, dyspnea
-treatment including differences between exacerbation treatment versus maintenance or routine treatment: assessment, monitoring, control of environmental factors, medication
-tube-like passageway that is a connection from the nasal cavities to the larynx
PE: (pulmonary embolism)
-patho: obstruction of the pulmonary artery or one or more of the branches
-risk factors: DVT, prolonged bed rest, surgery, heart disease, stroke
-prevention: healthy diet, exercise, quit smoking
-might say they are “going to die”
-treatment/ interventions: surgery, oxygen therapy, SCDs, emergency management
OSA: (obstructive sleep apnea)
-patho: occurs during sleep as the upper airways narrow or collapse, increasing resistance to airflow during inspiration, muscle tone of the nasopharynx decreases as the client falls asleep, which contracts the airway
-s/s: loud snoring with breathing cessation of 10 seconds, 5 or more times per hour
-three s’s: snoring, sleepiness, and significant other reporting the apnea episodes
-education: lose weight, avoid drug/alc, positioning during sleep, cpap at night, bipap, surgery could be an option
-risk factors: men, overweight (biggest)
- upper airways collapse increasing air resistance and increasing carbon dioxide
tuberculosis:
-patho: transmitted by aerosolized droplets inhaled from the coughing or sneezing of an infected individual, can remain suspended in air for several hours, lungs are the primary site of infection
-testing: lab tests, skin test, chest x-ray
-education: following medication is CRUCIAL, will not be contagious the whole period, long term treatment plan
-treatment/interventions: immediate isolation from others!
hypoxemia:
first sign is restlessness!
low blood oxygen
