Exam 1 Flashcards
1
Q
Nearsightedness
A
Myopia
2
Q
Farsightedness
A
Hyperopia
3
Q
Blurred to distorted vision
A
Astigmatism
4
Q
Loss of eye lens flexibility, comes with age, blurred near vision
A
Presbyopia
5
Q
Glaucoma patho
A
Increased IOP causes peripheral visual loss
6
Q
IOP in primary open glaucoma
A
greater than 21mm Hg
7
Q
Normal IOP range
A
10-21 mmHg
8
Q
Other signs of closed angle glaucoma
A
Halos, rainbows, pain
9
Q
IOP in acute closed angle glaucoma
A
greater than 30 mmHg
10
Q
What is the test for IOP?
A
Tonometry
11
Q
When should IOP measurements start?
A
With annual eye exams from age 40
12
Q
Drug categories: decrease aqueous humor production
A
- Beta Adrenergic Blockers
- Alpha Adrenergic
- Cholinergic agents
- Carbonic anhydrase Inhibitors
13
Q
Beta Adrenergic Blockers (2)
A
Reduce aqueous humor production
- Betoptic
- TImoptic
14
Q
Alpha adrenergic (1)
A
Reduce aqueous humor production
- Alphagan
15
Q
Cholinergic agents (1)
A
Reduce aqueous humor production
- Pilocarpine
16
Q
Carbonic Anhydrase Inhibitors (2)
A
Reduce aqueous humor production
- Diamox
- Trusopt
17
Q
Drugs that increase aqueous humor outflow
A
Prostaglandin Agonist
- Xalatan
18
Q
Closed angle glaucoma treatment
A
Surgery
19
Q
Cataracts patho
A
Progressive opacity or clouding of the LENS
20
Q
Which condition has poor night vision and inability to do simple things?
A
Cataracts
21
Q
What is AMD?
A
Degeneration of the fovea that causes blurry central vision
22
Q
Classic symptom of AMD
A
Scotoma = blind spots
23
Q
What are the two categories of AMD?
A
Dry (atrophic) - dilated eye exam
Wet (exudative) - amsler grid
24
Q
Collaborative management for AMD (4)
A
- Laser surgery for Wet (once a month)
- Antioxidant supplements - C, E, beta-carotene, zinc+copper
- Supportive care for low vision
- Smoking cessation
25
Diabetic Retinopathy
Gradual blindness from damaged blood vessels within the retina
26
Diabetic Retinopathy treatment
- Laser therapy
- Vitrectomy
- MANAGE THE CHRONIC DISEASE
- REPORT CHANGES ASAP
- PREVENT IN THE FIRST PLACE - annual exams
27
Blindness acuity
20/200
28
How can you correct myopia?
Keratorefractive surgery
29
Pre-anesthetic medications (eyes)
- Mydratic eye drops - cyclogyl
| - Cycloplegic eye drops - paralysis
30
What does cyclogyl do?
Dilates pupil
31
What kind of assessment should you get pre op
BASELINE assessment
32
Memory loss is ____ a normal part of the aging process
NOT a normal part of the aging process
33
Dementia is ____ ____ and other cognitive _____
Memory loss and other cognitive decline
34
STOMP B - clinical manifestations of AZ
```
Speech
Thinking abstractly
Object identification
Motor / memory
Personality
Behavior
```
35
Prodromal stage of dementia
MCI = mild cognitive impairment
36
Most common form of dementia
Alzheimers
37
Goal of alzheimer management
Maintain function for as long as possible
38
Meds for alzheimer
Acetylcholinesterase Inhibitors (Memantine)
39
Meds for psychotic behaviors, manage agitation, agression in alzheimers
Haldol, benzos
| *watch out for orthostatic hypotension
40
CAMS
AIDA
1. Acute onset
2. Inattention
3. Disorganized thinking
4. Altered level of consciousness
41
Severe on the geriatric scale
12-15
42
Increased CBF causes (4)
- systemic hypotension
- increase in body metabolic rate (fever, pain)
- systemic acidosis (hypercapnia, ischemia)
- cerebral vasodilation
43
Decreased CBF causes (6)
- Systemic hypertension
- Decrease in metabolic rate (sedation, paralysis, hypothermia)
- Systemic alkalosis (hypocapnia)
- Cerebral edema
- Low cardiac output
- Cerebral vasoconstriction
44
First sign of neurological deterioration
Decrease in LOC
45
Arousal is ______
Alertness
46
Content is _______
Awareness
47
Arousal is an evaluation of ___
RAS
48
Components of Glasgow
- Motor response
- Verbal response
- Eye opening
49
Decorticate posturing indicates dysfunction of ____
cerebral hemisphere
50
Decerebrate posturing indicates dysfunction of ____
brainstem
51
Which is worse, decorticate or decerebrate?
Decerebrate
52
A x O is under arousal or content?
Content
53
Reflexes that indicate brain dead
Oculocephalic reflex - Doll's eye movement
| Oculovestibular reflex - Cold caloric test
54
Early indicators of increased ICP
- Change in LOC
- Papilledema
- Slurring of speech
- Delay in response
- Vomiting
55
Late indicators of increased ICP
- Further decrease in LOC
- Cushing's triad
- Pupil changes
- Altered respiratory patterns
- Posturing
56
ICP monitoring nursing care
- INFECTION CONTROL
- aseptic technique
- vitals
- IV therapy
- Antipyretics and cooling blankets
- Avoid movements that increase ICP
- Log roll technique
- Maintain ventilation
- SAFETY
57
What med can you give for increased ICP?
Mannitor *Monitor serum osmolality!
- Sedatives + Paralytics
- Opioids
- Benzos (Ativan)
58
FAST
face, arm speech, time
59
Risks for hemorrhagic stroke
- Uncontrolled HTN
| - Ruptured aneurysm
60
NIH stroke rating scale
42 = worst (higher the worse)
61
Stroke clinical manifestations
- Risk for aspiration (assess swallowing)
- Decreased muscle sensation (ROM)
- Slower movement
- Sensory changes
- Elimination issues (bladder/toilet schedule)
- Personality and emotional lability
- Aphasia
62
Ongoing med management for stroke
- Anticoagulants (Aspirin)
- Antihypertensives
- Steroids
- Anti-Epileptic drugs
- Anti-anxiety
- Vitamin K, FFP for hemorrhagic
63
Primary head injury
Occurs as direct result of impact
64
Secondary brain injury can be prevented with
hypertonic fluids
65
What can you administer for open skull fractures?
Abx
66
Basilar skull fracture -- worry about:
Meningeal tear - TEST DRAINAGE FOR GLUCOSE (CSF)
- rinorrhea
- otorrhea
- facial nerve paralysis
- periorbital and mastoid ecchymosis
67
Epidural hematoma
- Source
- Location
- Classic presentation
Source - arterial
Location - temporal bone
Classic presentation - loss of consciousness, then AOx3 then loss of consciousness
68
In which closed head injury will you see nuchal rigidity?
Subarachnoid hematoma
69
Complications of closed head injury
DI, SIADH, CSW, herniation, seizures
70
Where do you see urine output more than 200 mL/hr
DI
71
Where do you see specific gravity less than 1.005
DI
72
Where do you see serum Na greater than 145?
DI
73
Where do you see fluid overload and urine output less than 400 mL/day
SIADH
74
Where do you see specific gravity greater than 1.02?
SIADH
75
CSW is a state of....
hypovolemia and hyponatremia
76
Where do you see dilutional hypontaremia?
SIADH
77
Epilepsy
2 or more unprovoked (primary) seizures
78
Examples of provoked (secondary) seizures
- brain tumor
- metabolic disorder
- acute alcohol withdrawal
- electrolyte disturbance
- high fever
- stroke
- head injury
- substance abuse
- heart disease
79
Generalized seizures (4)
- Tonic-clonic
- Absence
- Myoclonic
- Atonic
80
Simple seizures
Remain conscious, may have an aura
81
Complex seizures
Loss of consciousness, "syncope"
82
What should patients with Atonic wear
a helmet
83
Med for status epilepticus
Ativan
84
Which skull fractures can heal on their own?
Linear and basilar
85
For which skull fractures should you perform surgical intervention?
Depressed, Open, and basilar if it doesn't heal in 2 weeks
86
Drugs for all types of seizures (3)
- Depakote
- Depakene
- Dilantin
87
Drugs for partial and general tonic-clonic
- Tegretol
- Barbita
- Mysoline
88
4 cardinal symptoms of PD
Bradykinesia, rigidity, resting tremors, postural instability
89
Diagnosis of PD
Response to antiparkinsonian drugs
90
Trio of symptoms of hydrocephalus
- gait disturbance
- dementia
- urinary incontinence
91
pre HTN
120-129 / 80-89
92
HTN stage 1
130 - 159 / 90-99
93
HTN stage 2
160 + / 100 +
94
If older than 60, you want to start HTN tx if BP is
150 + or 90 +
95
If younger than 60, have DM, or CKD, start HTN tx if BP is
140 + or 90+
96
Leading causes of PAD
atherosclerosis and smoking
97
Drug therapy for PAD
- Plavix
- ASA
- Trental
- Pletal
* *Teach about bleeding precautions
98
What type of assessment do you want to perform after PTCA?
Neruvascular assessment
- pulses
- cap rephil
- temp, color
- sensation
99
Which has pain with dependent positions PAD or PVD?
PVD
100
Which has intermittent claudication?
PAD
101
Which has dependent rubor
PAD
102
Which do you want to elevate?
PVD - or if you have both
103
Which do you want moist dressing environment PAD or PVD
PVD
104
Which do you want to give compression PAD or PVD
PVD
105
Leading cause of blindness
Diabetic Retinopathy
106
Main risk factor for PD
Age
107
What meds do you caution post op eye surgery and why?
Opioids for pain because of post-op vomiting and constipation (both can increase IOP)
108
Ongoing medication for stroke
- Anti HTN
- Anticoagulants
- Anti-seizure
- Steroids to reduce edema
- Anti-anxiety
109
Anomia
Inability to find words
110
Apraxia
Inability to use words appropriately
111
Aphasia
Inability to speak or understand
112
Agnosia
Loss of sensory comprehension
113
What should you avoid in acute stroke care?
Interventions that increase O2 demand - suctioning, multiple tasks at once
