Exam 1 Flashcards
Sensation
the ability to perceive stimuli through one’s sensory organs such as the nose, ears, and eyes
Perception
the process by which we receive, organize, and interpret sensation
Sensory perception risk factors
the elderly, medications (chemo), medical conditions (brain tumors, stroke), lifestyle choices (smoking), and occupation (saw dust)
Primary prevention for sensory perception
safety goggles, earplugs, helmets, proactive management of chronic conditions, and regular hygiene
Secondary prevention for sensory perception
eye evaluations and hearing tests
- adults >40 yr should have an eye exam every 2 yr
- older adults >60 yr should have yearly eye exams
Cataract
a lens opacity/ blurring that distorts the image
Risk factors for cataracts
age (>65 yr), heavy sun exposure, chemical/toxin exposure, and direct eye injury
Cataract manifestations (early and late)
Early: slightly blurred vision and decreased color perception
Late: blurred and double vision (diplopia)
Peripheral vision is lost before central
Cataract surgery
- only cure
- pt is discharged 1 hr after procedure
- eyedrops (antibiotics and steroids) for 2-4 weeks
- activity restriction (no heavy lifting, no leaning forward)
- final best vision within 4-6 weeks
Sign of increased intraoccular pressure or hemorrhage after cataract surgery
Pain early after surgery
Glaucoma
- a group of eye disorders resulting in increased IOP
- peripheral vision is lost before central
Normal IOP
10 to 21 mmHg
Primary open-angle glaucoma (POAG)
- outflow of aqueous humor through the chamber angle is reduced, which causes an increase in IOP
- IOP is between 22 and 30 mmHg
- develops slowly
POAG manifestations
Early: vision is foggy, mild eye ache, headache
Late: halos, losing peripheral vision, and having decreased visual sensory perception
Primary angle-closure glaucoma (PACG)
- outflow of aqueous humor is blocked
- EMERGENCY!
- IOP is >30 mmHg
PACG manifestations
- sudden, severe pain around the eyes that radiates over the face
- colored halos around lights
- sudden blurred vision w/decreased light perception
Drugs for glaucoma
Myotics constrict pupils and increase drainage of aqueous humor
Trabeculectomy (glaucoma)
a procedure that creates a new channel for fluid outflow
Laser trabeculoplasty (glaucoma)
a procedure that burns the trabecular meshwork, tightening fibers, which increases the space between fibers and improving outflow
Macular degeneration
the deterioration of the macula (the area of central vision)
Dry age-related macular degeneration (AMD)
gradual blockage of retinal capillaries, allowing retinal cells in the macula to become ischemic and necrotic
Risk factors for dry AMD
HTN, female gender, short stature, family hx, and long term diet poor in carotene and vitamin E
-progresses faster in smokers
Management of dry AMD
focused on slowing the porgression of vision loss and helping the patient maximize remaining vision
Wet age-related macular degeneration (AMD)
growth of new blood vessels in the macula, which have thin walls and leak blood and fluid
Exudative macular degeneration
a type of wet macular degeneration but can occur at any age
Management of wet AMD or exudative MD
focused on slowing the process and identifying further changes in visual perception
- laser therapy to seal the leaking blood vessels
- occular injections with the vascular endothelial growth factor inhibitors (VEGFIs)
Dizziness
a disturbed sense of a person’s relationship to space
Vertigo
a sense of whirling or turning in space
Manifestations of vertigo
nausea, vomiting, falling, nystagmus, hearing loss, and tinnitus
Drugs for vertigo
dramamine, diazepam (valium), and meclizine (antivert)
Complete spinal cord injury
the spnal cord has been damaged in a wau that eliminates all innervation below the level of injury
Incomplete spinal cord injury
injuries that allow some function or movement below the level of the injury
Hyperflexion (SCI)
occurs when the head is suddenly and forcefully accelerated forward, causing extreme flexion of the neck (ex: head on vehicle collisions)
Hyperextension (SCI)
the head is suddenly accelerated and then decelerated (ex: vehicle collision where the vehicle is struck from behind)
Axial loading or vertical compression (SCI)
an injury that compresses the cord, or causes the vertebrae to shatter (ex: diving accidents, falls on the buttocks, or a jump)
Excessive rotation (SCI)
caused by turning the head beyond the normal range
Penetrating trauma (SCI)
an object that causes damage directly at the site or local damage to the spinal cord or spinal nerves
What is the priority assessments for a SCI?
Airway (C3-C5 is where breathing takes place)
Breathing
Circulation
Glasgow coma scale
scoring system for level of consciousness
-goes up to 15; 3 is a coma
Tetraplegia or quadriplegia
- paralysis involving all four extremities, as seen with cervical cord and upper thoracic injury
- have spasms
Quadriparesis
weakness involving all four extremities
Paraplegia
- paralysis involving only the lower extremities, as seen in lower thoracic and lumbosacral injuries or lesions
- muscles become flaccid and slowly atrophy
- NO spasms
Paraparesis
weakness involving only the lower extremities
Spinal shock syndrom
- occurs immediately as the cord’s response to the injury
- pt has complete BUT temporary loss of motor, sensory, reflex, and autonomic function that often lasts less than 48 hrs but may continue for several weeks
SCI and paralytic ileus
- inability of the intestine (bowel) to contract normally and move waste out of the body
- may develop within 72 hrs of hospital admission
Anterior cord syndrome
- front of the cord is damaged
- loss of pain and temperature below the level of injury
- can feel light touches
Posterior cord lesion
- back of the cord is injured
- can be caused by disk herniation, trauma, or heavy lifting
Brown Sequard syndrome
- ipsilateral paralysis or paresis
- pain and temperature are present on one side
Neurogenic shock
- EMERGENCY
- results from disruption in communication pathways between upper and lower neurons
- SpO2 <90% or symptoms of aspiration
- symptomatic bradycardia, including reduced LOC and decreased urine output
- hypotension with systolic <90
Interventions for neurogenic shock
provide fluids, vasopressors, and supportive care to stabilize the patient
Halo fixator
-a static traction device held by four pins in the skull
worn for 8-12 weeks
-clean pins q8hrs
-don’t move patient by holding the device
Drugs for spinal cord injuries
- dextran to increase capillary blood flow to prevent/treat hypotension
- atropine sulfate to treat bradycardia
- gabapentin and baclofin for muscle spasms
Autonomic dysreflexia
- potentially life threatening condition in which noxious visceral or cutaneous stimuli cause a sudden, massive, uninhibited reflex sympathetic discharge
- always monitor in patients with injury to T6 or higher
Manifestations of autonomic dysreflexia
- sudden rise in BP accompanied by bradycardia
- profuse sweating above the level of injury
- goose bumps below the level of injury
- flushing of the skin above the lesion
- blurred vision
- nasal congestion
- throbbing headache
- feeling of apprehension
Causes of autonomic dysreflexia
- distended bladder or bowel
- skin pressure or sores, tight clothing
- anything that would cause discomfort
- extreme temperature
Interventions for autonomic dysreflexia
- sit person up, remove tight clothing
- check bladder for distension
- check bowel impaction
- check skin for signs of irritation or pressure
- give nifedipine or nitrate as prescribed
Guillain-Barre Syndrome (GBS)
an acute inflammatory polyradiculoneuropathy that affects the axons and/or myelin of the peripheral nervous system, causing motor weakness and abnormalities in sensory perception
Risk factors for GBS
- possibly autoimmune
- association with immunizations
- frequently preceded by mild respiratory or intestinal infection
Manifestations of GBS
- ascending paralysis
- affects respiration, swallowing, talking, bowel and bladder function
- HTN, bradycardia
- nerve pain
What are the three stages of GBS and how long do they last?
- The acute or initial period (1-4 weeks): begins with onset of symptoms and ends when no further deterioration occurs
- The plateau period (several days up to 2 weeks)
- The recovery phase (gradually over 4-6 months, up to 2 years): regeneration of axons and myelin
Plasmapheresis (GBS)
- removes the circulating antibodies thought to be responsible of the disease
- plasma is removed from blood, and blood is returned to patient
- three to four treatments, 1-2 days apart
IV immunoglobulin (GBS)
- a mixture of antibodies given to treat the syndrome
- infuse slowly (watch for a headache/stiff neck)
- side effects: chills, mild fever, headache
- adverse effects: anaphylaxis, aseptic meningitis, renal failure
Interventions for GBS
- ABCs
- HOB elevated to 45 degrees
- suctioning equipment and oxygen readily available
- nitroprusside (nitropress) a beta blocker for HTN
- atropine for bradycardia
- gabapentin for nerve pain
Primary vs Secondary brain tumors
- primary tumors originate within the CNS and rarely metastasize outside the area
- secondary tumors result from metastasis from other areas of the body
Complications of brain tumors
- cerebral edema
- increased ICP
- neurologic deficits (seizure activity)
- hydrocephalus
- pituitary dysfunction (syndrome of inappropriate antidiuretic hormone or diabetes insipidus)
Supratentorial tumors
- located within the cerebral hemisphere
- result in paralysis, seizures, memory loss, cognitive impairment, language impairment, and vision impairment
- after surgery, keep HOB elevated 30 degrees
Infratentorial tumors
- located in the brainstem and cerebellum
- produce ataxia, autonomic nervous system dysfunction, vomiting, drooling, hearing loss, and vision impairment
- after surgery, keep flat and side-lying
What is the most common benign tumor?
meningomas; tend to recur after removal
Pituitary tumors make up ____ of brain tumors
1/4 th
What is the most common pituitary tumor? and what are the manifestations?
adenoma (benign); common in young and middle age adults
s/s: visual disturbances and hypopituitary signs, such as loss of body hair, diabetes insipidus, infertility, and headache
Acoustic neuromas
- s/s: hearing loss, tinnitus, dizziness, or vertigo
- surgical removal may cause damage to cranial nerves
- women are twice as likely to get them than men
Grade I tumor
- tissue is benign
- the cells look less like normal brain cells
- grow slowly
Grade II tumor
- tissue is malignant
- the cells look less like normal cells than Grade I
Grade III tumor
- malignant tissue has cells that look very different from normal cells
- abnormal cells are actively growing
Grade IV tumor
- malignant tissue has cells that look most abnormal
- tend to grow quickly
Signs and symptoms patients should report during assessment for brain tumors
- headaches that are usually more severe on awakening
- nausea and vomiting
- visual symptoms
- seizures or convulsions
- facial numbness or tingling
- loss of balance or dizziness
- weakness or paralysis
- difficulty thinking, speaking, or articulating
- changes in mentation or personality
Chemotherapy
- controls tumor growth and may decrease tumor burden
- involves more than one agent
Stereotactic radiosurgery
focused gamma radiation to destroy intracranial lesions selectively without damaging surrounding healthy tissue
Drug therapy for brain tumors (apart from chemo and radiation)
- analgesics (cdeine) for headaches
- dexamethasone (decadron) to control cerebral edema
- phenytoin (dilantin) for seizures
- PPIs for GERD and prevention of ulcers
Craniotomy
- an incision into the cranium to remove or debulk tumor
- burr holes are drilled into the skill and a saw is used to remove a piece of bone to expose tumor area
- if there is too much swelling, the piece of bone is left out (usually put in the abdomen for oxygenation) until it subsides
Interventions before and after brain tumor surgery
Before:
-ensure no alcohol, tobacco, anticoagulants, or NSAIDs are taken 5 days before surgery
NPO 8 hrs before
After:
- vital signs every 15-30 min for the first 4-6 hrs, then every hour
- if stable for 24 hrs, check vitals every 2-4 hrs
- report decreased LOC, motor weakness, aphasia, decreased sensation, and reduced pupil reaction to light
Superficial-thickness wounds
color? edema? pain? blisters? eschar? healing time? grafts?
- epidermis is damaged
- ex: sunburn, flash burn
- s/s: redness with mild edema, pain, increased sensitivity to heat
- pealing occurs 2-3 days after burn
- heals in 3-6 days
- no scars
Superficial partial-thickness wounds
color? edema? pain? blisters? eschar? healing time? grafts?
- involves entire epidermis and one third of dermis
- wounds are pink to red, blanch, and painful
- mild to moderate edema
- blisters
- heals in 10-21 days
- no scar, but minor pigment changes
Deep-partial thickness wounds
color? edema? pain? blisters? eschar? healing time? grafts?
- involves entire epidermis and extends past one third of the dermis
- wound is red to white
- Eschar is soft and dry
- moderate edema
- no blister, and rarely blanches
- heals in 2-6 weeks and leaves scars
- graft may be used if healing is prolonged
Full-thickness wounds
color? edema? pain? blisters? eschar? healing time? grafts?
- entire epidermis and dermis, leaving no skin cells to regenerate
- wound is black, brown, yellow, white, red
- Eschar is hard and inelastic
- edema is severe
- no blister
- heals in weeks to months
- graft is needed
Deep full-thickness wounds
color? edema? pain? blisters? eschar? healing time? grafts?
- extends beyond the skin and damages muscles, tendons, and bone
- wound is black, and not painful
- Eschar is hard and inelastic
- no edema and no blisters
- heals in weeks to months
- graft is needed
Dry heat
caused by open flame in house fires and explosions
Moist heat
caused by contact with hot liquids or steam
Contact burns
caused by hot metal, tar, or grease
Chemical burns
caused by home or industrial accidents
Electrical injuries
caused by electrical currents
Radiation injuries
caused by exposure or large doses of radioactive materials
Areas of the body with thin skin
- eyelids
- ears
- nose
- tops of hands and feet
- fingers and toes
- genitalia
Vascular changes from burns
- edema in the first 12 hrs and continues for 24-48 hrs
- hypovolemia, metabolic acidosis, hyperkalemia, and hyponatremia occur
- hemoconcentration increases blood viscosity, reducing blood flow
Diuretic stage from burns
- begins 48-72 hrs after burn
- shifts fluids back and diuresis occurs
- hyponatremia and hypokalemia occur
Cardiac changes from burns
- HR increases
- CO2 decreases
GI changes from burns
- paralytic ileus
- curling’s ulcer may develop within 24 hrs after a burn from stress
Metabolic changes from burns
- metabolism greatly increases
- oxygen needs and calorie needs are high
- body temperature increases
Resuscitation Phase of a burn:
When does it begin?
What are the priorities?
- begins at the onset of injury to 24-48 hrs
- priorities are to secure airway, support circulation (fluids), pain management, prevent infection, maintain body temp, and provide emotional support
Fluid therapy during resuscitation phase of a burn
Do’s and Don’ts
- administer one half of the total 24 hr prescribed volume within the first 8 hrs post burn and the remaining volume over the next 16 hrs (from time of injury)
- no bolus!
- no diuretics!
Manifestations of pulmonary injury from burns
hoarse, brassy cough, drooling, difficulty swallowing, wheezing and stridor
If a patient’s wheezes disappear suddenly, what do you do? Is it a good sign? or a bad sign?
indicates impending airway obstruction and demands immediate intubation!
Acute phase of a burn:
When does it begin? how long does it last?
What are the priority assessments and interventions?
- begins about 36-48 hrs after injury
- lasts until wound is closed
- assessment of respiratory and cardiovascular is important
- interventions focus on skin tissue integrity, enhancing wound healing, and preventing complications
Hydrotherapy (for burns)
- mechanical debridement
- using water to debride wounds
- no scrubbing!
Autolysis (for burns)
- enzymatic debridement
- the disintegration of tissue by the action of the patient’s own cellular enzymes
Standard wound dressings
- layers of gauze over topical agents held in place by tape
- changed every 12-24 hrs
Homograft or allograft
- skin or membranes from human tissue donors
- for temporary wound coverage and closure
- promotes healing or prepares the wound for permanent skin graft coverage
Heterograft or xenograft
- skin or membranes from animals
- for temporary wound coverage and closure
- promotes healing or prepares the wound for permanent skin graft coverage
Synthetic dressings
-made of solid silicone and plastic membranes
Grafting
for wound closure when full thickness injuries can’t close
Auto-contamination
the patient’s own normal flora overgrows and invades other body areas
Cross-contamination
organisms from other people or environments are transferred to the patient
Manifestations of a graft infection
- pervasive odor
- color changes
- change in texture
- purulent drianage
- exudate
Rehabilitative phase of a burn injury:
When does it begin? When does it end?
What are the priorities?
Problems?
- begins with wound closure, and ends when the patient achieves their highest level of functioning
- priority is on the psuchosocial adjustment of the patient, the prevention of scars and contractures, and the resumption of preburn activity
- problems include PTSD, sexual dysfunction, and severe depression
