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Med Surg > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are the clinical manifestations of disorders of the ear?

P, HL, V, D, T, ED

A
  • pain (otalgia)
  • hearing loss
  • vertigo
  • dizziness
  • tinnitus
  • ear drainage ( Otorrhea)
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2
Q

What are the causes of conductive hearing loss?

A
  • ear wax build up
  • ear infection
  • hole in the eardrum
  • stiff hearing bone
  • trauma to the ear
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3
Q

What are the causes of sensorineural hearing loss?

A
  • age related hearing loss
  • noise related hearing loss
  • inner ear infections
  • genetic syndrome
  • trauma
  • side effect of medication
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4
Q

What causes sensory hearing loss?

A
  • impaired function of inner ear or cranial nerve VIII
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5
Q

What is the cause of conductive hearing loss?

A
  • outer or middle ear conditions
  • foreign bodies
  • otosclerosis
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6
Q

What is a tympanoplasty?

A
  • surgical reconstruction of perforated tympanic membrane
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7
Q

What education is important for a pt pos op tympanoplasty?

A
  • no aspirin for a week prior to surgery
  • pre and post op audiograms and tympanograms
  • antibiotics
  • avoid excessive exercise
  • sneeze with mouth open
  • blow nose, one nostril at a time
  • no airplane travel for one month
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8
Q

What is Ménière’s disease?

A
  • effects both vestibular and auditory function
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9
Q

What causes Ménière’s disease?

A

Excess endolymph in the vestibular and semicircular canals

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10
Q

What are the signs and symptoms of Ménière’s disease?

A
  • sudden attacks of vertigo
  • tinnitus
  • hearing loss
  • N/V
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11
Q

What are the signs and symptoms of post Ménière’s disease attack?

A
  • vertigo for 2-4 hours
  • dizziness
  • unsteadiness
  • gait changes
  • depression
  • moody
  • hearing loss
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12
Q

What are the therapies used for an acute Ménière’s disease attack?

A
  • antihistamines
  • anticholinergic
  • benzodiazepine
  • antiemetics
  • anti vertigo
  • BR
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13
Q

What are the therapies used for a non-acute Ménière’s disease attack?

A
  • diuretics
  • antihistamines
  • calcium channel blockers
  • anti vertigo drugs
  • benzodiazepines
  • low sodium diet
  • surgery
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14
Q

What are the surgeries used for a non-acute Ménière’s disease attack?

A
  • endolymphatic shunt
  • vestibular nerve restriction
  • labyrinthectomy
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15
Q

What is presbycusis?

A

Hearing loss

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16
Q

What causes presbycusis in the external ear?

A
  • cerumen
  • increased hair growth
  • loss of elasticity
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17
Q

What causes presbycusis in the middle ear?

A

Atrophy of tympanic membrane

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18
Q

What causes presbycusis in the inner ear?

A
  • hair cell degeneration
  • neuron degeneration
  • calcification of ossicles
  • vestibular apparatus changes
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19
Q

What causes presbycusis in the brain?

A

Decline in the ability to filter sounds

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20
Q

What assessment findings would indicate presbycusis in the external ear?

A
  • impacted ear canal (hair or earwax)
  • collapsed ear canal
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21
Q

What assessment findings would indicate presbycusis in the middle ear?

A
  • conductive hearing loss
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22
Q

What assessment findings would indicate presbycusis in the inner ear?

A
  • diminished sensitivity to high pitched sounds
  • impaired speech reception
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23
Q

What assessment findings would indicate presbycusis in the brain?

A
  • sensitive to loud noises
  • inability to hear in loud environments
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24
Q

What are some nursing considerations for hearing disorders?

A
  • use simple sentences
  • write out difficult words
  • minimize distractions
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25
Q

What is glaucoma?

A
  • when the intraocular pressure increases leading to damage of the optic nerve causing loss of peripheral vision
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26
Q

Where does normal outflow ( reabsorption) of the aqueous fluid occur at?

A

At the angle where the iris meets the cornea

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27
Q

What causes vision loss in pt’s w/ glaucoma?

A
  • if inflow is greater then reabsorption which causes intraocular pressure to increase causing vision loss
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28
Q

What are the different treatment options for open angle glaucoma?

A
  • mitotic drops
  • beta blockers
  • surgery
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29
Q

What are the different treatment options for closed angle glaucoma?

A
  • miotics and hyperosmotic agents
  • laser iridotomy
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30
Q

What should the nurse educate a pt on glaucoma?

A
  • prevent the increase in intraocular pressure
  • avoid sneezing/ coughing
  • take eye drops burning and blurry vision are short lived
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31
Q

What actions increases IOP?

A
  • bending down
  • lifting heavy objects
  • steroids
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32
Q

What are contributing factors to cataracts?

A
  • sunlight
  • poor nutrition
  • smoking
  • aging
  • trauma to the eye
  • corticosteroid use
  • DM
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33
Q

What kind of post op care is giving after cataract removal surgery?

A
  • permanent glasses prescribed after 3 month
  • d/c w/ eye drops
  • avoid increase in IOP
  • shaded lens/ eye shield
  • sex in 6-8 weeks
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34
Q

What are the possible complications after cataract surgery?

A
  • hemorrhage into anterior chamber
  • vitreous prolapse
  • IO infection
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35
Q

What is macular degeneration?

A

loss in the center of the field of vision

36
Q

What is dry macular degeneration?

A
  • slow progressing macular atrophy with painless vision loss and accumulation of yellowish deposits
37
Q

What is wet macular degeneration?

A
  • more severe then dry and leads to blindness with rapid onset from overgrowth of the blood vessels in the macula
38
Q

What causes macular degeneration?

A
  • aging
  • genetics
  • UV exposure
  • hyperopia
  • smoking
    -light colored eyes
  • lack of nutrient intake
39
Q

What type of care should be given to a pt with macular degeneration?

A
  • no smoking
  • vitamin/ mineral supplement
  • intraocular injections of the endothelial to prevent wet MD
  • photodynamic therapy
40
Q

What nursing care should be given to visually impaired pt’s ?

A
  • communicate normally
  • address the pt not the caregiver
  • introduce yourself upon arrival
  • orient the pt
  • use sight- guided techniques
41
Q

What is the difference between the types of diabetes?

A

Type 1- autoimmune destruction of beta cells
Type 2- insulin resistance

42
Q

What is the diagnostic criteria for DM?

A
  • Hgb A1C greater than 6.5%
  • fasting glucose greater than 126 mg/dL
43
Q

What is the main goal of DM treatment?

A
  • maintain normal BG and prevent acute/ chronic complications
44
Q

What are the steps used to maintain normal BS?

A
  • monitor blood glucose levels
  • adequate Nutrtion
  • physical activity
  • recognize CM of hypo/hyperglycemia
  • correct use of medication
45
Q

What is the first thing you do if you suspect hypo/hyperglycemia?

A

Check BS level

46
Q

What should the nurse check for Q4 in a sick type 1 diabetic?

A
  • BS ( greater than 240)
  • ketones
47
Q

What are the different types of insulin?
Liz is the pro, R, N, G

A
  • rapid acting (lispro)
  • short acting (regular)
  • intermediate acting (NPH)
  • long acting (glaring)
48
Q

What are the different oral anti-diabetics?
B, S, M AG

A
  • biguanides ( metformin)
  • sulfonylureas (glyburide)
  • meglitinides ( repaglinide)
  • a- glucosidase ( acarbose)
49
Q

What is the mechanism of action of biguanides (metformin)?

A
  • decrease hepatic glucose production and insulin resistance
50
Q

What is the mechanism of action of sulfonlyureas (glyburide)?

A

Increase insulin production

51
Q

What is the mechanism of action of meglitinides (repaglinide)?

A

Increase insulin production

52
Q

What is the mechanism of action of a- glucosidase (acarbose)?

A
  • delays absorption of starches in the GI tract
53
Q

What the acute complications of DM?

A
  • DKA
  • HHS
  • hypoglycemia
54
Q

What is DKA ( diabetic ketoacidosis) ?

A
  • no insulin w/ generation of ketoacids or extremely high blood sugar
55
Q

What is HHS (hyperglycemia hyperosmolar state)?

Fluid disorder

A

Insulin deficiency and profound dehydration

56
Q

What is the difference between DKA and HHS?

A

DKA: sudden onset, usually affects type 1 DM
HHS: gradual onset, usually affects type 2 DM

57
Q

What are the CM of DKA?

A
  • fruit breath
  • kussmaul respirations
  • dehydration
  • serum glucose: >250mg/dL
  • ketones present
  • elevated K+
58
Q

What are the CM of HHS?

A
  • dehydration
  • electrolyte loss
  • 3 P’s
  • lethargy
  • weight loss
  • serum glucose: >600mg/dL
  • no ketones present
59
Q

How is DKA and HHS managed?

A
  • IV fluids
  • IV regular insulin to lower BS
  • monitor VS, LOC, and O2 sat
  • continuous ECG
  • Q1 UO
60
Q

What is the CM is a priority in a hypoglycemic pt?

A
  • diaphoresis ( sweating)
61
Q

What are the CM of hypoglycemia?

A
  • shakiness
  • diaphoresis
  • palpitations
  • cold clammy skin
  • anxiety
  • pallor
  • nervousness
62
Q

What is the rule of 15?

A

Hypoglycemic protocol
- 15g of fast acting carbs, recheck BS every 15 min

63
Q

What are other treatments for hypoglycemia?

A
  • 50% dextrose IV push 20-50 mL
    -1mg glucagon IM subQ injection
64
Q

What is diabetes insipidus?

A

Large amounts of diluted urine and polydipsia ( >20L / per day )

65
Q

What are the CM of primary HTN?

A
  • fatigue
  • dizziness
  • palpitations
  • angina
  • dyspnea
66
Q

What are the complications of primary HTN?

A
  • Aortic aneurysm
  • risk for stroke
  • risk for chronic renal insufficiency
  • retinal damage
67
Q

What labs does the nurse need to monitor in a pt w/ HTN?

C, RF, SE, BSL, OE

A
  • lipid panel
  • renal function
  • serum electrolytes
  • BS levels
  • ophthalmic exam
68
Q

What are the medications that can be used to treat HTN?

A
  • diuretics
  • adrenergic
  • angiotensin inhibitors
69
Q

What is peripheral artery disease (PAD)?

A
  • thickening of arterial walls r/t atherosclerosis
  • reduces blood flow to lower extremities causing ischemia
70
Q

What are the CM of PAD?
IC, P, D/AP, EP/DR

A
  • intermittent claudication ( cramping, pain from lack of blood flow)
  • paresthesia
  • diminished or absent pulses
  • elevation pallor and dependent rubor
71
Q

What does the skin on the leg of PAD look like?

T, S, T, H

A
  • thin
  • shiny
  • taut
  • hairless
72
Q

How is PAD managed?

A
  • drug therapy
    O statins, antihypertensives (ACE), anti diabetic agents
    O anti platelets ( aspirin or plavix)
    O Coumadin
  • lifestyle modifications
73
Q

What are arterial ulcers?

A
  • delayed or non healing wound infection
  • gangrene
  • critical limb ischemia
74
Q

What are the treatment options for PAD?

A
  • ballon angioplasty w, w/o a stent
  • PA bypass surgery
  • amputation
75
Q

What is the priority assessment in a PAD post ballon angioplasty surgery?

A
  • peripheral pulses
  • cap refill
76
Q

What is an aortic aneurysm?

A

Out-pouching or dilation of arterial wall

77
Q

What is a true aortic aneurysm?

A
  • at least 1 layer intact due to congenital or acquired problems
78
Q

What is a false aneurysm?

A
  • involves all layers due to injury or trauma
79
Q

What is a venous thromboembolism?

A

Superficial Blood clot with vein inflammation

80
Q

What is a deep vein thrombosis?

A

Deep blood clot with inflammation

81
Q

What anticoagulants can be used for prevention and treatment of VTE?

A
  • vitamin K antagonist: warfarin
  • thrombin inhibitor: lovonox, heparin
  • Factor Xa inhibitor: rivaroxaban
82
Q

what are the CM of chronic venous insufficiency (CVI)?

A
  • edema
  • lethargy skin
  • Brownish discoloration
    Venous leg ulcer
83
Q

What are the diffrent managements used for CVI treatment?

A
  • compression therapy
  • frequently elevate legs
  • wet to dry dressings
84
Q

What are the CM of a venous leg ulcer?

A
  • edema in the ankles and legs
  • wet
  • Irregular shape
  • cyanosis
85
Q

What are the CM of arterial ulcers?

A
  • can be found in the toes and feet
  • dry
  • Rounded
  • elevation isnt needed
  • pale pink or necrotic

Med Surg (4 decks)

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