Exam 2 Flashcards
What are the clinical manifestations of disorders of the ear?
P, HL, V, D, T, ED
- pain (otalgia)
- hearing loss
- vertigo
- dizziness
- tinnitus
- ear drainage ( Otorrhea)
What are the causes of conductive hearing loss?
- ear wax build up
- ear infection
- hole in the eardrum
- stiff hearing bone
- trauma to the ear
What are the causes of sensorineural hearing loss?
- age related hearing loss
- noise related hearing loss
- inner ear infections
- genetic syndrome
- trauma
- side effect of medication
What causes sensory hearing loss?
- impaired function of inner ear or cranial nerve VIII
What is the cause of conductive hearing loss?
- outer or middle ear conditions
- foreign bodies
- otosclerosis
What is a tympanoplasty?
- surgical reconstruction of perforated tympanic membrane
What education is important for a pt pos op tympanoplasty?
- 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
What is Ménière’s disease?
- effects both vestibular and auditory function
What causes Ménière’s disease?
Excess endolymph in the vestibular and semicircular canals
What are the signs and symptoms of Ménière’s disease?
- sudden attacks of vertigo
- tinnitus
- hearing loss
- N/V
What are the signs and symptoms of post Ménière’s disease attack?
- vertigo for 2-4 hours
- dizziness
- unsteadiness
- gait changes
- depression
- moody
- hearing loss
What are the therapies used for an acute Ménière’s disease attack?
- antihistamines
- anticholinergic
- benzodiazepine
- antiemetics
- anti vertigo
- BR
What are the therapies used for a non-acute Ménière’s disease attack?
- diuretics
- antihistamines
- calcium channel blockers
- anti vertigo drugs
- benzodiazepines
- low sodium diet
- surgery
What are the surgeries used for a non-acute Ménière’s disease attack?
- endolymphatic shunt
- vestibular nerve restriction
- labyrinthectomy
What is presbycusis?
Hearing loss
What causes presbycusis in the external ear?
- cerumen
- increased hair growth
- loss of elasticity
What causes presbycusis in the middle ear?
Atrophy of tympanic membrane
What causes presbycusis in the inner ear?
- hair cell degeneration
- neuron degeneration
- calcification of ossicles
- vestibular apparatus changes
What causes presbycusis in the brain?
Decline in the ability to filter sounds
What assessment findings would indicate presbycusis in the external ear?
- impacted ear canal (hair or earwax)
- collapsed ear canal
What assessment findings would indicate presbycusis in the middle ear?
- conductive hearing loss
What assessment findings would indicate presbycusis in the inner ear?
- diminished sensitivity to high pitched sounds
- impaired speech reception
What assessment findings would indicate presbycusis in the brain?
- sensitive to loud noises
- inability to hear in loud environments
What are some nursing considerations for hearing disorders?
- use simple sentences
- write out difficult words
- minimize distractions
What is glaucoma?
- when the intraocular pressure increases leading to damage of the optic nerve causing loss of peripheral vision
Where does normal outflow ( reabsorption) of the aqueous fluid occur at?
At the angle where the iris meets the cornea
What causes vision loss in pt’s w/ glaucoma?
- if inflow is greater then reabsorption which causes intraocular pressure to increase causing vision loss
What are the different treatment options for open angle glaucoma?
- mitotic drops
- beta blockers
- surgery
What are the different treatment options for closed angle glaucoma?
- miotics and hyperosmotic agents
- laser iridotomy
What should the nurse educate a pt on glaucoma?
- prevent the increase in intraocular pressure
- avoid sneezing/ coughing
- take eye drops burning and blurry vision are short lived
What actions increases IOP?
- bending down
- lifting heavy objects
- steroids
What are contributing factors to cataracts?
- sunlight
- poor nutrition
- smoking
- aging
- trauma to the eye
- corticosteroid use
- DM
What kind of post op care is giving after cataract removal surgery?
- permanent glasses prescribed after 3 month
- d/c w/ eye drops
- avoid increase in IOP
- shaded lens/ eye shield
- sex in 6-8 weeks
What are the possible complications after cataract surgery?
- hemorrhage into anterior chamber
- vitreous prolapse
- IO infection
What is macular degeneration?
loss in the center of the field of vision
What is dry macular degeneration?
- slow progressing macular atrophy with painless vision loss and accumulation of yellowish deposits
What is wet macular degeneration?
- more severe then dry and leads to blindness with rapid onset from overgrowth of the blood vessels in the macula
What causes macular degeneration?
- aging
- genetics
- UV exposure
- hyperopia
- smoking
-light colored eyes - lack of nutrient intake
What type of care should be given to a pt with macular degeneration?
- no smoking
- vitamin/ mineral supplement
- intraocular injections of the endothelial to prevent wet MD
- photodynamic therapy
What nursing care should be given to visually impaired pt’s ?
- communicate normally
- address the pt not the caregiver
- introduce yourself upon arrival
- orient the pt
- use sight- guided techniques
What is the difference between the types of diabetes?
Type 1- autoimmune destruction of beta cells
Type 2- insulin resistance
What is the diagnostic criteria for DM?
- Hgb A1C greater than 6.5%
- fasting glucose greater than 126 mg/dL
What is the main goal of DM treatment?
- maintain normal BG and prevent acute/ chronic complications
What are the steps used to maintain normal BS?
- monitor blood glucose levels
- adequate Nutrtion
- physical activity
- recognize CM of hypo/hyperglycemia
- correct use of medication
What is the first thing you do if you suspect hypo/hyperglycemia?
Check BS level
What should the nurse check for Q4 in a sick type 1 diabetic?
- BS ( greater than 240)
- ketones
What are the different types of insulin?
Liz is the pro, R, N, G
- rapid acting (lispro)
- short acting (regular)
- intermediate acting (NPH)
- long acting (glaring)
What are the different oral anti-diabetics?
B, S, M AG
- biguanides ( metformin)
- sulfonylureas (glyburide)
- meglitinides ( repaglinide)
- a- glucosidase ( acarbose)
What is the mechanism of action of biguanides (metformin)?
- decrease hepatic glucose production and insulin resistance
What is the mechanism of action of sulfonlyureas (glyburide)?
Increase insulin production
What is the mechanism of action of meglitinides (repaglinide)?
Increase insulin production
What is the mechanism of action of a- glucosidase (acarbose)?
- delays absorption of starches in the GI tract
What the acute complications of DM?
- DKA
- HHS
- hypoglycemia
What is DKA ( diabetic ketoacidosis) ?
- no insulin w/ generation of ketoacids or extremely high blood sugar
What is HHS (hyperglycemia hyperosmolar state)?
Fluid disorder
Insulin deficiency and profound dehydration
What is the difference between DKA and HHS?
DKA: sudden onset, usually affects type 1 DM
HHS: gradual onset, usually affects type 2 DM
What are the CM of DKA?
- fruit breath
- kussmaul respirations
- dehydration
- serum glucose: >250mg/dL
- ketones present
- elevated K+
What are the CM of HHS?
- dehydration
- electrolyte loss
- 3 P’s
- lethargy
- weight loss
- serum glucose: >600mg/dL
- no ketones present
How is DKA and HHS managed?
- IV fluids
- IV regular insulin to lower BS
- monitor VS, LOC, and O2 sat
- continuous ECG
- Q1 UO
What is the CM is a priority in a hypoglycemic pt?
- diaphoresis ( sweating)
What are the CM of hypoglycemia?
- shakiness
- diaphoresis
- palpitations
- cold clammy skin
- anxiety
- pallor
- nervousness
What is the rule of 15?
Hypoglycemic protocol
- 15g of fast acting carbs, recheck BS every 15 min
What are other treatments for hypoglycemia?
- 50% dextrose IV push 20-50 mL
-1mg glucagon IM subQ injection
What is diabetes insipidus?
Large amounts of diluted urine and polydipsia ( >20L / per day )
What are the CM of primary HTN?
- fatigue
- dizziness
- palpitations
- angina
- dyspnea
What are the complications of primary HTN?
- Aortic aneurysm
- risk for stroke
- risk for chronic renal insufficiency
- retinal damage
What labs does the nurse need to monitor in a pt w/ HTN?
C, RF, SE, BSL, OE
- lipid panel
- renal function
- serum electrolytes
- BS levels
- ophthalmic exam
What are the medications that can be used to treat HTN?
- diuretics
- adrenergic
- angiotensin inhibitors
What is peripheral artery disease (PAD)?
- thickening of arterial walls r/t atherosclerosis
- reduces blood flow to lower extremities causing ischemia
What are the CM of PAD?
IC, P, D/AP, EP/DR
- intermittent claudication ( cramping, pain from lack of blood flow)
- paresthesia
- diminished or absent pulses
- elevation pallor and dependent rubor
What does the skin on the leg of PAD look like?
T, S, T, H
- thin
- shiny
- taut
- hairless
How is PAD managed?
- drug therapy
O statins, antihypertensives (ACE), anti diabetic agents
O anti platelets ( aspirin or plavix)
O Coumadin - lifestyle modifications
What are arterial ulcers?
- delayed or non healing wound infection
- gangrene
- critical limb ischemia
What are the treatment options for PAD?
- ballon angioplasty w, w/o a stent
- PA bypass surgery
- amputation
What is the priority assessment in a PAD post ballon angioplasty surgery?
- peripheral pulses
- cap refill
What is an aortic aneurysm?
Out-pouching or dilation of arterial wall
What is a true aortic aneurysm?
- at least 1 layer intact due to congenital or acquired problems
What is a false aneurysm?
- involves all layers due to injury or trauma
What is a venous thromboembolism?
Superficial Blood clot with vein inflammation
What is a deep vein thrombosis?
Deep blood clot with inflammation
What anticoagulants can be used for prevention and treatment of VTE?
- vitamin K antagonist: warfarin
- thrombin inhibitor: lovonox, heparin
- Factor Xa inhibitor: rivaroxaban
what are the CM of chronic venous insufficiency (CVI)?
- edema
- lethargy skin
- Brownish discoloration
Venous leg ulcer
What are the diffrent managements used for CVI treatment?
- compression therapy
- frequently elevate legs
- wet to dry dressings
What are the CM of a venous leg ulcer?
- edema in the ankles and legs
- wet
- Irregular shape
- cyanosis
What are the CM of arterial ulcers?
- can be found in the toes and feet
- dry
- Rounded
- elevation isnt needed
- pale pink or necrotic
