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NURS 314: Med Surg > Exam 2: Electrolytes, Vision, Auditory > Flashcards

Exam 2: Electrolytes, Vision, Auditory Flashcards

1
Q

Fluid Volume Excess assessment findings?

A

Shiny Skin
Rapid Weight gain
Hypertension
Dyspnea, Crackles
Increased respiration (>20 BPM)
Bounding pulses
JVD
Peripheral edema
Seizures, Coma
Changes in heart sounds / Increased heart rate (>100 BPM)
Clear urine (USG < 1.010)
Abnormal electrolytes
Increased BUN (>20)
Increased sodium (>145)
Increased Hct (>52%)

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2
Q

Fluid Volume Deficit assessment findings

A

Poor skin turgor
Weight loss
Postural hypotension
Decreased urine (less than 30cc/hr)
Cloudy urine (USG greater 1.030)
Pallor
Decreased cap refill (>3 sec)
Muscle cramps
Dry, mucous membranes
Thirsty
Cold/clammy skin

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3
Q

Causes of isotonic fluid volume deficit (hypovolemia)

Lack of both water and electrolytes

A
  • Excessive GI loss: vomiting, NG suctioning, diarrhea
  • Diaphoresis w/o sodium and water replacement
  • Excessive renal system loses: diuretic therapy, kidney disease, adrenal insufficency
  • Burns
  • Hemorrhage, plasma loss
  • Altered intake: anorexia, nausea, impaired swallowing, confusion, NPO
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4
Q

Causes of dehydration

Lack of fluid in body - shift of water from plasma to interstital space

A
  • Hyperventilation or excessive perspiration w/o water treatment
  • Prolonged fever
  • Diabetic ketoacidosis
  • Insufficient water intake
  • Diabetes inspidius
  • Osomtic diuresis
  • Excessive intake of salt or hypertonic IV fluids
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5
Q

Fluid Volume Deficit interventions

A
  • Provide oral or IV rehydration therapy
  • Monitor I&O
  • Monitor vital signs
  • Monitor for changes in mental status (confusion: sign of worsening fluid imbalance)
  • Monitor weight
  • Implement fall precautions -> encourage use of call light
  • Encourage making position changes slowly
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6
Q

Causes of hypervolemia

Fluid volume excess - too much water and electrolytes

A
  • Compromised regulatory systems: heart failure, kidney disease, cirrhosis
  • Overdose of fluids
  • Fluid shifts that occur following burns
  • Prolonged use of corticosteroids
  • Severe stress
  • Hyperaldosterronism
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7
Q

Causes of overhydration

A
  • Water replacement w/o electrolyte replacement
  • Syndrome of inappropriate antidiuretic hormone
  • Excessive admin of IV D5W, use of hypotonic solutions for irrgations
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8
Q

Fluid Volume Overload interventions

A
  • Monitor I&O
  • Monitor daily weight
  • Assess breath sounds
  • Monitor peripheral edema
  • Maintain sodium-restricted diet
  • Maintain fluid restrictions
  • Use, monitor diuretics
  • Monitor Na, K+ levels
  • Position semi-folwers
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9
Q

What is the relationship between calcium and phosphate?

A

The two are equal
- If phosphate is high, calcium will be high
- If phosphate is low, calcium is low

** CAN GIVE PHOSPATE TO LOWER CALCIUM **

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10
Q

Cardiac monitoring is most important for which electrolyte?

A

Potassium

High or low

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11
Q

High ____ suppresses respiratory function

A

Magnesium

MONITORING RESPIRATORY FUNCTION IS KEY!!!!

Due to muscle weakness

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12
Q

What is the relationship between insulin and potassium?

A

insulin pushes potassium into the cells and therefore LOWERS serum potassium

INSULIN CAN BE USED TO LOWER POTASSIUM FOR SHORT-TERM SOLUTION

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13
Q

What are some causes of hyponatremia

A

Excessive sodium loss -> excessive sweater, wound drainage, NG suction
Inadequate sodium intake -> NPO, low sodium diet
Excess water gain
Decreased decretion of aldosterone

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14
Q

Hyponatremia Causes: Excessive sodium loss

A

GI losses: diarrhea, vomiting, fistulas, NG suction
Renal losses: diuretics, adrenal insufficency, Na+ wasting renal disease
Skin losses: burns, wound drainage

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15
Q

Hyponatremia causes: Inadequate sodium intake

A

Fasting diets

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16
Q

Hyponatremia causes: Excess water gain

A

Excess hypotonic solutions
Primary polydipsia (excessive thirst)

Water intoxication

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17
Q

Hypernatremia causes

A

Excessive sodium intake
Inadequate water intake
Excess water loss

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18
Q

Hypernatremia causes: excess sodium intake

A

IV fluids: Hypertonic NaCl, excess isotonic, IV sodium bicarbonate
Hypertonic tube feedings without water supplements
Near-drowning in salt water

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19
Q

Hypernatremia causes: inadequate water intake

A

Unconcious or cognitively impaired

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20
Q

Hypernatremia causes: excess water loss

A

Increased sensible water loss (high fever, heatstroke, prolonged hyperventilation)
Diruetic therapy
Diarrhea

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21
Q

What are the safety concerns associated with sodium imblanaces?

A

Mental status changes - confusion,Irritability, apprenhension
Seizure & coma
Weakness, dizziness, Postural hypotension

** IMPLEMENT FALL RISK AND SEIZURE PRECAUTIONS **

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22
Q

What are some interventions for hypernatremia?

A
  • Diuretics to get rid of excess fluid and sodium
  • Implement sodium-restricted diet (less than 2000 mg/day), meaning less salty food
  • Assess LOC and BP
  • IV - administer D5 in 0.45% Sodium Chloride (Hypotonic)
  • Monitor I/O
  • Provide oral hygiene, other comfort measures to decrease thirst
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23
Q

Interventions for hyponatremia?

A
  • Encourage foods, fluids high in sodium: crackers, chips, tomoato soup, beef broth
  • Administer IV solution: Lactated Ringers, 0.9% Isotonic
  • Monitor I&O
  • Monitor daily weight
  • Monitor VS, LOC
  • Monitor renal function (BUN)
  • Implement seizure, fall precautions
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24
Q

Cause of Hypokalemia

A
  • Overuse of diuretics, corticosteroids
  • Increased secretion of aldosterone
  • Loss of GI tract: vomiting, diarrhea, prolonged GI suctioning, excessive use of laxatives,
  • NPO status
  • Kidney disease: impairs reabsoprtion of K+
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25
Q

What are the safety concerns with potassium imbalances?

A

Cardiac function! ->
- heart rate, breathing rate
- muscle tone (due to muscle weakness)
- mental status changes

CONTINOUS CARDIAC MONITORING IS KEY

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26
Q

The following s/s are related to which eletrolyte imbalance?

  • Altered Cardiac Conduction
  • Irregular pulse/heart rate (HR > 100)
  • Confusion, Fatigue, Irritability
A

Hyperkalemia

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27
Q

The following s/s are related to which electrolyte imbalance?

  • Muscle weakness
  • Shallow breathing
  • Dizziness, altered mental status
  • Decreased pulse
A

Hypokalemia

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28
Q

What are some interventions for Hyperkalemia?

A
  • Kay-X-elate to remove K+
  • Calcium gluconate to lower K+
  • Limit intake of potassium-rich food
  • Cardiac monitoring through EKG – have telemetry closely look at the cardiac status
  • Monitor I/O
  • Monitor for signs of hypokalemia
  • No salt replacements (often potassium based)
  • Administer loop diuretics
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29
Q

What are some foods high in potassium that hyperkalemic patients should avoid?

A
  • Bananas
  • Leafy greens
  • Strawberries
  • Tomatoes
  • Oranges, Orange Juice
  • Kiwi
  • Broccoli
  • Avocados
  • Melon
  • Whole Grains
  • Citrus fruits
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30
Q

What foods should patients who are hypokalemic eat?

A
  • Bananas
  • Leafy greens
  • Strawberries
  • Tomatoes
  • Oranges / Orange Juice
  • Kiwi
  • Broccoli
  • Avocados
  • Melon
  • Whole Grains
  • Citrus fruits
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31
Q

What are some interventions for hypokalemia?

A

NEVER administer IV potassium by bolus because it leads to increased cardiac arrest. (Max recommended rate = 1 mEQ of K per 10 mL of solution; 10 mEq/H)

  • Implement fall precautions due to muscle weakness
  • K-dural
  • Discontinue diuretics/laxatives
  • Use potassium-sparing diuretics like spironolactone
  • Eat more foods rich in Potassium (
  • Administer K+ suppluments -> never IM or subq
  • Monitor urine output
  • Observe for shallow ineffecetive r/r
  • Med assessment: digoxin toxicity can be increased with hypokalemia
  • Assess hand grasps and DTRs
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32
Q

Assessments for chloride will be similar to what?

A

Sodium PLUS respiratory

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33
Q

The following s/s are related to which electrolyte imbalance?

  • Increased BP (>120/80)
  • Confusion
  • Headaches
  • **KUSSMAUL respirations **
A

Hypercholemia

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34
Q

The following s/s are related to which electrolyte imbalance?

  • Low BP (<120/80)
  • Low RR (<12 BPM)
  • Increased HR (>100 BPM)
  • Confusion
  • Disorientation
A

HYPOcholemia

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35
Q

What are some safety concerns related to HYPERcholemia?m

A
  • Confusion is a concerning factor for falls and accidents
  • Respirations -
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36
Q

What are some safety concerns related to HYPERcholemia?

A
  • Confusion is a concerning factor for falls and accidents
  • Respirations -> KUSSMAUL
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37
Q

What are some safety concerns for HYPOcholemia?

A
  • Confusion, disorientation and low BP are concerning factors for falls
  • Low RR needs significant attention to maintain a patent airway
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38
Q

HYPERcholemia interventions

A
  • taking medications to prevent nausea, vomiting, or diarrhea
  • reduce salt intake -> found in table salt
  • Carefully monitor fluid volume status
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39
Q

Low chloride should activate what?

A

RAAS -> saves Na+, which saves Cl

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40
Q

What interventions are associated w/ HYPOchloremia

A
  • Eat more salty foods – because of its direct relationship with sodium
  • Carefully monitor fluid volume status
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41
Q

Does Low aldosterone lead to high or potassium

A

High

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42
Q

The following s/s are associated with what electrolyte imbalance?

** Reduced excitability of muscles and nerves **
Fatigue, Lethargy, Weakness
Confusion, Coma
** Decreased Memory **
Increased BP
** Bone pain, Fractures **

A

HYPERcalcemia

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43
Q

Causes of HYPOcalcemia

A
  • Inadequate intake of calcium
  • Malabsoprtion issues
  • Diarrhea
  • Inadequate Vitamin D intake
  • End-stage kidney disease
  • Wound drainage
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44
Q

What are some safety concerns for HYPERcalcemia?

A
  • Seizures → Plan for seizure precautions
  • Weakness → Patient is at increased risk of falls
  • Confusion → Patient may not do ADLs properly, fall risk
  • Fractures → Patient is at increased risk of another fall, then another fracture.
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45
Q

What are some safety concerns for HYPOcalcemia?

A
  • Laryngeal/Bronchial Spasm → Patient’s airway is at risk, can be blocked
  • Seizures → Plan for seizure precautions
  • Weakness, Decreased BP → Patient is at increased risk of falls
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46
Q

Interventions for HYPERcalcemia

A
  • Stop medications related to calcium (supplements, antacids related to Ca)
  • Introduce low diet in Ca
  • Increase weight-bearing activities
  • Maintain adequate hydration -> 3000-4000mL/daily to promote renal excretion of calcium
  • IV isotonic saline, bisphosphonate, and/or calcintonin -> requires careful monitoring
  • Implement seizure precautions
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47
Q

The following s/s are related to what electrolyte imbalance?

  • Chvostek’s Sign (C-sign)
  • Trousseau’s Sign (T-sign)
  • Tetany
  • Laryngeal Spasm, Bronchial Spasm
  • Weakness
  • Hyperflexia
  • Numbness/Tingling in extremities, region around mouth
A

HYPOcalcemia

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48
Q

Safety concerns for HYPOcalcemia

A
  • Laryngeal/Bronchial Spasm → Patient’s airway is at risk, can be blocked
  • Seizures → Plan for seizure precautions
  • Weakness, Decreased BP → Patient is at increased risk of falls
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49
Q

Interventions for HYPOcalcemia

A
  • Diet high in calcium-rich foods
  • Implement seizure and coma precautions
  • Calcium + Vitamin D Supplements
  • IV calcium gluconate
  • CO2 retention promotion -> breathing into paper bag or sedation: control muscle spams from tetany
  • Diuretics -> need to switch to thiazide
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50
Q

Symptoms of HYPERphosphatemia are similar to what?

A

Hypocalcemia

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51
Q

The following s/s are associated with what electrolyte imbalance?

  • Seizures
  • Numbness/Tingling in extremities, region around mouth
  • Hyperreflexia
  • Muscle Cramps
  • Tetany
A

HYPERphosphatemia

And also HYPOcalcemia

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52
Q

What are safety concerns associated w/ HYPERphosphatemia

A

Seizures → Implement seizure precautions

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53
Q

Low calcium results in what level of phosphate?

A

High

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54
Q

Interventions for HYPERphosphatemia

A
  • Restricting intake of foods and fluids high in phosphorus (i.e, dairy)
  • Hemodialysis done for severe hyperphosphatemia -> rapidly decreases levels
  • Administer Loop Diuretic to increase phosphate excretion
55
Q

Interventions for HYPOphosphatemia

A

want to correct calcium levels
- Increasing oral intake w/ dairy products
- Taking phosophorus supplements
- IV solutions: sodium phosphate or potassium phosphate -> NEED TO MONITOR CALCIUM AND PHOSPHATE LEVELS Q6-12HRS.

56
Q

What are some assessments needed when giving IV solutions for HYPOphosphatemia

A
  • Need to monitor phosphorus and calcium levels q6-12hrs
  • Perform frequent assessments to determine if hypocalcemia, hyperkalemia, dysrthymias and hypotension are present (complications)
57
Q

Magnesium follows which other electrolyte?

A

Calcium

Low Mag means HIGH Ca

58
Q
  • Hyperactive DTRs
  • Chvostek’s Sign
  • Trousseau’s Sign
  • Dysrhythmias
  • Tremors/ Seizures
A

Hypomagnesemia

Similar to Hypocalcemia

59
Q

Interventions associated with HYPERmagnesemia

A
  • Avoiding Mg-containing drugs (i.e, Milk of Mag)
  • Limiting dietary intake of Mg foods (green veggies, nuts, bananas, oranges, peanut butter, chocolate)
  • Increase fluids, use diuretics to promote excretion of Mg
  • IV: calcium gluconate -> opposes effects of excess Mg on cardiac muscle
60
Q

The following s/s are assocaited with what electrolyte?

  • Facial flushing
  • Urinary retention
  • Lethary
  • Depressed DTR
  • Muscle paralysis
A

HYPERmagnesemia

61
Q

What electrolyte plays a role in the following:

  • Needed for production and use of ATP
  • Energy source for Na+/K+ pump
  • Muscle contraction and relaxation
  • Normal neurologic function
  • Neurotransmitter release
A

Magnesium

62
Q

Interventions associated with HYPOmagnesemia

A
  • Increase intake of Mg (oral, supplements)
  • IV: magnesium sulfate -> monitor VS, use infusion pump because rapid admin can lead to hypotension and cardaic/respiratory arrest
  • Encourage foods high in Mg (dark green veggies, nuts, whole grains, seafood, peanut butter, cocoa)
63
Q

Examples of hypotonic solutions

A
  • 0.45% normal saline
  • Dextrose in 5% water (D5W)
64
Q

Examples of Isotonic solutions

A
  • 0.9% saline
  • D5 in 0.25% saline
  • Lactated Ringers
65
Q

Examples of Hypertonic Solutions

A
  • 10% Dextrose
  • 3% Normal Saline
  • D5 in 0.9% Normal Saline
66
Q

When are isotonic solutions used?

A
  • Hypotension: increase Blood pressure
  • Blood transfusion: add volume
  • Blood loss: add volume
  • Dehydration

CAN CAUSE OVERLOAD IF YOU USE TOO MUCH, MONITOR BP

  • Solution doesn’t produce fluid shift
67
Q

When are hypotonic used?

A
  • Hypernatremia
  • Can be maintence fluid b/c daily loses are often hypotonic

NA LOWER CONCENTRATION THAN ICF -> FLUID DRAWN INTO CELL: causes swell

68
Q

When is hypotonic NOT used?

A

ICP -> can make it worse
- Look for cerebral edema when giving hypotonic:
- Headache, mental status changes (altered LOC: new confusion, agitated, restlessness), Seizure, coma

69
Q

When are hypertonic solutions used?

A

GIVE SLOWLY TO PREVENT MASSIVE SHIFTS
- Hypovolemia
- Hyponatremia
- Patient’s w/ head injury
- Peritoneal dialysis

“Thick and salty solutions” -> high osmolarity than body fluids

Fluid drawn OUT of cell -> cellular dehydration result

70
Q

What are some medications that affect electolyte balance?

A

Diuretics
- Impacts Na+, K+

Supplements
- Calcium, Potassium, Mag

Antacids
- Tums: Calcium based

Digoxin
- Low Mag and K+ can potentiate toxicity

71
Q

Cardiac functioning is a priority assessment for which electrolytes?

A

Potassium and Calcium

72
Q

Neuromuscular function is linked to which electrolytes?

A

Calcium and Magnesium

73
Q

Conjuctivitis clinical manifestations

A

Bacterial
- discomfort, pruritus, redness, mucopurulent drainage

Viral
- tearing, foreign body sensation, redness, and mind photophobia

Allergen
- Itching/Pruritus
- Redness
- NO discharge

74
Q

Conjuctivitis treatment

A

Bacterial
- Use Antibiotics, TID-QID for 7 days

Viral
- Mostly self-limiting Corticosteroids IF significant

Chlamydial
- Antibiotic drops

Allergic
- Artificial Tears, Antihistamines

75
Q

Nursing Care and Considerations for Conjunctivitis

A
  • Handwashing is key
  • Do not touch your eyes
  • Complete your course of antibiotics
  • Cannot wear contacts unless symptoms subside
  • Throw away all contaminated eye products
  • Environmental considerations: wash blankets, towels, pillow cases, etc.
76
Q

What is Keratitis

A

an inflammation or infection of the cornea

Typically a consequence of Conjunctivitis

77
Q

Who are at risk for Keratitis

A
  • Wear contacts
  • Wear contaminated eye products
  • Take immunosupressants
78
Q

Clinical manifestations of Keratitis

A
  • Inflamed cornea
  • Pain, photophobia (associated w/ viral)
79
Q

Keratitis treatment

A

Bacterial: antibiotic drops

Viral: Antiviral (Acyclovir)

80
Q

Nursing Care and Considerations for Keratitis

A
  • Wash eyes
  • Take full course of medication
  • Throw away contaminated eye products
  • DON’T wear contacts -> glasses instead
81
Q

Corneal Ulcer clinical manifestations

A
  • pain
  • foreign body feeling
  • tearing
  • purulent or water discharge
  • redness
  • photophobia
82
Q

Corneal Ulcer treatment options

A

Treatment is aggressive to avoid vision loss
- antibiotic, antiviral, or antifungal drops eyes given as often as every hour in first 24 hrs
- If left untreated, can result in corneal scarring and perforation (hole in cornea) -> will need transplant

83
Q

Nursing Care and Considerations: Corneal Ulcer

A
  • Treatment needs to be aggressive, if left untreated = loss of vision
  • Clear education about how to use eye drops  DON’T TOUCH EYE W/ END OF APPLICATOR
  • Hand washing
  • Discard contaminated eye products
  • Warm/cool compresses depending on what pt wants
84
Q

Anterior cornea thins and protrudes forward, taking on cone shape is known as what?

A

Keratoconus

85
Q

Keratoconus clinical manifestation

A

ONLY SYMPTOM: BLURRED VISION, can be corrected w/ glasses or contact lenses

86
Q

Keratoconus treatment options

A
  • Glasses or contact lenses
  • Intacs inserts: clear plastic lenses surgically placed on cornea perimeter to reduce astigmatism and myopia (used after glasses stop working)
  • Corneal transplant
87
Q

Myopia

A

inability to accommodate for objects at a distance

can see near objects but distance is blurry

88
Q

Hyperopia

A

inability to accommodate for near objects

Can see distant objects clearly

89
Q

Cataract clinical manifestations

A
  • Decreased vision
  • Abnormal Color Perception
  • Glare
  • Cloudy vision or halos
  • Worsening vision @ night
90
Q

Cataract treatments

A

Non-surgical
- updating eyewear, increasing light, lifestyle adjustment (not driving @ night)

Surgical: removal of clouded lens -> only “cure”

91
Q

Nursing Care and Considerations: Cataracts

A

Pre-op
- NSAID eye drop to reduce inflammatory response and dilating drops so eye can be seen

Post-op
- Antibiotics
- Activity restrictions: will vary based on Dr preferences
- Vision needs to be evaluated regularly / New prescriptions needed once cataracts are removed

92
Q

What is normal, and not normal, following cataract removal?

A

Increasing pain following surgery is NOT normal. Blurry vision IS normal

93
Q

Retinal detachment clinical manifestations

A

Photopsia
floaters
cobweb
“curtain going across vision field”

94
Q

Retinal detachment treatments

A

Depends on where detachment occurs, how much, has it happened before, etc:

  • Surgery
  • Pneumatic retinopexy
  • Scleral buckling
95
Q

Nurse Care and Considerations for retinal detachments

A

Very precise activity restrictions, that can very
- Discuss w/ patient so they are aware BEFORE procedure and can make needed accomodations
- Ex: Keep head down, No lifting, No bending head backwards, Lay on one side (left or right)

96
Q

Macular Degeneration Clinical Manifestations: GENERAL

A
  • Blurred/darkened vision
  • Blind spots in the visual field
  • Loses the CORE (center) of their vision first
  • Patient states that “everything looks fuzzy”
97
Q

Macular Degeneration Clinical Manifestations: Dry

A
  • Drusen (yellowish) deposits
  • Wherever the deposits are, they lose their vision
98
Q

Macular Degeneration Clinical Manifestations: Wet

A
  • Growth of new blood vessels in abnormal location
99
Q

Macular Degeneration Treatments

A

Intraocular injections

100
Q

Nursing Care and Considerations:
Macular Degeneration

A
  • Prevention is key: nutrition -> increase gluten (dark green leafy veggies) fatty fish.
  • Stop smoking, sunglasses to prevent UV exposure.
  • Can slow progression but cannot cure ARDM once it starts.
  • Assessment - if you see that the patient looks towards the peripheral sides of the eyes by turning their head, this is a sign of AMD.
  • Teach about reduction of fall risk: clutter in the home pets, rugs, carpets, cords.
  • Importance of adequate lighting
101
Q

External Otitis media clinical manifesations

A
  • Inflammation/infection in the external and canal
  • Ear is red and painful on the OUTSIDE
102
Q

External otitis media treatments

A
  • Topical ATB – i.e, ear drops
  • Corticosteroids
103
Q

Acute otitis media clinical manifestations

A

Localized signs of Infection:
- TM is bulging, RED, and PAIN noted

Systemic Signs of Infection:
- Fever (>100.4 F)
- Malaise (generalized feeling of being unwell)

Other side effects
- Nausea
- Vomiting

104
Q

Acute otitis media treatments

A

Antibiotics

If chronic, may require surgery
- Tympanoplasty helps promote fluid flow in the ear
- Mastoidectomy removes the mastoid

105
Q

Nursing Care and Considerations: Otitis Media

A
  • Take full course antibiotics
  • Dizziness → think about safety → Implement activity restrictions
  • Ear drop education
106
Q

Ear drop education should include what?

A
  • Ear drops kept at room temp
  • Tip of dropper should not touch ear
  • Lay on side w/ affected ear up, hold position for TWO minutes
  • Typically 2-4 times a day
107
Q

Ossification of ear structures needed for hearing is called what?

A

Otosclerosis

Movement is needed for hearing -> ossification prevents movement

108
Q

Otosclerosis clinical manifestations

A
  • Reddish blush of the tympanum
  • Hearing Loss
  • Difference in air and bone conduction
109
Q

Otosclerosis treatments

A
  • Surgery
  • Oral sodium chloride w/ vitamin d and calcium carbonate -> slows down progress
110
Q

Nursing care and considerations for Otosclerosis

A

Post-op:
- Sneezing, coughing, bending, lifting, straining needs to be avoided
- Avoid sudden movement -> fluid in labrinyth doesn’t move well

  • Hearing aids do not help the patient with otosclerosis due to loss of conduction, NOT loss of amplification (all caused by BONE formation)
111
Q

Unilateral benign tumor that occurs where vestibulocochlear nerve (CN VIII) enters internal auditory canal is called what?

A

Acoustic neuroma

112
Q

Acoustic neuroma clinical manifestations

A
  • Unilateral progressive, sensorineural hearing loss
  • Reduced touch senesation in posterior ear canal
  • Unilateral tinnitus
  • Mild, intermittent vertigo
113
Q

Acoustic neuroma treatments

A
  • Surgical removal of small tumors: can presreve hearing and vestibular function
  • Large tumors: can leave pt w/ permanet hearing loss and facial paralysis
  • Sterotatic radiosurgery can slow growth and preserve facial nerve
114
Q

Acoustic neuroma nursing care and considerations

A
  • Clear, colorless discharge from nose needs to be reported: could be CSF -> increases risk for infection
  • F/u care is important to monitor hearing and tumor recurrence
115
Q

Interventions for LOW VISION

A
  • Make environmental changes at home: adequate lighting, reduce clutter/cords, etc.
  • Lifestyle changes: no driving @ night, use magnifier
  • Discharge instructions: print bigger, discuss if colors cannot be seen for highlighting, etc
  • Ensure all team members know patient has low vision
  • Ask about what patient does at help to help aid w/ decreased vision
116
Q

Interventions for
NO VISION (Blindness)

A
  • Don’t rearrange things a lot so patient knows where things are, or be explicit when you do
  • White cane (will need OT to help teach how to use -> not used for balance, used to help discern what is in environment)
  • Use clock method to help describe where things are for the patient
  • Guided walking
  • Provide explanation about what is in environment during ambulation
117
Q

Interventions for low hearing / deafness

A
  • Speak clearly
  • Face patient so patient can see/read lips
  • Have adequate lighting so patient can clearly see you
  • Put safety plan in plan: pt cannot hear alarms, speakers, etc.
  • Provide interpreter for patients who use sign language
  • Discuss how patient communications -> read lips, write, use sign language -> very important for education
  • If hearing loss on one side, standing on good side
  • Reduce distractions when having conversations (decreased hearing can be hypersensitive to vision)
  • Discuss how patient know phone is ringing, door bell is going off, etc. -> can you accommodate at hospital? Flashing lights, texting. Etc
  • Provide whiteboard, pen/paper -> allow pt to write questions
118
Q

What is Meniere’s disease

A

labyrinth in ear becomes overloaded w/ fluid

119
Q

Meniere’s disease clinical manifestations

A

Overwhelming Episodic vertigo, tinnitus, fluctuating hearing loss, N&V

Usually has a trigger

120
Q

Meniere’s disease treatments

A

Acute attacks
- antihistamines (diphenhydramine)
- anticholinergics (atropine),
- benzodiazepines (lorazepam)
- antiemetics (prochlorperazine)
- antivertigo (meclizine)

Between attacks
- diuretics
- antihistamines
- calcium channel blockers
- low sodium diet
- diazepam, meclizine, fentanyl with droperidol (to reduce vertigo)

121
Q

Diphenhydramine, lorazepam, meclizine all have what as a side effect

A

Drowsiness

122
Q

Atropine has dry what as a side effect?
Because of this, you should not use this medication for what condition?

A

Dry mouth and eyes
Don’t use w/ glaucoma

123
Q

Nursing Care and Considerations for Meniere’s disease

A
  • Reduce stimuli - no TV (flashes of light, sound), shut door
  • Position on side in case vomit
  • Administer medications
  • Make position changes slowly to decrease dizziness
124
Q

Primary open angle glaucoma clinical manifestations

A

Gradual loss of peripheral vision field

125
Q

Primary angle-closure glaucoma clinical manifestations

A
  • sudden excruciating pain
  • n/v
  • colored halos around lights
  • MEDICAL EMERGENCY
126
Q

Primary open angle glaucoma treatments

A
  • Alpha agonists
  • Beta blockers
  • Carbonic anhydrase inhibitors
  • Cholinergic (Miotics)
127
Q

Primary open angle glaucoma treatments: Alpha agonists

A

decrease production of aqueous fluid and increase drainage
- Apraclonidne HCL
- Brimonidinen tartrate

128
Q

Primary open angle glaucoma treatments: Beta blockers

A

work by decreasing production of intraocular fluid
- systemic side effects of reduced BP, HR, SOB -> can be reduced by doing “punctual occlusion” – covering the tear duct in the corner of the eye following administration- reduces systemic absoprtion

  • Timolol maleate
  • Betaxolol HCL
129
Q

Primary open angle glaucoma treatments: Carbonic anhydrase inhibitors

A

reduce eye pressure by decreasing production of intraocular fluid

  • Brinzolamide ophthalmic suspension
  • Methazolamide
130
Q

Primary open angle glaucoma treatments:
Cholinergic (Miotics):

A

increase drainage of intraocular fluid through the trabecular network. Usually used in combination with other medications.

  • Pilocarpine HCL
  • Carbachol
  • Pilocarpine HCL
131
Q

If patients are using more than one type of eye drop, they need to wait ___ minutes between each medication.

A

5

132
Q

Patients should not take oral beta blockers for hypertension and use the beta blocker eye drops- why?

A

risk of lowered BP is considerable

133
Q

Medications that should be avoided with patients who have glaucoma

A

atropine
diphenhydramine
promethazine
hydroxyzine
oxybutynin (Ditropan for over-active bladder)

NURS 314: Med Surg (3 decks)

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