Exam 2: Electrolytes, Vision, Auditory Flashcards
Fluid Volume Excess assessment findings?
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%)
Fluid Volume Deficit assessment findings
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
Causes of isotonic fluid volume deficit (hypovolemia)
Lack of both water and electrolytes
- 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
Causes of dehydration
Lack of fluid in body - shift of water from plasma to interstital space
- 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
Fluid Volume Deficit interventions
- 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
Causes of hypervolemia
Fluid volume excess - too much water and electrolytes
- Compromised regulatory systems: heart failure, kidney disease, cirrhosis
- Overdose of fluids
- Fluid shifts that occur following burns
- Prolonged use of corticosteroids
- Severe stress
- Hyperaldosterronism
Causes of overhydration
- Water replacement w/o electrolyte replacement
- Syndrome of inappropriate antidiuretic hormone
- Excessive admin of IV D5W, use of hypotonic solutions for irrgations
Fluid Volume Overload interventions
- 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
What is the relationship between calcium and phosphate?
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 **
Cardiac monitoring is most important for which electrolyte?
Potassium
High or low
High ____ suppresses respiratory function
Magnesium
MONITORING RESPIRATORY FUNCTION IS KEY!!!!
Due to muscle weakness
What is the relationship between insulin and potassium?
insulin pushes potassium into the cells and therefore LOWERS serum potassium
INSULIN CAN BE USED TO LOWER POTASSIUM FOR SHORT-TERM SOLUTION
What are some causes of hyponatremia
Excessive sodium loss -> excessive sweater, wound drainage, NG suction
Inadequate sodium intake -> NPO, low sodium diet
Excess water gain
Decreased decretion of aldosterone
Hyponatremia Causes: Excessive sodium loss
GI losses: diarrhea, vomiting, fistulas, NG suction
Renal losses: diuretics, adrenal insufficency, Na+ wasting renal disease
Skin losses: burns, wound drainage
Hyponatremia causes: Inadequate sodium intake
Fasting diets
Hyponatremia causes: Excess water gain
Excess hypotonic solutions
Primary polydipsia (excessive thirst)
Water intoxication
Hypernatremia causes
Excessive sodium intake
Inadequate water intake
Excess water loss
Hypernatremia causes: excess sodium intake
IV fluids: Hypertonic NaCl, excess isotonic, IV sodium bicarbonate
Hypertonic tube feedings without water supplements
Near-drowning in salt water
Hypernatremia causes: inadequate water intake
Unconcious or cognitively impaired
Hypernatremia causes: excess water loss
Increased sensible water loss (high fever, heatstroke, prolonged hyperventilation)
Diruetic therapy
Diarrhea
What are the safety concerns associated with sodium imblanaces?
Mental status changes - confusion,Irritability, apprenhension
Seizure & coma
Weakness, dizziness, Postural hypotension
** IMPLEMENT FALL RISK AND SEIZURE PRECAUTIONS **
What are some interventions for hypernatremia?
- 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
Interventions for hyponatremia?
- 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
Cause of Hypokalemia
- 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+
What are the safety concerns with potassium imbalances?
Cardiac function! ->
- heart rate, breathing rate
- muscle tone (due to muscle weakness)
- mental status changes
CONTINOUS CARDIAC MONITORING IS KEY
The following s/s are related to which eletrolyte imbalance?
- Altered Cardiac Conduction
- Irregular pulse/heart rate (HR > 100)
- Confusion, Fatigue, Irritability
Hyperkalemia
The following s/s are related to which electrolyte imbalance?
- Muscle weakness
- Shallow breathing
- Dizziness, altered mental status
- Decreased pulse
Hypokalemia
What are some interventions for Hyperkalemia?
- 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
What are some foods high in potassium that hyperkalemic patients should avoid?
- Bananas
- Leafy greens
- Strawberries
- Tomatoes
- Oranges, Orange Juice
- Kiwi
- Broccoli
- Avocados
- Melon
- Whole Grains
- Citrus fruits
What foods should patients who are hypokalemic eat?
- Bananas
- Leafy greens
- Strawberries
- Tomatoes
- Oranges / Orange Juice
- Kiwi
- Broccoli
- Avocados
- Melon
- Whole Grains
- Citrus fruits
What are some interventions for hypokalemia?
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
Assessments for chloride will be similar to what?
Sodium PLUS respiratory
The following s/s are related to which electrolyte imbalance?
- Increased BP (>120/80)
- Confusion
- Headaches
- **KUSSMAUL respirations **
Hypercholemia
The following s/s are related to which electrolyte imbalance?
- Low BP (<120/80)
- Low RR (<12 BPM)
- Increased HR (>100 BPM)
- Confusion
- Disorientation
HYPOcholemia
What are some safety concerns related to HYPERcholemia?m
- Confusion is a concerning factor for falls and accidents
- Respirations -
What are some safety concerns related to HYPERcholemia?
- Confusion is a concerning factor for falls and accidents
- Respirations -> KUSSMAUL
What are some safety concerns for HYPOcholemia?
- Confusion, disorientation and low BP are concerning factors for falls
- Low RR needs significant attention to maintain a patent airway
HYPERcholemia interventions
- taking medications to prevent nausea, vomiting, or diarrhea
- reduce salt intake -> found in table salt
- Carefully monitor fluid volume status
Low chloride should activate what?
RAAS -> saves Na+, which saves Cl
What interventions are associated w/ HYPOchloremia
- Eat more salty foods – because of its direct relationship with sodium
- Carefully monitor fluid volume status
Does Low aldosterone lead to high or potassium
High
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 **
HYPERcalcemia
Causes of HYPOcalcemia
- Inadequate intake of calcium
- Malabsoprtion issues
- Diarrhea
- Inadequate Vitamin D intake
- End-stage kidney disease
- Wound drainage
What are some safety concerns for HYPERcalcemia?
- 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.
What are some safety concerns for HYPOcalcemia?
- 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
Interventions for HYPERcalcemia
- 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
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
HYPOcalcemia
Safety concerns for HYPOcalcemia
- 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
Interventions for HYPOcalcemia
- 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
Symptoms of HYPERphosphatemia are similar to what?
Hypocalcemia
The following s/s are associated with what electrolyte imbalance?
- Seizures
- Numbness/Tingling in extremities, region around mouth
- Hyperreflexia
- Muscle Cramps
- Tetany
HYPERphosphatemia
And also HYPOcalcemia
What are safety concerns associated w/ HYPERphosphatemia
Seizures → Implement seizure precautions
Low calcium results in what level of phosphate?
High
Interventions for HYPERphosphatemia
- 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
Interventions for HYPOphosphatemia
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.
What are some assessments needed when giving IV solutions for HYPOphosphatemia
- Need to monitor phosphorus and calcium levels q6-12hrs
- Perform frequent assessments to determine if hypocalcemia, hyperkalemia, dysrthymias and hypotension are present (complications)
Magnesium follows which other electrolyte?
Calcium
Low Mag means HIGH Ca
- Hyperactive DTRs
- Chvostek’s Sign
- Trousseau’s Sign
- Dysrhythmias
- Tremors/ Seizures
Hypomagnesemia
Similar to Hypocalcemia
Interventions associated with HYPERmagnesemia
- 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
The following s/s are assocaited with what electrolyte?
- Facial flushing
- Urinary retention
- Lethary
- Depressed DTR
- Muscle paralysis
HYPERmagnesemia
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
Magnesium
Interventions associated with HYPOmagnesemia
- 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)
Examples of hypotonic solutions
- 0.45% normal saline
- Dextrose in 5% water (D5W)
Examples of Isotonic solutions
- 0.9% saline
- D5 in 0.25% saline
- Lactated Ringers
Examples of Hypertonic Solutions
- 10% Dextrose
- 3% Normal Saline
- D5 in 0.9% Normal Saline
When are isotonic solutions used?
- 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
When are hypotonic used?
- Hypernatremia
- Can be maintence fluid b/c daily loses are often hypotonic
NA LOWER CONCENTRATION THAN ICF -> FLUID DRAWN INTO CELL: causes swell
When is hypotonic NOT used?
ICP -> can make it worse
- Look for cerebral edema when giving hypotonic:
- Headache, mental status changes (altered LOC: new confusion, agitated, restlessness), Seizure, coma
When are hypertonic solutions used?
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
What are some medications that affect electolyte balance?
Diuretics
- Impacts Na+, K+
Supplements
- Calcium, Potassium, Mag
Antacids
- Tums: Calcium based
Digoxin
- Low Mag and K+ can potentiate toxicity
Cardiac functioning is a priority assessment for which electrolytes?
Potassium and Calcium
Neuromuscular function is linked to which electrolytes?
Calcium and Magnesium
Conjuctivitis clinical manifestations
Bacterial
- discomfort, pruritus, redness, mucopurulent drainage
Viral
- tearing, foreign body sensation, redness, and mind photophobia
Allergen
- Itching/Pruritus
- Redness
- NO discharge
Conjuctivitis treatment
Bacterial
- Use Antibiotics, TID-QID for 7 days
Viral
- Mostly self-limiting Corticosteroids IF significant
Chlamydial
- Antibiotic drops
Allergic
- Artificial Tears, Antihistamines
Nursing Care and Considerations for Conjunctivitis
- 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.
What is Keratitis
an inflammation or infection of the cornea
Typically a consequence of Conjunctivitis
Who are at risk for Keratitis
- Wear contacts
- Wear contaminated eye products
- Take immunosupressants
Clinical manifestations of Keratitis
- Inflamed cornea
- Pain, photophobia (associated w/ viral)
Keratitis treatment
Bacterial: antibiotic drops
Viral: Antiviral (Acyclovir)
Nursing Care and Considerations for Keratitis
- Wash eyes
- Take full course of medication
- Throw away contaminated eye products
- DON’T wear contacts -> glasses instead
Corneal Ulcer clinical manifestations
- pain
- foreign body feeling
- tearing
- purulent or water discharge
- redness
- photophobia
Corneal Ulcer treatment options
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
Nursing Care and Considerations: Corneal Ulcer
- 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
Anterior cornea thins and protrudes forward, taking on cone shape is known as what?
Keratoconus
Keratoconus clinical manifestation
ONLY SYMPTOM: BLURRED VISION, can be corrected w/ glasses or contact lenses
Keratoconus treatment options
- 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
Myopia
inability to accommodate for objects at a distance
can see near objects but distance is blurry
Hyperopia
inability to accommodate for near objects
Can see distant objects clearly
Cataract clinical manifestations
- Decreased vision
- Abnormal Color Perception
- Glare
- Cloudy vision or halos
- Worsening vision @ night
Cataract treatments
Non-surgical
- updating eyewear, increasing light, lifestyle adjustment (not driving @ night)
Surgical: removal of clouded lens -> only “cure”
Nursing Care and Considerations: Cataracts
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
What is normal, and not normal, following cataract removal?
Increasing pain following surgery is NOT normal. Blurry vision IS normal
Retinal detachment clinical manifestations
Photopsia
floaters
cobweb
“curtain going across vision field”
Retinal detachment treatments
Depends on where detachment occurs, how much, has it happened before, etc:
- Surgery
- Pneumatic retinopexy
- Scleral buckling
Nurse Care and Considerations for retinal detachments
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)
Macular Degeneration Clinical Manifestations: GENERAL
- Blurred/darkened vision
- Blind spots in the visual field
- Loses the CORE (center) of their vision first
- Patient states that “everything looks fuzzy”
Macular Degeneration Clinical Manifestations: Dry
- Drusen (yellowish) deposits
- Wherever the deposits are, they lose their vision
Macular Degeneration Clinical Manifestations: Wet
- Growth of new blood vessels in abnormal location
Macular Degeneration Treatments
Intraocular injections
Nursing Care and Considerations:
Macular Degeneration
- 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
External Otitis media clinical manifesations
- Inflammation/infection in the external and canal
- Ear is red and painful on the OUTSIDE
External otitis media treatments
- Topical ATB – i.e, ear drops
- Corticosteroids
Acute otitis media clinical manifestations
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
Acute otitis media treatments
Antibiotics
If chronic, may require surgery
- Tympanoplasty helps promote fluid flow in the ear
- Mastoidectomy removes the mastoid
Nursing Care and Considerations: Otitis Media
- Take full course antibiotics
- Dizziness → think about safety → Implement activity restrictions
- Ear drop education
Ear drop education should include what?
- 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
Ossification of ear structures needed for hearing is called what?
Otosclerosis
Movement is needed for hearing -> ossification prevents movement
Otosclerosis clinical manifestations
- Reddish blush of the tympanum
- Hearing Loss
- Difference in air and bone conduction
Otosclerosis treatments
- Surgery
- Oral sodium chloride w/ vitamin d and calcium carbonate -> slows down progress
Nursing care and considerations for Otosclerosis
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)
Unilateral benign tumor that occurs where vestibulocochlear nerve (CN VIII) enters internal auditory canal is called what?
Acoustic neuroma
Acoustic neuroma clinical manifestations
- Unilateral progressive, sensorineural hearing loss
- Reduced touch senesation in posterior ear canal
- Unilateral tinnitus
- Mild, intermittent vertigo
Acoustic neuroma treatments
- 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
Acoustic neuroma nursing care and considerations
- 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
Interventions for LOW VISION
- 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
Interventions for
NO VISION (Blindness)
- 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
Interventions for low hearing / deafness
- 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
What is Meniere’s disease
labyrinth in ear becomes overloaded w/ fluid
Meniere’s disease clinical manifestations
Overwhelming Episodic vertigo, tinnitus, fluctuating hearing loss, N&V
Usually has a trigger
Meniere’s disease treatments
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)
Diphenhydramine, lorazepam, meclizine all have what as a side effect
Drowsiness
Atropine has dry what as a side effect?
Because of this, you should not use this medication for what condition?
Dry mouth and eyes
Don’t use w/ glaucoma
Nursing Care and Considerations for Meniere’s disease
- 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
Primary open angle glaucoma clinical manifestations
Gradual loss of peripheral vision field
Primary angle-closure glaucoma clinical manifestations
- sudden excruciating pain
- n/v
- colored halos around lights
- MEDICAL EMERGENCY
Primary open angle glaucoma treatments
- Alpha agonists
- Beta blockers
- Carbonic anhydrase inhibitors
- Cholinergic (Miotics)
Primary open angle glaucoma treatments: Alpha agonists
decrease production of aqueous fluid and increase drainage
- Apraclonidne HCL
- Brimonidinen tartrate
Primary open angle glaucoma treatments: Beta blockers
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
Primary open angle glaucoma treatments: Carbonic anhydrase inhibitors
reduce eye pressure by decreasing production of intraocular fluid
- Brinzolamide ophthalmic suspension
- Methazolamide
Primary open angle glaucoma treatments:
Cholinergic (Miotics):
increase drainage of intraocular fluid through the trabecular network. Usually used in combination with other medications.
- Pilocarpine HCL
- Carbachol
- Pilocarpine HCL
If patients are using more than one type of eye drop, they need to wait ___ minutes between each medication.
5
Patients should not take oral beta blockers for hypertension and use the beta blocker eye drops- why?
risk of lowered BP is considerable
Medications that should be avoided with patients who have glaucoma
atropine
diphenhydramine
promethazine
hydroxyzine
oxybutynin (Ditropan for over-active bladder)
