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Adult care 2 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Cataracts

A

common cause of adult curable blindness
-clouding or opacity of lens due to structural changes in proteins= gradual loss of vision
-Development= slow and painless
Very reversible

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2
Q

Normal-age related vision changes

A

Diminished visual acuity, light sensitivity, brightness contrast, dark adaptation, recovery from glare. Lenses thicken, harden, appear yellowish and opaque

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3
Q

abnormal eye changes

A

Cataracts, glaucoma, macular degeneration, diabetic retinopathy, detached retina, floaters

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4
Q

Risk factors for cataracts

A

Over 50, DM, familial history, smoking and alcohol, obesity, hyperlipidemia, HTN, trauma to eye or Hx of eye surgery, exposure to sun and UVB rays, long-term corticosteroid meds, Caucasian race

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5
Q

Vision changes with cataracts

A

Lens clouding=decreased light to retina= limited vision
CATS
Cloudy/blurred vision
Acquiring frequent eyeglass Rx
Tones down colors
Sensitivity to glare and light

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6
Q

Cataract S/S

A

Painless and slow onset of blurring vision, sensitive to glare, halos around objects, loss of acuity from dimness to distortion, reading and night driving difficult, decreased color perception

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7
Q

Cataract assessment signs

A

Haziness of lens, inability to see fundus, no red reflex

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8
Q

Pre-op cataract surgery care

A

NPO, void, measures to decrease IOP, eye drops to dilate pupil, all consents signed, may clip eyelashes

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9
Q

Outpatient surgery types for cataracts

A

Intracapsular and extracapsular

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10
Q

Intracapsular cataracts surgery

A

Removal of lens and its capsule through wide incision in cornea

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11
Q

extracapsular cataract surgery

A

Contents of lens aspirated by large-bore needle through small incision in cornea, leaving posterior portion of lens capsule behind

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12
Q

Post-op cataract surgery care

A

HOB up, semi-fowlers position, lying on back or unoperated side, monitor for N/V, eye drops to constrict pupil, antibiotics, anti-inflammatory, minimum light

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13
Q

Cataract prevention

A

Wearing hats and sunglasses (UVA and UVB protective coating) when in sun
-smoking cessation
-eat low-fat diet rich in antioxidants and vitamins E and C
-avoid ocular injury (wear goggles when using power tools)

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14
Q

Complications following cataract surgery that requires physician to be notified

A

Pain, conjunctival injection, vision loss, sparks, flashes, floaters, N/V, excessive coughing

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15
Q

Complications of cataract surgery

A

Infection, wound dehiscence, hemorrhage, severe pain, uncontrolled elevated intraocular pressure

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16
Q

Post-op and D/C teaching

A

Infection, bleeding, elevated IOP major complications
- report any drainage, excessive tearing or decline in visual acuity or acute unrelieved pain
-wear eye shield at night for 2-3 weeks
-usually resume normal self-care activities: no heavy lifting, straining at stool, bending at waist for few days
-eye drops will be ordered postop

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17
Q

Glaucoma

A

Leading irreversible blindness in adults esp >40, no cure, group of ocular conditions, no cure
-Damaged optic nerve due to increased IOP resulting in vision loss
-open angle most common

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18
Q

Dx of glaucoma/recommended screening schedule

A

Measure IOP(tonometer) and visual acuity (snellen)
normal IOP= 10-21 mmHg
Screening should start at 40!

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19
Q

glaucoma risk factors

A

SAVE
Sixty or older(esp family Hx), African American, Asian, Hispanic, vascular problems (HTN, DM,migraines,myopia), elevated IOP (greater than 21mmHg)

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20
Q

What happens when glaucoma is left untreated

A

Progressive vision loss and damage that cannot be reversed- permanent blindness

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21
Q

Ophthalmic agents used to treat glaucoma

A

“ABCC’s”
Alpha agonists(Bromionidine)
Beta blockers (Timolol)
Cholinergics(Pilocarpine), carbonic anhydrase inhibitors (CAIs, acetazolamide,Diamox)

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22
Q

Glaucoma med s/e

A

bradycardia, bronchoconstriction, orthostatic hypotension, tremors,

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23
Q

Nursing interventions to prevent glaucoma med s/e

A

Prevent systemic absorption by lacrimal pressure- punctal occlusion
-strictly adhere to med schedule
-if >1 med, give 5 min apart to prevent washout

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24
Q

Detached retina

A

Tissue at the back of the eye pulls away from a layer of blood vessels that provide necessary oxygen and nourishment. Emergency!

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25
Q

S/s detached retina

A

Sudden appearance of many floaters, flashes of light in one or both eyes, blurred vision, gradually reduced side vision, curtain-like shadow over your visual field

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26
Q

Nursing care for detached retina

A

NPO-surgery
Limit activity, avoid pressure on eye.
Educate postop to wear eye patch, especially at night. Position to reduce swelling and pressure on eye. Use eye drops as prescribed.

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27
Q

Teaching for pt with gas bubble

A

Avoid rubbing eyes and traveling to high altitudes or riding in plane. Lasts 6-8 weeks or 10 days-1month. Vision slowly improves as bubble dissipates.
Avoid straining or causing an increase in pressure of eye. Some pain and blurry vision for few days=normal. Swollen, tender, red for several weeks. May have to keep head in certain position for few days

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28
Q

Gas bubble-detached retina

A

Inserted to float over detached area and pushes it back against back of eye.

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29
Q

Macular degeneration

A

Two forms: wet and dry (more common) forms
Deterioration of the macula (part of the retina at back of eye)= central loss of vision

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30
Q

Macular degeneration S/S

A

S/s:
-blurred vision
-center of vision dark
-develop central loss of vision->impaired reading and recognition of objects but side vision and mobility remain intact
-glasses dont help
-need low-vision aids
-laser surgery may help by sealing off damaged blood vessels to prevent bleeding and scar tissue

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31
Q

Dry form-macular degeneration

A

Atrophy, retinal pigment degeneration, drusen accumulations, other s/s, slow progression of visual loss
-light sensitive cells in eye begin to breakdown=blurry central vision in eye;both eyes
Slower onset than wet form

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32
Q

Wet (neovascular exudates)-macular degeneration

A

Blood or serum leak from newly formed vessels beneath retina moving macula(quick deterioration and damage to macula)=scar formation and visual problems

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33
Q

Client education for macular degeneration

A

Nurses should encourage:
-wearing UV protective lenses in sun
-smoking cessation
-exercising regularly
-eating a healthy diet consisting of fruits and veggies to inc consumption of antioxidants
-taking vitamins in divided doses twice a day to delay progression

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34
Q

Diet and supplements-macular degernation

A

Zinc oxide 80 mgm
Cupric oxide 2 mg
Beta carotene 15 mgm
Vitamin C 500 mgm
Vitamin E 400 IU

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35
Q

Drugs that risk hearing loss

A

Aminoglycoside antibiotics (Mycin)- ototoxic
Antineoplastics (ICS platinum)- ototoxic
Loop diuretics (furosemide)-ototoxic
Propranolol (inderal)-tinnitus and hearing loss
ASA and NSAIDs-tinnitus

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36
Q

Communication with elder adult with hearing loss

A

Speak clearly and at a normal pace without over exaggerating lip movements. Eye contact, face them head on

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37
Q

Care of hearing aids

A

Remove and clean at bedtime
- NO alcohol or harsh soaps
-use damp cotton pad/cloth with either water/saline
-carefully remove cerumen
- disengage battery
-store in safe place

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38
Q

Asthma

A

Narrowing/constriction of the bronchioles; alveoli not effected; “reactive airway”

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39
Q

Asthma causes

A

Allergic reactions- modifiable and nonmodifiable

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40
Q

Modifiable asthma causes

A

Smoking, exercise, occupational dust and chemicals, indoor and outdoor pollution

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41
Q

Nonmodifiable asthma causes

A

Allergies, genes, age, Aa deficiency

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42
Q

Pink puffer

A

Emphysema

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43
Q

Blue bloater

A

Chronic bronchitis

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44
Q

COPD is

A

Both emphysema and chronic bronchitis

45
Q

Chronic bronchitis is AKA

A

Blue bloaters

46
Q

Emphysema is AKA

A

Pink puffer

47
Q

Chronic bronchitis

A

Entire respiratory tract is covered in mucous which is a barrier to gas exchange

48
Q

Emphysema

A

Enlarged alveoli and CO2 retention

49
Q

S/s chronic bronchitis

A

Wheezing, JVD, edema, weight gain (abdominal,trunk), ascites, productive cough, decreased activity tolerance, cyanosis, O2 sats~ middle 80s
Increased mucous production that worsens in the morning
Cardiac dysrhythmias

50
Q

S/s emphysema

A

O2 sats read “normal” ~95/96
Enlarged alveoli with CO2 retention
-AMS, confusion,barrel chested, pink/ruddy red color, inc WOB, inc caloric needs, activity intolerance, agitation, anxiety, clubbed fingers, old and skinny, quiet chest, leans forward when breathing, purse-lipped breathing, anxious

51
Q

Pulmonary rehabilitation

A

Improves exercise intolerance and overall QOL
-breathing
-relaxation techniques
-smoking cessation
-energy conservation
-exercise
-group support

52
Q

Management of exacerbations-asthma

A

Rescue inhaler/ nebulizer (albuterol), oxygen administration, anti-inflammatory- ICS

53
Q

Management of exacerbations-COPD

A

SABA, ICS, oxygen therapy

54
Q

Oxygen therapy considerations and safety

A

Hyperoxygenation- can lead to respiratory acidosis
-only tx shown to alter course of advanced COPD
-start on 2L, never more than 4L
-can suppress drive to breathe or cause oxygen toxicity: VENTIDC
Vision, ears, nausea, twitching, irritability, dizzy, convulsions

55
Q

Client education-COPD

A

report sputum color and amt change, report s/s infection and fever
Inhale bronchodilator FIRST then ICS, rinse mouth following ICS
-proper hydration
-proper use of oxygen
-flu and pneumococcal vaccines
-climate, avoid high temp and humidity

56
Q

Client education-emphysema

A

Purse lipped breathing to blow off CO2, increased caloric needs, high calorie and high protein diet, oxygen use, CPAP use

57
Q

Client education-asthma

A

Take ICS daily, albuterol=rescue drug. Rinse mouth after ICS. Report white tongue and oral mucous membranes

58
Q

Rescue inhalers vs maintenance therapy

A

Rescue inhalers=SABA-albuterol
Maintenance-LABA and ICS inhalers

59
Q

Rescue inhalers

A

SABA-albuterol, should be used less than twice a week

60
Q

Maintenance therapy-inhalers

A

LABA- long acting beta agonists
Inhaled corticosteroid inhalers, anti-inflammatory ex

61
Q

Assessment criteria-elder abuse

A

Repeated injuries, bruises and grip marks, repeat ER visits, refusal to go to same ER, fractures/breaks, hygiene deficit

62
Q

Interventions-elder abuse

A
63
Q

Types of elder abuse

A

Physical, emotional, financial, neglect

64
Q

Usual victim and abuser in elder abuse

A

Usual victim: elder parent, white Caucasian elder woman, elder with dementia/confusion, elder unable to take care of self

65
Q

What increases the risks for elder abuse?

A

Caregiver stress, family situations, caregiver personal situations, financial strain, sandwich generation

66
Q

Role of nurse in elder abuse

A

REPORT-MANDATED!
Interview elder and caregiver SEPARATELY
-provide resources for caregiver respite care, support

67
Q

Normal aging changes-memory

A

Forget where you put things(keys, wallet, phone, etc)

68
Q

S/s dementia

A

Two cognate functions significantly impaired:
- memory
-communication and language
-attention span limited
-reasoning and judgement
-visual perception

69
Q

Mini-cog

A

Screening tool with three item recall and clock drawing test. Unsuccessful recall of three items after clock drawing distractor=probable dementia

70
Q

BCAT

A

Brief cognitive assessment tool- determines level of cognitive impairment not dementia severity (delirium/confusion)

71
Q

S/s depression

A
72
Q

Differences in s/s of dementia vs depression

A
73
Q

FAST score-Alzheimer’s disease

A

NOT stroke FAST assessment- 7 stages
1=normal adult
2=normal older adult
3=early dementia
4=mild dementia
5=moderate dementia
6=moderatly severe dementia
7=severe dementia

74
Q

Alzheimer’s stages

A

Early-mid, moderate, late

75
Q

Early stages-Alzheimer’s

A

Subtle memory changes
Difficulty remembering names and events; mild forgetfulness- short term memory loss; go over with pt about progression of disease and future plan if aware of Alzheimer’s

76
Q

Moderate stages- Alzheimer’s

A

Forgets names of family members, requires more assistance with ADL’s, experiences delusions, hallucinations, increased anxiety. Can become more violent, sleeps more during day. Safety and self care=major concern
-wandering
-longest stage
-Sundowning

77
Q

Late stages-Alzheimer’s

A

All speech is lost, lose urinary and bowel control, cannot walk, bedridden, cannot swallow or speak-need constant care

78
Q

7M’s of Alzheimer’s disease

A

Middle stage:
Memory, movement, mental health,maintain safety

79
Q

Interventions for early stage Alzheimer’s

A
80
Q

Interventions for moderate state Alzheimer’s-memory

A

-Reorient and remind, remain patient, keep simple, do not scold

81
Q

Interventions for moderate state Alzheimer’s-movement

A

-Independent as allowed, routines, exercise, fun games

82
Q

Interventions for moderate state Alzheimer’s- mental health

A

-calm, distract, no hurry, hallucinations, limit outside noise, well-lit room, remove reflective times

83
Q

Interventions for moderate Alzheimer’s stage-maintain safety

A

-beware of driving, hide keys, supervise cooking, beware of wandering
WANDER:
W=wear ID bracelet/GPS
A= Avoid stressful, unfamiliar places/crowds
N= Needs met
D= Display signs providing cues
E= exercise is important
R= remove access to doors, windows(locks/alrams)

84
Q

Interventions for late stage Alzheimer’s

A
85
Q

Alzheimer’s drugs

A
86
Q

When Alzheimer’s drugs are used in the progression of the disease

A
87
Q

Management of behavioral problems with Dementia

A
88
Q

How do you best communicate with someone with dementia

A
89
Q

Management strategies for aggression/agitation- dementia

A

Redirect/refocus
Identify what they are communicating with you-hungry, bathroom, tired, etc

90
Q

Physical problems/medications that can make dementia symptoms worse

A

Anticholinergics, HTN/cardiac drugs, chemotherapeutics,

91
Q

Vascular dementia

A

Caused by block/interruption of bloodflow to brain

92
Q

Sundowning

A

Worsening progression of confusion, behavior issues at night, wandering, hallucinations, agitation
Triggers: exhaustion, sickness, new med, low exposure to sunlight

93
Q

Sundowning interventions

A

Redirect/refocus
Plan activities around pt cognition- do ADL’s and hygiene at morning, take walks during day, have established routine
-avoid caffeine at night
-low noise, calm, relaxing environment
-avoid taking long late naps
-remain calm, reassure pt you are there and they are safe
-nothing in room creating shadows,well-lit, remove reflective items, maintain safety

94
Q

Respite care

A

Someone else takes care of elder for a few hours a couple days a week to allow caregiver a break, temporary LTC placement

95
Q

Stress and impact on the lay caregivers

A

Can lead to neglect/abuse

96
Q

Interventions to help lay caregivers

A

Respite care, support groups

97
Q

Paperwork needed to be a caregiver

A
98
Q

Tool for care giver strain

A
99
Q

How to use/administer tool for care giver strain

A
100
Q

“Test” for depression

A

Geriatric depression scale (short=15, long=30). Score of five or higher indicates high risk for depression, needs further evaluation.

101
Q

Is depression ever normal

A

No. More common in older adults. Risk increases when functional ability decreases

102
Q

Medications used to treat depression

A

SSRI

103
Q

Apraxia

A

Inability to perform certain motor movements (brush teeth)

104
Q

Aphasia

A

Can’t understand speech or create it (pictures help)

105
Q

Agnosia

A

Can’t recognize objects, ppl, interpret senses(may not recognize spoon or ppl they normally see. Sensation to pee, but incontinent. Given food but do not recognize what they are eating)

106
Q

Amnesia

A

Memory loss-cannot recall memories, who they are, birthday, address, etc

107
Q

Anomia

A

Cannot recall name of objects. Know what it is, but can’t name it

108
Q
A

Adult care 2 (4 decks)

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